Simulation is great, but nursing students need more placements

Simulated learning – a technique for training nurses that replicates practical scenarios in a controlled environment – is an issue which combines two current political debates: the future of the NHS workforce and the role of technology in education.

Placements are seen as a solution to training more nurses, reducing the workloads of trained nurses and addressing the recruitment crisis currently facing the NHS.

But simulation raises questions about the role of technology in replacing hands-on experience within a clinical setting.

It is clear from our research that the notion of simulation “replacing” clinical placements is too simplistic. Indeed, innovations in the use of simulation, particularly at modern universities, promise significant benefits. Yet these benefits can only be realised through immediate investment in traditional clinical placements.

Placement requirement

Nursing requires its trainees to undertake in-depth practical training on clinical placements before they qualify. This requirement – currently set at 2,300 hours of placement training by the Nursing and Midwifery Council (NMC) – places a significant burden on both universities and the NHS.

The increased demand for nurses, combined with structural problems in the health service exacerbated by the pandemic, has seen the placement system beginning to creak. More and more time is being spent by universities trying to secure placements for their students, and the current shortage of clinical placements raises doubts as to whether promised increases to the number of domestically trained nurses can be delivered.

Simulated training is often proffered as an easy fix. Involving closely supervised training designed to replicate clinical practice, simulation expends less financial and human resources than clinical placements and, importantly, can be conducted away from a clinical setting. Examples include the use of virtual reality, high-fidelity mannequins and focused e-learning.

It is hardly surprising then that universities have fully embraced simulation. A recent MillionPlus report Who trains the nurses? Universities and the placements shortfall shows how modern universities have successfully invested in cutting-edge simulation, with many reporting reduced pressures on the placement system as a result.

Simulated confidence

MillionPlus institutions welcomed the decision by the NMC in January to double the maximum number of simulated training hours a student nurse can undertake from 300 to 600. However, the same universities recognise that simulation cannot and should not replace clinical placements. In fact, some of the benefits that come with simulation, rather than solving the problem, will instead increase pressure on placement capacity. Why? The answer is two-fold.

Improvements in student satisfaction arising from simulation promise to address a long-standing issue. Since 2008, the number of student nurses dropping out of their courses has remained stubbornly at around 25 per cent. Poor placement experiences are repeatedly cited as one of the top reasons for students leaving their studies.

However, simulated learning has seen dramatic improvements in the confidence and knowledge that students take to their clinical placements. This, in turn, has seen student satisfaction improve. While the long-term benefits of reductions in the number of students dropping out are obvious, short-term demand for clinical placements for students who would otherwise have dropped out is likely to increase, placing pressure on the system.

Staffordshire University and the University of Suffolk offer compelling real-world examples, both having successfully embedded simulation into their existing curricula. This has helped bridge the often-daunting divide between classroom learning and applying that knowledge in a clinical setting. The effect on student well-being as they embark on their clinical placements has been extremely positive.

Likewise, the use of simulation at University of East London has seen the confidence of students in their own skills and ability skyrocket, making for a more comfortable transition from classroom learning to a practice setting.

More training is now available for students seeking careers in areas where placement capacity is limited. And online sessions have given students greater access to practitioners from similar backgrounds to them. Seeing themselves reflected in the existing NHS workforce has instilled a sense of belonging in students and has seen student satisfaction improve.

Removing barriers

The second increase in pressure on the placement system emerging alongside the wider use of simulation comes from the ability of new technology to remove existing barriers to the nursing profession. This would see an increase in the supply of student nurses requiring clinical placements.

For instance, technology can lessen geographic barriers that students in remote areas experience. The University of the Highlands and Islands, an institution with more than a dozen campuses across Scotland, recently opened a simulation suite. Live video streaming services allow students at other campuses to participate in simulations, removing much of the need to travel and/or relocate that previously faced such students.

Social barriers also prevent the uptake of nursing as a career. The University of Central Lancashire has used aspects of its simulated learning programme to target candidates for whom university education would not previously have been a consideration. Through the university’s Return to Study Programme and Practice Based Pathway, participation in nursing has been widened to historically under-represented groups in the region.

This widening of the geographic and social net is essential if targets for increased number of domestically trained nurses are to be met, yet greater placement capacity in the short-term will be needed to accommodate the additional students.

So while simulated learning will have a positive effect on student attrition and help further democratise nursing as a viable career option for those in isolated communities, this – paradoxically – would lead to greater demand for placements. The barrier that clinical placement shortages might present to achieving the benefits of lower attrition and increased numbers accessing nursing should only increase the urgency with which policymakers reform workforce planning and provide more stable and longer-term funding for placements.

Though simulation can go a long way in easing current nurse shortages, it can only achieve these goals alongside well-funded and more easily available clinical placements. The investment in simulated learning at modern universities shows that those in the sector well recognise the potential such technology could bring. It is now time for the UK and Scottish governments to invest in placement capacity to ensure the benefits from technological advances are not squandered.