Learning never stops for nurses and nurse educators. We frequently update the resources here to make it easy for you to keep up on research, reports and articles from industry thought leaders.

Eileen C. Thomas, PhD, RN

January 2017


The Institute of Medicine made a recommendation that 80% of all nurses possess a minimum of a bachelor of science in nursing degree by 2020 (Institute of Medicine, 2011). As a result of an influx of nurses returning to school, the shortage of public/community health clinical practice sites led to competition between schools for student placements in community settings. Finding appropriate clinical practice sites has become a challenge, not only for nursing students but also for students in all practice-disciplines with a required clinical or practice experience component. Immersive learning in a virtual environment effectively addresses the problem of identifying and securing appropriate community-based sites for practice experiences and provides a safe environment for students to learn how to conduct a windshield survey.

Key Points

  • Simulation, commonly used as a supplemental educational strategy to teach healthcare professional students hands-on skills, has become a valuable tool to provide practical experiences in a safe environment before students are expected to function in real-world acute care clinical settings.
  • Finding clinical practice sites in community settings has become a challenge and resulted in competition between schools for student placements in the community.
  • The use of simulation in nursing education provides opportunities for students to learn and apply critical thinking skills and theoretical principles of nursing care in a safe environment. Immersive virtual environments can be used to teach community/public health concepts such as community assessment by conducting a windshield survey.
  • Virtual environments can be used in a variety of programs outside of nursing and can be a valuable immersive learning experience for students in many different practice disciplines with a required clinical or practice experience component.

Keywords: immersive learning, finding appropriate clinical practice sites, windshield survey

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Robyn P. Cant, Simon J. Cooper

Journal of Nursing Education and Practice 2015, Vol. 5, No. 11


E-simulation involves goal-based role play using digital simulations that take place via a computer screen. Learners interact with the program via multi-media applications such as animation and video, graphics, sound, vision, and text through the use of advanced Web authoring tools. When the simulation is Web-based (via a remote server), this allows data collection and real-time feedback. We aimed to explore how the Internet has been utilized for the purposes of e-simulation in healthcare education.

Key Points

  • E-simulation involves learners in goal-based role-play using digital simulations that take place via a computer screen. These programs depict real-life clinical case situations to engage the learner in problem-solving.
  • Some studies of e-simulation (with programs based either locally on a personal computer, or on the worldwide web) have been shown to be largely as effective as other teaching methods in teaching clinical skills. For example, a randomized controlled trial involving first-year nursing students in learning pre- and post-operative skills on a computer screen or in a skills laboratory had similar learning outcomes
  • The time is right for greater distribution and sharing of Web-based simulation resources for teaching in both undergraduate and at professional levels.  Web-based simulation programs are a valuable resource that can be used in combination with traditional forms of laboratory and classroom teaching, in order to facilitate the development of students’ clinical competence.

Keywords: clinical simulation, simulation education, virtual learning environments, e-simulation in healthcare education

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The INACSL Standards Committee

Simulation operations encompass the infrastructure, people, and processes necessary for implementation of an effective and efficient simulation-based education (SBE) program. The interactions of these pieces must form a system that integrates with larger educational and health care entities to realize the goals of SBE. SBE is no longer an adjunct to health care training and/or professional development programs but an all-inclusive integrated program requiring business acumen and technically knowledgeable personnel that serve as team members providing leadership and support in the delivery of SBE. The required knowledge, skills, and attributes to implement evidence-based best practices for simulation experiences are evolving rapidly.

The International Nursing Association for Clinical Simulation and Learning (INACSL) is the global leader in transforming practice to improve patient safety through excellence in health care simulation. INACSL is a community of practice for simulation where members can network with simulation leaders, educators, researchers, and industry partners. INACSL also provides the INACSL Standards of Best Practice: Simulations, an evidence-based framework to guide simulation design, implementation, debriefing, evaluation, and research

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Suling Li, PhD, RN

National Council of State Boards of Nursing

In this presentation, Suling Li discusses the role of simulation in nursing education, the rise of technology in learning and the trend toward outcome-based nursing education. Furthermore, she points out that the rationale behind trends includes overcoming faculty shortages and the lack of clinical sites.

The strengths and weaknesses of virtual patient simulations are discussed, and a key question posed is: What is the role of simulation in nursing education in relation to clinical education? Potential advantages include:

  • Reduces training variability and increases standardization
  • Guarantees experience for every student
  • Can be customized for individualized learning
  • Is more accurate reflective learning especially with HPS
  • Is student-centered learning
  • Allows independent critical-thinking and decision-making, and delegation
  • Allows Immediate feedback
  • Offers opportunity to practice rare and critical events
  • Can be designed and manipulated
  • Allows calibration and update
  • Can be reproduced
  • Occurs on schedule
  • Offers opportunities to make and learn from mistakes
  • Is safe and respectful for patients
  • Allows deliberative practice
  • Uses the concept of experiential learning

Li also explores the value of other nursing education options as well as the goal of NCSBN’s Research Initiative on Simulation: “To explore the role of high fidelity simulation in basic nursing education in relation to real clinical experience.”

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Published November 15, 2017

It has come to our attention that misinformation about AACN’s position on the use of simulation in nursing education has been circulating within our community of interest. To set the record straight, we would like to clarify that AACN does not prohibit the use of simulation in offering quality clinical learning experiences. In addition, none of AACN’s current task forces are working on statements that would curtail the use of simulation. Further, the Commission on Collegiate Nursing Education (CCNE), AACN’s autonomous accrediting arm, encourages innovative practices, including the use of simulation, so long as there are also direct-care clinical practice experiences (all experiences cannot be replaced by simulation). Some state boards of nursing regulate the number of clinical learning hours that can be completed via simulation in schools of nursing within their states. Some national certification bodies additionally require a minimum number of direct-care clinical hours for exam eligibility purposes. Please address any questions about the use of simulation to AACN’s Chief Communications Officer, Robert Rosseter, at rrosseter@aacnnursing.org.

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Journal for Nurses in Professional Development

November/December 2012, Volume 28 Number 6, p 260 – 269


Currently, high-fidelity simulations (HFS) are widely used in nursing education and are being introduced into acute care to assist with orientation programs, continuing education, certification courses, and staff development. In a review of the literature, many articles were found that describe HFS and its advantages and how to use the technology. But, there are few research studies to support the use. Upon completion of a review of the literature and an analysis of utility, the data do not clearly show that HFS is the best practice for the orientation and education of staff nurses. Overall, HFS is recognized as a safe way to learn, and most nurses like participating in HFSs. However, before the healthcare industry continues on this journey of widespread adoption of HFSs, more research needs to be done to show that the increased skills and knowledge of the nurse obtained through simulation does translate into safer patient care and better patient outcomes.

Key Points

  • Please note: this article discusses the use of mannikins and e-learning.
  • HFS is defined as “a technique, not a technology, to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion.”
  • Newly graduated nurses come to healthcare settings expecting simulations to be a part of their continuing education, so the use of simulation by staff development is no longer an option. The learning needs of the Baby Boomers, Generation Xers, and Millennials are all addressed by HFSs. 
  • Although the research is limited to support some of the claims about the benefits, indicators point to HFS as a tool to assist with the acquisition of knowledge, confidence, and possibly, critical thinking skills by both new graduates and experienced nurses in a risk-free, experiential learning environment.

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July 2014  Volume 5, Issue 2


Providing high-quality clinical experiences for students has been a perennial challenge for nursing programs. Short patient length of stays, high patient acuity, disparities in learning experiences, and the amount of time instructors spend supervising skills have long been issues. More recently, other challenges have emerged: more programs competing for limited clinical sites, faculty shortages, facilities not granting students access to electronic medical records, and patient safety initiatives that decrease the number of students allowed on a patient unit or restrict their activity to observing care.

Key Points

  • The use of this technology accelerated in nursing programs in the mid-2000s as faculty realized that simulation allowed students to practice skills, critical thinking, and clinical decision making in a safe environment.
  • With the challenges of providing high-quality clinical experiences and the availability of high-fidelity manikins, the use of simulation in nursing education has grown rapidly.
  • Simulated clinical experiences include simulation scenarios involved medium- or high-fidelity manikins, standardized patients, role playing, skills stations and computer-based critical thinking simulations.

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American Association of Colleges of Nursing

The use of simulations in nursing, including interactive nursing simulations, has generated a great deal of discussion in the nursing community. Questions range from “how does the CCNE define clinical practice experiences“ to “Can simulation replace ‘traditional’ clinical practice experience? How much simulation is acceptable”?

As an organization committed to helping increase the quality of education and providing nurse educators with tools to help them better teach critical skills such as critical thinking, we encourage the discussion.

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Clinical Simulation in Nursing, 12(S), S5-S12. INACSL Standards of Best Practice: SimulationSM Simulation Design

Simulation technologies, including the immersive e-learning clinical virtual simulations (CVS) and solutions that Healthcare Learning Innovations develops, are offering a new avenue for teaching and achieving the learning outcomes that nursing programs, clinics and hospitals strive for.


Standardized simulation design provides a framework for developing effective simulation-based experiences. The design of simulation-based experiences incorporates best practices from adult learning, education, instructional design, clinical standards of care, evaluation, and simulation pedagogy. Purposeful simulation design promotes essential structure, process, and outcomes that are consistent with programmatic goals and/or institutional mission. The design of effective health care simulations facilitates consistent outcomes and strengthens the overall value of the simulation-based experience in all settings.

All simulation-based experiences require purposeful and systematic, yet flexible and cyclical planning. To achieve expected outcomes, the design and development of simulations should consider criteria that facilitate the effectiveness of simulation-based experiences.

Potential consequences of not following this standard may include ineffective assessment of participants and inability of participants to meet identified objectives or achieve expected outcomes. In addition, not following this standard can result in suboptimal or inefficient utilization of resources when designing simulation activities.

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Presented by Laurie Posey (The George Washington University, USA)

Online Learning Consortium Blended Learning Conference and Workshop, 2014

The George Washington University School of Nursing’s (GW SON) accelerated Bachelor of Science in Nursing (BSN) program requires students to complete a challenging curriculum within a compressed time frame, integrating dense clinical content with hands-on skills development. The new hybrid BSN program has been evaluated from a variety of perspectives. 

Blended learning enables educators to take advantage of the flexibility and active-learning benefits of the online environment while meeting students’ needs for clinical skills practice in a lab setting and guided instruction in the classroom. To provide assistance in realizing these benefits while expanding the reach of the program, the US Health Resources and Services Administration (HRSA) funded the Teaching and Transforming through Technology (T3) project to transition GW SON’s BSN program to a blended learning format.

In summary, transitioning any academic program to blended learning requires careful planning, from introducing students to a new way to learn, orienting and supporting faculty in the design and implementation of blended learning approaches, and designing courses and activities to ensure educational quality and effectiveness. As some students prefer traditional, classroom-based approaches, it is important to inform applicants of the blended format so that they can self-select into a program that is consistent with their preferred learning style. With careful planning and good instructional design, blended learning can increase active learning in the classroom and provide educators with flexibility to innovate and meet the demands of a fast-paced, challenging curriculum.

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Kathleen Huun, PhD

Indiana State University, Department of Baccalaureate Nursing Completion, Terre Haute, IN, USA 47809

Published by INACSL


Simulation has become commonplace yet must be expanded for distance/online nursing students. Evidence-based simulation entities (e-simulations, video simulation, and telepresence simulation) provide asynchronous and synchronous options. For quality assurance, the selected modality is best when aligned with Quality Matters (QM™) standards in the form of component design standards for ease of student and faculty use. A variety of simulation modalities are reviewed for component (simulation) design to provide high-quality simulation aligned with course design, delivery, and objectives for online/distance nursing students.

The full text of this publication is available on the INACSL site. However, key points include:

  • Virtual simulation must be used effectively in online undergraduate nursing programs.
  • The QM™ framework aids in the selection and integration of virtual simulation modes.
  • Virtual simulations aligned with QM™ offer ease of implementation and evaluation.
  • Virtual simulations aligned with QM™ course/component design enhance student success.
  • Virtual simulation primes students to navigate technology-based health care systems.

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José Miguel Padilha, RN, MScN, PhD, Paulo Puga Machado, RN, MScN, PhD, Ana Leonor Ribeiro, RN, MScN, PhD, José Luís Ramos, RN, MScN

The full text of this publication is available on the INACSL site.


The introduction of simulation has produced significant improvements in nursing education. The technological evolution gives way to new opportunities through new pedagogical strategies. Some limitations found in high-fidelity simulators can be overcome by clinical virtual simulation (CVS). However, little is known about students’ perceived ease, usefulness, and intention to use this new pedagogical strategy applied to nursing education. The aim of this study is to assess the ease, usefulness, and intention of pre-graduate nursing students to use a clinical virtual simulator.


The results showed an average of perceived ease to use the simulator of 8.99 (SD ± 1) and a perceived usefulness and intention of 9.60 (SD ± 0.55) to use the clinical virtual simulator in pre-graduate nursing education. Results also showed an average of 9.55 (SD ± 0.73) for relevance and an average of 9.71 points (SD ± 0.59) for the facilitator role of CVS in nursing education.


The pre-graduate nursing students revealed perceived ease, usefulness, and intention to use CVS as an important complementary strategy for their nursing education programs.

The full text of this publication is available on the INACSL site.

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By Rhea Kelly



A recent survey of thought leaders in the nursing field revealed that nursing education programs are accelerating adoption of virtual simulation and other cutting-edge technologies. The National League for Nursing Center for Innovation in Simulation and Technology, found that 65 percent of nursing education programs currently use virtual simulation to train students, 84 percent use instructional video for skill development and 75 percent employ online/distance learning. Rounding out the technology landscape:

  • Adaptive quizzing and testing (used by 64 percent of nursing programs);
  • Electronic health record applications (60 percent);
  • Integrated digital curriculum (49 percent);
  • Mobile apps (41 percent);
  • Social media (37 percent);
  • Facetime/videoconferencing (35 percent)
  • E-portfolios of student work (31 percent)

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Published by AACN, January 2019

As the voice of academic nursing, the American Association of Colleges of Nursing (AACN) serves as a catalyst for excellence and innovation in nursing education, research, and practice. This whitepaper discusses the challenges nurse educators and nursing programs face, and the use of a variety of teaching methods, including online education and adaptive learning.


To prepare graduates for the evolving healthcare system, programs will need to encompass didactic, simulated, and clinical field learning opportunities in diverse settings, including community, primary care, long-term care, acute care, hospice, and virtual care settings (telehealth).

A growing emphasis within the domain of learning science involves promoting active learning, e.g., the flipped classroom movement and personalized-paced learning. Priming for classroom learning (both actual and virtual) by creating self-study, and guided exposure to concepts and content (knowledge) followed by teacher coaching of knowledge application in the classroom holds much promise to enhance learning. For example, through a problem-based unfolding case study, learners are guided through multiple steps where previous knowledge must be recalled and applied to make clinical decisions.

Adaptive learning is evolving and has significant potential to facilitate the impact of teaching/learning. It uses computer technology (algorithms) that provide individualized responses based on student interactions (comprehension) in real-time, making the learning personalized. The field of adaptive learning encompasses artificial intelligence and other curricular technologies, using knowledge domains such as cognitive science, predictive analytics, and learning theory.

Access to online education and new technologies is growing. Increasingly, a design-build approach is being used with pairing of faculty with an instructional designer to promote innovation and effective teaching methods in the classroom. Such approaches help address limited resources, rising education costs, and demands to expand enrollments as well as diverse student learning styles. New models of instruction, inclusive of large class sizes, necessitate revised strategies for team teaching, utilization of preceptors and/or teaching assistants, and small group work, and for the testing of other advanced approaches driven by technology, such as Artificial Intelligence /Machine Learning. These options offer opportunities for multi-pronged approaches that facilitate student-centered learning.

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Trevor Rasmusson

Learning Innovation, American Sentinel University

John R. Bourne

Editor-in-Chief, International Journal on Innovations in Online Education

October 24, 2017


This paper was created to stimulate thinking about the art of the possible in using storytelling for online education. We explore the possibilities for storytelling, visualization, peer discussion, gamification, and interaction as a learning paradigm. Written for educators and instructional designers/technologists, this paper provides concrete ways to engage in digital nonlinear storytelling at no cost by using open source software.

This article as well as a downloadable PDF are found here:

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