Other Titles
A Multi-patient Simulation to Increase Exposure to Diversity and Evaluate Clinical Judgement [Title Slide]
Abstract
Lack of readiness for practice in newly licensed Registered Nurses (RN) is not a new problem in nursing education. Existing literature demonstrates a preparation-practice gap, lack of practice readiness, and a crisis of competency in newly licensed RN. A large-scale study by Kavanagh and Szweda1 found that only 20-24% of newly licensed nurses demonstrated acceptable levels of practice readiness. With over 10,000 assessments collected to date, the researchers note a continued decline in practice readiness with 2020 data showing only 9% of newly licensed nurses demonstrating acceptable levels2. To address this gap, a multi-patient simulation-based experience (SBE) was developed given that simulation is a valid teaching strategy to assist students in development of skills, knowledge, and critical thinking3,4,5.
This presentation will discuss the development and implementation of a multi-patient SBE into the final semester of the Accelerated Track Bachelor of Science in Nursing (BSN) program. This SBE integrated diverse patient experiences and included an innovative method to reflect on clinical judgment. Scenarios were selected to reflect common entry level patient care assignments that would require in the moment decisions regarding prioritization and patient care needs. A challenge in the evaluation of student readiness for practice is the inability for faculty to individually assess each student’s care of multiple patients. The multi-patient SBE allowed faculty to have a consistent evaluation method for each student as they complete their final semester. Additionally, with the implementation of the new American Association of Colleges of Nursing (AACN) Essentials, gaps were noted in student exposure to diverse patients. The populations represented in the selected scenarios included an African American senior, a caregiver involved in the transition of care, and a transgender adolescent.
Three evaluation methods were used. Students answered questions during the SBE at dedicated pause points to reflect on their decision making. The Lasater Clinical Judgment Rubric (LCJR)6 was used by facilitators to evaluate each student at the end of the SBE. Students completed the Simulation Effectiveness Tool-Modified (SET-M)7 and four faculty developed questions at the end of the SBE. The LCJR and SET-M aggregated results and thematic analysis of the pause point and reflection questions will be shared during this presentation.
Notes
References:
1. Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses' clinical reasoning. Nursing Education Perspectives, 38(2), 57–62. https://doi.org/10.1097/01.NEP.0000000000000112
2. Kavanagh, J. M. & Sharpnack, P. A. (2021). Crisis in competency: A defining moment in nursing education. Online Journal of Issues in Nursing, 26(1). https://doi.org/10.3912/OJIN.Vol26No01Man02
3. Haerling, K., & Prion, S. (2021). Questions regarding substitution of simulation for clinical. Clinical Simulation in Nursing, 50, 79-80. https://doi.org/10.1016/j.ecns.2020.06.014
4. Jeffries, P. R. (2021). Simulation in nursing education: From conceptualization to Evaluation (3rd ed.). Wolters Kluwer.
5. Roberts, E., Kaak, V., & Rolley, J. (2019). Simulation to replace clinical hours in nursing: A meta-narrative review. Clinical Simulation in Nursing, 37, 5-13. https://doi.org/10.1016/j.ecns.2019.07.003
6. Lasater K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496–503. https://doi.org/10.3928/01484834-20071101-04
7. Leighton, K, Ravert, P., Mudra, V., & Macintosh, C. (2015). Updating the simulation effectiveness tool: Item modifications and reevaluation of psychometric properties. Nursing Education Perspectives, 35(5), 317-323. https://doi.org/10.5480/15-1671
Sigma Membership
Alpha
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Simulation, Teaching and Learning Strategies, DEI and BIPOC, Nursing Education, Advances in Education, Baccalaureate Nursing Students, Newly Licensed Nurses, Novice Nurses
Recommended Citation
Holtel, Elizabeth; Herron, Gina; Stuffle, Megan; and Remick, Jennifer, "A Multi-patient Sim to Increase Exposure to Diversity and Evaluate Clinical Judgement" (2025). Biennial Convention (CONV). 28.
https://www.sigmarepository.org/convention/2025/presentations_2025/28
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-11-18
Funder(s)
Indiana University, Indianapolis
A Multi-patient Sim to Increase Exposure to Diversity and Evaluate Clinical Judgement
Indianapolis, Indiana, USA
Lack of readiness for practice in newly licensed Registered Nurses (RN) is not a new problem in nursing education. Existing literature demonstrates a preparation-practice gap, lack of practice readiness, and a crisis of competency in newly licensed RN. A large-scale study by Kavanagh and Szweda1 found that only 20-24% of newly licensed nurses demonstrated acceptable levels of practice readiness. With over 10,000 assessments collected to date, the researchers note a continued decline in practice readiness with 2020 data showing only 9% of newly licensed nurses demonstrating acceptable levels2. To address this gap, a multi-patient simulation-based experience (SBE) was developed given that simulation is a valid teaching strategy to assist students in development of skills, knowledge, and critical thinking3,4,5.
This presentation will discuss the development and implementation of a multi-patient SBE into the final semester of the Accelerated Track Bachelor of Science in Nursing (BSN) program. This SBE integrated diverse patient experiences and included an innovative method to reflect on clinical judgment. Scenarios were selected to reflect common entry level patient care assignments that would require in the moment decisions regarding prioritization and patient care needs. A challenge in the evaluation of student readiness for practice is the inability for faculty to individually assess each student’s care of multiple patients. The multi-patient SBE allowed faculty to have a consistent evaluation method for each student as they complete their final semester. Additionally, with the implementation of the new American Association of Colleges of Nursing (AACN) Essentials, gaps were noted in student exposure to diverse patients. The populations represented in the selected scenarios included an African American senior, a caregiver involved in the transition of care, and a transgender adolescent.
Three evaluation methods were used. Students answered questions during the SBE at dedicated pause points to reflect on their decision making. The Lasater Clinical Judgment Rubric (LCJR)6 was used by facilitators to evaluate each student at the end of the SBE. Students completed the Simulation Effectiveness Tool-Modified (SET-M)7 and four faculty developed questions at the end of the SBE. The LCJR and SET-M aggregated results and thematic analysis of the pause point and reflection questions will be shared during this presentation.
Description
Newly licensed nurses often lack practice readiness, a long-standing issue in nursing education. To address this, a multi-patient simulation was implemented in the final semester of a prelicensure nursing program to increase student exposure to care for patients with diverse backgrounds and health conditions. During the simulation, strategies were implemented to promote clinical judgement and decision making. Validated tools were used to evaluate clinical judgement and simulation effectiveness.