1. Enhancing Clinical Competencies using Multi-Patient Simulations Julie Fomenko, MSN, RN Susan Greathouse, MSN, BN, RN Texas A & M University-Corpus Christi Corpus Christi, Texas Presented at the Human Patient Simulation Network World 2016 Conference, Tampa, FL February 16-18, 2016

2. Objectives Discuss gaps between nursing education & practice Outline development of multi-patient simulation (MPS) at TAMU-CC’s Islander Regional Hospital Describe the incorporation of Interprofessional Education (IPE) activities into our multi-patient simulation experiences Discuss challenges regarding the use of multi-patient simulations in nursing curricula

3. Texas A&M - Corpus Christi

4. Background  Healthcare in rapid state of change (Mills & Mullins, 2008; Wu, Fox, Stoke, & Adams, 2012)  Significant nurse shortages & issues with nurse retention (American Association of Colleges of Nursing, 2013; Bureau of Labor Statistics, 2015; Mills & Mullins, 2008)  Graduate nurses-difficulties with critical thinking & clinical competencies (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014)  35% of graduate nurses meeting entry level expectations per nurse leadership (Bowles & Candela, 2008; Chunta & Edwards, 2013; del Bueno, 2005)

5. Issues Impacting Clinical Competency Difficulties with application of knowledge, skills, & attitudes (KSAs) First attempt NCLEX struggles Unprepared for management/supervision Student clinical experience & site concerns Faculty issues Retention of new graduates

6. Professional Guidelines INACSL Standards of Simulation - Best Practices NCSBN Simulation Guidelines 2014 IPE Core Competencies

7. IPE Core Competencies Transcending boundaries to transform learning (Interprofessional Education Collaborative, 2011)

8. Benner’s Novice to Expert Theory Learning is experiential Learning is situational 5 stages of development in clinical competence Highlights the educators' role in student progression (Benner,1984)

9. (NLN/Jeffries Simulation Framework, 2012)

10. Simulation Design Characteristics Simulation Objectives Utilize KSAs expected of a novice nurse to provide competent, evidenced-based nursing care

11. Simulation Design Characteristics Demonstrate clinical judgment & critical thinking as a novice nurse, enabling accurate & safe individualized care

12. Simulation Design Characteristics Demonstrate effective communication among health care team members supporting collaboration & provision of optimal patient care

13. Simulation Objectives Critically evaluate one’s actions (or failures to act) within one’s scope of practice & as a member of an interprofessional health care team

14. Simulation Design Characteristics Fidelity

15. Simulation Design Characteristics Problem Solving & Student Support

16. Simulation Design Characteristics Debriefing

17. Challenges Realism “The instructor behind the screen” Communication Roles Preparation Staffing Evaluation

18. Feedback Survey Tools Students Community Partners Instructors IPE

19. Future Directions Refinement of IPE Learning Objectives Analysis of Data Evaluation Tool for MPS Impact on Patient Outcomes Enhancing Realism Electronic Health Records

20. Acknowledgments Thank you to the Texas Higher Education Coordinating Board for their support & funds through the Nursing Innovation Grant Program Thank you to the faculty & administration of TAMU-CC College of Nursing & Health Sciences

21. Selected References American Association of Colleges of Nursing (2013). Annual survey of baccalaureate and graduate nursing programs 2012-2013. Retrieved from http://www.aacn.nche.edu/media-relations/NrsgShortageFS.pdf. Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Upper Saddle River, NJ: Prentice Hall Publishers. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. Stanford, CA: The Carnegie Foundation for the Advancement of Teaching. Bureau of Labor Statistics. (2015). Registered Nurses. Retrieved from http://www.bls.gov/ooh/healthcare/registered-nurses.htm. Bowles, C., & Candela, L. (2008). Recent RN graduate perceptions of educational preparation. Nursing Educational Perspectives, 29(5), 266- 271. Chunta, K., & Edwards, T. (2013). Multiple-patient simulation to transition students to clinical practice. Clinical Simulation in Nursing,9(11), e491-e496. Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in pre-licensure nursing education. Journal of Nursing Regulation, 5(2), S1-S64. Interprofessional Education Collaborative. (2011). Core competencies for interprofessional collaborative practice. Retrieved from http://www.aacn.nche.edu/education-resources/ipecreport.pdf. Jeffries, P. (2016). The NLN Jeffries simulation theory. Philadelphia, PA: Wolters Kluwer. Mills, J. F., & Mullins, A. C. (2008). The California nurse mentor project: Every nurse deserves a mentor. Nursing Economics, 26(5), 310-315. Todd. M., Manz, J. A., Hawkins, K. S., Parsons, M. E., & Hercinger, M. (2008). The Development of a quantitative evaluation tool for simulations in nursing education. International Journal of Nursing Education Scholarship, 5(1), 1-17. Wu, T. Y., Fox, D. P., Stokes, C., & Adam, C. (2012). Work-related stress and intention to quit in newly graduated nurses. Nurse Education Today, 32(6), 669-674. doi:10.1016/j.nedt.2011.09.002

22. Thank you julie.fomenko@tamucc.edu susan.greathouse@tamucc.edu Texas A&M University-Corpus Christi