innovation – GW Nursing Magazine

November 1, 2021November 10, 2021

Amid Transition, School is Poised for a Promising Future

A School in Transition

When she applied to teach at the George Washington University, Crystel Farina, Ph.D.(c), RN, CNE, CHSE, knew very little about the School of Nursing or the university. “I applied solely because the dean was Pamela Jeffries,” said Ms. Farina, director of simulation and experiential learning.

Crystel Farina aiding students in PPE fitting — Ms. Farina aiding students during on campus PPE fitting

A doctoral candidate at Notre Dame of Maryland University, Ms. Farina joined the Nursing School in August 2017. She had been aware of Dr. Jeffries, Ph.D., RN, FAAN, ANEF, FSSH, and her work on simulation since 2004, when Ms. Farina was teaching at Chesapeake College in Maryland and grew interested in simulation and nursing education.

“She was the one in all the articles who was teaching me how to actually do simulations,” Ms. Farina said of Dr. Jeffries, whom she first met in 2015 at the National League for Nursing’s Leadership Development for Simulation Educators. Dr. Jeffries was one of the “giants of simulation,” who formed a faculty group leading the program.

“It was like seeing a rockstar,” she said. “Oh my gosh, it’s her!”

Dr. Jeffries, who recently stepped down as dean at the School of Nursing—a role she held from 2015 to 2021—to become dean of Vanderbilt University’s nursing school, turned out to be “very down to earth, very relaxed, and very warm and fuzzy,” Ms. Farina recalled.

“I applied solely because the dean was Pamela Jeffries. She was the one in all the articles who was teaching me how to actually do simulations.”

– Ms. Farina

“Once I got over the awe of sitting with the godmother of simulation, it was very easy to have a conversation and talk about what we were doing at the college level, what we needed to do for nurse practitioners, and simulation in health care education,” Ms. Farina said.

This characterization of Dr. Jeffries as a down-to-earth, amicable rockstar is a common refrain among those who know and have worked with her. And the dean’s departure to Nashville, Tenn., comes amid a larger transitional time at the school and at GW.

Of course, the COVID-19 pandemic has disrupted many best-laid plans. From an academic and administrative perspective, the School of Nursing was lucky to have put certain programs and processes in place prior to the pandemic, which helped mitigate some remote- and digital-only growing pains.

Pamela Slaven-Lee, D.N.P., FNP-C, FAANP, CHSE, senior associate dean for academic affairs and clinical associate professor, now serves as interim dean of the School of Nursing. GW recently announced that Mark Wrighton, chancellor emeritus at Washington University in St. Louis, will begin serving as interim president in January and will fill that role for up to a year and a half.The School of Nursing was about two-thirds of the way into its strategic plan when the pandemic began, requiring that in-person activities shut down in mid-March 2020. Despite this hurdle, the faculty and staff were able to fulfill the goals of that plan. And, although her departure was eminent, Dr. Jeffries saw to it that the next strategic plan was in place before she left. As she and her colleagues reflect on her legacy and vast achievements at GW, they see a bright future for the school, which has already earned national accolades that are more typical of much older and more mature schools.

The View from ‘Athens of the South’

Reached by video chat in Nashville, Dr. Jeffries said she hopes people will look back on her GW legacy as six years of bringing the school to another level. “We grew—maybe from adolescence to young adulthood,” she said.

Dr. Jeffries is very proud of starting GW’s doctoral nursing program and building up the breadth and depth of the school’s research base. “It still needs to grow more, but the quantity and quality of our research efforts have definitely scaled up,” she said. She also takes pride in the school’s No. 22 ranking for nursing graduate education by U.S. News & World Report and successful school-wide health policy branding.

Joe Velez speaking with construction crew at VSTC — Joe Velez, GW Nursing’s Executive Director of Operations, speaking with crew at remodel project

Six years ago, when Dr. Jeffries came to GW—after serving as vice provost for digital initiatives at Johns Hopkins University, and before that as an associate dean at Hopkins and at Indiana University Bloomington—her priorities were to build upon the foundation her predecessor, Jean Johnson, established as founding dean some five years prior. Having inherited high-quality programs, Dr. Jeffries wanted to take the school to the next level.

“I had an analogy of a three-story house. Dr. Johnson built the first floor. I had the second floor, which continued to build on our reputable programs,” Dr. Jeffries said. “To build the research base on the third level, I wanted to start a Ph.D. program and to diversify revenue, because we were very tied to tuition dollars and enrollment numbers.”

Dr. Jeffries started a professional development office called Ventures, Initiatives and Partnerships (VIP), and she sought to improve the school’s national rankings. She aimed in five years to move the school into the top 25 graduate programs in the U.S. News & World Report rankings. (It previously ranked No. 58.) It took six years, but the school bested that goal by three slots.

“I had an analogy of a three-story house. Dr. Johnson built the first floor. I had the second floor, which continued to build on our reputable programs,”

– Dr. Jeffries

In the 2022 U.S. News rankings (the Georgetown-based publication ranks schools based on the prior year’s data, which can sound like predicting the future), the Nursing School is also tied for No. 28 in the category of “Best Nursing Schools: Doctor of Nursing Practice” with Oregon Health and Science University; University of California, San Francisco; University of Texas Health Science Center at Houston; and Washington State University.

In the U.S. News specialty nursing school rankings, the GW School of Nursing is No. 8 in “Best Master’s Nurse Practitioner: Family,” and is tied for No. 6 in “Best Master’s Nursing Administration” with University of Alabama at Birmingham and University of North Carolina at Chapel Hill. And in the U.S. News online nursing program rankings, GW is No. 2 for “Best Online Master’s Nursing Programs for Veterans,”No. 3 for “Best Online Master’s Nursing Administration Programs,”No. 7 for “Best Online Master’s Nursing Programs (tied with University of Nevada, Las Vegas), and No. 7 for “Best Online Family Nurse Practitioner Master’s Programs.”

Creating a doctoral program to help train nursing scientists was necessary to become a top-tier school, according to Dr. Jeffries, who also is proud of starting the school’s Center for Health Policy and Media Engagement. The latter draws upon the school’s location in the nation’s capital.

“I don’t think I would have changed anything if I could have read the tea leaves and known COVID was going to hit in March 2020,” Dr. Jeffries says. “In fact, we actually prepared ourselves not knowing it was happening.”

Pivoting Online

Prior to March 2020, the Nursing School had already begun assembling the necessary personnel to strengthen its creation and delivery of online programming. Dr. Jeffries hired e-learning specialists, instructional designers, videographers, a graphic designer, and a director of online learning and technology.

“I’m glad that was done, because that served us well in COVID,” she said. “We already had online education going at GW Nursing, but I put more resources and support into building a team.”

She also brought on a team to help run the expanded simulation center on the Ashburn, Va., campus, home to a state-of-the-art Objective Structured Clinical Examination (OSCE) center. “They had to pivot during COVID to produce and really facilitate faculty with the virtual simulations,” Dr. Jeffries said. And after lockdowns ended, that team facilitated safe in-person lab simulations.

Associate Professor Dr. Karen Whitt monitoring OSCEs at VSTC simulation lab

During the pandemic, Dr. Jeffries would wake up each morning and ask herself what she needed to get through the day.

“I built community with our faculty, staff, and students,” she said. There were weekly town hall meetings for nearly 70 weeks, and Dr. Jeffries helped staff leaders, who had never managed people remotely, and professors, who could not see their students in person, navigate the new normal.

“We did keep community together,” she said, noting the school’s instructional continuity in particular. “Our students graduated on time for the most part.”

“Some of us thought—I was one—we could come back in three or four weeks,” she said of the beginning of the pandemic. “I stayed very focused to get through. I always had to hold it together. Someone has to be the leader.”

Looking forward, Dr. Jeffries notes that telehealth is poised to be a game changer for the profession, and she expects the pivot online will continue even after the pandemic is in the rearview mirror. There is a need for telehealth competencies and full integration into curricula, she said, and nursing schools ought to teach students to assess patients via digital platforms, such as Zoom. Patients are also increasingly tracking their own health data, something nurses should take advantage of.

“We’ve got to be mindful of that,” Dr. Jeffries said.

She looks forward to continuing to see the School of Nursing’s programs flourish, as well as new programs emerge. She expects the healthcare landscape to continue to change, and thinks public health is a priority, particularly the focus on health equity that COVID exposed, as outlined in the National Academy of Medicine’s report “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.”

“I see the next five years as a little different. Right now we are transitioning in COVID, but we are still in COVID. But our antennas are up for different things,” she said. “I think we’ve learned we can do things differently.”

Big Shoes to Fill

Dr. Slaven-Lee, now interim dean, came to GW two months before Dr. Jeffries did in 2015. She was excited to join a young school, about five years old, and the opportunities that its youth presented. Dr. Slaven-Lee served previously in a leadership role at Georgetown University and looked forward to returning to teaching. That was not in the cards, however.

“Dr. Jeffries developed our matrix structure with two communities and academic programs, and made a lot of infrastructure changes. With that, it opened up a lot of leadership opportunities,” Dr. Slaven-Lee said. “I came here saying, ‘I want to go back to teaching and not so much leadership.’ As is often the case, I ended up back in a leadership role.

Interim Dean Slaven-Lee at vaccine clinic — Interim Dean Slaven-Lee (center), Patsy Deyo and Assistant Professor Dr. Maggie Venzke meet with Va. Del. David Reid at GW Nursing-run COVID-19 Vaccination Clinic.

”Dr. Slaven-Lee worked closely with Dr. Jeffries on developing the simulation program, which “became a signature part of our academic programs,” and building the academic affairs unit. “Really further developing all the things that you do as your school continues to mature—evaluation plans, standardizing how you evaluate your academic programs, master plans of evaluation, standardizing how you evaluate each course, clinical placement models, all those sorts of things,”she said.

In the past six years, Dr. Slaven-Lee has seen GW’s reputation soar and has noticed changes in the applicant pool. She does not think anyone else applied for the same job she did in 2015, but now, “The caliber of the candidates that we see trying to come to GW and join our faculty community is outstanding.”

Part of that, she thinks, is the national recognition the school has received in rankings. “Considering how young the school is—we’re 11 years old—that’s absolutely remarkable that we’ve been able to accomplish that,” she said.

Since becoming interim dean on July 1, Dr. Slaven-Lee has drawn on what she learned from working with Dr. Jeffries, whom she called “a great mentor.” She also is very focused on the school’s strategic plan.“

The strategy I have in my mind is to stay focused on the school. Stay focused on our students, faculty, staff, and strategic plan,” she said. She is also focused on enhancing the curriculum with an eye toward diversity, equity, and inclusion, she said, as well as the “Future of Nursing”report.

“The caliber of the candidates that we see trying to come to GW and join our faculty community is outstanding.”

– Dr. Slaven-Lee

“It’s not just, ‘Hold everything steady until a new dean comes.’ It’s ‘Continue on the upward trajectory.’ Holding things steady would be a disservice to the school. We’ve got to keep things moving upwards,” she said. “I’d be derelict in my duty if I just tried to hold things steady. When you’re ranked 22, that takes some work. You can’t just hold steady. You’ll fall backwards.”

Dr. Slaven-Lee expects the school’s rankings to continue to improve, and like Dr. Jeffries, she anticipates that there will be online and hybrid programming and teaching in the future. She also echoed Dr. Jeffries’ thinking about the school’s unique role in the heart of Washington, D.C.,and in northern Virginia.

“We want very much to brand and distinguish ourselves as the school of nursing that’s about health policy,” she said, noting that most GW School of Nursing researchers focus on health disparities and inequities.

“The juncture where it all starts coming together is the research informing the policy informing the practice. It’s not something we are trying to be. It’s something we are actually becoming,” she said. “We want to leverage our position in the nation’s capital.” The school also developed a dual Master of Science in Nursing and Master of Public Health degree, which matches renewed interest in that intersection.

She aims, she said, to fill Dr. Jeffries’ big shoes.“Dean Jeffries is an incredible leader. She is very well known for being a great communicator. She always had a vision,” Dr. Slaven-Lee said. “She did so much in the just six years she was here.”

The Power of Simulations

Dr. Slaven-Lee, Dr. Jeffries, and Ms. Farina—the director of simulation and experiential learning, who chose to apply to work at GW because of Dr. Jeffries—all point to simulation as one of the areas of greatest change at the School of Nursing in the past five years.

Dr. Slaven-Lee said it was “absolutely pivotal for the development of our programs” to require all faculty to be trained in best practices for simulations. “Simulation is a pedagogy that is incredibly powerful. By virtue of that, if it’s used inappropriately, it can have negative impacts on the students’ evaluation and development,” she said.

Simulation training on campus is also a signature event for the school and for students. “These are big events. That’s how they know the campus. It’s about developing alumni. We’re known in the community for being expert simulationists,” she said. And many professional societies and vendors come to GW for talks on best practice simulation.

GW Nursing students in VSTC Simulation Lab — GW Nursing students in virtual reality simulation room.

“It’s not uncommon to see a whole panel of GW faculty talking about simulation,” Dr. Slaven-Lee said.

Ms. Farina’s tenure at GW has seen sustained growth in the school, she said. When she began working at the school, there was summer enrollment for the first time; there had only been spring and fall terms previously. And some of the conferences and other events that provided the most momentum in pushing the school forward centered on simulation.

Much of that success is owed to Dr. Jeffries, who played an essential role in securing funding for renovations of the simulation center and for expanding its offerings.

“She was really supportive in ensuring that I had the authority to request that all faculty had a standard of education for simulation before they came and facilitated simulation experiences,” Ms. Farina said. She noted that Dr. Jeffries was also involved in creating a massive open online course (MOOC), in which more than11,000 learners have enrolled and participated.

GW Nursing School students now do a lot of virtual and face-to-face simulations, and the curriculum is aligned with didactic content, skills labs, and simulations.“It’s all lined up that way so that they can apply everything they learned each week to providing simulated patient care,” she said. “They sit in lectures; then they learn a few skills; and then they are able to apply all that knowledge to providing care for that simulated patient.”

Ms. Farina hopes the nursing program continues to expand and thinks the school has a shot at top 10 in the U.S. News rankings. She also expects the school to become, in the next two years, one of 2,000 accredited by the Society for Simulation in Healthcare. “It shows that our simulation is high fidelity, high quality,” she said of that accreditation.

Collaborative Culture

Majeda El-Banna, Ph.D., RN, CNE, ANEF, had previously taught at several nursing programs, large and small, stateside and abroad—including Al-Zaytoonah University of Jordan, where she was dean of the School of Nursing—before arriving at GW in 2013. She began as adjunct professor and is now associate professor, chair of acute and chronic care faculty community, and director of the Registered Nurse to Bachelor/Master of Science in Nursing (RN to BSN) program.

“GW really attracted me with the mission and vision,” she said. And when she started teaching at the school eight years ago, “I said, Oh my goodness!This is the place where I want to be.” She has been extremely happy at GW since.

Where some of her colleagues may think the School of Nursing’s growth has been meteoric, Dr. El-Banna, who has taught in nursing programs for more than 20 years, was part of one school that tripled in size in two years. That was a little more of a dramatic pace than she has seen at GW.

Still, when she first arrived on campus, the nursing program was small enough that communication could occur in a more ad hoc fashion. As the school grew, there needed to be more formalized processes.

She credits Dr. Jeffries’ establishment of the Ph.D. program as a very significant and difficult feat, and the faculty communities that Dr. Jeffries pioneered—the school’s take on departments—have facilitated growth, cooperation, and mentorship. When Dr. El-Banna compares Dr. Jeffries’ approach to communication between faculty and staff, spread across the Foggy Bottom and Virginia campuses and many others remote across the country, to those she has observed at other schools, she thinks what the School of Nursing has achieved is remarkable in this regard.

During Dr. Jeffries’ tenure, faculty was encouraged to collaborate on research, and research funding increased. A buddy system paired new hires in their first year with seasoned colleagues who helped them acclimate to GW. And the dean also welcomed faculty, staff, and students to her home regularly, including for holiday parties.

“GW really attracted me with the mission and vision. I said, Oh my goodness! This is the place where I want to be.”

– Dr. El-Banna

“How did she have the time to hold so many social events in her house?” Dr. El-Banna wondered. “That is different from other schools.”

The “culture of collaboration” at the School of Nursing is one of the things that attracted Dr. El-Banna initially, and which has kept her happily at the school. Dr. Jeffries would ask faculty members where they saw themselves in a few years, and once she knew their plans, would provide guidance on necessary future steps. She would also keep her eyes and ears open for future opportunities, which she would share with faculty.

“I don’t know how she remembers all the things about all the faculty,” Dr. El-Banna said. “It’s amazing.”

When she reflected more on the changes she has seen at GW during Dr. Jeffries’ tenure, and the culture she foresees continuing, Dr. El-Banna reached for an affable metaphor. “It feels more like a family,” she said.

AUTHOR Menachem Wecker

June 5, 2021November 5, 2021

Innovation in Policy Teaching

The Innovation

While the COVID-19 pandemic has devastated the world in many ways, it has also fueled innovation and inspired resilience among many sectors of society. One of the many ways our GW Nursing community has been adaptive is through enhanced teaching methods, a prime example being the policy course, NURS 6205 – Health Policy, Quality, and Political Process. This course is designed to orient both master’s and undergraduate students to the policy environment, connect the dots between policy and health care quality, introduce the political process, and encourage students to be advocates.

In years past, one of the major assignments was for each student to contact their federal or state representative and dialogue with them about a specific policy issue. However, in the summer of 2020, COVID-19 had thrown Capitol Hill into chaos and the demands of legislating at that time were all consuming for members of Congress and Hill staff. Realizing this, one of the course professors, Ellen Kurtzman, created an alternative way to enhance students’ education while not inundating Hill staff with calls. Students were given options to either proceed with having a dialogue with a representative, join a virtual lobby day, or engage with a Hill staffer in a virtual Q&A session.

Q&A with a Hill Staffer

Dr. Ellen Kurtzman, Ph.D., MPH, RN, FAAN, a former Robert Wood Johnson Foundation (RWJF) Fellow, used her contacts to recruit guest lecturers from Congressional offices. This provided students with the opportunity to interact with someone working on Capitol Hill while being sensitive to the dramatic political climate. Dr. Kurtzman said that the experience was both useful and inspiring because each staffer who chose to give these lectures and talk to students, did so out of a passion for inspiring nurses to be engaged in policy.

This option, which many students chose, provided an opportunity to learn why each staffer picked this career and what, in their backgrounds and experience, led them to Capitol Hill. They were able to dialogue with students about the most pressing issues in Congress (the 116th), how to be an effective advocate, and how to best interact with a lawmaker.

When asked about the decision to host these Q&A sessions, and what that experience was like, Dr. Kurtzman explained that the staffers who spoke were policy generalists and their job depends on constituents coming to tell them what is important to their stakeholder group or using their expertise to help them interpret a bill. Dr. Kurtzman summed up the message to students as “we can’t do our job without you, so coming to visit shouldn’t be intimidating.”

With regard to the interview sessions, Dr. Joyce Pulcini, Ph.D., RN, PNP-BC, FAAN – the course coordinator – stated that the helpfulness lies in getting instructions and encouragement directly from staffers; helping students to “break the fear” of talking to legislators. She said that based on student feedback, this assignment gave them a sense of what advocacy is – that the term finally began to “become real and come alive for them.” Dr. Kurtzman agreed by saying that these extra training sessions are an important piece of the training puzzle if we are to expect students to advocate or approach their representatives on their own.

In the spring 2021 semester, Dr. Melissa Batchelor, Ph.D., RN-BC, FNP-BC, FGSA, FAAN, a former Health and Aging Policy Fellow, set up the interview session with Hill staffers. Dr. Pulcini noted how unique and extremely helpful it is to have multiple faculty members “who have worked on the Hill and know the players.”

Lobby Day

The lobby days, the other option provided, were also very successful with the students. Virginia hosted a virtual lobby day this semester, free and specific to students, that they were encouraged to attend. Maryland hosted a similar virtual lobby day option, too. Dr. Pulcini noted that these virtual sessions are another COVID-19 related innovation – stemming from necessity – but have allowed for much higher participation rates, including among our students, who might not have otherwise traveled to the state capitals to participate.

This past year has been a crucial and dynamic time for nursing legislation, particularly at the state levels. For one, scope of practice laws are finally changing in many states like Virginia because of COVID-19. Between this and the fact that most nurses will end up conducting state level (rather than federal) political advocacy, these opportunities for students to get state lobbying experience has been invaluable.

Dr. Pulcini said that these virtual options will become a regular part of the course because they provide expanded opportunities and meaningful interaction for our students.

Why this is unique and innovative

GW Nursing is uniquely situated with the right environment, context, and connections to allow for this type of innovative educational experience to exist. This “Only at GW” opportunity enables students to learn from Hill staffers and begin to immerse themselves in the legislative process.

Dr. Kurtzman credits her time as a Robert Wood Johnson Fellow with her ability to bring this opportunity to students. Her goal during her fellowship was to absorb as much as she could and translate and disseminate the lessons learned into her classroom teaching. She is proud to have been able to enhance the experience of her students and leverage her year on the Hill to inform her teaching.

Gregg Margolis, Director of the RWJF Health Policy Fellows Program, said that this innovation is a great example of how he hopes and expects alumni, like Dr. Kurtzman, to share their experience once they return to their teaching positions. He said that because many policy makers “lack the perspective of frontline providers,” it is “important for students and clinical workers to engage with them.” He added that it is equally important that they learn how to do it effectively, though.

The student perspective

One of our former nursing students, Mehdi Rahmati, now a cardiac nurse at GW Hospital, took this course with Dr. Kurtzman in the summer semester and attended the Q&A session with legislative correspondent, Shivani Pampati. About this experience, Mehdi said:

“It allowed us to learn and know how legislatures would like to connect with healthcare workers and what avenues are more effective. The interaction [of hearing from and speaking with the Hill staffer] also helped break down the walls of pessimism and hesitation that some of us had in contacting a senator. Knowing that not only can our voice be heard, but that we, as healthcare providers, can serve as a resource to the legislatures was eye opening.”

When asked how his time at GW Nursing as a whole influenced his understanding of policy, he said that he now has an appreciation for how policy is woven into everything and how important it is to nursing…

“… especially during the current pandemic. In this course, we were discussing policies every class, but I appreciated the discourse with other professors and the administration about the importance of healthcare policies and their impact on nursing. How, for instance, the government drafted policies to fight the pandemic that directly impacted nurses and healthcare workers. We learned that now, more than ever, we as nurses should take great interest in policy work, otherwise policies will be drafted without our input, and those policies will directly change our day-to-day work at the hospitals, nursing homes, clinics, and elsewhere. “

**A special thank you to NURS 6205’s guest speakers from the Hill: Shivani Pampati (legislative correspondent), McKenzie Fields (legislative aide), Alexander Urry (policy advisor), and Samantha Koehler (policy aide).

AUTHOR Haley Stepp

June 4, 2021June 14, 2021

A Pioneering Model

The student-run COVID-19 testing center, which got up and running in record time, offers an inspiring blueprint for the future, nursing experts say.

When Mark Tanner came to GW’s Virginia Science and Technology Campus weekly to get tested for COVID-19, the former assistant dean for the bachelor of science in nursing program parked adjacent to Enterprise Hall. He entered the building, scanned his GW badge, and walked up to the registration desk, where nursing students scannedQR codes on testees’ phones to call up their appointments, verify names and birth dates, and scan test tubes that would contain their samples. From behind plexiglass, the students—who were gloved and masked—wrote Dr. Tanner’s name and birth date on the test tube and verified his identity with his GW ID or license.

Dr. Tanner took his test tube and walked down a hall in the building’s former cafeteria, which was sufficiently capacious to accommodate the center, to one of six testing booths. If it was a busy time of day, he could wait a few minutes, but often he went right in. He would hand his test tube to the nursing student (gowned, gloved, and clad in an N95 mask and face shield), and the latter verified his birth date. Dr. Tanner had taught many of these students in first-semester didactic courses, but the students would invariably stick to protocol.

“Every experience I had, they always ask, ‘Hey. How are you? Have you done this before?’ even though they knew who I am, and they knew I’d done it before,” he said. “They’re doing the things that they should be doing. They’re neither relaxing nor taking anything off. There’s a sense of pride knowing they’ve come to our program; they’ve come this far; and they’re doing well with this very important task.

Each time, the student explained the procedure to Dr. Tanner, directed him to sit and drop his mask below his nose, and swabbed 10 seconds per nostril. The student nurse placed the swab in the test tube, broke it off and capped it, and then Dr. Tanner was ready to go. A courier picked up samples twice daily from the site, at noon and at 4 p.m., for delivery to Foggy Bottom for processing in a GW lab. Dr. Tanner usually had his results, which he could check via a mobile application, within about a day.

“It’s been very well and smoothly run,” he said. “I’m rarely there for longer than 5 to 10 minutes from the time I stand in line until the time I’m back in my car.” There’s a huge amount that happens in a very short clip, and the testing center did that more than 500 times per week at its peak. But equally as impressive is the speed with which the COVID-19 testing center was created and launched and how effective it has been during these difficult and uncertain times.

An ‘Aha Moment’

When GW announced in March 2020 that it would be going virtual, the School of Nursing was already well poised for online instruction, which it had been doing previously, but clinical placements became a problem when area hospitals said they couldn’t accommodate student-nurses. The Commonwealth of Virginia ruled that simulations could count for clinical experience, so that semester’s students could graduate.

“But then the new group comes in. What do you do with the new group? Summer, fall, and now spring. We really were beginning to scramble a little bit,” said Karen Drenkard, associate dean of clinical practice and community engagement.

By early summer, Dr. Drenkard was representing the Nursing School on GW’s pandemic task force and was co-running the task force’s health and wellness subcommittee. As the university moved toward bringing essential community members back to campus, there was a need for a COVID-19 surveillance polymerase chain reaction (PCR) testing program. Two testing centers were created in Foggy Bottom—one for symptomatic and the other for non-symptomatic people—and by mid-August, Dr. Drenkard had a mandate to create and operate a testing center on the Virginia campus for the 550 faculty, staff, and students, who reported there for work.

“I’m not sure when we had the aha moment, but it’s 25 miles away, and the students have their clinical labs in Ashburn, the employees work in Ashburn, and we have housekeeping staff, faculty, students, and essential staff that are all going to be there,” Dr. Drenkard said.

The semester was slated to begin some two or three weeks after the Nursing School received direction to start the testing center, so Dr. Drenkard—who had only been at GW for about a year—needed to move very quickly. The former chief nurse who spent a decade at the five hospitals of the Inova Health System, had served also on the Northern Virginia regional emergency preparedness disaster task force for the hospital alliance right after September 11, 2001.

“I had a lot of disaster management experience, and I had operations experience,” she said.

Dr. Drenkard corralled a group, which included people she hadn’t met before and who hadn’t met one another, and oriented everyone toward the goal and looming deadlines. “We were able to break down a lot of barriers very quickly,” she said. She also brought aboard two people with whom she had worked previously and upon whom she knew she could count.

She enlisted Bonnie Sakallaris—who was chief nurse of the Alexandria, Va., hospital system and had worked with Dr. Drenkard at Inova—as the COVID-19 testing center director. “She was thinking that she was going to retire. I called her on Aug. 12 and said, ‘Would you be interested in doing this with me? I have no idea how long it’s going to last, but it’s going to be crazy. Do you want to come with me?’” Dr. Drenkard said. “She called me back in two hours and said, ‘Yes. I do.’”

“When you’re a nursing executive or a hospital administrator in the executive suite, you stand up new programs frequently, and often without a whole lot of notice. I had never opened up a testing center before, but both Karen and I have on multiple occasions, with very little notice, developed a whole new program, staffed it, and opened it up,” Dr. Sakallaris said. “There are organizational things that you know you have to do. This was not foreign territory.”

Dr. Drenkard also hired Patsy Deyo, M.S.N. ’14—who is in her Ph.D. dissertation phase in translational health sciences at GW’s School of Medicine and Health Sciences, and who worked previously in academic affairs at the Nursing School—to run student-nurse educational training.

“I knew we could do it. I wasn’t sure how,” Deyo said with a laugh. “There were so many moving pieces and so many different things that had to happen in such a short time that anywhere along the lines there could have been hiccups that would have impacted our being able to do it.”

The group secured supplies (including the highest level of personal protective equipment, PPE, that it could to protect the student nurses), drafted colleagues from different parts of the university, and found ways to involve students. (It also created and ran a flu vaccination clinic adjacent to the COVID testing center, as a “one-stop shop,” for two weeks in October.)

“I said, ‘If I’m going to put students who aren’t licensed yet in a situation where they’re exposed to some people who could possibly have COVID, they have to have N95s, face shields, gowns, and nitrile gloves,” Dr. Drenkard said. “We used very stringent infection control, and none of my testers ever got COVID.”

From the start, staff members were very open with the student nurses, asking how the process could improve and what challenges could be foretold and skirted. “We kept modifying what we did based on what they were seeing and said, ‘No idea was too crazy or far-out to try,’” Dr. Sakallaris said.

Students have expressed to Dr. Sakallaris something quite similar to how she feels herself: that as the pandemic unfolded, she felt drawn to the front lines to do something useful and to be part of the solution.

“This offers that opportunity,” she said. “It’s very gratifying to know that you’re doing something really important to manage and eventually stop this pandemic. That feels really good. It’s fun to see a plan come together.”

And though the group went into creating the clinic expecting there would be great lessons but also initial glitches, the process went surprisingly smoothly from the start, according to Dr. Sakallaris. “There was no chaos,” she said. “It was all really well controlled.”

students in PPE getting instructions — Nursing student volunteers in PPE receiving instructions

Charge Nurse

Throughout the day—10 a.m. to 4 p.m. on Mondays and Thursdays, and 10 a.m. to 2 p.m. on Tuesdays and Wednesdays—student nurses rotate through three roles: registrar, tester, and charge nurse. One student is charge nurse in the morning, and another takes over after lunch. That person is in charge of ensuring the center has adequate inventory and supplies, oversees lunches and breaks, and enforces social distancing and masking protocols in the center. She or he also delivers test samples to the courier for transport to the Foggy Bottom lab.

Veronica Nguyen—who worked at the testing center during the spring 2021 semester—found it nerve wracking the first time she served as charge nurse. Only one other student from her group had held the charge nurse position before, and Nguyen trained with Dr. Sakallaris and with that previous charge nurse.

“You worry about keeping everyone happy and running daily operations as smoothly as you can,” Nguyen said. “Especially for someone with limited leadership experience, it can be daunting to delegate tasks and make decisions. However, developing my leadership skills in a setting like the testing center was incredibly helpful.”

Faculty provided a safe learning environment to facilitate student growth and development, and debrief sessions at the end of the day helped the team address collectively issues that arose during the day. “This time allowed me to reflect on my role and work with my peers to improve,” Nguyen said. “I’m thankful that the testing center created this role. These experiences can help us develop our leadership style and practice as we go into our jobs as full-time nurses.”

Working at the testing center also helped Nguyen bridge the gap between didactic knowledge and practical nursing skills. “The testing site represents a crossroads of our nursing education, training, and experiences at clinical. At the center, we can practice practical skills like properly donning and doffing PPE, participate in patient education, and learn among peers,” she said. “The testing site offers opportunities for team management and building leadership skills.”

Another student nurse who worked at the testing center spring 2021, Timothy Barksdale, also found that the experience connected directly to what he was learning in his classes. “I am learning about COVID procedures in all my clinicals and classes, so the PPE requirements and general knowledge is very intertwined,” he said. “This clinical has absolutely raised my confidence in patient care as a whole and with COVID specific protocols.”

When Seneka Lea worked at the center during that same semester, she discovered there’s a lot more to the center than just swabbing noses and scanning test tubes.

“I was surprised at the number of individuals tested at the Virginia campus everyday, and then more so at the Foggy Bottom campus. Before my experience, these numbers didn’t really mean anything to me,” she said. “But in understanding the importance of surveillance and contact tracing on preventing outbreaks in our GW community, it is impressive to see how many individuals we test on a weekly basis.”

Lea learned something different from each of the three roles at the testing center. As a tester, she learned to ensure sample quality and to reassure patients (nasal swabs aren’t fun, she assures). As registrar, she fine-tuned customer service skills and attention to detail. And as charge nurse, she learned the importance of teamwork and assuming responsibility.

Normally—when it’s not a pandemic—student nurses don’t get a lot of primary care experience, because their clinical experiences tend to focus on acute care.

“This is a real chance for them to see how a primary care, very-specialized clinic works, and to see all the roles that go into making it happen. It gives a different experience than we’ve been able to provide in the past, and it really allows them to understand the full picture of what’s going on,” Dr. Tanner said. “It’s a hopefully once in a lifetime opportunity to work through a pandemic and to provide this service.”

student wiping down chair — Nursing student volunteer wiping down chair

Student Innovations

In addition to their assigned roles as registrar, tester, and charge nurse, students also kept their eyes and ears open and made an impact on important parts of the testing center processes, center staff said.

One nursing student read the label on a sanitizer bottle and questioned testers taking the swabbed specimens where they needed to go and only then coming back and sanitizing chairs. The instructions said the sanitizer had to sit for a minute before cleaning to be effective. After the student approached staff with that realization, the center process changed. Now, testers spray the chair and let the sanitizer sit while they deliver the specimen. By testers’ return, the sanitizer has done its magic and is ready to be wiped down.

On another occasion, students got the idea to help Spanish-speaking facilities and housekeeping staff on the Virginia campus understand more about COVID in their mother tongue. One of the students, who was fluent in Spanish, provided the text for the educational materials. “The students felt that it was very important to do this project,” Deyo said. “It was so well received.”

“The students were really picking up on knowledge deficits among groups of people coming in to get tested and were able to put together educational materials to address that,” Dr. Tanner said. “They served a really good role. They were the ones who noticed that and brought it to the faculty, who were overseeing and working with them.”

In another instance, students suggested minimizing the distance between the donning and doffing site and testing booths, so they wouldn’t have to walk through the entire testing center in full PPE. A new, closer space was identified, with the students’ help, and students set it up, sanitized it, and arranged supplies, Deyo said.

In normal times, students have less of an opportunity to bring fresh sets of eyes and ears in their clinicals and to provide feedback that revolutionizes processes, according to Dr. Tanner.

“Absolutely, there are people who may have those ideas, but the nature of this being a new clinic, really gave them more a sense of freedom to go ahead and say, ‘Hey. I’m seeing this,’” he said. “When you’re a student and you’re going into a well-established clinical site, you see something, but you may wonder why they do that. You may ask that question, but it’s not going to be very typical—I certainly know that as a student I wouldn’t have felt comfortable being like, ‘Hey. You guys should change this.’”

Nursing student administering flu vaccine

Looking Ahead

As Dr. Drenkard thinks back on all that GW was able to accomplish with its COVID testing, she thinks the university sits squarely in the top tier of those who showed leadership in pandemic management and surveillance. “The capacity to stand something up quickly and to use students who are in clinical training as a resource—these are all really important assets,” she said.

Dr. Drenkard also thinks that the testing center broadcasts an important and broad message about nursing. “As a profession, we’ve struggled a little bit to really shine as leaders, and this was an example of a combination of so many things going together,” she said. “Nursing and nurses taking on leadership and a nurse-led testing site and center shows what can happen and shows people what nurses are capable of.”

There will almost certainly be testing in some form over the summer, and the hope is that need will greatly reduce by the fall.

Now that COVID vaccinations are more prominent, the testing center has shifted to reduced hours. But there is still a potential role the center will play in vaccinations going forward.

It was able to do that with a flu vaccine clinic that the Nursing School stood up adjacent to the COVID-19 testing center, which provided flu vaccines in two weeks to everyone reporting to the Virginia campus who wasn’t already vaccinated. “The thing that we could really look at and see how we can incorporate is working on vaccination clinics,” Dr. Tanner said.

“It’s great to know we can do it on such a short time frame and make it effective. We hope that we don’t have to do it again that quickly,” he said of the COVID testing center. “Academics are made to move kind of slow and deliberate; it’s not the same thing as the clinical environment. But knowing that we were able to do that is a great thing to know and if we have a similar situation—which goodness I hope we don’t—it’s great to know that we were able to do that.”

Dr. Sakallaris agreed. “There’s going to be another crisis at some point, so this is the lesson that I would take away from that: When there’s a crisis looming, take a look at what your students can do, what can they learn from this, and how can we marry those two things. I think that’s been the most valuable thing,” she said.

“When there is a crisis, when there is something new going on, it’s a significant opportunity for learning for your students. Use that. Staffing this with student nurses is unique,” she added. “Other places have tested college students, but they’ve used contract labor and that sort of thing. I don’t know of any other place that has used their student nurses.”

And, of course, their flu vaccination clinic is likely to return in future flu seasons, as it has operated in the past. “It is a really good opportunity for student nurses to do IM (intramuscular) injections,” Deyo said.

AUTHOR Menachem Wecker

May 11, 2019October 12, 2020

New Tools of the Trade

A growing body of literature supports the connection between poverty and related social determinants of health in shaping health outcomes, especially in early brain and child development. GW Nursing’s Ashley Darcy-Mahoney, in partnership with the National League for Nursing (NLN), developed an online toolkit aimed at helping nursing schools better educate students on how to identify and address factors not previously considered when providing pediatric care.

“Early detection and management of socioeconomic barriers is an important and emerging component of pediatric scope of practice,” said Dr. Darcy-Mahoney, an associate professor at GW Nursing and director of infant research at GW’s Autism and Neurodevelopmental Disorders Institute. Expanding pediatric care providers’ scope of practice to include identifying and addressing the social determinants of health will require additions to existing nursing curricula to cover these new topics.

In the new toolkit, Pediatric Adversity and Early Brain Development, Dr. Darcy-Mahoney offers a concise way for faculty in schools of nursing to explore the literature about pediatric adversity and consider ways to integrate the social determinants of health into existing curricula.

By partnering with NLN, Dr. Darcy-Mahoney hopes to leverage the organization’s considerable reach as a leader in nursing education in disseminating the toolkit, she said.

“The rollout of the NLN’s latest Advancing Care Excellence for Pediatrics program was an excellent place for this toolkit to be housed,” she said, describing the program that identified education about social determinants of health as a critical gap in nursing curricula.

This toolkit is aimed at “meeting the growing demand for quality care of children at greatest risk, living in circumstances beset by poverty, neglect and abuse,” Dr. Darcy-Mahoney said. The toolkit is divided into four modules that can be incorporated into a nursing curriculum to “educate future pediatric clinicians in understanding the drivers of inequity and equipping them with the knowledge, skills and courage to build more equitable health systems and organizations.”

The toolkit is free and available for download at:
go.gwu.edu/NLNtoolkit.

by reese rackets

May 11, 2019October 15, 2020

Exploring New Avenues in Advanced Practice Nursing Education

simulation lab photos overlaid by advanced practice ahead yield sign

A growing and aging population, large numbers of students and competition for clinical sites have created a “traffic jam” in advanced practice nursing (APN) education. At the same time, with a growing provider shortage, it’s more important than ever that the profession efficiently produces well-prepared providers.

GW Nursing Dean Pamela Jeffries describes the state of nurse practitioner (NP) education as a “traffic jam” due to the lack of available clinical sites and the larger number of NP students compared to medical students. Many nursing leaders across the nation this year have taken steps to clear the roads, turning to simulation to supplement clinical education hours as another avenue to provide the clinical practice hours and competency testing for NP students. While accrediting organizations require that NP students undertake a minimum of 500 direct patient care clinical hours to prepare for their future role, many programs require hundreds more clinical hours. Simulation offers a way to clear congestion at clinical sites while ensuring students are prepared to deliver high-quality care.

Health care simulation experts from professional organizations, schools and technology companies gathered in January of this year in Washington, D.C., to discuss how best to evaluate health care simulation in NP programs.

Hosted by the National Organization for Nurse Practitioner Faculties (NONPF) and GW Nursing, the Thought Leaders’ Summit on Simulation in NP Education examined existing evidence, discussed the challenges of evaluation and began formulating next steps.

Then in March, more than 100 nursing educators attended GW Nursing’s second annual simulation conference, which this year focused on simulation in NP education.

State of the science

While a framework for the effective use of simulation is established at the pre-licensure nursing level, little evidence exists regarding simulation’s use in APN programs.

NP education is fundamentally different from pre-licensure education and requires an entirely different approach from the established framework at the undergraduate level, said Mary Beth Bigley, CEO of NONPF.

“When we get to this level of education, standardized patient encounters have more value because it evaluates those higher-level skills,” Dr. Bigley said.

Carla Nye, clinical associate professor at the Virginia Commonwealth University School of Nursing, and Suzanne Campbell, associate professor at The University of British Columbia School of Nursing, previously surveyed the research related to simulation in NP education. Their examination of literature produced between 2010 and April 2015 found that a minimal number of research studies had been completed, the quality of studies was low, the studies used small sample sizes, the use of existing International Nursing Association for Clinical Simulation and Learning (INACSL) standards wasn’t known and there was a lack of standardized scenarios. An update of their work looking at research published between 2015 and 2019 did not show much improvement in the state of the science, Drs. Nye and Campbell said.

Despite its flaws, the existing body of research does offer promising outcomes, according to Drs. Nye and Campbell: Students like simulation and see its value; students self-report more confidence; simulation learning can be transferred to clinical settings; and simulation can improve communication skills.

Drs. Nye and Campbell also conducted their own inquiry to describe the current use of simulation in advanced practice registered nurse (APRN) programs. The study was born of the research arm of a Simulation in Advanced Practice Nursing Task Force organized after discussions about APN simulation at the 2016 INACSL annual conference.

Results of a descriptive survey sent to all APN programs in the United States and Canada show that a majority of the programs employed simulation up to 20 hours, with participants reporting a wide range of zero to more than 100 hours. Simulation is most frequently implemented in physical assessment courses, their survey showed, but it was also used in many other courses.

Schools most frequently reported using standardized patients (SPs), but the use of manikins, computer and virtual simulation, task trainers, interprofessional simulation, video recording and distance/telehealth was also reported.

This survey also showed that 98 percent of respondents reported using simulation in their APN programs, and 77 percent of respondents supported the replacement of some percentage of clinical hours with simulation. Drs. Nye and Campbell stressed survey participants who chose to complete the survey may have a pro-simulation bias.

When we get to this level of education,
standardized patient encounters have more value because it evaluates those higher-level skills.”
Mary Beth Bigley

Barriers

The survey study conducted by Drs. Nye and Campbell found that faculty skill and staff support were the most reported barriers to simulation use. Programs reported additional barriers to simulation use in APN programs, such as an inconsistent course-by-course approach to simulation, an increase in student fees to pay for resources, competition with undergraduate simulation resources and distance education.

In small working groups, summit attendees identified forces that inhibit the adoption of simulation in achieving NP competencies. Lack of resources and equity of resources between programs led the list, with limited faculty knowledge and skills and a dearth of peer-reviewed literature also emerging as major areas of concern.

Educators evaluate an NP student’s ability to obtain a patient health history, conduct a physical exam, work through a diagnosis and create a management plan. All of these skills are based on critical thinking rather than manual skills, Dr. Bigley said.

Standardized patients are considered the highest-fidelity level of simulation, but the resources required to both train and pay SPs were repeatedly cited as a barrier.

NP education is already undergoing a major shift, with programs working toward compliance with the goal of a Doctor of Nursing Practice (DNP) as the entry to practice by 2025.

“NONPF is committed to the DNP as the entry degree by 2025. NP practice should be at the DNP level,” said Lorna Finnegan, executive associate dean at the University of Illinois at Chicago and NONPF president.

Need for adoption

Despite the challenges and complications, NP educators agree that simulation will only grow in its value to the field.

Emerging evidence shows that learning does occur during simulation experiences, said Angela McNelis, associate dean for scholarship, innovation and clinical science, at GW Nursing.

Reliance on the current precepted clinical model is a challenge to sustain or expand, so educators must focus on maximizing student time in clinical settings and exploring alternative models, she said.

The demands and technology savviness of this generation of learners dominated the summit’s discussions about the need for adoption of simulation.

Current evidence shows that students report increased confidence, decreased anxiety and communication skills development in simulation scenarios, Dr. McNelis said.

Faculty members who work closely with students know that simulation works, said Pamela Slaven-Lee, senior associate dean for academic affairs at GW Nursing. “We’re in the rooms with the students, and we see the light bulb come on. We see the learning, we know it’s happening, and we need the research so we can move forward. Our undergraduate colleagues are ahead of us,” Dr. Slaven-Lee said.

Current students are digital natives, Christine Pintz, professor at GW Nursing, said during the panel presentation at the March conference. “These are individuals who understand the simulation process and also want this process,” she said.

Anecdotal evidence also reinforces the openness to including simulation in NP programs, with one attendee sharing that her colleagues call simulation “on-campus clinical hours.”

Moving forward

To address the need for a standardized, efficient, sustainable model for NP clinical education, a team led by Drs. Bigley and Jeffries presented their proposed study on “The Use of Simulation in Family Nurse Practitioner Education.” A white paper with a call to action regarding the need for more evidence to use simulations in NP clinical education is expected to be published later this year and should set the stage for a rigorous study.

Evidence is needed through conducting multisite studies on NP clinical education to obtain evidence for new models of education. In the current environment, significant shortages of clinical sites, clinical preceptors and financial resources pose barriers to NP education. These barriers create an opportunity for educators to develop new models capitalizing on the strong tradition of preceptor-based clinical experiences and leveraging innovative and evidence-based simulations that meet national competencies and continue to prepare graduates for practice. As noted by Dr. Jeffries, the future can be accomplished if there is a concerted effort to generate evidence through robust and rigorous research on simulation in NP education. The current clinical model faces ongoing challenges and requires new thinking. It is time to be bold and institute new models that include evidence-based simulation.

AUTHOR Erin julius

May 11, 2019October 12, 2020

Simulation Is The Foundation

Proponents of health care simulation education have said for years that it improves clinician performance and reduces patient safety errors, but until recently they have lacked the data and evidence to share with academic leaders and policymakers.

Simulation education in health care has advanced rapidly in the past decade, due in large part to the efforts of nurse educators. The National Council of State Boards of Nursing (NCSBN) in 2014 released the results of a landmark simulation study, which was followed up in 2015 by the publication of the National League for Nursing (NLN) Jeffries Simulation Theory. GW Nursing Dean Pamela Jeffries’ work as one of the consultants of the NCSBN study and her eponymous theory helped legitimize simulation education in pre-licensure nursing education.

The NCSBN National Simulation Study examined the role and outcomes of simulation in pre-licensure nursing education. The study provided substantial evidence that simulation can be effectively substituted for up to 50 percent of traditional clinical experience in all pre-licensure nursing courses, under conditions comparable to high-quality, high-fidelity situations described in the study.

The study results reaffirmed simulation education advocates’ belief in this type of experiential learning strategy while providing concrete data to address concerns held by simulation skeptics. The research team had its own skeptics—they were unsure of how well simulation could supplement traditional clinical experiences in certain areas, including mental health, pediatrics and obstetrics, but the data showed no significant differences as long as the correct simulation technique was used.

“For me personally, it was those areas that the simulation worked for that surprised me a little, as someone who likes traditional clinical experiences,” said Nancy Spector, the NCSBN director of regulatory innovations and a consultant on the study.

Study results influence state policy

The NCSBN study marked a shift in how nursing schools and policymakers viewed simulation education. Each state’s board of nursing makes its own decisions regarding how much simulation can be used to supplement traditional clinical experiences in pre-licensure programs. After the NCSBN study was published, many states amended their policies and increased the amount of allowable simulation. “The study has had a really positive impact on what boards of nursing are allowing,” Dr. Spector said. There was no evidence before the study, so boards made arbitrary decisions regarding simulation, and some states didn’t allow any amount of simulation to be used to supplement clinical experiences.

One year after the study was published, the NCSBN convened an expert panel to develop national simulation guidelines for pre-licensure nursing programs. These guidelines included evidence to support the use of simulation and information for faculty and program directors on how to incorporate high-quality, high-fidelity simulation in their programs.

Since the NCSBN released these guidelines in 2015, more than half of all pre-licensure programs in the country have adopted them, according to a survey conducted by the NCSBN evaluating the simulation landscape. That survey also revealed that high-fidelity simulation use has substantially increased for almost all undergraduate courses since 2010.

High-quality simulation fosters better student outcomes

GW Nursing is committed to providing students with high-quality, high-fidelity experiences and has made significant investments in simulation under the direction of Dr. Jeffries, an innovator in promoting and advancing the field of simulation education.

Recent renovations at Innovation Hall on GW’s Virginia Science and Technology Campus nearly doubled the simulation space available to nursing students. The new Objective Structured Clinical Examination (OSCE) center contains 12 patient exam rooms and two acute care rooms, bringing the total simulation space available to both undergraduate and graduate students to nearly 20,000 square feet.

While the new OSCE space was designed for nurse practitioner students to improve their clinical skills, GW Nursing also recently invested $400,000 in upgrades to make simulation as comparable to a hospital setting as possible for undergraduate students, said Crystel Farina, the school’s director of simulation and experiential learning. Those upgrades include eight new moderate-fidelity simulators (manikins that breathe and have a pulse to practice certain skills, but with fewer features than high-fidelity manikins), new beds, IV pumps, medication dispensing machines and workstations on wheels. The school launched another renovation this spring that will add additional simulation and debriefing space, new technology, a virtual reality space and a simulated operating room.

As simulation director, Ms. Farina ensures that all of the school’s many simulation events run smoothly. Simulation is integrated throughout GW Nursing’s entire curriculum—every course has some sort of simulation experience in it, Ms. Farina said. “My role is to ensure that not only does the simulation continue, but that it’s high quality and meets the standards of best practice,” she said.

Those standards, which are set by the International Nursing Association for Clinical Simulation and Learning (INACSL), were developed based on the NLN Jeffries Theory and the NCSBN guidelines. Nursing schools now have a solid framework and explicit standards to guide the development of high-quality simulation experiences. While the virtues of simulation as a teaching strategy are well established, Ms. Farina and other dedicated simulation educators are quick to point out that it’s crucial that students engage in high-quality, high-fidelity simulations. When simulations are conducted improperly, or not in accordance with the guidelines and standards set forth by NCSBN and INACSL, simulation can actually be harmful to students.

In the early days of simulation use, instructors would purposefully introduce mistakes into a simulation in the hopes that students would catch the mistake, Ms. Farina said. “We didn’t know how important it was to the students’ self-esteem and to their socialization as a nurse if they didn’t catch the mistake,” she explains.

The NLN Jeffries Theory set forth guidelines that simulation should be collaborative and transparent—the student, simulated patient (if one is used) and faculty should know exactly what’s expected and what the objectives are.

“There’s no way students can meet the objective if they get caught up in how to program the IV pump,” Ms. Farina said.

Schools that implement high-quality and high-fidelity simulation have seen improvements in student performance and clinical confidence. “Anecdotally, we’re seeing much better outcomes from simulation now that we have the NLN Jeffries Theory,” Ms. Farina said. “Their ability to talk with each other and other care providers is definitely enhanced. Their teamwork is also much better—they’re able to work as a team, and they don’t see things as individual tasks.”

Dr. Jeffries’ groundbreaking work has influenced nurse educators for years, even before the publication of the NCSBN study and her eponymous theory. Jeffries’ 2007 book, “Simulation in Nursing Education”, was Kellie Bryant’s go-to resource when she was hired as the director of simulation learning at New York University College of Nursing in 2008.

“From my experience, her book was how a lot of us got started in simulation,” Dr. Bryant said. “I’m talking over 10 years ago when there weren’t conferences or other books or journals—that book was our template for simulation.”

In her current role as executive director of simulation at Columbia School of Nursing, Dr. Bryant is using Dr. Jeffries’ evidence-based approach to developing high-quality simulations, with a focus on creating simulation experiences that address proper medication administration. “We know that medical errors are a leading cause of mortality and death, and a component of that is giving the wrong medication or the wrong dose,” she explained.

Dr. Bryant and her colleagues began with manikin-based simulations, then moved on to using standardized patients (actors portraying patients) for students to practice the proper protocols, such as reading a patient’s chart correctly, conducting safety checks, scanning a patient’s identification band and more. “The clinical instructors in the hospital are reporting that students have stronger skills than in the past, and seem more comfortable with medication administration,” Dr. Bryant said. “That’s because of simulation, because of deliberate practice. Students understand the rationale, and realize for each step why it’s important to follow protocol.”

Best practices and certifications for simulation educators

Although Dr. Bryant relied heavily on Dr. Jeffries’ early books for guidance due to the lack of available training opportunities, she cautioned novice educators against jumping into simulation.

“All schools are realizing that if they don’t have a simulation program or a simulation-based curriculum, then they’re behind the curve,” she said. “Everyone knows they have to use simulation, but people aren’t really prepared to utilize it the best way. You have to be trained, you have to have that theoretical background and you need to know what you’re doing.”

For aspiring simulation educators, that begins with securing support from their school’s leadership as well as procuring funds to attend a training program or conference. “Education is the key—before you can start using it with students and teaching other faculty, you have to know what you’re doing and have that expertise first to utilize it and to teach others,” Dr. Bryant said.

Without simulation training and instruction on what qualifies as high quality and high fidelity, schools will be out of compliance with the NCSBN and INACSL standards.

Educators who are committed to advancing their simulation knowledge and skills can become professionally certified. The Society for Simulation in Healthcare developed its Certified Healthcare Simulation Educator (CHSE) certificate in 2012 to recognize educators for their expertise in simulation. The certification demonstrates that an individual is committed to simulation and has specialized skills and knowledge.

Nursing schools with CHSE-certified educators ensure that their simulation is high quality and high fidelity, which is key to following the standards and best practices set forth by the NCSBN simulation study and the subsequent guidelines.

“If you have a CHSE-certified person in your simulation center, you have high quality and high fidelity,” Ms. Farina said. “It really does support what the study was requiring. A lot of schools out there are doing simulations but are completely missing that high-quality, high-fidelity piece because they don’t know the pedagogy.”

Interprofessional simulation

While nurse educators have advanced the field of simulation and set the standards for assessing clinical skills, other health care professions have also been using simulation technology for years.

Chad Epps, executive director at the Center for Healthcare Improvement and Patient Simulation at the University of Tennessee Health Science Center, recalls using a simulation-based model for practicing anesthesia during his medical residency program in 2001. “I learned how to use anesthesia on a simulator before I ever did it on a patient,” he said. “That left an impression on me in terms of its potential as an educational modality.”

Dr. Epps pursued his interest in education and simulation as he embarked on a career as an anesthesiologist. He became the director of simulation at the University of Alabama at Birmingham (UAB), where he started a program for nurse anesthetists and developed the curriculum, which included interprofessional simulation experiences. In his various simulation educator positions, Dr. Epps has pushed for more interprofessional experiences that mimic real-world clinical environments.

“We graduate these professional health students, and they go into clinics and the clinical world, and they’re suddenly exposed to all of these other professions,” he explained. “In the past, [these students] never learned anything about those professions so they didn’t know what their role was, or what the other professions’ role was.”

During his time at UAB, Dr. Epps and his colleagues developed simulation experiences for nursing and medical students that included specific competencies developed by the Interprofessional Educational Collaborative with intentional objectives related to the Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS) teamwork system for health care professionals designed by the Agency for Healthcare Research and Quality. Studies have shown that hospitals that implement TeamSTEPPS have improved patient outcomes, and Dr. Epps wanted the medical and nursing students to become familiar with that model of communication.

“At first, students thought [the interprofessional simulation] felt very strange,” he said. “But it got to the point where if we did a simulation with just medical students and the nursing students weren’t there, they’d look around and say, ‘Where are the nursing students, something’s wrong.’”

In addition to increasing interprofessional experiences among health care students, Dr. Epps said he expects to see simulation used more widely among health care providers to improve patient safety. “We shouldn’t just use simulation for students, we should use simulation for practicing professionals,” he said. “The airline industry has done this—if you’re a commercial pilot, you have to go through simulation every six months or you risk losing your license. We don’t have that in health care yet, although we probably need it.”

Where does simulation go from here?

Simulation-based curricula and the use of simulation have been adopted by the majority of pre-licensure nursing programs. Our work continues in conducting the research to design best practices and to learn more about how simulation-based experiences affect student learning and, ultimately, patient outcomes and quality, safe care.

AUTHOR meredith lidard kleeman

May 11, 2019October 12, 2020

The Future of Graduate Simulation – Let’s Built It Together

Pam Slaven-Lee speaking at 2019 Sim Conference

AUTHOR PAMELA SLAVEN-LEE

Over my years of staffing, organizing and refining simulation-based learning events and how we use them in nurse practitioner education, I’ve seen learning happen. I’ve watched the proverbial “light bulb come on,” as students examine a standardized patient, or receive feedback from an instructor after an Objective Clinical Structured Exam exercise.

Our undergraduate colleagues, however, are ahead of us in establishing a body of literature to support simulation events and introducing best practices for instituting them. Too often, I still hear of simulation being used for summative assessments rather than formative learning. Experience shows that simulation used in high-stakes testing does not benefit our students and, in reality, can shake their confidence. True learning occurs and confidence is built through a formative use of simulation.

Now is the time to establish these best practices.

During GW Nursing’s March simulation conference, I invited my graduate colleagues to join us in a simulation consortium, where we can acknowledge challenges before us, share resources and establish best practices. I now broaden that invitation to those readers interested in helping develop the use of simulation in advanced practice nursing education.

Join us and let’s build a future of graduate simulation together.

To get involved, visit go.gwu.edu/simconsortium today.

Pamela Slaven-Lee, DNP, FNP-C, CHSE
Sr. Associate Dean for Academic Affairs
School of Nursing
The George Washington University