The use of simulation in health professional education is not as new and shiny as it once was. This is a good thing; simulation is now used on a global scale and is fully embedded, valued and recognised as part of healthcare education. We know that simulation provides learners with a safe and authentic space to develop, practise and refine their clinical skills. We also fully recognise the value that simulation has in developing non-technical skills and how this positively impacts many core attributes, from team-working to communication. We can confidently say that simulation-based education has a direct and positive impact on the delivery of safe and effective patient care.
Embedding simulation into healthcare education has been a lengthy process and its success is based on much more than merely providing an effective learning space or identifying a champion to drive it forward. Simulation is a concept in its own right.
Restrictions on practice learning in nursing due to the COVID-19 pandemic meant that the Nursing and Midwifery Council (NMC) allowed universities to implement more simulated learning through their emergency and recovery programme standards. The NMC has now committed to exploring ways in which universities could again increase their flexibility around the use of simulation (NMC, 2023). This could allow greater freedom around how we use simulation in nursing education to manage issues around capacity in practice learning to strengthen nursing student education, experience and confidence in a safe learning environment.
We in nursing higher education pride ourselves on using the best evidence-based practice to help our students learn, understand, and debrief from their clinical practice experiences, and we can achieve this through simulation. Real-life, hands-on nursing practice and care, however, is often not like it is in the textbooks. We have a duty to ensure that simulation activities are true and authentic, especially if it is to be used to replace actual clinical experience. What should we do when we want to truly recreate the reality of healthcare provision? How do we recreate simulation that reflects the actual delivery of patient care in challenging, chaotic settings? We are talking about the side of healthcare delivery that we hear about all too often in the media.
The Royal College of Nursing (RCN) has told us through its Corridor Care Survey (2023) that more than 70% of respondents reported that, within emergency medicine, they were caring for patients in a non-designated clinical area such as a corridor, waiting room or storeroom. Should we be conducting simulated learning in such areas? These are questions we often ponder upon and worry about. We want our future nursing workforce to be skilled, competent and confident. We want to prepare them to be safe practitioners through developing their knowledge, skill and professional behaviour and we know that we can use simulation to do this. We strive to kit out our simulated environments with all the latest equipment and gadgets, some that are rarely seen in clinical practice. Should we say that using a coat hook instead of a drip stand is acceptable? Should we be using scenarios where a clinical area has unsafe staffing levels? Does delivering a gold standard ‘textbook’ simulation fully prepare students for the current realities of the NHS?
If we in nursing education start using more real-life simulations, are we further embedding the problem and telling our future nurses to accept this as the new normal? This feels uncomfortable and somehow normalises a bigger problem. We know that simulation can be used for so much more than advancing someone's hands-on clinical skills, so perhaps we could and should be using simulation in a much more political way.
Let's consider how we can use it to empower our future nursing workforce to reject poor care and to be able to properly articulate their professional concerns to make some sustainable changes so we can put a halt once and for all to this not-so-good side of nursing. So, is it time to make simulation real? We think so. Let's use it to better empower our nurses of the future.