Simulation is Crucial to Nursing Education, Says Joanna A. Hall


Simulation is Crucial to Nursing Education, Says Joanna A. Hall
Joanna A. Hall is a member of the International Nursing Association for Clinical Simulation & Learning. (Jason Burt)

Joanna A. Hall has been assistant professor and director of simulation at the University of Arkansas at Little Rock School of Nursing since August 2019. There she oversees the Center for Simulation Innovation, a 9,500-SF, 20-bed simulation hospital that takes nursing students through various patient scenarios. Before that, she worked 5½ years as a registered nurse specializing in cardiovascular issues at CHI St. Vincent in Little Rock.

Hall holds a master’s of nursing science degree from the University of Arkansas for Medical Sciences and two bachelor’s degrees — one in nursing and another in health science and community and health promotion — from UA Little Rock.

As it stands today, how behind is Arkansas in meeting the state’s nursing needs?

It’s difficult to pinpoint where, exactly, Arkansas falls related to meeting nursing demand ... In an effort to remain competitive in the now-national recruitment game, Arkansas has continued to raise nursing wages throughout the pandemic; however, a glaring weak link in the production line of new nurses is nurse educator pay. Investments in nurse educators are long-term investments in our health care system. Incentivizing nurse educators to come to Arkansas and, here’s the key, to stay in Arkansas is a long game approach but one that our state has ample opportunity to better meet. Our state is, however, proactively implementing partnerships between local health care institutions and those that train nurses to strengthen this pipeline and keep our highly skilled nurses in Arkansas.

Has the pandemic changed nursing in specific ways? How does the School of Nursing address those changes?

The pandemic changed arguably every aspect of nursing from content delivery in nursing education to day-to-day operations at the bedside. Specifically, the nursing landscape has completely changed with regard to staffing and workforce trends amid a sharp rise in nurse burnout. Gone are the days of nurses working for an organization for their entire career and retiring there. Now the health care landscape is overwhelmed by staff and travel nurses following the money with limited loyalty to any one organization. Pre-pandemic statistics indicated that over 40% of new nurses were leaving the profession within their first three years of practice. Newer statistics from the American Association of Critical Care Nursing (2021) show that 66% of acute and critical care nurses are contemplating leaving nursing. Aware of these alarming trends, the UA Little Rock School of Nursing is committed to exceptionally preparing our students for the reality of nursing practice. We recognize the important role of and need for access to simulation, and incorporate simulation-based learning experiences in every course of our nursing program. Allowing students the opportunity to experience the highs and lows of nursing in a safe simulation space fosters not only knowledge acquisition and skill mastery but personal growth, professional role development and necessary clinical judgment.

How important is simulation to a nursing education?

Simulation is arguably one of the more crucial aspects of nursing education. The theory aspects covered in class coupled with the student nurse experience in a traditional clinical setting converge in simulation. Students are able to take the knowledge they have acquired from class and clinical and put it into practice in simulation as a safe space to make mistakes and learn from them. We cannot guarantee every student will get to experience some of the higher-risk, lower-incidence medical issues such as a postpartum hemorrhage or heart attack in the traditional clinical setting; however, we can ensure every student gets to experience those types of scenarios in simulation. n

What does Arkansas need to do to catch up to the need for nurses?

Arkansas still has room for improvement in access to technology in nursing programs and health care organizations, especially in our more rural communities. It is well established that nursing simulation and technology enhance learner clinical judgment and skill development. At UA Little Rock, we know our investment in simulation fosters knowledge acquisition and prioritization and ultimately develops safer, more competent nurses. Simulation is no longer a novelty in nursing education, reserved only for well-funded schools or organizations; it is now an industry standard that should be in every nursing program and health care organization in our state. After all, the result of a better prepared nursing workforce is better care and better outcomes for all of Arkansas.

Are there specific barriers that some students face in getting critical nursing education?How can we overcome those?

One of the bigger lessons learned from the pandemic was how unequal the playing field is for many of our students. In an urban university with a somewhat nontraditional nursing student body, otherwise simple matters such as paying for books, finding child care to be able to attend class, or having Internet access to complete required tasks became significant barriers. We work to combat the barriers of lack of access and means by collaborating with community partners such as CHI St. Vincent, Saline Memorial Hospital and many more to provide scholarships and pathway programs. It takes a village to successfully graduate a nursing student; this is one of the many things the UA Little Rock School of Nursing does phenomenally well. Additionally, our college maintains a dedicated student support specialist to further support students with academic, emotional, personal and financial needs as they arise. Regardless of background, students should have as equal of an opportunity to be successful as possible. Systemwide support is one of the best tools we have to tackle many of these barriers.

Has the pandemic changed the game for nursing in any specific ways? How does the School of Nursing address those changes?

The pandemic changed arguably every aspect of nursing from content delivery in nursing education to day-to-day operations at the bedside. Specifically, the nursing landscape has completely changed with regard to staffing and workforce trends amid a sharp rise in nurse burnout. Gone are the days of nurses working for an organization for their entire career and retiring there. Now the health care landscape is overwhelmed by staff and travel nurses following the money with limited loyalty to any one organization. Pre-pandemic statistics indicated that over 40% of new nurses were leaving the profession within their first three years of practice. Newer statistics from the American Association of Critical Care Nursing (2021) show that 66% of acute and critical care nurses are contemplating leaving nursing. Aware of these alarming trends, the UA Little Rock School of Nursing is committed to exceptionally preparing our students for the reality of nursing practice. We recognize the important role of and need for access to simulation, and incorporate simulation-based learning experiences in every course of our nursing program. Allowing students the opportunity to experience the highs and lows of nursing in a safe simulation space fosters not only knowledge acquisition and skill mastery but personal growth, professional role development, and necessary clinical judgment. In our Center for Simulation Innovation, we firmly believe that enhancing student educational experiences with simulation renders them better prepared to meet the increasing physical, intellectual and emotional demands inherent to nursing. It is our hope that the early and often approach to simulation in our program will build resilience and set our students up for longer-term success in Arkansas’ health care industry.

Among your goals are advancing diversity, equity and inclusivity within the simulation center. Why is that important to nursing?

The first thing that comes to mind is Marian Wright Edelman’s quote “You can’t be what you can’t see.” Look around. What do you see? The communities we live in are infinitely different from appearance to background and everything in between. The nursing workforce should reflect the communities they are serving. Further, the nursing workforce should be prepared to take care of diverse populations in a culturally competent way. In central Arkansas we have a very diverse patient population that we want our students to be able to provide extraordinary care to regardless of presentation or preference. In this light, we foster diversity, equity and inclusivity practices in our simulation experiences. We stand on the belief that if we can provide a safe space for students to learn to communicate with and care for a wide variety of patients, they will be better prepared to engage and lead in an ever-changing, increasingly diverse health care landscape.

Running the center would seem to be a capital-intensive project. How do you go about getting the support you need to keep it going and, more importantly, keep up with new technology and methods?

Our Center for Simulation Innovation is immensely capital-intensive. We are able to keep our simulation center not just running, but thriving, with unwavering support from our school, university, industry partnerships and outside funding. Administration within the School of Nursing and UA Little Rock continue to believe in the greater vision we have for our simulation center and our path forward. Outside funding sources such as the Willard & Pat Walker Charitable Foundation continue to foster our growth, allowing us to acquire and maintain big-ticket items such as our new audiovisual system, simulation management platform and state-of-the-art manikins. We are always exploring additional grant and funding opportunities while working to bolster existing community partnerships and seeking new engagements to further support our growing simulation center and the future we envision. Without the support and financial backing of these supporters, we would not be able to have the significant impact we do on our students, our community and the future of nursing.