Innovation Center

Simulation to Prepare Graduate Nursing Students for Clinical

Faculty Role
Jill M. Forcina Hill, Lisa Woodley, and Megan Goodwin

Abstract
Limited clinical sites and faculty to teach graduate students to be undergraduate clinical faculty have led to the exploration of
innovative teaching strategies. This article describes and evaluates a simulation experience to supplement didactic learning
about best clinical teaching practices within a graduate nursing course. Scenarios were created to simulate complex teaching
situations with a patient, an undergraduate nursing student, and a clinical faculty member. Evaluations were positive regarding
knowledge, performance, self-confidence, critical thinking, and satisfaction. Results of this project support the use of
simulation in the preparation of graduate nursing students to become clinical faculty.
KEY WORDS Clinical Faculty – Graduate Nurse Education – Simulation

T
his article describes a simulation experience implemented as
an innovative strategy for best clinical teaching practices within
a graduate-level nursing course. Currently, nursing schools
across the United States turn away thousands of qualified applicants
annually due, in part, to their inability to find enough clinical faculty
(American Association of Colleges of Nursing, 2015). Adding to the
problem is that many nurses enter into the clinical faculty role without
any formal training as teachers (Gaberson & Oermann, 2014; Yi,
Kennedy, & Fang, 2016).
Ideally, the education of clinical faculty includes application of
best teaching practices in both the clinical and classroom settings.
Unfortunately, the challenges of achieving this goal are numerous
and include difficulty in securing clinical site placements; insufficient
expert clinical faculty to serve as preceptors; and the need to navi-
gate complex hospital compliance requirements, travel constraints,
and budgetary limitations (Andresen & Levin, 2014; Kaufman, 2010).
About the Authors Jill M. Forcina Hill, PhD, RN, CNE, CNL, OCN,
CHPN, is an assistant professor, University of North Carolina at Chapel
Hill School of Nursing, Chapel Hill, North Carolina. Lisa Woodley, MSN,
RN, CNE, CHPN, is an assistant professor, University of North Carolina
at Chapel Hill School of Nursing. Megan Goodwin, BSN, RN, was a lab
operations manager, Education Innovation Simulation Learning
Environment, University of North Carolina at Chapel Hill School of
Nursing. The authors are grateful to Teresa Shellenbarger, who
shared her initial work on the use of simulations in graduate nurse
education and allowed the adaptation of scenarios presented in her
original publication on the topic. For more information, contact Dr.
Forcina Hill at forcina@email.unc.edu.
The authors have declared no conflict of interest.
Copyright © 2018 National League for Nursing
doi: 10.1097/01.NEP.0000000000000304
The use of simulation as a teaching method for graduate students
learning the role of clinical faculty has the potential to address these
challenges (Krautscheid, Kaakinen, & Warner, 2008; Shellenbarger &
Edwards, 2012).
SIMULATION DESIGN
The simulations described were conducted over a period of two years
in a graduate-level course focused on clinical teaching in nursing. The
simulation design, implementation, and evaluation were developed to
emphasize five key components: fidelity, objectives, problem solving,
student support, and debriefing (Jeffries, 2005). Most simulation ses-
sions had six graduate students participating as clinical faculty in six
different scenarios. A total of six sessions and 36 students partici-
pated over the two years of implementation.
Simulations took place within the skills lab room of the school of
nursing in a large public university in the Southeast. Each scenario in-
cluded a “live” mock undergraduate nursing student, role-played by
lab faculty, as well as a low-fidelity manikin serving as the patient.
Graduate students took on the role of the clinical faculty member
teaching the undergraduate student. Although students directed pa-
tient interactions with the manikin, course faculty served as the “voice”
of the patient.
Learning objectives were provided to students as part of their
preparation for the experience. Students were also given background
information about the undergraduate student and patient in the
assigned scenario, step-by-step instructions for the nursing skills in-
cluded in the scenarios, and a sample undergraduate nursing student
clinical evaluation tool. Faculty used a script to guide scenarios with
the freedom to ad lib as necessary to meet the objectives.
Scenarios were designed to reflect complexities that clinical fac-
ulty may face when teaching undergraduate student nurses. Scenar-
ios were developed using an ecological approach, with problems in

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Innovation Center

each scenario evident through the operationalization of three different
domains: the characteristics, knowledge, and experience of the pa-
tient and nursing student (individual); the culture of the clinical setting
(environment); and the objectives of the nurse-to-patient interactions
(objective). For example, scenario 2 centered on a nervous student
missing required safety checks in medication administration for an
irritated patient in pain. Table 1 shows how the three domains were
operationalized in six simulation scenarios.
With one faculty member acting as the patient “voice,” a second
faculty member facilitated each simulation, offered support, and
guided debriefing using practices recommended by Decker et al.
(2013). These sessions emphasized an open and trusting environ-
ment and reflected a collaborative effort among faculty and students.
A time frame of 20 minutes was allotted for each scenario, with
roughly half of this time given to debriefing.
RESULTS
Following Jeffries’ (2005) framework for evaluation, outcomes included
knowledge, performance, self-confidence, critical thinking, and satis-
faction. Faculty distributed a postsimulation survey that consisted of
a dichotomous evaluation of simulation objectives as “met” or “not
met,” as well as series of open-ended questions. Observation and
analysis of the debriefing were also used in the evaluation.
Knowledge was evaluated by determining if the graduate stu-
dents felt that the simulation objectives were met. Of 31 responses
received, all students felt that simulation objectives were met. Com-
ments were also overwhelmingly positive, including “the scenarios
provided opportunities to teach an undergraduate student before,
during and after a skill” and “the most helpful part of the simulation
was being able to practice what we might say in various situations.”
Faculty also noted achievement of higher-level learning, with
students demonstrating the ability to apply, analyze, evaluate,
and synthesize classroom information with the events that took
place in the simulation experience.
Performance was evaluated through observation and debriefing.
The surveys indicated that the students viewed the debriefing activity
as particularly beneficial to performance evaluation. In an open-ended
question about what students considered the most helpful part of the
activity, nearly half (15/31) referred to the “feedback” or “discussion”
after the simulation. Specifically, students commented that they
“appreciated the ability to ask questions and seek input” and that
the “group discussion afterwards [was] positive and [provided]
constructive feedback.”
Self-confidence was evaluated as a function of how students de-
scribed their preparation for the simulation. Most participants re-
ported that they prepared by reviewing the background information
and the skills that the undergraduate nursing student would perform,
as well as reflecting on past clinical experiences and potential out-
comes. Overall, students reported that they felt more confident in
their ability to take on a role as clinical faculty after the simulation.
Seven students addressed the “low stress, interactive and non-
threatening” environment as a particularly beneficial part of the expe-
rience. Other comments indicative of enhanced self-confidence
included: “[I am] more prepared with…effective ways to handle
the patient/student interaction” and “I will remain calm and know
how and when to intervene.”
Faculty involved in the simulations observed students applying
principles of adult learning, evidence-based clinical teaching strate-
gies, and creative and effective approaches to problem solving.
When asked how they will incorporate what they learned into their
clinical teaching practice, students responded positively with evi-
dence of reflection and intent. For example, students stated: “I will

Table 1: Operationalization of Domains in Simulation Scenarios

Scenario Individual Environment Objective

1a • Uncompassionate student • Unpleasant odor Emptying colostomy

nurse • Lack of privacy in room
• Anxious patient

2 • Nervous student • Medication administration policy Timely/appropriate medication

• Irritated patient, in pain • Inconvenient location of Pyxis administration

3 • Pediatric patient • Developmentally appropriate pediatric response Safe injection

• Competent student to injection
• Needle stick policy

4 • Overly confident student • Lengthy central line dressing change policy Central line dressing change
• Friendly, retired nurse as • Busy clinical day
patient

5 • Student with relevant life • Discharge policy Discharge teaching

experience • Postpartum depression screening policy
• Unengaged patient

6 • Novice junior-level nursing • Policy and procedures regarding nasogastric NG tube placement
student (NG) tube placement
• Alert and oriented patient • Exaggerated patient response
a
The content in scenario 1 was adapted with permission from Shellenbarger and Edwards (2012).

2 Month 2018 www.neponline.net

Copyright © 2018 National League for Nursing. Unauthorized reproduction of this article is prohibited.

use…role playing to focus on the affective [learning objectives]”; “I
plan to leverage pre-conference and relate evaluations to clear,
behavior-based detailed rubrics”; and “I will carry forward the com-
munication skills we practiced and take ownership/control of conver-
sation[s] with [the] student when something goes wrong.”
Satisfaction was evaluated by asking students what changes
they would make to improve the simulation experience. Nearly half
of the students (15/31) stated that they would not make any changes.
Suggested changes were minor and included repeating one of the
scenarios with live recommendations for action from faculty, adding
more time to the experience, and increasing the number and amount
of simulations used within the course. Faculty satisfaction with the
simulations has been consistently high.
CONCLUSION
The results of this project support the use of simulation in the prepa-
ration of graduate nursing students to assume the role of clinical fac-
ulty. In turn, this may help meet the increasing demand for qualified
clinical faculty teaching undergraduate nursing students. Simulation
experiences provide opportunities for graduate students to think on
their feet and utilize critical thinking skills, practice a variety of teaching
techniques with undergraduate students, and evaluate the effective-
ness of these techniques. In addition, simulations afford course fac-
ulty the opportunity for consistent teaching opportunities among all
graduate students enrolled in a clinical teaching course and allow
graduate students to observe and learn from each other. The latter
Nursing Education Perspectives
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Innovation Center
is especially important because clinical teaching is usually done in iso-
lation and clinical faculty rarely have the opportunity to observe each
other in practice (Gaberson & Oermann, 2014).
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