Virtual Clinical Experiences in Nursing Education Today

Introduction

Even as the United States struggles to cope with a critical nationwide shortage of nurses, existing nursing education programs are unable to meet the demand for unlicensed nursing students to gain real-world clinical experiences. In response, a growing number of vendors and nursing education programs are integrating virtual clinical experiences into the nursing curriculum. These virtual clinical experiences are especially effective because many young nursing students have grown up with computer-based technologies and readily understand how the process operates. The purpose of this paper is to provide the results of a review of online, peer-reviewed, and scholarly resources concerning these issues, followed by a summary of the research and important findings on the integration of virtual clinical experiences into the nursing education curriculum today.

There is a growing emphasis on integrating virtual clinical experiences into the nursing education curriculum in response to a shortage of opportunities for real-world clinical experiences, as well as the mandates of the Affordable Care Act, which underscored the need for increased use of electronic health information systems to support transparency and patient-data transferability to healthcare providers across the country (Allen, 2013). As a result, nursing students today must possess a new skill set that includes a comprehensive understanding of how to access and analyze data appropriately, as well as how to use this information for quality improvement initiatives intended to improve patient care and clinical outcomes (Allen, 2014). In sum, nursing students are already learning the skills needed to benefit from virtual clinical experiences.

Current Virtual Clinical Experience Literature in Nursing

One of the more rigorous curricular requirements for nursing students at present is completing so-called "clinicals." While these real-world training experiences are essential, they can also be taxing for both students and nursing educators. According to nursing consultants at Lippincott Nursing Education, "A key part of nursing education is participating in clinicals, which is basically following real nurses around and interacting with real patients" (para. 3). Clinical experiences are an integral and indispensable part of the nursing education process. As one nursing program explains:

"For nearly all professionals outside of healthcare, internships are a rite of passage along the way toward a higher education degree or post-graduation employment. For nurses, however, the traditional 'internship' has a different spin: clinical experience. For all intents and purposes, clinical experience is to nurses what an internship is to business students, and clinical experiences for nurses provide important insight and practice that may improve patient care in the future" (The importance of clinical experience, 2018, para. 2).

Although it is reasonable to suggest that virtual clinical experiences cannot replace traditional hands-on experiences altogether, it is also becoming increasingly apparent that this learning strategy can provide a wide array of benefits. The Lippincott consultants add that traditional clinicals are "an invaluable opportunity for nursing students to get hands-on experience with patients in the workplace. But the reality is, not all hospitals are able to accommodate the demand from nursing education programs to have unlicensed trainees throughout their facility" (Limited clinical sites for nursing students, 2017).

The integration of virtual clinical experiences into the traditional nursing education curriculum can also help mitigate problems associated with the provision of traditional clinicals. The United States is currently experiencing a severe shortage of nurses of all types (Nardi & Gyurko, 2015), and many nursing schools are restricting their enrollment levels due to a lack of opportunities for students to participate in traditional clinical experiences (Limited clinical sites for nursing students, 2017). These constraints are especially acute in nursing specialty programs such as psychiatric mental health or maternity-pediatrics (Limited clinical sites for nursing students, 2017). According to the consultants at Lippincott, "There is a silver lining to the issue of having limited clinical sites for nursing students [because] there is a growing acceptance of nursing schools replacing clinical hours with virtual simulations, which allow students to experience many different patient scenarios hands-on, from the safety of the classroom" (Limited clinical sites for nursing students, 2017, para. 4).

Virtual clinical experiences differ in some fundamental ways from traditional clinicals, but both approaches share many of the same beneficial outcomes as well as some additional advantages. The traditional clinical experience involves a nursing educator accompanying a group of nursing students to a clinical site, where students receive assignments to care for one or two patients for the day (Limited clinical sites for nursing students, 2017). This traditional approach means that the nursing educator is required to spend time with each student during specific tasks such as medication administration or psychomotor skills, often resulting in an exhausted educator and students who only benefited from a small amount of personal attention — meaning they likely failed to make any meaningful decisions concerning patient care (Limited clinical sites for nursing students, 2017).

Consequently, guidance from the Lippincott Nursing Educator website emphasizes that, "Due to this lack of decision-making, it is difficult to assess whether or not the student has understood the complexity of the health care environment and the need to multitask and problem solve — critical skills for clinical practice" (Limited clinical sites for nursing students, 2017, para. 5).

Taken together, it is clear that providing virtual clinical experiences in the form of simulations represents a timely and valuable enterprise. In a virtual clinical experience context, simulation is defined as "a technique rather than a technology that is able to provide realistic environments or practice proxies for the purposes of learning, training, and practice" (Sanko, 2017, p. 22). The advantages of using simulations for nursing clinicals include the following:

Is Virtual Clinical Experience Being Used in Nursing?

While additional research in this area is needed, the empirical evidence from various pilot programs and studies across the country provides ample proof of the efficacy of virtual clinical experiences in helping nursing students acquire the skills they need to transition to the actual workplace. One such initiative has been implemented by New York University, where nursing students receive fully half of their clinical hours through clinical simulations (Limited clinical sites for nursing students, 2017). This initiative resulted in a corresponding 50% increase in the university's nursing faculty capacity and allowed enrollment to grow from 613 students in 2007 to 900 in 2012, with no negative effects on student outcomes or faculty work-life balance (Limited clinical sites for nursing students, 2017).

Likewise, a study by Grady (2011) concerning the efficacy of a virtual clinical experience initiative showed that it provided comparable learning experiences to traditional clinicals, along with some additional benefits. Grady (2011) reports that the program was "a successful method of clinical nursing education, offering students exposure to clinical situations not available by other means" (p. 194). In addition, the virtual clinical experience program provided individualized instruction to nursing students that is not possible through traditional clinical experience. Grady concludes that, "Opportunities for dialogue, critical reflection, and synthesis allowed students to experience the benefits of a traditional experience, enhanced through technology and tailored to the specific needs of the students" (2011, p. 194).

Conclusion

The day may come — and it may be sooner than many expect — when all nursing clinical experiences are provided in a virtual format, especially given the current trends in their popularity across the country and the growing number of commercial vendors offering specialized virtual clinical products for various nursing programs and specialty areas. At present, the research is consistent in showing that clinical experiences are an essential part of any nursing program, but the traditional model is fraught with constraints and limitations that make the addition of virtual clinical experiences to the nursing education curriculum a valuable and timely enterprise. It is reasonable to conclude that most, if not all, students entering nursing programs today and in the future will receive at least part of their clinical experiences in a virtual format.

References

Allen, P. (2013, May). Preparing nurses for tomorrow's healthcare system. American Nurse Today, 8(5), 46–49.

Barry, J. & Hardiker, N. R. (2012, September). Advancing nursing practice through social media: A global perspective. Online Journal of Issues in Nursing, 17(3), 9–12.

Godsall, L. & Foronda, C. (2012, May 1). Instructional design as a change agent in a school of nursing. Distance Learning, 9(3), 1–4.

Grady, J. L. (2011, May/June). The virtual clinical practicum: An innovative telehealth model for clinical nursing education. Nursing Education Perspectives, 32(3), 189–192.

Limited clinical sites for nursing students. (2017). Lippincott Nursing Educator. Retrieved from http://nursingeducation.lww.com/blog.entry.html/2017/03/26/limited_clinicalsit-lA99.html.

Nardi, D. A. & Gyurko, C. C. (2015, September). The global nursing faculty shortage: Status and solutions for change. Journal of Nursing Scholarship, 45(3), 317–321.

Sanko, J. S. (2017, January 1). Simulation as a teaching technology: A brief history of its use in nursing education. Distance Learning, 14(1), 21–24.

The importance of clinical experience. (2018). Retrieved from https://onlinenursing.duq.edu/blog/importance-clinical-experience-nursing-internship/.

Weideman, Y. L. & Culleiton, A. L. (2014, November/December). A virtual pregnancy for pre-licensure nursing students: Nine months up and close. Nursing Education Perspectives, 35(6), 410–414.