Standards, Simulation, and Mentoring in Nursing Education

Criticisms of Educational Standards

There are a number of common criticisms of educational standards. The first is the concern that a predetermined set of standards creates a "teach to the test" mentality rather than truly educating students to be creative problem solvers. Another concern is that of equity in education: namely, that students with different learning styles, learning challenges, or socioeconomic obstacles are unfairly penalized by the format of standardized tests (What do critics of standards have to say?, 2004, Educational Broadcasting Corporation).

Most educators would agree, however, that standards must exist in some form — that is, every unit taught must have an objective for student learning and that students must have goals throughout the educational process. The concern lies in having standards imposed upon a classroom in a manner that is not truly appropriate for students' needs and is not conducive to process-based learning. Ultimately, learning is a process, not a destination. Feedback through the use of formative rather than summative assessments is essential so that teachers can adapt to learners; an excessive focus on testing can discourage this flexibility. Of course, professionals in the field must ultimately exhibit core competencies, but the objective is professional excellence — not creating good test takers. Test taking is necessary for certain phases of introducing nurses to the profession, such as passing a licensing exam, but not every component of a nursing educational program should be constructed with the sole aim of passing such a test.

The Value of Simulation in Nursing Education

Simulation exercises are particularly useful for kinesthetic learners and visual learners. People who learn by doing or by seeing are often at a disadvantage in a standard classroom environment. It is also essential, of course, that nursing students understand the academic rationale behind what they are doing so they can act independently in practice and make spontaneous decisions when necessary. However, material should be offered in many different ways within the learning environment to ensure that students grasp content beyond the purely theoretical level. As one expert explains, "simulation occurs whenever we use a synthetic environment to achieve learning outcomes… It can be as straightforward as using standardized patients, basic task trainers, high-fidelity simulators, or a surgical environment where you are using animal or cadaveric tissue. Any time you are creating a scenario that simulates the real thing and allows deliberate practice and feedback, you have a simulated experience" (Gabriel, 2013).

Simulation also provides a valuable bridge between life in the classroom and life in a work setting. Students can be evaluated against real workforce standards without any negative impact on actual patients' lives if they make mistakes. Although simulation technology can be expensive, the better it can replicate real-world experiences, the greater its instructive potential. The expense of malpractice litigation and lost lives is far greater — as is the cost of losing new nurses who quit when overwhelmed by the realities of clinical practice.

Building Competency and Autonomy Through Simulation

Nursing education should be viewed as a process of gradually giving students more core competencies and greater autonomy in the clinical setting. This may begin with simulations under close instructor guidance, so that students gain physical reinforcement from completing tasks while also understanding why they are performing them. Gradually, students can use simulation technology in a more autonomous fashion and begin to learn from their own experiences rather than from close instructor facilitation.

An ideal nurse is competent in both practice and knowledge. The nurse must have the kinesthetic confidence to perform tasks and cannot simply articulate theory about why certain procedures should be performed in a specific manner. At the same time, the nurse must understand why she is doing what she is doing in order to operate autonomously and not merely replicate rote tasks. In a skills laboratory, "simulation allows deliberate practice in a safe environment where you get an opportunity to learn procedures or team processes… It's a great opportunity to identify the kind of things you may overlook, the kind of things you don't even know you don't know" (Gabriel, 2013). Structured experiential learning of this kind supports both technical skill development and independent clinical reasoning.