WEBVTT 00:00:00.060 --> 00:00:05.380 position:50% align:middle - [Moderator] Richard Smiley has worked as a statistician in the research department at NCSBN 00:00:05.380 --> 00:00:06.810 position:50% align:middle for 19 years. 00:00:06.810 --> 00:00:12.020 position:50% align:middle During his time at NCSBN, he has co-authored studies on the use of simulation 00:00:12.020 --> 00:00:18.560 position:50% align:middle in nursing education on data from the National Nursing Workforce Survey and on best practices for Substance 00:00:18.560 --> 00:00:20.790 position:50% align:middle Use Disorder Monitoring Programs. 00:00:20.790 --> 00:00:25.360 position:50% align:middle He has undergraduate degrees in Mathematics and Computer Science and graduate degrees 00:00:25.360 --> 00:00:27.660 position:50% align:middle in Statistics and Demography. 00:00:27.660 --> 00:00:33.660 position:50% align:middle He is past president of the Chicago Chapter of the American Statistical Association. 00:00:40.000 --> 00:00:46.280 position:50% align:middle - [Richard] Hello, I am here to present, An Update on the Status of Simulation Regulation. 00:00:46.280 --> 00:00:50.560 position:50% align:middle In this presentation, I will go through an extended review of the State 00:00:50.560 --> 00:00:56.540 position:50% align:middle of Nursing Simulation Regulation, describe the methods of the update, 00:00:56.540 --> 00:01:01.550 position:50% align:middle present the results, and discuss the study implications. 00:01:01.550 --> 00:01:05.840 position:50% align:middle I will answer questions live after the presentation has ended. 00:01:05.840 --> 00:01:11.340 position:50% align:middle During the presentation, you are welcome to submit questions in the Q&A box. 00:01:11.340 --> 00:01:18.180 position:50% align:middle The use of simulation in nursing education has increased dramatically over the past two decades. 00:01:18.180 --> 00:01:24.610 position:50% align:middle Research has documented the benefits to student learning and nursing educators' ability to effectively 00:01:24.610 --> 00:01:26.812 position:50% align:middle evaluate student performance. 00:01:27.450 --> 00:01:36.180 position:50% align:middle Concurrently, RN and LPN/VN educational programs have struggled to obtain adequate clinical placements, 00:01:36.180 --> 00:01:43.070 position:50% align:middle as many hospitals have chosen to reduce the number of students allowed in the clinical setting. 00:01:43.070 --> 00:01:50.173 position:50% align:middle This has led to the increased use of simulation hours as a substitute for required clinical hours. 00:01:52.010 --> 00:01:58.320 position:50% align:middle As a result, regulators have become increasingly involved in overseeing the use of simulation 00:01:58.320 --> 00:02:04.270 position:50% align:middle in nursing education, especially with regards to the use of simulation hours 00:02:04.270 --> 00:02:06.930 position:50% align:middle as a substitute for clinical hours. 00:02:06.930 --> 00:02:16.640 position:50% align:middle Since evidence on the effect of such substitution was lacking, NCSBN undertook the National Simulation Study 00:02:16.640 --> 00:02:25.220 position:50% align:middle with the intent of providing guidance to boards of nursing on the regulation of simulation experiences. 00:02:25.220 --> 00:02:32.380 position:50% align:middle The project began in 2010 with a pre-survey that was sent to pre-licensure RN programs. 00:02:32.380 --> 00:02:38.870 position:50% align:middle The survey was used to collect information regarding each school's curriculum, use of simulation, 00:02:38.870 --> 00:02:43.361 position:50% align:middle facilities, and substitution of simulation for clinical hours. 00:02:45.100 --> 00:02:49.110 position:50% align:middle At the end of the survey, respondents were invited to be considered 00:02:49.110 --> 00:02:56.130 position:50% align:middle for participation in the National Simulation Study by passing along their contact information 00:02:56.130 --> 00:02:58.461 position:50% align:middle to the study manager. 00:02:58.461 --> 00:03:06.740 position:50% align:middle 10 schools were selected for the National Simulation Study from those programs who offered to participate. 00:03:06.740 --> 00:03:13.880 position:50% align:middle The five ADN and five BSN programs selected were geographically diverse and 00:03:13.880 --> 00:03:17.640 position:50% align:middle in solid standing academically. 00:03:17.640 --> 00:03:23.470 position:50% align:middle Within each program, students were randomly assigned to one of three groups, 00:03:23.470 --> 00:03:32.460 position:50% align:middle traditional clinical experience with no or minimal simulation used, 25% simulation experience in place 00:03:32.460 --> 00:03:39.060 position:50% align:middle of traditional clinical experience, or 50% simulation experience in place 00:03:39.060 --> 00:03:41.310 position:50% align:middle of traditional clinical experience. 00:03:43.920 --> 00:03:50.160 position:50% align:middle The students were tracked throughout their two-year course of study and were followed as new graduates 00:03:50.160 --> 00:03:54.658 position:50% align:middle in their first six months of their initial clinical practice. 00:03:55.180 --> 00:04:01.390 position:50% align:middle Students were assessed on clinical competency and nursing knowledge and they rated how well their 00:04:01.390 --> 00:04:05.806 position:50% align:middle learning needs were met in both the clinical and simulation environments. 00:04:07.210 --> 00:04:13.023 position:50% align:middle Over 600 students completed the study requirements at the time of graduation in 2013. 00:04:13.023 --> 00:04:18.000 position:50% align:middle At the end of the study, there were no statistically significant differences 00:04:18.000 --> 00:04:23.830 position:50% align:middle in clinical competency as assessed by clinical preceptors and instructors, 00:04:23.830 --> 00:04:29.770 position:50% align:middle no statistically significant differences in comprehensive nursing knowledge assessments, 00:04:29.770 --> 00:04:36.884 position:50% align:middle and there were no statistically significant differences in NCLEX pass rates among the three study groups. 00:04:38.869 --> 00:04:44.360 position:50% align:middle In 2014, prior to the release of the results from the National Simulation Study, 00:04:44.360 --> 00:04:52.660 position:50% align:middle a survey was mailed out to NCSBN's member and associate member boards of nursing to assess the status 00:04:52.660 --> 00:04:56.520 position:50% align:middle of regulation of simulation and nursing. 00:04:56.520 --> 00:05:02.350 position:50% align:middle Responses collected from the survey and an extensive search through published regulations were used 00:05:02.350 --> 00:05:04.950 position:50% align:middle to answer two questions. 00:05:04.950 --> 00:05:10.040 position:50% align:middle Number one, "How many jurisdictions currently have regulations regarding the use 00:05:10.040 --> 00:05:13.460 position:50% align:middle of simulated clinical experiences?" 00:05:13.460 --> 00:05:20.123 position:50% align:middle Number two, "What percentage of clinical experience hours may be replaced by simulation?" 00:05:22.330 --> 00:05:29.890 position:50% align:middle The survey found that the majority of the jurisdictions at the time did not have specific written regulation 00:05:29.890 --> 00:05:32.750 position:50% align:middle regarding the use of simulation hours. 00:05:32.750 --> 00:05:39.820 position:50% align:middle And, that a number of jurisdictions that did mention simulation in their regulations did not specify a 00:05:39.820 --> 00:05:45.110 position:50% align:middle maximum percentage of clinical experience hours that could be replaced by simulation. 00:05:46.730 --> 00:05:52.790 position:50% align:middle It should be noted that just because a jurisdiction does not have specific written regulation, 00:05:52.790 --> 00:05:57.180 position:50% align:middle does not mean that simulation is not being regulated. 00:05:57.180 --> 00:06:03.450 position:50% align:middle Some jurisdictions mentioned approving the use of simulations and educational programs on a case-by-case 00:06:03.450 --> 00:06:14.790 position:50% align:middle basis In 2015, an expert panel convened by NCSBN evaluated the data gathered through the National 00:06:14.790 --> 00:06:22.450 position:50% align:middle Simulation Study, examine previous research, and use their collective knowledge to develop National 00:06:22.450 --> 00:06:28.120 position:50% align:middle simulation guidelines for pre-licensure nursing programs. 00:06:28.120 --> 00:06:32.830 position:50% align:middle An article in the Journal of Nursing Regulation presented the guidelines, 00:06:32.830 --> 00:06:38.260 position:50% align:middle the evidence to support the use of simulation, and the information for the faculty and program 00:06:38.260 --> 00:06:44.538 position:50% align:middle directors on preparation and planning for using simulation successfully in their nursing programs. 00:06:46.830 --> 00:06:54.110 position:50% align:middle Specifically, the guideline stated that the study provides confidence that substituting up to 50% 00:06:54.110 --> 00:07:00.660 position:50% align:middle simulation for pre-licensure clinical experiences promotes outcomes similar to traditional clinical 00:07:00.660 --> 00:07:09.890 position:50% align:middle experiences as long as faculty are adequately trained, committed, and in sufficient numbers when there is a 00:07:09.890 --> 00:07:15.750 position:50% align:middle dedicated simulation lab with appropriate resources, when the vignettes are realistically and 00:07:15.750 --> 00:07:22.000 position:50% align:middle appropriately designed, and when debriefing is based on a theoretical model. 00:07:22.780 --> 00:07:28.030 position:50% align:middle The guidelines included checklists for faculty and programs to help ensure that the standards 00:07:28.030 --> 00:07:29.295 position:50% align:middle would be met. 00:07:31.561 --> 00:07:39.990 position:50% align:middle In 2017, a survey was sent to nursing programs that followed up on the 2010 pre-study survey conducted 00:07:39.990 --> 00:07:43.710 position:50% align:middle for the National Simulation Study. 00:07:43.710 --> 00:07:51.580 position:50% align:middle The survey showed that high-fidelity simulation used at undergraduate courses increased substantially 00:07:51.580 --> 00:07:56.660 position:50% align:middle during the seven-year period after the 2010 survey. 00:07:56.660 --> 00:08:04.140 position:50% align:middle It also showed that 24% of the respondents reported their institution's policies regarding simulation 00:08:04.140 --> 00:08:07.310 position:50% align:middle changed in the past two years. 00:08:07.310 --> 00:08:11.901 position:50% align:middle This was mainly attributed to the Simulation Study and guidelines. 00:08:13.830 --> 00:08:20.670 position:50% align:middle In order to more clearly quantify that impact, the current review was undertaken. 00:08:20.670 --> 00:08:27.510 position:50% align:middle Specifically, the purpose of this study is to determine the impact of the National Simulation Study and 00:08:27.510 --> 00:08:32.980 position:50% align:middle subsequent guidelines on the regulation of the use of simulation in nursing education. 00:08:32.980 --> 00:08:39.020 position:50% align:middle This was accomplished by replicating some elements of the 2014 baseline study. 00:08:39.020 --> 00:08:46.330 position:50% align:middle In February, NCSBN staff reviewed the statutes and regulations of the jurisdictions who provided data 00:08:46.330 --> 00:08:53.760 position:50% align:middle to the baseline study and updated the answers to the two questions that were asked to jurisdictions. 00:08:53.760 --> 00:08:57.790 position:50% align:middle The first question was, "How many jurisdictions currently have regulations 00:08:57.790 --> 00:09:02.960 position:50% align:middle regarding the use of simulated clinical experiences?" 00:09:02.960 --> 00:09:11.895 position:50% align:middle For RNs, the number of boards with specific regulation regarding simulation rose from 22 in 2014 to 38 00:09:11.895 --> 00:09:16.858 position:50% align:middle in 2021, an increase of over 25%. 00:09:16.858 --> 00:09:21.920 position:50% align:middle The second question was, "What percentage of clinical experience hours may be 00:09:21.920 --> 00:09:25.070 position:50% align:middle replaced by simulation?" 00:09:25.070 --> 00:09:32.480 position:50% align:middle For RNs, the number of boards who specifically stated that no hours substitution was allowed declined 00:09:32.480 --> 00:09:36.818 position:50% align:middle from 5 to 1 while the number of boards who had the guideline 00:09:36.818 --> 00:09:44.280 position:50% align:middle recommendation of 50% as a substitution maximum rose from 1 to 22. 00:09:44.280 --> 00:09:54.320 position:50% align:middle For LPN/VNs the number of boards with specific regulation regarding simulation rose from 20 in 2014 00:09:54.320 --> 00:09:57.710 position:50% align:middle to 33 in 2021, an increase of 20%. 00:09:57.710 --> 00:10:05.090 position:50% align:middle For LPN/VNs, the number of boards who specifically stated that no hour substitution was allowed declined 00:10:05.090 --> 00:10:12.440 position:50% align:middle from 3 to 0 while the number of boards who had the guideline recommendation of 50% as a substitution 00:10:12.440 --> 00:10:16.853 position:50% align:middle maximum rose from 0 to 21. 00:10:18.700 --> 00:10:23.550 position:50% align:middle I will note something that was not included in the numbers just presented. 00:10:23.550 --> 00:10:28.300 position:50% align:middle During the pandemic, over 15 jurisdictions issued statements and emergency 00:10:28.300 --> 00:10:32.540 position:50% align:middle orders specifically addressing the use of simulation. 00:10:32.540 --> 00:10:38.490 position:50% align:middle Most of the orders involved relaxing some restrictions on the use of simulation by boards of nursing that 00:10:38.490 --> 00:10:41.460 position:50% align:middle already had specified regulations. 00:10:41.460 --> 00:10:47.750 position:50% align:middle Six boards removed or shifted caps on the permissible percentage of simulation hours that could be 00:10:47.750 --> 00:10:50.063 position:50% align:middle substituted for clinical hours. 00:10:52.110 --> 00:10:59.600 position:50% align:middle In summary, the use of simulation in educational programs has risen substantially in the past decade. 00:10:59.600 --> 00:11:07.130 position:50% align:middle For both RN and LPN/VN programs over 60% of jurisdictions now specifically referred to the use 00:11:07.130 --> 00:11:11.585 position:50% align:middle of simulation in program approval regulatory documents. 00:11:12.490 --> 00:11:19.760 position:50% align:middle Over a third of RN and LPN/VN educational programs allow the substitution of simulation hours 00:11:19.760 --> 00:11:22.847 position:50% align:middle for up to 50% of clinical hours. 00:11:24.160 --> 00:11:30.090 position:50% align:middle The impact of the National Simulation Study and subsequent guidelines are seen in the large number 00:11:30.090 --> 00:11:37.260 position:50% align:middle of jurisdictions that shifted from no regulation of simulation to allowing the study maximum of 50% 00:11:37.260 --> 00:11:42.100 position:50% align:middle of simulation hours substituted for clinical hours. 00:11:42.100 --> 00:11:44.960 position:50% align:middle We will now go live for questions. 00:12:04.740 --> 00:12:06.400 position:50% align:middle Welcome. 00:12:06.400 --> 00:12:13.880 position:50% align:middle If you have any questions, please be sure to put them in the Q&A box and I hope 00:12:13.880 --> 00:12:16.390 position:50% align:middle you found this discussion worthwhile. 00:12:16.390 --> 00:12:26.610 position:50% align:middle I think it was a very energetic exercise on our behalf to go through and see just the impact that that study 00:12:26.610 --> 00:12:32.060 position:50% align:middle had on what's been taking place in nursing regulation. 00:12:32.060 --> 00:12:43.710 position:50% align:middle And, I think this reflects not only our study but other work that's been done on simulation that there's been a 00:12:43.710 --> 00:12:54.530 position:50% align:middle great and growing interest in this topic over the last 10 or 15 years in terms of boards getting a 00:12:54.530 --> 00:12:59.120 position:50% align:middle handle on it. So, let me see. 00:12:59.310 --> 00:13:07.136 position:50% align:middle Refresh the screen here and just see if there's anything popping into the chatbox or the Q&A box. 00:13:07.136 --> 00:13:08.617 position:50% align:middle Let's see. 00:13:16.070 --> 00:13:23.007 position:50% align:middle Yeah. "Did any of the simulations include telehealth?" 00:13:24.530 --> 00:13:29.090 position:50% align:middle For the studies we were dealing with, I think most of what we were studying was 00:13:29.090 --> 00:13:36.007 position:50% align:middle the in-lab simulations. 00:13:36.200 --> 00:13:43.440 position:50% align:middle I think future studies, we're going to be working on looking at virtual reality 00:13:43.440 --> 00:13:45.340 position:50% align:middle and things like that. 00:13:45.340 --> 00:13:51.932 position:50% align:middle But, for the moment this was strictly related to in-person simulation. 00:13:51.932 --> 00:13:53.526 position:50% align:middle Yes. 00:13:53.526 --> 00:13:57.770 position:50% align:middle And, I am starting to see a lot of questions appear in the box now. 00:13:57.770 --> 00:14:05.000 position:50% align:middle So, is there any similar information related to post-licensure programs? 00:14:05.000 --> 00:14:09.290 position:50% align:middle No. I was looking at pre-licensure programs, so no. 00:14:09.290 --> 00:14:19.070 position:50% align:middle And, I don't know if those are as heavily regulated. 00:14:19.070 --> 00:14:27.490 position:50% align:middle But, it's kind of where I was looking into regulations that usually appears in a different place. 00:14:27.490 --> 00:14:33.128 position:50% align:middle "Will NCSBN do any investigation for counting simulation hours as two to one ratio for clinical 00:14:33.128 --> 00:14:37.538 position:50% align:middle hours due to the focused learning that occurs?" 00:14:38.840 --> 00:14:47.740 position:50% align:middle We are currently engaged in discussions for a study that partially will involve trying to answer some 00:14:47.740 --> 00:14:59.190 position:50% align:middle of these questions that I...we are hoping to undertake another simulation study in...not this year 00:14:59.190 --> 00:15:02.890 position:50% align:middle but hopefully coming up soon we'll do another simulation study. 00:15:02.890 --> 00:15:05.543 position:50% align:middle And, I believe that would be incorporated. 00:15:09.940 --> 00:15:16.010 position:50% align:middle "Is there any plan to study the use of virtual simulation in contrast to face-to-face simulation?" 00:15:16.010 --> 00:15:23.120 position:50% align:middle Yes, the plans are...if assuming we do do another simulation study, the focus would be 00:15:23.120 --> 00:15:24.908 position:50% align:middle on virtual simulation. 00:15:26.510 --> 00:15:32.710 position:50% align:middle "Will there be additional follow-up post-pandemic for the increased use of the simulation and outcomes?" 00:15:32.710 --> 00:15:37.310 position:50% align:middle I think that's a simple question. Yes, we are hoping to do this. 00:15:37.310 --> 00:15:44.210 position:50% align:middle And, boy, a lot of questions on virtual simulation which is encouraging for us. 00:15:44.210 --> 00:15:54.110 position:50% align:middle Because like I said we are hoping to do a study on this that would be kicking off not this year but hopefully 00:15:54.110 --> 00:15:56.127 position:50% align:middle next year maybe. 00:15:59.010 --> 00:16:04.320 position:50% align:middle "Are there any concerns coming forward about programs that are not providing simulation using 00:16:04.320 --> 00:16:06.720 position:50% align:middle the recommended standards?" 00:16:06.720 --> 00:16:20.150 position:50% align:middle Boards do things differently and one thing that was very clear to me is even...although I was 00:16:20.150 --> 00:16:28.138 position:50% align:middle capturing a lot of information about boards that are applying and adjusting to these standards, 00:16:28.138 --> 00:16:34.500 position:50% align:middle there were...even those boards had differences. As you went through the regulations, 00:16:34.500 --> 00:16:39.163 position:50% align:middle as you find out what they do, everybody does things a little bit differently. 00:16:39.163 --> 00:16:47.380 position:50% align:middle And so, even the boards that didn't have specific standards, it was clear they were usually doing 00:16:47.380 --> 00:16:53.660 position:50% align:middle something to address simulation and were aware of what was going on with their programs. 00:16:53.660 --> 00:17:02.930 position:50% align:middle So, I think I wouldn't say that there are concerns about the boards that aren't doing 00:17:02.930 --> 00:17:05.070 position:50% align:middle the specific standards. 00:17:05.070 --> 00:17:13.740 position:50% align:middle I think we'd like to see more of them but there's still...there's evidence that they are still monitoring 00:17:13.740 --> 00:17:19.820 position:50% align:middle simulation and I think they may be moving in that direction anyways. 00:17:19.820 --> 00:17:23.238 position:50% align:middle So, [inaudible] that. 00:17:25.890 --> 00:17:29.850 position:50% align:middle "Result of the original study issued guidelines for RN and LPN programs, 00:17:29.850 --> 00:17:37.360 position:50% align:middle there was no data for LPN programs will be studies to address this specifically?" 00:17:39.723 --> 00:17:44.348 position:50% align:middle I don't know. I mean... 00:17:47.948 --> 00:17:59.580 position:50% align:middle I, offhand, can't say if there will be something done with LPNs specifically regarding the study. 00:17:59.580 --> 00:18:09.810 position:50% align:middle And, anyway, and then there's a comment saying, "We need a better understanding of what constitutes 00:18:09.810 --> 00:18:15.980 position:50% align:middle valuable clinical experiences to be absolutely necessary for entry into practice." 00:18:15.980 --> 00:18:19.190 position:50% align:middle I agree. So, let's... 00:18:19.190 --> 00:18:28.850 position:50% align:middle I think I'm going to refresh this screen just to see if anything else has popped up in the Q&A so I'm not 00:18:28.850 --> 00:18:30.662 position:50% align:middle missing anything here. 00:18:33.400 --> 00:18:35.627 position:50% align:middle I think that may be it. 00:18:35.940 --> 00:18:42.760 position:50% align:middle Oh here's another question, "Are there criteria or standards set forth by NCSBN 00:18:42.760 --> 00:18:45.940 position:50% align:middle regarding simulation product vendors?" 00:18:45.940 --> 00:18:55.860 position:50% align:middle No. No. We definitely have not dealt with that issue beyond asking a couple of questions about what, 00:18:55.860 --> 00:18:57.950 position:50% align:middle you know, what products do you use? 00:18:57.950 --> 00:19:04.950 position:50% align:middle But, I would think that might be something more in the realm of INACSL, 00:19:04.950 --> 00:19:12.670 position:50% align:middle the nursing simulation organization that deals with that. 00:19:12.670 --> 00:19:18.157 position:50% align:middle If there are standards I would think they would be the ones that would be looking for that.