From Your Nursing Professor The Simulation Edition

Simulation makes nursing students nervous.

I know.

You're being watched. Your classmates are watching. Someone is probably sitting behind a computer somewhere controlling the mannequin. You know something is going to happen, but you don't know what.

And then we're asking you to walk into the room and act like you're the nurse.

That's intimidating.

But here's something I wish I could convince every nursing student of before they walk into a simulation: You are probably not going to do anything we haven't seen before.

I spent five years as a director of simulation. At one point, my department was running as many as 30 simulations a week. At this point, I've watched thousands of nursing simulations.

I've seen a lot. Actually, I've seen it all. And then some.

I Promise, You Are Not Going to Shock Me

I've watched a student perform CPR on a mannequin while the mannequin repeatedly begged them to stop.

I've watched a student go through six pairs of sterile gloves trying to get them on without breaking sterile technique.

I've watched students freeze. I've watched students cry. I've watched students make decisions that caused a simulated patient to deteriorate.

And I've watched a mannequin code while the student looked at it and said: “Huh. I didn't expect that.”

And then walked out of the room.

So when you come out of a simulation horrified because you forgot to reassess the patient or gave a terrible SBAR, please understand: You're going to have to work pretty hard to give me a story I haven't heard before.

Whatever just happened probably felt enormous to you. To the simulation faculty? We've seen some version of it before.

Yes, We Know You're Nervous

Students sometimes apologize for being nervous during simulation. You don't need to. Of course you're nervous. You're being asked to make decisions while faculty members are watching you. Your classmates may be watching you. There's a mannequin talking to you. There are monitors alarming.

You're trying to remember what you learned in class while simultaneously remembering where the oxygen is, how to use the equipment, what you're allowed to do, what you're supposed to say, and whether you're forgetting something incredibly obvious.

That's a lot.

We know the environment itself can create anxiety. The goal isn't to make you anxious. But there is something about that pressure that is also surprisingly realistic.

Because someday you may be doing something with a physician standing beside you watching. You may have another nurse watching. You will almost certainly have family members watching.

Closely. Sometimes very closely.

You'll have alarms going off, people asking you questions, and someone waiting for you to decide what happens next.

Learning to think while other people are in the room is part of becoming a nurse.

Your Classmates Probably Would Have Done the Same Thing

I know having your peers watch you can be one of the worst parts of simulation. You make a mistake and immediately think: Everyone just saw that.

They did.

But here's something I've learned from years of debriefing simulations. A student will make a mistake. We'll get to debriefing. I'll ask the rest of the group: “Be honest. How many of you would have done the same thing?”

And probably 75% of the room raises their hands. Sometimes almost everyone does.

Students observing aren't sitting there thinking: I can't believe they did that. A lot of them are thinking: That's exactly what I would have done.

You aren't only learning from your own simulation. You're learning from each other. Sometimes watching someone else make a decision, and then seeing what happens because of that decision, is just as valuable as being the person inside the room.

It's Okay to Cry

I've seen plenty of students cry during simulation. Sometimes they're overwhelmed. Sometimes they're frustrated with themselves. Sometimes something about the scenario hits close to home. And sometimes they care so much about doing well that when they think they didn't, the emotions come out.

That's okay. I've told students before: Sometimes you're crying because you care. You wanted to help the patient. You wanted to know what to do. You wanted to get it right. And when you feel like you didn't, that can be upsetting.

Take a minute.

We're still going to talk about what happened. We're still going to learn from it. Crying doesn't change that.

You Are Allowed to Make a Mistake Here

This may be the most important thing I can tell you about simulation. It is okay to make a mistake.

Really.

Simulation is one of the few places in nursing school where we can actually let you make certain decisions and see what happens.

Think about clinical.

If you're about to do something that could seriously harm a real patient, your instructor or the nurse isn't going to stand across the room thinking: Let's see how this plays out.

We're going to stop you. We have to. There's a real person in that bed. But simulation gives us something we don't always have in the hospital. We can let the scenario unfold.

You get to be the nurse. You get to make the decision. And then you get to see the outcome of that decision. Sometimes you make the right decision and the patient improves. Sometimes you don't.

And that's when things can get really interesting. Because now we have something to talk about.

Sometimes the Mistake Is the Best Part

That probably sounds strange coming from someone who spent years running simulation. But some of the best learning I've seen in simulation has happened after something went wrong.

You missed a cue. Okay. Why did you miss it?

You chose an intervention that didn't work. What information were you using when you made that decision?

You didn't recognize that the patient was deteriorating. What were you focused on instead?

You waited too long to call for help. What made you think you still had more time?

That's where simulation becomes valuable. Not because we caught you doing something wrong. Because now we can slow the whole situation down and look at how you were thinking.

And then you get another chance to think differently the next time.

Yes, We're Going to Talk About Your Mistakes

This is the part I don't want to sugarcoat. It's okay to make mistakes in simulation. That doesn't mean we're going to pretend they didn't happen. We're going to talk about them. That's what debriefing is for.

If your decision wasn't safe, we're going to discuss why. If you missed something important, we're going to go back and find it. If there was another action that should have happened first, we're going to talk through it. If you didn't know something, we'll figure out what you need to know next time.

That conversation isn't happening because we're angry with you. And it isn't happening because we're collecting evidence that you're bad at nursing. The conversation is the point. If we let you make a mistake and then never helped you understand what happened, we wouldn't be doing our job.

You Might Be Doing Something for the First Time

I think students sometimes forget this. Maybe you learned about the skill in class. Maybe you watched a video. Maybe you practiced part of it in lab. But now you're being asked to use it while managing an entire patient situation.

That may be the first time you've ever done that. Why would you expect yourself to be great at it?

Think about almost anything else you've learned to do. You weren't excellent the first time. Nursing skills aren't magically different because you're wearing scrubs. Sometimes simulation is where you discover that knowing the steps and actually performing them while caring for a patient are two very different things.

That's why you're practicing.

We Aren't Expecting Perfect Nursing

When I watch a simulation, I'm not expecting to see an experienced nurse walk into the room. I'm watching a nursing student. There's a difference.

You're learning how to recognize what matters. You're learning how to make decisions. You're learning when to act. You're learning when to ask for help. You're learning how to communicate. You're learning how to do all of those things at the same time.

That's hard.

And you're going to be imperfect while you're learning it.

The Mannequin Will Be Fine

I've watched thousands of simulations. I've seen students make excellent decisions. I've seen students make decisions that went very differently than they expected. I've seen panic, laughter, tears, complete silence, and some truly creative nursing interventions.

And after all of those years, the thing I wish students worried about less is looking perfect. That's not what simulation is for.

Come in. Be the nurse. Make the decisions. See what happens.

And if you make a mistake, we'll talk about it. That's not the part of simulation that went wrong. That's often the part where the learning starts.

And don't worry.

The mannequin will be fine.