Clinical Simulation in Nursing (2019) 26, 1-2

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Editorial

Simulation in Advanced Practice

As co-editors, we are pleased with the overwhelming Canadad‘‘Simulation in Advanced Practice Nursing
response to our call for manuscript submission to this Programs: A North-American Survey’’dand found that there
special issue of Clinical Simulation in Nursing on Simula- was almost universal use of simulation. The International
tion in Advanced Practice Nursing. Graduate nursing edu- Nursing Association for Clinical Simulation and Learning
cation programs prepare advanced practice nurses (e.g., standards were used to guide the development and imple-
clinical nurse specialists, nurse practitioners, nurse mid- mentation of the simulations, and the majority of the survey
wives, and nurse anesthetists) to work in education, respondents supported replacing some clinical hours with
research, and practice settings. However, diminishing grad- simulation. Despite the National Council of State Boards of
uate faculty, complexities/transitions of care, limited con- Nursing supporting substitution of high-quality simulations
tact in practice settings, and maintaining competence for up to half of traditional clinical hours in prelicensure
challenge many advanced practice nursing education pro- undergraduate nursing programs (Alexander et al., 2015), ev-
grams. Innovative approaches to education and curricular idence from graduate advanced practice nursing education
transformation suggest that an increased use of simulation programs is lacking. A recent systematic review comparing
can lead to increased knowledge, confidence, and practice high-fidelity simulation to online or traditional classroom lec-
skills without jeopardizing patient/health care safety. A tures also reported limited evidence to support the use of simu-
range of simulation modalities are being used to achieve lation within nurse practitioner programs (Warren, Luctkar-
specific learning outcomes, from technical skills to commu- Flude, Godfrey, & Lukewich, 2016). Although results of this
nication and teamwork skills. Simulation has added value review suggest that high-fidelity simulation improved student
in many advanced practice nursing education programs, knowledge, confidence, and satisfaction, more evidence to
and this is clearly evident in the high caliber of manuscripts evaluate the theory-to-practice gaps, effectiveness of simula-
published in this special issue. tion training within graduate education, and the impact of
We sought manuscripts that presented data derived from simulation on patient outcomes is needed.
the following topics: (a) quantitative, qualitative, or mixed The manuscripts accepted for this special issue address
methods studies; (b) emerging practice issues; (c) topics some of these theory-to-practice gaps. Guido-Sanz and
related to complex patient care, transitions of care, colleagues’ (in this issue) described the process for
continued competence, quality of care, cultural proficiency, simulation design and case development using the Interna-
mentorship, team/health care dynamics, communication, tional Nursing Association for Clinical Simulation and
and conflict resolution; and (d) recommendations for Learning Standards of Best Practice for Simulation and
advancing effective nursing practice, education, and Jeffries Simulation Theory in ‘‘Role Transition and
research. We are very pleased with the selection of ten Communication in Graduate Education: The Process’’.
manuscripts for this special issue on the topic Simulation in Anecdotal results suggested that a high-fidelity unfolding
Advanced Practice Nursing. case simulation improved intraprofessional communication
The manuscripts chosen for this special issue address and role transition between undergraduate and adult
education of advanced practice nurses using simulation, and gerontology acute care nurse practitioner students. La-
others include a research or evaluation component of using Manna and colleagues’ (in this issue) discussed the
simulation with advanced practice nurses. Nye and col- resource, procedural, and technical items to support
leagues’ (in this issue) conducted a survey of advanced diagnostic reasoning and clinical decision-making to use
practice nursing programs in the United States and simulation in graduate education in ‘‘Teaching Diagnostic

1876-1399/$ - see front matter Ó 2018 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.ecns.2018.11.004
Simulation in Advanced Practice Nursing 2

Reasoning to Advanced Practice Nurses: Positives and create meaningful learning experiences for all Advanced
Negatives’’. Kelly, Blunt and Nestor (in this issue) also Practice Registered Nurse students, and the challenges are
described ‘‘After-Hours/On-Call Simulation in Primary many. Anderson and colleagues’ (in this issue) encourage
Care Nurse Practitioner Education’’ and its effect on us to bravely risk and innovate to meet this goal. This inno-
critical thinking and decision-making. In this manuscript, vation can begin with dialog and collaboration.
the authors suggested that almost 50% of nurse practitioner
roles could include after-hour and on-call duties, yet just Monica Parry, MEd, MSc, NP-Adult, PhD, CCN(C)
over 10% of practicing nurse practitioners covered this in Associate Professor and Coordinator
their graduate education. After participation in this after- Nurse Practitioner Programs
hour/on-call simulation using standardized patients, stu- Lawrence S. Bloomberg Faculty of Nursing
dents were able to practice a skill expected by employers. 155 College Street, Suite 130, Toronto
The simulation provided concrete experiences that students ON M5T 1P8, Canada
continued to use up to one year after graduation. E-mail address: [email protected]
All ten manuscripts accepted for this special issue
contribute to our knowledge in simulation in advanced Mary K. Fey, PhD, RN, CHSE-A, ANEF
practice nursing. Some offer recommendations for the Associate Director
infrastructure, people, and processes necessary for quality Institute for Medical Simulation
simulation in advanced practice nursing. This information Center for Medical Simulation
forms a basis to assist us to push beyond assessing student 100 1st Ave, Boston, MA 02129
knowledge, confidence, and satisfaction to more formal E-mail address: [email protected]
evaluations of the effectiveness of simulation training
within graduate education and the impact simulation has
on patient outcomes. The National Council of State Boards
of Nursing’s view to support the substitution of high-quality
References
simulations for up to half of traditional clinical hours in Alexander, M., Durham, C. F., Hooper, J. I., Jeffries, P., Goldman, N.,
prelicensure undergraduate nursing programs (Alexander Kardong-Edgren, S., ., & Tillman, C. (2015). NCSBN simulation
et al., 2015) is one solution for inadequate opportunities guidelines for prelicensure nursing programs. Journal of Nursing
for hands-on undergraduate clinical experiences. This is Regulation, 6(3), 39-42. https://doi.org/10.1016/S2155-8256(15)
30783-3
not unlike many advanced practice nursing programs that
Warren, J. N., Luctkar-Flude, M., Godfrey, C., & Lukewich, J. (2016). A
struggle to secure an adequate depth and breadth of clinical systematic review of the effectiveness of simulation-based education
experiences for graduate students. Nurse educators in on satisfaction and learning outcomes in nurse practitioner programs.
Advanced Practice Registered Nurse programs strive to Nurse Education Today, 46, 99-108.

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