Using Simulation to Create the Competencies You Want

Hospitals today are looking for a broader range of talents in new nurse hires. At the top of the list are leadership skills.

Rather than just completing tasks assigned by a physician, nurses today make critical and life-saving decisions. Take it from Rosanne Greenan, RN, CEN, of Northern Westchester Hospital:

“Nurses are no longer caretakers to the healthcare team, carrying out tasks ordered by physicians. Now we are leaders of the team as well as patient advocates and educators. In the ED where I work, nurses are the first to assess patients and often establish the goals for their hospital stay. Physicians view us as colleagues who make concrete observations and offer valuable suggestions.”¹

A nurse graduate who lacks leadership skills can be at a disadvantage in today’s new environment. The same holds true for an experienced nurse whose skills are not kept current and reinforced. The prerequisites to meeting today’s nurse expectations are not only hard skills, but soft skills, like teamwork and problem-solving. This is much different than what was expected of nurses 25 years ago.

为了满足这些日益增长的期望，护士教育者正在不断转向模拟。根据国家护理委员会（NCSBN）的说法，我们现在知道，多达50％的临床时间可以取代模拟。²But,not all simulation is equal。就像护理发生了变化一样，模拟也是如此。

临床模拟过去是“任务培训”的代名词。现在，模拟是关于在任务培训只是一小部分的环境中进行现实生活的排练。

Nursing has settled into a new norm. In this article, we discuss how nursing has changed in the past 25 years, and how increasing your simulation fidelity can help you impart the necessary skills in today’s nursing environment.

1. Patient-Centered Care Is Under a Microscope

Nursing has always been at the core of patient-centered care. What has changed is the transparency associated with that care and the assessment of key performance indicators.

Hospitals today are held to strict government standards regarding patient satisfaction and safety measures. In addition, hospitals operate under an unprecedented influence from major patient safety advocacy groups – and with a bold transparency to the public.Nurses are the largest staff element that can influence the results。

护士雇主正在寻找对人为因素，系统因素和态度如何影响以患者为中心的护理的护士。这对您的仿真程序意味着什么是忠诚的计算。提供更高水平的现实主义可以更好地为学习者做好现实生活的准备。

在Laerdal，我们坚持认为模拟与模拟器无关 - 这与学习经历有关。但是，当您试图在现实世界中赋予硬和软技能时，模拟器仍然是基础。

了解您的情况，目标和期望的结果是基于您所需的现实主义水平的绝佳基础。坚持这些构建基础，并避免在可能损害参与者需要学习的经验的领域妥协。

2. A New Importance Placed on Diagnosis & Assessment

There is a general expectation – within nursing and among patients – that nurses can give an accurate, detailed patient analysis and make recommendations to other members of the care team. And, while a nurse’s scope of practice has clear limits in the context of assessment and diagnosis, the limits are not what they were 25 years ago.

Each year in the U.S., an estimated 12 million people experience diagnostic errors.³This number equates to 1 in 20 adults per year, and it is typically common diseases that are missed.

这是忠诚计数的另一种情况。为了实现诊断忠诚度，请选择一个可以呈现逼真的生命体征，可以显示意识迹象并具有正确的解剖结构和关键地标的模拟器。

You should also consider features like:

• Correct auscultation sites
• Realistic limb articulation
• The ability to perform fundamental therapeutic procedures

These features will be critical to your learner’s initial patient assessment, and will provide an opportunity to conduct physiological monitoring.During a high-fidelity simulation, learners can truly grasp the reality of their actions.

When coupled with validated scenarios, a high-fidelity simulator allows for evidence-based decision-making, followed by clinical interventions with “real” human reactions. This becomes especially important when training for low-frequency, high-acuity emergencies as part of a team.

在这种情况下，模拟有助于促进护士专注于批判性思维，临床推理和临床判断技能的环境，此外还可以促进知识。

3. "Transition Shock" Is a Growing Concern

“Transition shock”, the jump from nursing education to nursing practice, is credited as one of the major reasons for high turnover rates among new nurses.⁴在工作第一年内，新护士流失率高达25％，因此令人担忧。⁵

Managerial confidence in new nurses is also a concern within many hospitals. A survey shows that only 10% of nurse executives believe that new nurses are competent to perform their jobs.⁶At the same time, the desire to minimize the time-to-floor and maximize new nurse productivity is on the average nurse executive’s mind.

All of this can lead to workforce stress, and it can manifest itself in a decrease in patient safety and patient satisfaction. One study showed that 75% of new nurses observed had been seen to commit medication errors.⁷

通常，机构将寻求通过教学培训，咨询或协议和程序的审查来解决此类问题。这样的措施很少产生证明有效的参与度。

High-fidelity simulation can have a major impact on these circumstances, not only as a form of training but as a form of intervention.模拟吸引学习者,提高学习者受潮湿腐烂ention, and directly impacts patient care management.^9,10,11

无论您是代表护理学校还是医院，将模拟作为干预措施都可以帮助您缩小注意力，并赋予护士在当今护理环境中需要的信心和能力。

Simulate What NursesReallyNeed to Achieve

The changes that the nursing field has seen within the past 25 years point to a need for more hands-on, inclusive, and immersive experience for nurses in training. With additional attention on teamwork, communication skills and safe care practices,护士受益于早期和额外接触基于模拟的培训。

Research findings suggest that students who engage in simulations experience an increase in overall self-efficacy, develop confidence to assess vital signs, and provide an improved patient education.¹²

Nursing now requires an extraordinary focus on patient safety, diagnosis, assessment, and clinical reasoning. At every level, nursing today involves a new level of leadership, and a new sense of ownership.

High-fidelity simulation can provide the necessary support for nurses to develop with competence, with compliance, and positioned to optimize patient care. If you would like to better prepare your nurses to meet the challenges in healthcare today, please contact us. We are here to help.