We hear about the worsening nursing shortage today, but what many people don’t realize is that there is not a shortage of applicants. Instead, nursing schools are grappling with the challenges of limited capacity, according to the American Association of Colleges of Nursing (AACN). A dearth of qualified nurse educators, clinical placements, and other training resources prevents nursing schools from increasing candidate admissions to produce competent new graduates in adequate supply to meet the ever-growing demand for healthcare.
While real-world training remains the gold standard, realistic simulations in a safe environment have become a significant part of nursing education. Simulation can include “low fidelity” traditional methods such as tabletop exercises and role-playing by other trainees or faculty members, as well as static manikins (full or partial body simulators). Newer, “high fidelity” simulation modalities include standardized patient actors, as well as programmable, tech-enabled manikins with varying levels of physiologic function, and emerging immersive scenarios in virtual reality (VR).
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We did a survey in November 2023 of 957 nursing instructors in which 84% cited their nursing program’s lack of simulation facilities and resources as a reason for denying acceptance to qualified applicants. To address this gap, institutions such as the University at Buffalo, Maria College in Albany, N.Y.; John Wood Community College in Quincy, IL; Texas Tech University in El Paso; and the University of Manitoba are integrating immersive VR into their curriculum to supplement traditional methods while allowing them to scale their simulation options and offer novice nurses a chance to experience the unpredictable nature of the nursing profession.
By creating realistic virtual environments, often dealing with high-acuity but low-occurrence scenarios, nurse learners gain valuable hands-on experience that “puts theory into practice” for developing decision making and clinical judgment skills — but without putting real-life patients at risk.
Wide open options
While virtual reality first gained popularity in the gaming world, it has a serious role in other applications besides entertainment as the technology evolves — education, healthcare, manufacturing, fitness, tourism, design, customer service, etc. The purpose for adopting VR in nurse training is not to be trendy, but to look at learning objectives and how to best accomplish them.
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Nurse training programs use immersive VR simulations to increase matriculation, address an educator shortage, supplement clinical sites, offer multiple diverse but standardized clinical experiences, and to increase learner concentration, engagement and confidence. In fact, a 2020 study by PwC found that business learners using immersive VR were 3.75 times more emotionally connected to the training content than traditional classroom learners, and 2.3 times more engaged than other computer screen-based e-learners.
Moreover, instructors can design virtually any scenario imaginable in VR — how the patients present themselves, patient orders, lab results, medication administration records (MARs), and anything else in the electronic health record (EHRs) — to guide and evolve the simulation, without going to the expense of staffing, setup, teardown, special rooms, and other scheduling logistics involved with patient actors or manikin-based simulations.
One-third of the nursing instructors we surveyed also indicated that “disengaged learners and/or shorter attention spans” presented a pressing challenge. More dynamic teaching methods other than traditional classroom lectures, such as interactive simulations and collaborative learning, are potential methods for creating deeper engagement. We also found that 43% of the 204 nurse learners surveyed preferred VR-based nursing simulations — and were evenly divided between immersive headset-based VR and computer screen-based experiences. Live role-play was favored by 37%, with manikins the first choice of only 19%.
Generation gap
I’m not discrediting manikin simulations — it’s not an “either/or” choice with VR. Recent research by faculty at two nursing schools in Canada emphasizes the effectiveness of combining the two simulation forms. There are tactile components of training for the acquisition of psychomotor skills best utilized with the manikin to build muscle memory — practicing injections and intravenous insertion, for example — while VR is far more productive at cultivating “soft skills” such as empathy, therapeutic communication, and clinical judgment. I speak from experience when I say that fostering a sense of empathy toward a manikin presents a considerable challenge, underscoring the value of VR in enhancing these critical interpersonal skills.
As digital natives, younger “Generation Z” nurses are comfortable with digital platforms such as social media and video games. They have grown up using technology both personally and professionally and are used to the regular evaluation and feedback involved in gamified applications.
However, in my decade-plus as a nurse educator, I’ve observed a certain hesitancy among some of our more experienced instructors when it comes to embracing technological innovations. This reluctance stems not from a dislike of the technology itself, but rather from a concern over the investment of time required to learn and implement these tools effectively, coupled with the apprehension that they may fail at critical junctures. What if you get your students ready for the experience and then the tool doesn’t work? There are many programmable manikins gathering dust in classroom closets because instructors often prefer the familiarity and reassurance of tried-and-tested books, lectures, and slides.
A natural progression
Remember how a quarter century ago, we were often reluctant to use PowerPoint presentations for fear of projector failures or the dreaded blue screen? The thing about technology is, it improves and becomes easier over time. Vendors are working to make tools more user-friendly. Transitioning the delivery format of your lesson components simply requires time to adjust and become comfortable and confident with new training modalities.
In the first decade of the 2000s, the debut of internet-connected mobile phones revolutionized our lives in ways we couldn’t have imagined. I think that in another decade, using VR in education won’t be a matter of debate; it will seem as natural as using a smartphone. The transition period we’re in right now may make it seem a heavy lift, but we’re approaching the tipping point. VR is already helping nurses to hone the skills essential for delivering safe and quality care to patients, and to improving Next Generation NCLEX nursing licensing examination scores.
Photo: shironosov, Getty Images
Christine Vogel, MSN, RN, CHSE, CHSOS, is a lead nurse educator at UbiSim , where her passion for innovation in nursing education drives her to design, pilot, and evaluate evidence-based immersive virtual reality (VR) simulations for nurse learners. With a distinguished career that extends over 25 years in nursing, including more than a decade dedicated to academic roles, her work is inspired by a commitment to enhance the educational journey of nurse learners and improve patient care.
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