Technology can significantly help nursing students learn the complexities of nursing practice or act as a source of frustration that takes valuable time away from education. Here is a brief look at some of the technologies in use in nursing education, the impact of AI, and practical tips for using educational technology effectively.
Tech in Use
Technologies advancing nursing education include simulations and virtual reality. “Simulations are a cornerstone in nursing education, offering students a risk-free environment to practice clinical skills and make critical decisions,” according to Sandra Russo, PhD, RN, director of the nursing program at Touro School of Health Sciences. She notes that the simulations at her school involve high-fidelity mannequins, standardized patients, and scenario-based learning that closely mimic real-life situations.
According to Russo, virtual reality creates immersive scenarios, and its ability to provide repetitive practice in a controlled environment ensures that students are well-prepared for various clinical situations. Virtual reality has the advantage of engaging students in multiple locations in one virtual environment, notes John J. Gallagher, DNP, RN, CCNS, CCRN, professor/clinical nurse specialist, program director for simulation strategy and innovation, Frances Payne Bolton School of Nursing at Case Western Reserve University. This eliminates barriers related to travel to a specific location, he suggests and can support interdisciplinary education hampered by differing schedules and sites.
Russo notes that other technologies include mobile apps, games-based learning platforms, and in-class participation tools such as clickers.
AI Arrives
Today, educators are beginning to see AI used in high-fidelity simulation, where AI can provide a dynamic learning experience based on a student’s action, notes Shermel Edwards-Maddox, PhD, RN, CNE, RN-BC, clinical assistant professor, Andy & Barbara Gessner College of Nursing, University of Houston. From a faculty perspective, she notes, AI can be used to help write case studies and simulation scenarios, help develop NCLEX-style exam questions, and aid in plagiarism detection.
AI can save time with specific tasks such as creating forms, course descriptions, checklists, and evaluations. Still, according to Gallagher, it has significant limitations in performing functions such as critical analysis and comparison of ideas/concepts. Appropriate integration of AI into coursework is essential to prepare students to use this tool, according to Gallagher, while setting limits on its use in completing assignments. AI isn’t without its challenges, agrees Maddox, who warns of its potential to facilitate academic dishonesty.
Practical Guidance
When it comes to deciding whether to use technology, educators need to ask the question, “Why use this technology over a different method?” according to Kate Lindley, MSN, RN, CHSOS, CHSE, national simulation director at Rasmussen University. Sometimes,” she notes, “simple tools can be more effective than high-tech solutions.” Basic simulations, for instance, might be more suited for teaching fundamental skills, while advanced VR scenarios can be used for complex clinical situations.
Educators need to align technology with educational objectives and allow it to complement other teaching methods, notes Jenna Sissom, MSN-Ed, RN, assistant professor, school of nursing at Lipscomb University. “More technology does not equal more learning,” she says.
“Take one piece of technology at a time,” suggests Maddox. She notes that using the department’s instructional designer can be a way to get nursing faculty familiar and on board with using technology.
“Faculty do not adopt new technology easily,” notes Sunny G. Hallowell, PhD, APRN, PPCNP-BC, associate professor and nurse practitioner, Villanova University. She notes that faculty and students have to succeed in the basic operation of technology before they can become comfortable using it for learning. Faculty must “clearly articulate the learning objectives to be achieved by using a new technology, rather than to apply an innovation because it is new,” she says.
It’s not always easy to ask for help – especially when the help needed involves support for your mental health.
Through a program called “Code Lilac,” Memorial Hermann Health System aims to provide easy access to mental health support for nurses and other staff and perhaps relieve any stigma associated with seeking it.
According to a press release, the program began at Children’s Memorial Hermann Hospital in 2015 after staff attended a workshop on vicarious trauma. The program expanded systemwide in March 2022. The program is a “multidisciplinary peer-to-peer support program designed to offer emotional support to workforce members who have experienced stressful patient- or work-related events,” according to the release. It’s also among the country’s most extensive and robust hospital-based peer responder programs.
Some 500 Code Lilac peer responders are part of 17 teams trained in psychological first aid. They provide support to both clinical and nonclinical staff.
“Nursing is heavily integrated with the team,” says Leah Blackwell, MSN, MBA, RN, NEA-BC, vice president and chief nursing officer for Memorial Hermann – Texas Medical Center, in an interview. On both the campus and system level, nurses are engaged on the steering committees to make sure that they’re providing that voice of the bedside nurse.
“The thing that I like about nurses being engaged in this initiative is their encouragement and normalization of calling Code Lilac,” says Blackwell, an executive sponsor of the program. “They’re trying to reduce that stigma. We all need support for mental health and well-being. They do an excellent job of trying to normalize Code Lilac with their peers.”
Code Lilac also helps build connections among nurses, notes Blackwell. “It’s great when you have an ICU nurse peer responder who responds to an ER Code Lilac. They see each other across the campus and say, ‘Oh, we’re all the same,’ even if we work in different places. It helps build camaraderie among nurses.”
Code Lilac Providing Relief
Code Lilac “is for a wide variety of work-related scenarios,” said Blackwell. “Whether it’s burnout and you’re just having a hard time getting through the day, compassion fatigue, moral distress, or anxiety. People call because they’re not sleeping well before their shifts.
Whether it’s a patient death that just occurred or a slow buildup of stress, “that’s where Code Lilac can intercede and provide immediate relief or help direct them to the right place on the continuum, whether it’s counselors or other things that we have available.” According to Memorial Hermann, those resources can include individual and group support sessions.
Most often, nurses call a Code Lilac due to workplace violence or moral distress, according to Blackwell. Initiating a Code Lilac can be as straightforward as calling a system hotline or the chaplaincy department. A trained responder may arrive within the hour, according to Blackwell. Or, if a team needs support, sometimes the response will be at the end of the shift when the team can gather.
Blackwell says the peer responders receive comprehensive multi-day and quarterly training on trauma-informed care. The preparation includes role-playing and scenario-based training.
Helping Out on Tough Days
Blackwell notes that the work environment, long hours, and patient care intensity make nursing a high user for the Code Lilac program. “I appreciate having it as a resource to offer nurses on those really, really tough days.”
Out of great tragedy, sometimes great good can come. Such is the case with Austin Simon, son of Tiffany Simon, MSN, RN, CCRN, whose passing away at the age of 15 months old sparked a program that promises to help save the lives of children across the country who suffer from medically complex conditions.
Born with a heart defect and undergoing a subsequent tracheostomy, Austin experienced a medical emergency when his tracheostomy was plugged. Simon and her husband called 911. When they arrived on the scene, they looked “terrified,” says Simon in an interview. Their EMS training had not prepared them for dealing with an infant with a plugged tracheostomy, and they resorted to bag-valve masking Austin, which was an incorrect procedure, as Austin didn’t have an airway above his trach. Tragically, Austin suffered a severe hypoxic brain injury and died after he had to be taken off a ventilator a few days later.
“This wasn’t just something that happened to my husband, Austin, and me,” says Simon. “This also happened to those paramedics that were on the scene. There wasn’t anybody that walked away from that situation feeling good or okay about it,” she says.
After her son died, Simon went to nursing school and wound up working in the same pediatric ICU at Children’s Nebraska in Omaha, where Austin was cared for for most of his life. There, she met Natalie McCawley, MSN, RN, CCRN. Years later, Simon worked as a trauma outreach coordinator at Children’s Nebraska, and McCawley served as transport outreach coordinator. McCawley had suffered her own loss, her niece Sydnee, who was diagnosed with stage four lymphoma at just six years old and passed away.
Together, they soon realized that the paramedics and EMTs they worked with had quite a bit of discomfort in caring for children, especially those with special healthcare needs. Simon and McCawley thought, “Sydnee’s and Austin’s stories are just one of a few,” says McCawley, whose father was a volunteer EMT. “And so we finally looked at each other and said, if not us, then who? What are we doing to offer resources and training to the communities, keep these families at home, and allow them to be taken care of in their home communities?” says McCawley.
“We both decided that this was something that we needed to do not only for our patients but also for the medical communities that serve them,” says Simon.
Launching Project Austin
Started in 2015 at Children’s Nebraska, Project Austin provides a standardized care model for first responders and community emergency departments with patient-specific information, resources, education, and training. According to Simon, the eight-person Project Austin team identifies children who are patients at Children’s Nebraska and have complex medical needs. They then work with the family to create an emergency medical plan, including the EMS system and community hospital in that plan. The program serves over 2,000 children across eight states and partners with some 700 EMS departments.
“We’re trying to redefine what ‘healthcare team’ means and include that child’s local 911 system, EMS, and their community hospital,” says Simon, a supervisor at Project Austin. “Including them into that plan makes them part of the child’s healthcare team.”
“Our outreach is specific to EMS and the community emergency department,” explained McCawley, Project Austin program manager – external affairs. “With Project Austin, we provide education and training and very robust emergency medical planning within the home communities. We look at the resources within that community so we can work with the resources they have available.”
For children with medical complexity, “It’s not if they’re going to have a medical emergency, it’s when they’re going to have a medical emergency,” says Simon. “It’s making sure that that team responding to them and that medical emergency is prepared and ready to care for them.” The results so far are impressive, including a 27% reduction in hospital admissions, a 23% reduction in ED visits, and a 50% decrease in overall hospital length of stay.
Going National
Simon says the team wants to expand Project Austin, which won an ANCC Magnet Prize last year, into a national collaborative. The goal is to “work with regional pediatric hospitals across the nation so that they can deploy Project Austin within their facility to assist other children with medical complexity as well as the EMS and community hospitals that serve them,” says Simon.
The emergency medical plan is a paper plan that parents, EMS, and emergency departments have on file. Project Austin is now converting to a QR code system via a web- and mobile-based application. Simon says that each child will be given a QR code that can be scanned to access that emergency plan.
“It takes a village,” says McCawley, “and that’s what we’re doing is bringing a village together to care for these medically complex kids.”
Exhorting nursing staff and leadership to pay attention to the need for diversity, equity, and inclusion (DEI) is all well and good, but how do you put into practice ways and methods that make DEI a reality?
“It all starts with self-reflection,” according to Danielle McCamey, DNP, ACNP-BC, FCCP, assistant dean of strategic partnerships at the Johns Hopkins School of Nursing in Baltimore. “We have to truly take an honest inventory of where we are on our respective journeys and where our biases show up in our practices.” McCamey is the founder/CEO of DNPs of Color, an initiative to create and nurture a community of doctor of nursing practice (DNP)-prepared nurses of color.
Having gained that awareness and accepting that you will make mistakes, educate yourself and step outside your comfort zone, she says. “Take inventory of what your circle of friends’influence looks like. Do they represent diverse perspectives and voices? What positions of power and privilege do you hold, and how do you take up space for yourself? How do you show up and advocate for others who may not share the same level of privilege?”
Most important, she notes, is to, “Take action. Utilize your skills, knowledge, and position. If you see something isn’t right, say something. You might save a life in that moment or give someone the gift of recognizing their areas of growth to do better.”
Nurse leaders, she notes, can work to implement DEI policies by including different voices and perspectives at the table to speak on policies. “The more buy-in you have on different levels, the more people will feel included and engaged, and they will work to ensure that DEI culture and policies achieve their intended goals.”
Nurse leaders can advance DEI in various ways, according to Margaret Rosenzweig, PhD, CRNP-C, AOCNP, FAAN, distinguished service professor of nursing and professor of medicine at the University of Pittsburgh School of Nursing. They include:
Ensuring that the vision for DEI is shared and active.
Educating staff and colleagues on how to address bias and promote DEI.
Create events and space for hospital staff to work with the community in assessing needs and promoting health.
According to Crystal Beckford, chief nursing officer (CNO), recruitment and retention of a diverse nursing workforce are key to DEI efforts at Luminis Health Doctors Community Medical Center in Lanham, Maryland. Some 83% of the nursing staff is now diverse.
“We’ve made a concentrated effort to speak, teach, coach, and mentor at area nursing schools, historically black colleges and universities, and community colleges,” notes Beckford. “Our efforts include offering internship opportunities for students that hopefully lead to future employment.”
She notes that this year, she worked closely with the Maryland Hospital Association, nursing leaders, and state lawmakers to pass legislation to create a Pathway to Nursing Pilot Program.Across several pilot sites at community colleges, the program will provide support services to Licensed Practical Nurses (LPNs) to lower attrition rates, increase the number of LPNs and potentially the number of Registered Nurses, and advance educational partnerships with local health systems, according to Beckford.
In addition, Beckford notes that monthly “Coming To The Table” sessions provide a platform for candid conversations that celebrate diversity and encourage mutual understanding. Moreover, the hospital fosters belonging and professional development through several Business Resource Groups (BRGs), with the African American BRG being the largest. These groups offer networking, mentorship, and advocacy spaces, empowering employees to thrive in an inclusive environment.
McCamey received the AACN Pioneering Spirit Award in May, at the National Teaching Institute & Critical Care Exposition.
As a nurse, you’re empathetic and compassionate and go out of your way to ensure you provide your patients with the best possible care. But when it comes to looking after yourself, self-care may get prioritized far down the list – or not at all.
Such a mindset may be harmful to you and, ultimately, your patients. Nurses are great patient advocates, but “we do need to start advocating for ourselves because you can’t keep helping everyone. Then you don’t have anything left in your reserves,” said Linda Roney, EdD, RN-BC, FAAN, associate professor, Egan School of Nursing and Health Studies, Fairfield University.
“I think you have to be selfish, which is hard in a selfless profession to balance, but I think that is one of the ways that we can keep ourselves healthy. You have to prioritize yourself,” said Crystal Smith, DNP, RN, NE-BC, director of the medical-surgical unit at Children’s Nebraska.
As healthcare professionals and organizations celebrate Nurses Week with its theme of “Nurses Make the Difference,” now is a perfect time to assess your attention to self-care. In this article, we’ll offer practical strategies to help you care for yourself.
No Perfect Time
When it comes to self-care, “one of the biggest lessons for me is that self-care is not a one-size-fits-all,” said Roney. Nurses need to be aware of their unique needs.
Another awareness is not to wait for the perfect time for self-care. Roney said you can work on “small, incremental changes” for five or ten minutes that can accumulate over a day. You might try “habit stacking”: combining a potentially burdensome task with something enjoyable, notes Roney.
Days Off and “Zen Dens”
Smith meets with her new nurses at Children’s Nebraska in Omaha to discuss a self-care plan. If a nurse is struggling, Smith can consult the nurse’s plan and see the measures that might help that person.
One self-care policy at Children’s Nebraska allows nurses to take a day off if they need to recharge—if “your tank isn’t full enough to come in and give all of yourself that day,” said Smith. There are no negative repercussions should a nurse choose to do so.
Nurses are also encouraged to disconnect completely when they need a break. “It’s very hard to get away from the work when you’re at work,” Smith explained. Nurses are encouraged not to take their work phones on break but to trust that the staff can handle the patients while away.
Another self-care tactic involves “Zen dens.” When the hospital opened a new tower two years ago, these rooms were built into each unit. Zen dens have a lock, a massage chair, essential oil diffusers, books, and low lighting. A nurse can connect a phone to a speaker to play quiet music. “You can go in there and decompress how you need,” said Smith.
Smith noted that accessibility of these Zen dens is key. “We as organizations have always had places for people to do that, but never right on the unit. It’s tough to get a nurse or even a doctor to leave the unit where their patients are without any way to communicate with them.”
Added to these measures is a “Thrive” team, a department dedicated to employee wellness, noted Smith. Two members of Thrive are Howie, a golden retriever, and his handler, David. They may, for instance, join the staff for a debriefing after a difficult patient or family situation. Besides Howie and David, Thrive has a team of trained peer supporters and group facilitators available 24/7 for clinical and non-clinical team members.
Howie, the golden retriever, and his handler, David, make their rounds
What’s more, staff are encouraged to go home after a death in the facility. Death in general is very hard, noted Smith, “but I would say especially in pediatrics, it’s usually very traumatic. To expect the nurse who just went through that with a family and a patient to turn around then and take an entirely new patient, the mental load of that is really heavy. And so, to the best of our ability, we try to give them the option to go home.” At the same time, the facility understands that a nurse may want to stay at work instead of going home as a way of coping.
Back to Basics
As a nurse, you also need to take to heart the common-sense advice you probably give to patients about self-care, such as the following:
Sleep and downtime. You may want to spend some downtime on your phone, but be wary of it, noted Roney. “You feel as if you are relaxing and having a positive experience. But all this time is going on, cutting into your sleep/wake cycle.”
Nutrition and hydration. “If you talk to any nurse, most of us would agree we would put our needs after our patient, so there are many times we might miss a lunch break, or we may eat several hours later than we usually do because there might be something going on with our patient and we need to put their needs first,” said Roney. As a solution, “really be intentional and plan on bringing your meals and snacks to work.” Stay hydrated throughout your shift, noted Roney.
Simple measures such as making sure to take your breaks, eat your meals, and use the bathroom regularly while on shift are a start for self-care, according to Sarah K. Wells, MSN, RN, CEN, CNL, clinical practice specialist, practice excellence team, American Association of Critical-Care Nurses (AACN). Next, prioritize quiet times and activities that bring you joy each day.
Moments of Gratitude
Practicing gratitude can also help with self-care. In talking to an experienced nurse who was struggling, Smith told her, “You guys have to remember that the tiniest things you do make the biggest difference.”
Smith says, “Sometimes we must find and center ourselves around those tiny moments of gratitude. It’s easy to leave work and feel like your entire day was terrible. But really, you probably did many good things throughout the day.”
