High-Fidelity Nursing Education

High-Fidelity Nursing Education

As anyone in the field would surely attest, nursing is a career that is both incredibly rewarding while also fraught with significant demands and challenges. One area in particular that has been making strides in supporting nurses is the expanded and refined use of simulation—in order to practice the clinical skills necessary to ensure safe patient care.

Using life-like computerized mannequins to replicate the complex patient environment of the clinical setting, simulation offers nursing students the opportunity to practice in a safe atmosphere before beginning full-time work in a real clinical setting. Simulation benefits students, faculty, and health care providers, and also carries the power to transform the health care system through improvements in quality, safety, efficiency, and care outcomes.

At a number of nursing schools throughout the country today, simulation is integrated as part of the formal nursing curriculum, resulting in success for students and faculty alike. However, this wasn’t always the case. As with any new technology, simulation technologies are sophisticated systems that come with many advantages, but some challenges to manage as well. It took time—combined with a passion for nurse education and a persistence to get it right—for appropriate curriculums to be developed.

Overcoming the myth of simulation

Early uses of health care simulation date back to the 1960s and include the use of airway simulators for anesthesia training and CPR instruction, as well as for medication administration training. For instance the Institute of Medicine’s (IOM’s) 1999 report, “To Err Is Human: Building a Safer Healthcare System” highlights the promise of deliberate practice in curbing medical errors through improved communications, team performance, education, and training, all of which can be accomplished with the use of simulation.

Motivated by early simulation success, in the early 2000s many provider organizations and schools of medicine and nursing purchased or received donations of high-fidelity simulators ranging in costs of $75,000–$100,000 each. While there were high expectations for immediate use and derived benefits of these simulation technologies in nursing, some people in the industry had the notion that nursing simulators would perform on their own with the simple click of a button—and that students would “magically” learn the content. With that idea, faculty members were left to fend for themselves in conducting simulation design, implementation, management, and monitoring.

In 2004, staff at Robert Morris University integrated these very life-like simulations into their nursing curriculum. That effort has led to today’s unprecedented and innovative template for nursing simulation curriculum at the Robert Morris University School of Nursing and Health Sciences.

Laying the foundation for curriculum development

Integrating simulation in nursing education requires an understanding of these high-fidelity mannequins, which are as true to life as one can imagine, with an advanced level of realism. They speak, they bleed, and they react. They respond to interventions with changes in heart rate, lung and heart sounds, and vital signs. As a result, some of the most effective uses of these simulators is to recreate what are known as low-occurrence, high-risk scenarios such as strokes, heart attacks, and other critical health situations. While these medical situations may not happen with regular frequency, when they do, they require an incredibly swift and accurate response from nurses. In other words, the ability to teach and practice responding to these situations, in the safe and controlled environment of the simulation lab, is invaluable.

But implementing simulations in educational settings—universities, colleges, and career schools—has not been easy. To meet this challenge, an interdisciplinary team at Robert Morris University School of Nursing and Health Sciences, in Moon Township, Pennsylvania, took on the task of investigating barriers and roadblocks to simulation adoption, from understanding the technology behind the mannequins to curriculum writing and development of a well-planned educational experience, in addition to faculty development and pilot testing.

Among the issues under review were the following:

  • How prevalent is simulation in nursing education?  
  • How can nursing faculty design an effective simulation experience?
  • What constitutes a worthwhile simulation experience for nursing students?  
  • What’s the best way to measure learning outcomes, including knowledge and critical thinking?

Considering curriculums

After much research; hands-on experience; and feedback from students, teachers, and even system designers, RMU implemented its currently used Simulation Learning System (SLS) curriculum in 2009. At the heart of the program are the following three components:

Pre-scenario: Nurse faculty members receive guidance on a wide range of areas, including simulation set-up, features and functions, and anticipated possible student reactions. They are also advised to think about others—besides the students and mannequins—who should be involved with the SLS process to make it as real as possible (i.e., should there be parents or other family members?). Time parameters are also important. Each scenario can range from as little as 20–30 minutes, to 50 minutes or an hour. Reading materials and relevant background research are also suggested for the faculty. And finally there are pre-scenario learning activities, which prepare students with the tools necessary to be successful during the scenario, without giving away the details.

Scenario: Faculty instructors receive tips on how to run the scenario, including making changes to the mannequin to best suit their needs, guiding students through the experience, and facilitating a debriefing where students view and reflect on their performance, answer critical-thinking questions, and link theory to practice.  

Post-simulation: This is the debriefing component and the chance to evaluate how the scenario went. Part of this phase is faculty administering post-exams, post-tests, and concept mapping to solidify what students have learned with the simulation. In addition, students have the ability to reinforce content with animated movie clips, which clarify concepts related to pathophysiology or procedural skills.

RMU also responded to common faculty recommendations for implementing high-fidelity human simulation (HFHS), including:

  • Appoint a dedicated coordinator or champion.
  • Offer technological support.
  • Provide adequate facilities.
  • Use standardized programming forms.
  • Arrange for adequate facilities.
  • Fund supplies that enhance realism.
  • Offer workload release time.

Next steps for RMU

With its new Regional Research and Innovation in Simulation Education (RISE) Center, RMU continues its commitment to simulation learning and advancement. Opened in 2009, the RISE Center features two high-fidelity treatment rooms, a critical-care room, two classrooms/debriefing areas, and a low-fidelity nursing skills practice lab.

With additional funding, RMU has hired both a simulation technician and simulation specialist, who integrated simulations, including approximately eight scenarios with over 100 students. Students who are about to graduate or transition also rely on simulations to prepare for the real-world nursing environment.

Thus far, more than 120 Robert Morris nursing students and five nursing faculty have participated in simulation experiences facilitated through the SLS. Post-evaluations reveal positive results from students on dimensions such as satisfaction, value, simulation realism, and applicability of the simulation to real-world clinical settings. In addition, students demonstrate improved SLS post-test scores following simulation experiences.

An administrative software system allows RMU to track usage statistics; usage rates have increased exponentially, from four scenarios in 2008 to more than 20 in 2011, as have the types of simulations offered.

Additional simulation recommendations

Among the recommendations for an effective simulation experience are these:

  • Ensure adequate time and resources. Invite faculty to learn about simulations and underlying technologies, while creating a sense of anticipation about the simulation experience among students. 
  • Utilize standards and guidelines as much as possible. The first set of simulation standards was recently released by the International Association of Clinical Simulation and Learning (INACSL) and can serve as a guide for both novice and expert simulation educators.
  • Overcome faculty fears relating to lack of support, assistance, and time. 
  • Hire staff that can assist in implementing, managing, monitoring and evaluating the simulation program. Rely on a technician to handle technical glitches, video, and sound.
  • Solicit feedback from both faculty and students on issues such as usability, learning experience, and outcomes. 
  • Seek out other nursing schools with experience and expertise in using simulations.
  • Partner with providers, associations, and reputable vendors.
  • Consider simulation certification.
  • Rely on highly developed simulation learning systems that alleviate the pressure of simulation design, implementation, administration, pre- and post-testing, and tracking.  Especially important are competencies related to Quality and Safety Education for Nurses (QSEN,www.qsen.org) competencies, which should be integrated into every simulation experience. 

The next phase for simulation in nursing

As new developments occur, simulations within the nursing curriculum are likely to change and evolve somewhat rapidly. Among the new and emerging trends:

  • Team spirit: Team training will occur across disciplines and specialties. Team STEPPS,  (http://teamstepps.ahrq.gov/) is an evidence-based team training system developed by Department of Defense’s Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality (AHRQ.).
  • Research: Research on simulations will surge. Especially critical are issues related to the impact of simulation on patient outcomes and on provider effectiveness. Among the questions currently under investigation: How can simulation be used for high stakes testing situations? What are the knowledge and clinical competency outcomes of students when simulation technology is used for clinical experiences? (NCSBN study) 
  • Patient safety: Simulation will emerge as a patient safety strategy. Organizations will increasingly view simulation as a tool to promote patient safety, prevent medical errors, and curtail costly readmissions.

Is Graduate School for You?

You’ve decided on a career in allied health, but how do you get from where you are now to the career or your dreams? Figuring out where you’re headed is a great start, but it is only the beginning. Now you need to create a plan and set a course of action to reach your goals.

If graduate school is part of the picture, you will need to find out which schools offer the allied health degree you seek.

During the search for the perfect school to continue your education, don’t overlook Historically Black Colleges and Universities (HBCUs). They provide an invaluable environment for learning, networking and embracing heritage.

If you are interested in attending an HBCU, there are many allied health graduate degree programs available. HBCUs range from sprawling universities to compact urban campuses, with schools scattered throughout the country, and they grant advanced degrees ranging from pharmaceutical science to rehabilitation counseling.

Deciding on a graduate program can seem like a daunting task, but research can help organize the process. Following are some key points to keep in mind as you consider various HBCUs.


Geographical location is a big consideration, so it’s vital that you figure out where you want to live and study for the next several years. Ask yourself: Do you prefer rural or urban environments? Is it imperative that you’re close to family and friends?

You should also delve deeper into campus life and student satisfaction. If possible, visit the campus and talk to current students to gain a first-hand perspective about the campus environment and program pros and cons. If an on-site visit is impossible, the admissions office may be able to set up a conversation with a current student via telephone or email.


How do you plan to finance your graduate education? Clearly, this is a crucial factor and will play an important role in your program selection. Options may include any combination of grants, scholarships, loans, financial aid, family contribution and employer reimbursement. Examine the different programs offering the degree you seek and determine their tuition costs. Factor in available financial aid, such as teaching assistantships and work-study positions.

Job Opportunities

Graduate school is a valuable step in your career planning, but it is not the end of the road. Your goal should be to land a top job in your field upon graduation. Consider what types of job opportunities are available to graduates at each program. View career center Web sites and find out if schools offer placement assistance and career counseling, such as job fairs, recruiting programs, individual appointments and workshops.


Graduate school gives you an opportunity to really focus on your area of interest and become an expert. Therefore, the academic program you select should reflect your specialty area and learning goals. Ask yourself: Are you looking for a rigorous academic challenge? Is a school’s reputation important to you? Consider the professors and their research interests to find the best fit. Furthermore, even graduate programs in the same subject often vary in terms of requirements. Examine the specializations available and what courses you find most interesting.

Make a Choice

In order to make an informed decision, there are several methods you can use to assist you with selecting a program. It can be useful to make a list of the pros and cons of the various schools where you’ve been accepted in order to compare and contrast them. Use the above categories as a way to analyze their offerings.

It is also helpful to get feedback from as many people as possible, especially those familiar with HBCUs: family, friends, colleagues, professors, advisors. Those who are directly removed from the situation can often provide a valuable perspective.

Finally, figure out what feels right to you and, ultimately, go with your gut instinct. Take a week and spend each day pretending you’ve decided to attend a different program. You may be surprised at your reactions.

No matter what field you choose within allied health and which HBCU you decide to attend, your degree is your first step to achieving your career goals. Research potential programs carefully and you’ll find your best fit for successful professional training and personal growth.

Picking an HBCU

For a comprehensive listing of HBCUs with advanced degree programs, the Web site www.edonline.com/cq/hbcu is a good place to start. Here is just a sampling of some of the diverse possibilities you will find:

Florida A&M University, Tallahassee, Fla.
Looking for a large university? Florida A&M has a total enrollment of over 12,000 students. With 36 master’s degree programs with 56 majors/tracks, two professional degrees, and eleven Ph.D. degree programs, there is a lot to choose from. Florida A&M has a School of Allied Health Sciences that offers programs in physical therapy, occupational therapy and health sciences, as well as a College of Pharmacy and Pharmaceutical Science.

Fort Valley State University, Fort Valley, Ga.
If helping people cope with difficult situations is your interest, Fort Valley State offers master’s degree programs in mental health counseling and rehabilitation counseling. A land-grant state university with an enrollment near 2,500 and boasting over 70 student organizations, Fort Valley State provides one-on-one learning, as well as a commitment to the community and the greater world.

Meharry Medical College, Nashville, Tenn.
This unique program includes a School of Allied Health Professions that offers master’s degrees in physical therapy, speech pathology and audiology. Since the other schools at Meharry are also in the field of health—medicine, dentistry, public health and biomedical science—you will study with an array of health profession students.

Howard University, Washington, D.C.
If you are considering pursuing a Ph.D. in an allied health field, check out Howard University. Located in our nation’s capital, Howard is a private, comprehensive, research-oriented university with a strong academic reputation and a rich history as an HBCU. With a graduate student enrollment of more than 1,200, Howard offers a Ph.D. in human nutrition and pharmaceutical science, in addition to a number of master’s degrees within its College of Pharmacy, Nursing and Allied Health Sciences.

Mixed Messages

Of the 2.2 million nurses in the United States, the vast majority still conforms to the traditional white/female nurse profile. Only 4%-5% of nurses are male, 4% are African American, 3.4% are Asian/Pacific islander, 1.6% are Hispanic and 0.5% are Native American/Alaskan Native.1

With the exception of male nurses, whose numbers are on the increase, these percentages have essentially not changed in 10 years, despite ongoing changes in the makeup of the U.S. population. For example, the growth of the Hispanic population is now outpacing that of the nation as a whole. And yet, according to the most recent National Sample Survey of Registered Nurses by the U.S. Department of Health and Human Services’ Division of Nursing, Caucasians still account for approximately 90% of the total number of registered nurses in the U.S., even though they comprise only about 72% of the total population.

It seems to me that at least three issues are raised as a result of these figures. First, although there has been a steady change in the racial and ethnic makeup of the greater U.S. population, the nursing profession does not reflect this change. The underrepresentation of minorities in nursing and schools of nursing can be attributed to a variety of factors, including the high dropout rate of minority students at the high school level.2 Additionally, a minority student’s acceptance into a nursing school does not guarantee his or her successful completion of the program.

Secondly, these statistics raise the issue of cultural competency—both within the profession and in nursing education. Providing culturally competent care is the key to ensuring that underserved minority populations receive quality health services. Yet most nursing schools continue to design their curricula around the needs of the majority, leaving out the unique needs of the other 28% of the population. Perhaps nursing schools would be better able to recruit and retain students if they would offer a curriculum that would teach students to take care of people from all ethnic backgrounds.

Towards a Multicultural Curriculum

Embracing multicultural education is a shift from the norm of educating from a Eurocentric perspective, but by doing so, the opportunities for people of different cultures to learn about each other and themselves increase. A multicultural perspective means accepting that a variety of cultures exist and understanding that each one may have its own different traits, beliefs and traditions.


Although there are exceptions, basic nursing education generally does not include information relevant to minority populations. For example, in many instances hair care for African Americans, and also some Hispanics, is different than hair care for whites. Yet this issue is rarely discussed in nursing schools. It is addressed in teaching about personal hygiene, but instruction is generally based on the needs of the white population. This approach leaves nurses underprepared to provide care to minority patients whose hair texture may be different. Unfortunately, what often happens is that the nurse may not provide any hair care at all—a good example of how a lack of cultural competency affects the quality of patient care.

A second example is the dietary instruction that student nurses receive. Sometimes the foods included in the teaching plan may not be the same foods that a minority patient consumes at home. Therefore, the instruction is ineffective because the patient’s cultural food traditions have not been taken into consideration.

Negative Reinforcement

A third issue, based on my own experience as the only Latina student in my nursing program, is the way students of color may be perceived and treated within the educational experience—by faculty, administration and peers. In researching my doctoral study, “Understanding the Experiences in Nursing School: A Latina Perspective,” Latina students described to me such incidents as a faculty member telling a student: “Spanish students do not pass my course.” Another student told of being asked by a fellow student if she was “hiding a knife or a gun” in the brace on her leg, because “you Puerto Ricans are always shooting people.”

In another incident, a Latina student who felt she had received an unfairly low grade on a paper took her case to the school’s director of nursing, who asked, “Is Spanish your primary language?” The student replied, “No. What does that have to do with it?” The director’s response was: “I wish you had said ‘yes,’ because that would explain the problems you are having.”

Being continually bombarded with cultural insensitivity and negative stereotypes can be detrimental to a minority student’s success in school. Non-inclusion can also be a contributing factor to a student’s failure to complete his or her nursing studies. Students of color need to receive positive messages and images to enhance and support their learning experiences. A nurturing educational experience is beneficial to all students, not just those who are white.

Whatever their race or ethnicity, students need to feel they are a respected part of the educational experience, and they need to be trained to offer culturally competent care to a diversity of patients. If educators don’t provide all nursing students with an opportunity to develop a multicultural perspective—i.e., to view nursing and patients from a broader perspective than just a Eurocentric one—then we have shortchanged them in their education.


1. U.S. Department of Health and Human Services, Bureau of Health Professions, Division of Nursing (1996). National Sample Survey of Registered Nurses.

2. Nieto, S. (1996). Affirming Diversity: The Sociopolitical Context of Multicultural Education (2nd edition).

Earn Your e-Degree

Have you ever dreamed of earning a degree without setting foot in a classroom? Are you self-motivated and a whiz on the Internet but lack the time needed to enroll in an on-campus program? If so, a distance learning program in allied health may be right for you.

Clearly, distance learning (or eLearning) is a great option that enables you to work at your own pace and in your own space. However, it is not the best choice for everyone. According to Josh Baron, director of academic technology and eLearning at Marist College in Poughkeepsie, N.Y., there are some important pros and cons to consider before firing up your laptop and taking the plunge into the world of cyber-school.

Education Anytime, Anywhere

One of the major benefits of distance learning is that it enables students to participate in quality learning, anytime, anywhere, Baron states. “For many students, especially adult learners, one of the most significant Ôpros’ is the ability to learn on your own time instead of having to attend regularly scheduled classes,” he says. For students who are working full time or are unable to commute to classes at specific times, distance learning provides an opportunity for flexibility. Your geographic location will not limit you to local programs, and you can often save money through lower program costs and zero commuting expenses.

In addition, a digital learning experience is more interactive. The multimedia regularly used in distance learning programs engages and connects with students in new and unique ways, and it can often be a more effective teaching tool than traditional educational aids such as textbooks. Learning is instantaneous; there is no lost time idly flipping through pages or commuting to and from school. The learning and the benefits of new knowledge are immediate.

Furthermore, distance learning may help take the bias out of the educational process.

“Distance learning programs can often be great equalizers, breaking down stereotypes that often arise in face-to-face courses. Since you often never see each other, racial and other stereotypes do not surface as often,” Baron offers. This may result in the grading process being more fair and objective as well.

Challenges of Electronic Education

Despite all their benefits, distance learning programs are not without their drawbacks. Students need to be accountable for their own learning, which can be a formidable task. “The Ôfreedom’ that comes with distance learning also comes with an increase in responsibilities,” says Baron. For students who are accustomed to a traditional classroom setting, it can be difficult to stay self-motivated. It’s crucial to exercise good time management. If you crave structure, look elsewhere, but if you prefer to be on your own timetable, then eLearning plays to your strengths.

Another challenge that students may face comes from the reliance on new technology. It’s important to remember that computers are machines, and like all machines, they can break or malfunction, cutting into valuable learning time. Furthermore, it is also necessary for students to be up to speed with their computer knowledge. This may require more training to obtain new skills for optimum participation in distance learning.

Some students may also dislike the lack of face-to-face interaction. Without students and teachers meeting in person, communication blunders may arise. Baron adds that without the benefit of eye contact and other visual cues, statements can be misconstrued and jokes taken seriously. For successful eLearning, it is important to develop new communication skills for the electronic age.

Selecting a Program

Research is an extremely important step when applying to any type of higher education program. As you beginto research distance learning programs, expect to dedicate a considerable amount of time to exploring programs and learning about your options. Be sure to visit program Web sites to read about the courses and curriculum to see if they fit your interests. Talk to employers and professionals in the field and ask about the reputations of the particular programs you are considering.


Contact the admissions or career placement professionals at each school to see if they can put you in touch with recent graduates. When you contact the programs’ alumni, find out what they are doing now and how they feel about their educational experience. Speaking to them will help you ascertain how marketable the degree is and will give you insight into the pros and cons of the different programs. Don’t overlook this step; it can be an invaluable part of your decision-making process.

Perusing an advanced degree—whether at a traditional university or an online one—is a huge investment of both time and money, so you want to be sure you will receive a valuable degree in return. Baron recommends making sure that the institution is accredited by an official accreditation agency recognized by the U.S. Department of Education. A degree from a non-accredited institution is usually not valued by employers and may cause problems if you ever need to transfer credits. For more information, take a look at Baron’s article on this topic at www.elearners.com/ resources/accreditation.asp.

Once you’ve decided that distance learning is right for you, the process of choosing a program is not different from the criteria you would use to select any graduate program in allied health; the programs themselves are oftentimes not so different either. As Baron states, distance learning is more of an “evolution” than a “revolution.” Although the Web brings major innovation to the world of learning, it still comes down to good teachers and motivated students to make the process successful. Remember, your career goals are only a click away.

Surviving Graduate School

You did it! Not only did you make it through your undergraduate degree with flying colors, but you also worked your way through graduate school’s required hardships, like the grueling application process, entrance exams, ascertaining letters of recommendation and more. And now the road to your career is welcoming you like a red carpet, and it seems as if the hard part is over. Or has it only just begun?

The hoops you need to jump through to get into grad school can distract you from the reality of the hard work ahead. But graduate school doesn’t have to be intimidating. Remember when you thought college was scary? Now, as a seasoned student, you are ready to tackle a new challenge with ease. Relax and you might even enjoy yourself. Here are some tips to make the most of your new venture and smooth the transition from undergrad to graduate school.

Get Involved

Graduate school is about more than just academics. In order to feel connected and part of your campus, explore the different extracurricular activities that interest you. There are a vast number of choices, ranging from groups that are university-wide to those for graduate students only. Join a mountain biking club, participate in a pre-professional society or run for student government. These experiences will help you to meet other graduate students while doing things that you enjoy. And they won’t hurt your resume either.

Keep Your Eye on the Prize

Making new friends is part of what graduate school is all about. Meeting people and socializing is not only a great way to unwind, but it also helps you forge relationships like those you will have with future colleagues. However, while everyone loves a party, make sure that your social life doesn’t affect your grades. Your courses should always be your number one priority. Don’t pick up the bad habits of skipping class, oversleeping, or turning in late assignments. Reward yourself with fun outings after all your homework and studying is complete.

Create a Time and Money Budget

It’s easy to get overwhelmed by so many conflicting demands. As a graduate student, you may face more personal and professional responsibilities than you had as an undergraduate, such as work or family. Make a schedule and calculate your available hours per week, including school as well as outside obligations. Then divide up these hours for study, rest, entertainment, etc. Once you’ve laid out your schedule on paper, it will be easier to see where your time is going and how you can use it more efficiently. Additionally, money might be more of an issue now, especially if you have taken out loans to finance your education. Similar to the time schedule, listing your monthly expenses will also help you to be aware of your spending habits and highlight areas where you can possibly cut costs.

Forge Your Career Path With Experience

Graduate school is a time for you to solidify your career goals, and your courses are more specific to your field of study than they were in your undergrad years. Whether you are already clear about your ultimate goals or not, explore your interests through electives and internships. If your program doesn’t have required fieldwork built in, create your own opportunities. Get to know your professors and the career services staff. Many campuses offer services such as career fairs, recruiting programs and counseling appointments. Visit the career center early to make sure you don’t miss out on anything. Join professional associations in order to network within your industry. Take advantage of the resource you have in your classmates as well. Many of them may be working professionals who are attending school part time or have worked for several years before going back to school. Their valuable industry insight and contacts can help you to get your foot in the door.

Be Confident


Receiving your bachelor’s degree proves you can be a successful student. Don’t doubt your abilities in graduate school even if the work seems more difficult and the expectations higher. Remember, the students around you are all in the same boat, facing the same fears, whether they are fresh out of college or returning to school after working. It is helpful to form study groups and to attend help sessions. Don’t be afraid to enlist tutoring if necessary. Make a list of your accomplishments and post it above your desk to remind yourself of how far you’ve come and how much you can accomplish.

Don’t Forget to Have Fun!

Before entering the so-called “real world,” reap the benefits of student life. At what other time in your life will you have exposure to a world-class learning environment, as well as a pool of people roughly your own age with similar interests? So sign up for that extra course, spend a few more minutes playing ultimate Frisbee on a sunny afternoon, and give yourself a break. You’ve worked hard and you deserve it!