December 20, 2017By Dr. Kim Baily

Is Your School Ready for State Board Simulation Standards?

If the state boards opt for standards, what will the standards be and will your school be ready? A number of national organizations have developed standards for simulation programs. These include the International Nursing Association For Clinical Simulation and Learning (INACSL) and the Society for Simulation in Healthcare (SSH). In 2014, the National Council of State Boards of Nursing (NCSBN) completed an extensive study concerning the use of simulation as a substitute for traditional clinical experience.

Results of the study, indicated that high-quality simulation experiences could be substituted for up to 50% of traditional clinical hours across the pre-licensure nursing curriculum. The study was based on programs with high-quality simulations, standards of best practice, a debriefing method grounded in educational theory and trained dedicated simulation faculty.

Following this study, an expert panel chosen by NCSBN evaluated the study data as well as other research and by combining standards from INACSL with the NCSBN data, developed national simulation guidelines for prelicensure nursing programs. The Guidelines are:


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  1. ‘‘There is a commitment on the part of the school for the simulation program.
  2. Program has appropriate facilities for conducting simulation.
  3. Program has the educational and technical resources and equipment to meet  the intended objectives.
  4. Lead faculty and simulation laboratory personnel are qualified to conduct simulation.
  5. Faculty are prepared to lead simulations.
  6. Program has an understanding of policies and processes that are a part of the simulation experience’’ (Alexander et al. 2015)

Becoming accredited by one of the national simulation organizations is a time consuming and expensive process which is likely beyond the scope of many schools. Sabrina Beroz has developed the Program Assessment Survey for Simulation (PASS) which is a simplified no cost tool for evaluating simulation programs (Beroz, S. (2017) Clinical Simulation in Nursing, 13(6), 270-277. The PASS survey is based on the check lists form the NCSBN Simulation Guidelines for Prelicensure Nursing Program and the INACSL Standards of Best Practice.  Below are some of the interesting results from the PASS study (25 programs):

  • 66% substituted simulation for traditional clinical experiences
  • 30% had a framework to provide sustainability
  • 22% had policies and procedures to ensure consistency between simulation experiences.
  • 85% of the coordinators had job descriptions
  • 19% had formal plans for faculty development
  • 37% stated they had adequate physical space.
  • 70% used content experts during debriefing.
  • 37% identified the need for additional manikins.
  • 33% used a learning theory as a foundation for the simulation program.
  • 59% had a formal curriculum map for simulation integration
  • 37% used a theory based debriefing method.
  • 48% had a method for sharing student performance with clinical instructors.
  • 33% evaluated facilitators.

The PASS study identified the lack of faculty development/time, space and equipment as three major barriers to successful simulation. The study concluded that “Nursing programs spend an inappropriate amount of money in start-up costs compared to ongoing expenses for faculty development and maintenance of simulation programs”. Debriefing was conducted by faculty who did not receive formal training and was conducted without a basis in theory.

How many state boards of Nursing will accept the results of the NCSBN study cart blanche and allow schools to increase the time students spend in simulation? That remains to be seen.  The California State Board of Nursing (CA-BRN) for example, is not accepting the study as it stands but is requiring further research to be collected from within the state of California.

The key to substituting simulation for traditional clinical experiences is that simulation must be conducted at “a high level”. As state boards adopt standards, schools will be required to validate that they meet the new standards. Ideally, a national certification would validate a school’s commitment to high level simulation however, this process may be beyond the reach of many schools.


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Alternatively, a careful review and implementation of some if not all of the INACSL or other standards will provide evidence that a simulation program is based on educational theory and current practice. Administrators not involved directly in simulation, need to learn about the latest changes in simulation education in order that they can understand and support simulation programs. Clinical faculty cannot be thrown into simulation without adequate training and experience and a manikin on a gurney does not make a simulation program.

When your state board implements standards, will your program be ready?


Today’s article was guest authored by Kim Baily PhD, MSN, RN, CNE, Simulation Coordinator for Los Angeles Harbor College. Over the past 15 years Kim has developed and implemented several college simulation programs and currently chairs the Southern California Simulation Collaborative.

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Learn more about the State Board Simulation Standards


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