2HeadsR > 1 : A Strategy for Role Assignment in Nursing Simulation From Baylor University

The Sim Team at Baylor University Louise Herrington School of Nursing in Dallas, Texas developed an innovative strategy for assigning roles in healthcare simulation.  In today’s article from Jeanne Carey, MEd, RN, CHSE, Director of Simulation at Baylor University Louise Herrington School of Nursing, the team is excited to share their approach in the hopes other nursing simulation educators will want to try the “Baylor Method” of simulation, and for those interested, partner with them in research of the strategy! From Baylor:

Traditionally, simulation occurring within pre-licensure nursing education includes assigning students predetermined roles that are typically nursing-specific and responsible for particular duties such as documentation, medication administration, or assessment. Designating primary and secondary nurse roles is another common approach to role assignment in simulation. This portioning of duties among multiple participants allows students to divide and conquer, rather than prioritize and delegate.

Students often challenge this distribution of nursing tasks, saying it is not a realistic representation of a nurse’s workload. However, logistical parameters such as time, space, and available resources necessitate scheduling multiple participants in one simulation scenario. Benefits from simulation are directly tied to the student’s level of involvement in the simulation; students who are assigned roles requiring increased patient interaction display higher levels of critical thinking during the simulation and debriefing processes. The greater the distribution of nursing-specific duties among multiple students, the increased likelihood of some roles not being as involved and not stimulating as much critical thinking. The Two-Heads-Are-Better-Than-One (2HeadsR >1) strategy for role assignment in simulation assigns two students to act in the role of one nurse.


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The students are instructed to move and act as if they are one person; they cannot be in two places at one time, nor can they simultaneously engage in separate activities. This strategy encourages students to collaborate, prioritize patient care, and delegate as needed. The two students verbalize their clinical reasoning with one another to develop a plan of care. If there is a difference of opinion regarding the most appropriate next action to take, the students must provide rationale for their plan if they are to sway their partner.  An agreement is necessary, to proceed in care of the simulated patient.

Assigning two students to operate as one nurse decreases role confusion and empowers both participants to take any nursing action they deem appropriate. Acting alongside a buddy decreases anxiety which improves learning; students appreciate having a peer by their side to discuss options and to explore questions. Opportunities to practice teamwork, collaboration, and professionalism abound throughout the simulation activity and mimic the role of nurses working as members of interdisciplinary teams in the clinical setting. Students report increased confidence after participating in simulation utilizing the 2HeadsR >1 strategy; they reflect on their ability to recognize critical elements, make sound judgment calls, and initiate appropriate interventions in a timely manner.

The 2HeadsR >1 strategy affords clinical faculty a new perspective for assessing critical thinking skills. Instructors and others observing the simulation scenario, gain insight into a student’s decision-making.  Viewed actions can be linked with verbalized thought processes, revealing levels of clinical reasoning and potential gaps in knowledge. It is easier to follow the thinking behind the observed actions and evaluate skills such as communication, prioritization, delegation, and situational awareness.

The 2HeadsR >1 strategy is built upon the evidence in support of collaborative cognition. Research shows that when two people combine their sensory information, the resulting performance is oftentimes better than either individual could execute alone; this is especially true if the individuals engage in open dialogue and express opinions with each other. Collective decision-making can surpass that of either individual and is enhanced by the diversity among the thinking styles or personalities of the participants.


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The two students working as one nurse learn to recognize their own strengths and limitations; they appreciate the benefits of teamwork and acknowledge their own potential to contribute as a member of the team.  The learn to resolve disagreements by listening to other perspectives. The 2HeadsR >1 strategy encourages students to practice different styles of communication while conversing with the patient, a member of the healthcare team, and one another. This repeated exposure to the QSEN competency of Teamwork & Collaboration during simulation scenarios employing the 2HeadsR >1 strategy will prepare the students to provide higher quality and safer nursing care upon graduation.

Interested in learning more about the 2HeadsR >1 strategy for role assignment? Watch for a full-length article to be published as an Educational Innovation in an upcoming issue of the Journal of Nursing Education or contact Jeanne Carey, Director of Simulation at Baylor University Louise Herrington School of Nursing through the link below!

Learn more about 2HeadsR >1 ~ A Strategy for Role Assignment in Simulation!


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