Nursing education is the foundational pillar that enables future nurses to become competent and knowledgeable in their respective practices. This education was normally provided to nursing students through various didactic theoretical lectures and practical clinical training but recently, the use of advanced simulation technology as an adjunct educational tool has slowly become a significant addition to student centric learning.
History of Simulation
The concept of simulation practice can be traced back to the fields of military, aviation, and nuclear power (with military having used simulation the longest), dating back to the 18th century. Simulation was initially created as a cost-effective strategy for training professionals because it was considered exorbitant to train in these areas in the real world. As the years progressed however, the healthcare profession realized the practicality and usefulness of incorporating advanced simulation technology into educational practice and as a result, spurred the growing movement of simulation in healthcare training settings and educational establishments around the world.
The Impact of Simulation on Nursing Students
The emergence of computer technology has led to the development of innovative tools for healthcare professionals such as simulation technology and patient simulators Simulation technologies have had a profound effect on the nursing profession because it allows nursing students to apply their recently learned skills and knowledge to solve real life scenarios in a safe and structured setting.
In a typical simulation session, two students are often asked to participate and mimic the roles of a registered nurse or a certified nurse assistant (CNA). The rest of the remaining students are then asked to go to a separate room and observe the scenario through a one-way mirror and a live video stream. At the start of the session, the facilitator usually gives report on the patient, which allows the students to familiarize themselves with the patient’s situation, history, charts, and medications in order to successfully manage and implement high quality nursing care for the patient. As the simulation progresses, the facilitator controls the patient’s prognosis and provides cues to the team to enhance the realism of the situation. Once the simulation is completed, the students are then asked to head back to the debriefing room to discuss their experiences.
During the debriefing session, the students learn through self-reflection, group interaction, and questions asked by the facilitator. The use of group discussion engages students in reflective learning and enables the group members to consider a situation from multiple perspectives and consider other alternatives in order to broaden their scope of practice and clinical understanding. By performing simulation scenarios on a regular basis, students are able to develop better critical thinking skills, decision-making abilities, and application of theoretical knowledge in real-life situations.
Facilitating Simulation into Nursing Practice
According to the Institute of Medicine (IOM), approximately 98,000 people die every year from medical errors in U.S. hospitals, and a significant number of those deaths are associated with medication errors. This means that adverse events affect nearly 1 of 10 patients in the hospital setting. Based on this staggering number, the IOM called for a systematic change in healthcare practices and identified simulation practice as a resource to address the needed reform. By fostering experiential learning, simulation ingrains good nursing habits early, while discouraging bad nursing habits from forming before it becomes second nature.
In addition to allowing individuals to hone their nursing skills, simulation has also proven to increase student confidence and self-efficacy once they transition into the clinical setting. Nursing efficacy is an important aspect in nursing practice because it gives the students the confidence required to provide excellent nursing care to their patients. By incorporating what they have learned in simulation, more students are self-reliant in their capabilities, which are invaluable in ensuring that patient safety is implemented in the hospital setting.
Implications for Future Nursing Practice and Further Study
The shortage of availability of clinical sites is quickly becoming the norm for many nursing schools due to changing healthcare reform and the struggling economic crisis. One solution to combat the shortage of clinical sites however is to utilize simulation practice to replicate essential aspects of clinical situations for beginning nursing students. The National Council of State Boards of Nursing is currently conducting a landmark, longitudinal study to examine the knowledge and clinical competency outcomes of students when simulation technology is used in the place of actual clinical experiences. Although calls for additional research in these areas need to be performed, simulation is still quickly gaining momentum as the gold standard for effective learning practice in nursing education.
According to the American Association of Colleges of Nursing, only 2.1% of deans and directors are 45 years of age or younger. Further, according to the Robert Wood Johnson Foundation, a large percentage of senior nursing faculty members and Academic Nurse Administrators (ANAs) will retire over the next decade, and half are likely to retire by 2020. While experienced ANAs are retiring or resigning, formal mentoring for incoming Novice Academic Nurse Administrators (NANAs) remains relatively absent. Few nurses or nursing faculty fully grasp the complex responsibilities of this position. Typically, ANAs preside over the perpetual cycle of nursing student admission, academic progression, student attrition, and graduations. The specific roles and legal responsibilities of ANAs are outlined by each state in their state nurse practice act. Most programs are offered in community colleges or universities.
Regardless of the location or type of nursing educational program, ANAs are responsible for the majority of decisions made regarding the legal operations of these programs. Ultimately, ANAs are critical to the delivery, operations, and sustainability of nursing education and ultimately to the perseverance of the nursing profession. Unfortunately, formal nursing educational programs seldom address the daunting operational challenges that ANAs—and particularly NANAs—face when attempting to meet the expectations of this role transition. Consequently, vacancies loom across the nation, creating an urgent need for retention through formal mentoring.
Significant Challenges for ANAs
Experienced and novice ANAs are responsible for their nursing program’s state approval through accreditation. This lengthy endeavor requires at least one year of advanced preparation. State accreditation for pre-licensure nursing programs includes a program self-study and program evaluation, generally under severe time constraints. Accreditation topics under review include a total program evaluation plan, sufficiency of resources, appropriate administration, nursing faculty, nursing content experts, curriculum assessment, adequate clinical facilities, demonstration of student engagement, and a self-study summary. Additional responsibilities include monitoring the program’s National Council of Licensure Examination for Registered Nursing (NCLEX-RN) pass rates, sustaining student enrollment, maintaining nursing faculty stability, retaining program accreditation, and remaining fiscally sound despite varying degrees of institutional rigidity. Seasoned ANAs recognize that the terminal goal for each nurse graduate is to successfully pass the NCLEX-RN exam and thus earn state registered nursing licensure.
For ANAs, policymaking occurs continuously. Issues are brought to administration and faculty for exploration of the necessity to make or change policies to ensure that educational and nursing practice standards are current, and to change policies when they are not. Changes are also generated by requirements of affiliating health care agencies, university, college, and statewide policy recommendations that require extensive institutional buy-in and support. Many ANAs exert great efforts to receive institutional and faculty support in the operations of their nursing programs. A 2014 study in Nursing Education Perspectives found that among 242 ANAs, factors associated with job dissatisfaction included a lack of institutional support, mentorship, recognition, and respect. Furthermore, over a decade ago, it was reported that aging, bullying, and stress correlated with increased vacancies among all ANAs. In a current online survey of nursing faculty from 12 of the 15 highest-ranked universities, 22.5% reported not having a mentor, most (61.2%) found mentors on their own, and only 16.3% had formally assigned mentors. Overall, studies have revealed that the most helpful role transition experiences came from mentoring (53.5%), while (30.2%) came from work experiences, strongly indicating the need for formal mentoring.
Formal Mentoring Praxis
In Integrated Theory & Knowledge Development in Nursing, authors Peggy Chinn and Maeona Kramer define praxis as the integration of knowing: empirical, ethical, aesthetic, personal, and emancipatory concepts. In formal mentoring, experienced ANA mentors will apply their integration of knowing through mentorship of NANAs with the following conceptual guidelines:
Empirical: Use of a practical and pragmatic approach to mentoring
Ethical: Addresses the legal issues affecting nursing education
Aesthetic: Sharing of creative artistic diagrams, charts, and visual aids
Personal: Storytelling of lessons learned as an experienced ANA
Emancipatory: Supporting the independence and growth of the mentee
Critical Social Theory (CST) and NANA Mentoring
Critical social theorists aim to aid in the process of progressive social change by identifying not only what is, but also identifying the existing (explicit and implicit) ideals of any given situation and analyzing the gap between what is and what might and ought to be. In Advances in Nursing Science, P.E. Stevens identified six tenets of CST. Three of the six tenets of CST have important underpinnings to the praxis of leadership mentoring for NANAs. The first tenet examines the academic institutions’ social, political, and economic influence on the development of a formal NANAs mentoring program. The second seeks to reduce invisible oppressive institutional rigidity found in an academic environment while the third seeks to provide formal mentoring that emancipates and liberates the NANAs leadership potential.
Strategy and Implementation
Following the attendance of a formal mentoring workshop, ANAs would be assigned to mentor NANAs for one year. The three tenets of CST would serve as guides for the ANAs mentoring endeavors. Informed by CST and the praxis (integration of knowing), ANAs will share knowledge beyond empirics to more aesthetic, ethical, personal, and emancipatory patterns. The ANA mentor and NANA mentee would agree upon a formal mentoring schedule of two-hour weekly meetings to address specific nursing program director related topics, such as:
Faculty to Director Role Transition
Compliance with the State Nurse Practice Act
Program Directors Manuals/Handbooks
Maintaining State Program Accreditation
Writing of Policies and Procedures
Seeking Institutional Support
Handbooks (Student & Faculty)
Ethical and Legal Issues
Hiring and Orientation of New Staff and faculty
Collegiality Among Stakeholders
New Student Orientations
New Student Admissions
Student Essential Behaviors
NANAs Scholarly Expectations
Director & Faculty Professional Development
This formal mentoring program design aims to report positive post survey responses in job satisfaction and retention among NANAs. It is intended to create scholarly academic dialogue to explore the implementation of this mentoring model for NANAs. Future research and discussion will focus on the qualitative experiences of the ANAs mentors’ roles and NANAs mentees as participants. The provision of the CST as a framework for the praxis of formal mentoring guides ANAs in their mentoring endeavors. The success of a praxis leadership mentoring model can facilitate enhanced role transition and increased retention among NANAs.
One of my greatest pleasures in life is being a mentor to the next generation of nurses (not all of them, obviously!). I’ve learned over the years that the mentor/mentee relationship should be taken seriously. Mentoring relationships have often grown organically in my career. Though they are informal in nature, they provide a touchstone, an outlet, and a path for success to the mentee.
One thing you have heard in this career is that nurses eat their young. I’m not convinced that this is unique to the profession. Look around you and you’ll see someone in need of a helping hand in their life, and I’ll bet you have something to offer.
Here are 10 ways you can make the most out of your mentoring relationship.
1. Start by taking inventory of yourself.
What are your strengths and weaknesses as a nurse? With experience can come bad habits, corner cutting, and sloppiness. You don’t want to pass those on as wisdom. Conversely, I’ve gained deeper insight into the process of nursing, how to work within a system to promote change, how to put patient safety and outcome at the top of my priority list. These are the things I want to share.
2. Model the behavior you want to see.
I hate to say it but anyone can talk the talk. Oddly enough, I found that hand washing is a great silent instructional tool to model the correct behavior. There are plenty of nurses modeling bad behavior, but it only takes one person to do the right thing for it to catch on.
3. Be quick with praise.
The new nurse often works in a vacuum of praise. They are just expected to always be correct. I point out the correct behavior when I see it. That moment of reinforcement will last a lifetime. I’ll bet you can think of a time when someone praised you.
4. Don’t let a bad habit take root.
Gentle correction like, “You are doing great. I can see why you did it that way, but let me show you the right way… and here’s why.” The trick is to give constructive criticism in a way that works to change behavior without humiliating the receiver. One humiliation can sour a relationship. I never give correction in front of other people. I just don’t do it. Gentle correction in private is the way to go.
5. Be willing to learn.
Medicine requires a lifelong commitment to learning—and not just doing CE’s to renew your license every few years. Every day I find some new facet of my practice where I don’t know something. How does this medicine work? What is the natural course of this disease? What is the meaning of this lab value? Modeling to my mentee that I’m a learner encourages him/her to be a learner as well.
6. Be comfortable enough to share your mistakes.
We’ve all made them. I let my bad experience be a learning tool for my mentees.
7. Show the wonder of medicine.
Enthusiasm, excitement…these things can die if not frequently watered and fed. We have so much pressure on us as nurses that we can forget to see that caring for another human is a wonderful experience. The human body is an awesome machine for carrying around our mind. Even in great states of stress or disability, it can surprise us with its tenacity. It can also surprise us with its fragility.
8. Invest time in your mentee.
Time is all we have on this good earth. It’s my most valuable gift and when it comes to mentoring, I give it freely. Someday, one of these young nurses is going to be caring for me, and I want the compassion that I have for my patients and my craft to be reflected in the next generation of nurses.
9. Have fun.
If you aren’t laughing, you aren’t alive. Caring for the sick and injured at the bedside is tough cookies. Having a ready joke, seeing humor in difficulty, smiling…these are valuable coping tools that I use daily.
10. Finally, be compassionate.
It’s our most valuable asset. Having compassion for our fellow humans sharing this journey of life helps give us meaning. Compassion leads to love, and kindness, a desire to understand the plight of others, to intercede in tough circumstances, to be a good servant to mankind. That’s what we should want to pass on to the next nurse.
Don’t let a mentoring opportunity pass you by. You’ll find, like I did, that being a mentor is fun, rewarding, and a two-way street. I get 10 times as much as I give.
When Jannel D. Gooden, BSN, RN, was a new nurse, the first six months were traumatic for her. Her short-lived time in an adult oncology unit had her second-guessing her decision to become a nurse.
“I went through a spectrum of emotions and confusion, and at the time, I felt very isolated in the experience,” Gooden recalls. “I now know that it is a common thread all nurses share. The novice nurse journey is difficult.”
After she left her first position, Gooden says she made it her mission to create and expand on helping guide new nurses. She currently works as a travel nurse in the pediatric critical care setting throughout California. In her free time, she makes videos which she posts on her Instagram account @NoviceIsTheNewNurse to give advice to new nurses so that they learn and no longer feel alone.
A video posted by RN, BSN (@noviceisthenewnurse) on
Some of Gooden’s videos came about because she read through the journal notes she kept during her first three years in nursing and came up with a topic. She will share what was troubling her at the time in a way that she feels will help other nurses. Other times, she makes videos in response to questions that new nurses have emails or messaged to her. Sometimes, she simply speaks directly from her heart.
“I believe everything I went through in my first few months as a new nurse shaped my passion for helping new nurses in their journey,” says Gooden.
Some of her videos even feature doctors giving advice to new nurses. But she has a specific reason for including them. “We work with physicians every shift, no matter what specialty of nursing we are in. It is vital to patient care that we learn to effectively communicate with our physicians, that we are not intimidated by them, and that we develop a healthy working relationship,” explains Gooden. “Using a physician to offer advice to new nurses softens their identity. It gently takes them down from that unapproachable platform and allows a new nurse to hear advice in their safe place. It allows the new nurse to receive the advice without the nerves of the workplace or the pressures of pending orders that need to be carried out. It provides a new perspective on how they are viewed in the workplace and what is expected from them as a team member.”
A video posted by RN, BSN (@noviceisthenewnurse) on
The term “new nurse” doesn’t just necessarily mean someone fresh out of nursing school. Gooden says that when she switched to the critical care field, she became a new nurse all over again. “Every day was a mental, physical, and emotional workout. The equipment was unfamiliar, the families were scary, the patients and all the wires, the time management skills—some days I was afraid to even tough my own patient,” she says. All that is in the past, but by sharing her experiences with new nurses, she is making a difference.
Gooden gets asked a lot of questions, and Minority Nurse asked her about advice she would give to new minority nurses who might be experiencing discrimination, bullying, and/or stereotypes. “Discrimination and bullying are topics we sweep under the rug in nursing school. No one seems to talk about it, but it is a very real thing for new nurses of all ethnic backgrounds,” Gooden says. “New nurses carry a certain enthusiasm and hope that all nurses need to be reminded of it. My greatest advice is to hold on tight to your light. Try not to get discouraged in your practice during the very inevitable difficult moments. Your work will speak louder for you than any words you could ever speak, so do not get lost in the stupidity of others. Be an advocate for yourself. Do not allow anyone to treat you unfairly. Know when and how to put your foot down, all while maintaining your professionalism.”
Top Five Pieces of Advice for New Nurses
Gooden has top pieces of advice that she would give to new nurses, and they focus on what she believes are not emphasized in nursing school, a consistent part of the nursing curriculum, or ingrained into nursing training.
1. Be Confident.
Your patient cannot trust you, if you cannot trust you.
2. Know How to Delegate.
We are taught the meaning but not taught how to execute the verb. One piece of advice I always suggest? Get to know your CNAs and PCTs. This creates a more comfortable environment for you to be able to ask them to complete a task for you. It also shows your respect for their line of work by getting to know them outside of your needs.
Find a friend and let it all out—preferably a nursing buddy you can trust. If you do not release the frustrating energy in a healthy way, your patients will feel your tension. When you are tense, you are also more inclined to make mistakes.
4. Don’t Be Afraid to Ask Questions.
Question everything! Ask every why and how that comes to mind. The new nurse who does not ask questions is the nurse that scares everyone on that unit.
5. Be an Advocate.
Knowing how to advocate for yourself is truly what makes you a more comfortable advocate for your patients. So please, speak up for yourself.
Gooden is in the process of creating a YouTube channel featuring her advice for new nurses. In the meantime, you can find them on her Instagram. “I want to help new nurses because I am forever that new nurse. If one fails, we all fail because we collectively make up a profession that the world depends on,” says Gooden. “I want new nurses to gain confidence with their practice because people do not stop getting sick because we are afraid. Once you can overcome fear as a new nurse, then the door to growth is wide open.”
Globalization is changing the way we live and work, and by extension, it is transforming the experiences and aspirations of students entering Nurse Practitioner (NP) programs. Many of today’s students enter NP programs with a desire to acquire the advanced knowledge and skills needed to make a difference in faraway and remote places across the globe. Given budgetary and logistical constraints in nursing programs nationwide, existing curricular and institutional resources must be used in innovative and creative ways to develop, support, and mentor students with the potential for global leadership.
With more college students studying abroad, more students are entering NP programs with experience in global health care activities or services. Students with international experience may have participated in a high school foreign student exchange program, studied abroad in college, or travelled with a volunteer- or faith-based mission, or may have had a personal background in international travel. Many of these students have an expanded worldview and want to become NPs so that they can make a difference globally. In response, schools of nursing are establishing departments of international and global health, creating systematic course work and certificate programs in global health and leadership, and offering experiential global opportunities as part of their curriculum. I share one student-faculty mentoring experience I had in the hopes that it can serve as an exemplar in creating global opportunities in schools of nursing.
The journey began with a 52-year-old certified palliative care and hospice nurse who entered an Adult Nurse Practitioner Program with the secret desire to deliver hospice and palliative care to the terminally ill suffering from HIV/AIDS and cancer in the remote villages of Kenya. Her unrelenting vision enabled me, as a faculty member, to recognize the personal, social, and career attributes of a global leader and to create an innovative NP curriculum to support the student’s development.
Recognizing the Personal Attributes of a Global Nurse Leader
I first met the student at my university’s master’s-degree orientation for new students in the summer of 2011. I was her academic advisor, and she had come to my office to map out her course work and plan of study. Equipped with her notepad and ready to take notes, she was startled by my first question. I told her to dream big and asked: “If you could do anything at all, what would you do with your NP degree?”
Without hesitation, her response was: “My dream is to travel to the remote villages in Kenya to deliver hospice and palliative care to those who are terminally ill and suffering from HIV/AIDS and cancer.” Her tone was an alarming blend of authenticity, sincerity, and optimism. Fascinated by this student’s passion and enthusiasm and intrigued by her conviction of purpose, I asked her to tell me what she knew about Kenya.
Having traveled to Kenya myself, I was thrilled to have a frame of reference. I could easily recall highlights of Kenya’s topographic and demographic data. I even retained a working knowledge of Kenya’s Ministries of Health, its governmental structure, and its key economic drivers. Admittedly, the student really did not know much about the country and had never traveled there. But as her story unfolded, I discovered that she knew something far more valuable than all of the facts, figures, and statistics that I was expecting to hear.
Several years ago, the student was approached by a colleague who asked a favor. Knowing the student was a hospice and palliative care nurse, her colleague asked if she would write to her friend, a palliative care social worker in Kenya who was struggling with the enormity of suffering in her country. Without hesitation, the student agreed and thus began their ongoing virtual relationship.
For three years, the student and the palliative care social worker in Kenya shared their lives and their experiences with death and dying. Across continents, cultures, languages, and barriers, they developed an appreciation and an understanding of each other, as well as their triumphs and struggles. The student learned about the palliative care social worker’s beliefs and values and how they influenced her views about life and about death and dying. The student was very much aware of her own values and belief system and willingly shared them with the palliative care social worker. Without judgment, but with curiosity, openness, and sensitivity, the student compared and contrasted their cultures, traditions, perceptions, misperceptions, and views. She reflected upon the similarities and differences along with the challenges and potential conflicts.
Teaching is a two-way street, and that day this student taught me how to recognize the attributes of a global nurse leader. Through telling her story, this student demonstrated self-confidence, self-awareness, cross-cultural communication, flexibility, adaptability, and the passion to take on new challenges. She possessed the core attributes of a global leader but did not recognize this in herself. I was compelled to assist this student with realizing her potential.
This student came to graduate school with a global mindset, a passion for global health, and the vision of a leader. To place such energy and passion on hold—for two years—while working through a master’s degree in nursing would be unfortunate. Worse yet, imagine extinguishing the flames of passion for global health by ignoring the vision when we need more global nurse leaders. I needed to engage this student in her graduate course work in such a way that it strengthened and supported the commitment to her dream. Moreover, I wanted to assist the student with realizing that she had the ability and skills to make her dream a reality.
I asked the student if she would be willing to make a commitment to the ongoing development of her knowledge, abilities, and skills as a global leader by working with me to develop a structure and foundation for her dream. She agreed, and from that moment on, her dream began to crystallize. Graduate school was no longer classes and coursework; it became her passion, her life’s work, and the pursuit of her dream.
For the next year, the student and I worked together, using the existing curriculum, to develop a rich and engaging plan of study that provided the opportunity for balancing ideas, perceptions, and critical perspectives from her partnership with the palliative care social worker against evidence-based knowledge and theoretical frameworks.
The student’s literature review led her to the work of Dr. Anne Merriman and Hospice Uganda Africa. The student used her research courses to examine Merriman’s model for affordable oral morphine in Uganda to relieve end-of-life suffering. In addition, she investigated Merriman’s model as a possible model of care for the palliative care social worker’s community. The student’s partnership with the social worker had given her a global advantage. She had developed the adaptability, flexibility, and stability to deeply engage in the assessment and evaluation of the challenges and barriers related to one specific issue in one area of the world not only from a Western perspective, but from a broader perspective.
Merriman’s accomplishments as a leader resonated with the student. In her Nursing Leadership and Nursing Theory courses, the student focused on transformational leadership and change theory to better understand Merriman’s accomplishments in advancing palliative care in Africa. Eventually, the student interviewed Merriman for a Nursing Leadership class assignment. The Skype conversation with Merriman was a defining moment in the student’s career. Merriman’s respect, interest, and sincerity reflected the heart of most passionate leaders. They spend time investing in and sharing with others who share their vision in order to educate, advocate, spread, and advance their mission.
Relationship building is an essential component of becoming a global leader. The student’s relationship with the palliative care social worker in Kenya was invaluable to her development and success as a global leader. Her vision was born out of their partnership. However, how was this student going to make her dream happen? In order to actualize her dream, she needed to identify support or opportunities for collaboration, partnership, research, or even funding. She needed experience in navigating organizations. In addition, she needed to join international professional nursing organizations to network and to create and maintain relationships.
I arranged for the student to meet with senior administrators from both the School of Nursing and the School of Medicine at my university to build support for her work. As a result of those meetings and making those connections, she was introduced to major global leaders doing work in her area of interest.
Furthermore, the student was inducted into Sigma Theta Tau International in 2012 and, together, we presented the extraordinary outcome of our relationship at the Sigma Theta Tau International Research Congress in Sydney, Australia. Through this experience, the student had the opportunity to work with me one-on-one to prepare for her podium presentation. This type of guidance and support can facilitate high-quality results, and many leaders report this type of coaching as vital to their success. In addition, the student had the unique opportunity to network with global nurse leaders from all over the world.
•Do not allow perceived time constraints or fears of failure deter your desire to become an educational innovator. The impact of this successful innovation on student learning and faculty development far outweighs time and risk.
• Tying innovative teaching strategies into existing curricular structure provides a means for measurement and evaluation of student outcomes.
• This innovative approach for developing global nurse leaders will not work for all students. Recognizing the attributes of a global leader in someone with the passion for global service will optimize successful results.
• Never underestimate the power of virtual collaboration when developing global relationships.
As transformational coaches, educators can make learning come alive for students by becoming aware of a student’s vision, strengthening that vision by connecting it to the learning, and then empowering the student to make his or her dreams happen.
Sandra Davis, PhD, DPM, ACNP-BC, is an assistant professor at the George Washington University School of Nursing.