Simulation

Episode 6: Simulation

In this episode of Beyond Nurse Residency, host Nicole Weathers interviews Dr. Katie Knox, a nursing professor and simulation education specialist. They discuss the history and importance of simulation in healthcare and how it can be incorporated into nurse residency programs. Dr. Knox shares her personal experience with simulation and provides actionable steps for listeners to integrate simulation into their training programs. This episode is a must-listen for anyone looking to improve their nursing education and training programs.

Guest: Katie Knox, PhD, RN, CHSE, Co-director of the Nursing Clinical Education Center and Clinical Assistant Professor at the University of Iowa College of Nursing. 

Katie has clinical experience working in a medical-psychiatric unit at UIHC and clinical teaching experience working with students on various medical-surgical units caring for adults with complicated medical conditions. Katie has been a clinical instructor for the College of Nursing since 2014, specializing in clinical teaching in inpatient units, laboratory, and simulation settings.   

Katie’s research interest area is data collection and outcomes dissemination for transition-to-practice programs, such as nurse residency programs. Katie is a graduate of the University of Iowa College of Nursing, receiving her BSN, MSN, and her PhD, and has her certification in Healthcare Simulation Education.   

To learn more about our nurse residency program and other offerings, please visit our website: https://nursing.uiowa.edu/ionrp  

To learn more about our nurse residency program and other offerings, please visit our website: https://nursing.uiowa.edu/ionrp

Transcript

Nicole Weathers

You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, Nicole Weathers, director of the Iowa Online Nurse Residency program. Thanks for joining us. Let's jump in.

When I think back to my experience as a student and new nurse, I don't ever remember engaging in what we now call simulation. We had Skills Labs, we had clinicals and practicums, but nowhere in my plan of study did I ever encounter simulation. I actually wasn't exposed to the idea of simulation until many years later, maybe 2010, 2011. Now a simulation for many is just a routine part of the academic education. What is even cooler is there are many practice environments that have their very own simulation centers, and we are lucky enough here in Iowa to even have a mobile simulation unit. If you haven't already figured out in this episode, we're talking all about simulation and incorporating simulation into a nurse residency program. My goal for this episode is that our listeners will walk away with concrete and actionable steps they can take to integrate simulation into their orientation and nurse residency programs, regardless of their resources. So, I have with me today our guest, Dr. Katie Knox, from the University of Iowa College of Nursing. So, Katie, can you please take a minute and tell us a little bit about yourself?

Katie Knox

I am Katie Knox. I'm a three-time graduate of the College of Nursing at the University of Iowa. I have a certificate in healthcare simulation education. So that kind of makes me a specialty educator in simulation, I'm a clinical assistant professor at the College of Nursing and I'm Co director of the Nursing Clinical Education Center, which is housed within University of Iowa Hospitals and Clinics. So, I have a couple different roles, a couple different hats and I love everything that I do in my job. Nicole and I just figured out recently that we graduated in the undergraduate program the same year. So like Nicole, I didn't have any experience in simulation in my undergraduate education either. I was introduced in simulation in my Master’s program. We had an assignment where we had developed like a portion of simulation. But I can tell you I wasn't sold on simulation at that time. I didn't know how helpful of a tool it would be for nursing students. I was slow to buy into simulation. I share that about myself for you, because maybe you're you're feeling the same way as a listener, so maybe I can change your mind and help you understand the value of simulation through this podcast and really give you some of those concrete actionable items that Nicole talked about.

Nicole Weathers

Awesome. Well, I am so excited to have this conversation with you today, so why don't we jump into things? So, before we get too far into all the things, can you give us a little bit of like the lay of the land, a good foundation regarding simulation. So what exactly is it? How long has it really been around, etcetera?

Katie Knox

Sure. Yeah. So I'm I'm betting everybody listening has experience simulation. So the thing that pops into most people's mind is hands on CPR training. That's a simulation. It's training for certain tasks to like CPR. So those anatomical models think of those torsos that the head and neck and shoulders and chest that you use for CPR. Those are anatomical models, so they're designed for practicing certain skills. So those have been around a really long time. Think about 1800s. Maybe there is a leg or an arm and then nurses practice nursing tasks. With those different anatomical models the first full body mannequin was created in 1911 by a doll company, so that's kind of still stuck around a lot of people call mannequins dolls, but they're much more sophisticated than that, right now. A lot of mannequins use computers to run the mannequins. It's often just a Wi-Fi connection that connects a computer. Computer to a mannequin and the computer sort of tells the mannequin how to respond physiologically so computerized mannequins have been around since about the 60s. So they were really expensive when they first came out. They've gone down in price a whole lot. Mannequins, maybe you've experienced one that had heart sounds and lung sounds. The first one was named. Harvey and that's all it had were heart sounds and lung sounds. But simulation in general, the field of simulation, healthcare simulation came, from the world of aviation. So if you picture those flight simulators. Those were used to help train pilots, so simulation in aviation and healthcare. Typically the goal is to help recreate emergency events, so things that people don't experience very often and are unexpected events. So in a flight simulator, the pilot isn't just, you know, on Autopilot with their simulation. They're experiencing emergency events and figuring out how to react to them. So the same in healthcare simulation, these are called high-impact low probability events. So they don't happen very often, but when they do it's a big deal and people need to know how to respond. So the idea is to replicate these type of events and simulation and see how the participants react. A lot of times in emergency situations we sort of lose our brain. Right. We don't think clearly and experiencing those type of events in a simulation helps people respond. We often use checklists and things like that to know what. to do. We can predict how those participants in simulation, we give them a chance to react in a safe environment, and that's the other big part of simulation is that it's a safe environment. We aren't going to cause harm to our patients because they're typically mannequins. So it's a safe environment in which people can have practice and and practice how they would respond to different events.

Nicole Weathers

Well, I think that's, you know, really great like obviously you know in healthcare we sometimes can lose, you know, focus a little bit as far as you know every time we are training a new nurse like they are learning as we go. But as a person who a consumer of healthcare like we never want the new nurse to be learning on one of our loved ones, right? So giving them the opportunity to experience some of these low probability events in a safe environment obviously increases the likelihood that they are going to be able to do what they need to do when when the time comes in a real environment. So I think that's really great and really just astonishing how long simulation has actually been around. So you know, coming out of the COVID-19 pandemic, I have to be honest because I've heard this from leaders across the country, but simulation it's kind of gotten a bad rap, along with maybe online learning. You know, I hear from practice leaders that their new new nurses need more time with real patients and less time in the simulated online zoom type of environment, so talk to us now about the research or the benefits of simulation. And then maybe we can even get into some of the different ways that it can be done.

Katie Knox

Sure, I agree to some extent with those leaders that have talked about. You know, there's too much online learning, practicing nurses or nursing students need to get more hands on time. But there is a research basis to how much time is spent in simulation. So in 2014 there was a big study by the National Council of State Boards of Nursing. So they were really trying to figure out if the outcomes for pre licensed or nursing students varied. Based on the amount of stimulation they experienced. So it's really common knowledge and you may experience this wherever you are, that there's not enough clinical sites for nursing students to get that hands on practice. They're hard to secure. They're hard to find. So they were trying to figure out if they could replace some of that clinical time with simulation. So the recommendation from the study was that up to 50% of traditional clinical hours could be substituted with simulation experiences. So the key to that was high quality simulation experiences and we know that simulation can vary from place to place, so I think that's where some of the bad rap has come from. Is that simulation isn't often high quality and isn't of the caliber that would replace that clinical experience. So based on that study, that 2014 study each State Board of Nursing can improve the amount of acceptable simulation that replaces clinical time. So Iowa has approved 50% replacement of clinical hours with simulation and 13 other boards of nursing have done the same. So in the study they looked at. No replacements of zero, 25% replacement and 50% replacement. So that was the highest amount that they had studied. So that high quality simulation again I think is the key. So one of the great benefits of simulation is that it offers time for the participants to think. Nursing we all know is doing more than just a set of tasks and checking things off your To Do List we have to make the connections about why we're doing it and how it impacts the patient outcomes. So simulation allows that sort of protected time in a safe, safe space that allows the participants to think about what we do as nurses and why we do it. So the bottom line, just like residency programs, simulation has a positive impact on patient outcomes. That has really been proven time and time again, and then it's an acceptable type of learning tool for students and practicing nurses.

Nicole Weathers

So I'm going to go on a little bit of a tangent here. So you talk about high quality simulation and you I you mentioned in your introduction that you actually have a specialty certification in simulation. So if one of our listeners wanted to learn more about that and how do I become better at simulation? Or maybe I'm interested in also doing like a certificate where can? Where does that exist and how can they learn more?

Katie Knox

Yeah, the certificate is a CHSE, it's. Lightheartedly called the cheesy certificate, so that's a certified healthcare simulation educator that's offered through the Society of Simulation and Healthcare or SSH. So it requires someone to be practicing in simulation for a couple years. So two years. Be facilitating simulations. If that's not possible for you, if you are one of those people who does about four bazillion things a day and simulation may just be one slice of the part of your day, I don't know that I would suggest being a a certified educator. I would look more into organizations that provide standards of best practice. For simulation, I think the high quality simulation comes from knowing the parts of simulation. There's a pre brief part where the participants learn about what it is that they're going to do in this simulation, there's the actual simulation part where they're working with the patient and there's a debrief part and the debrief part is really important and the most important part of that whole simulation process I talked, I talked about those connections that people make, they need to understand the why of what they're doing and debriefing. That allows the time for the participants to make those connections. So I think that's where the high quality simulation comes from. Is looking at the standards of best practice and simulation and doing a little homework and research about what those are.

Nicole Weathers

So you know, you said, I mean the the really complex mannequins have been around since 1960s. So obviously there are best practice recommendations out there that maybe our listeners should know about. So what are some of the key do's and don'ts?

Katie Knox

Yeah, I think people tend to make simulation too complicated. It can be very simple. The definition, according to researchers is really simulation is anything where we're replicating something that you would be doing in real life. So think about that simple CPR class that you take, think about unfolding case studies. Think about tabletop simulations where maybe you arrange an order of something you. I mean you have active learning and those are really in my mind simulation with a really broad definition of simulation, so it doesn't have to be the fancy mannequin with the computer. Simulation can be a lot of different things, but my biggest suggestion is to keep it simple. Think about your objectives. Try not to change the world in one simulation. Just keep a couple objectives in mind. I'm thinking 2 to 3. Another way you can think about objectives is what behaviors do I want to see during the simulation? What do I want my learners to do and to take away with them when they leave? So just a couple is enough and then that debriefing time that I talked about, save time for debriefing. Even if you have to make this actual simulation shorter, 5 minutes working with the patient or working through the simulation and then allow at least double that amount of time, so 10 minutes in order to debrief. So debrief is really important. It's that time where the learners make connections, there's a lot of research about that time to reflect in their practice. Allowing time for that is key.

Nicole Weathers

Anything else like as far as best practices? So I I think keep it simple because sometimes we think, oh, complex simulators equal complex scenarios that that is really the purpose of those. So I love that you pointed out. Simple is actually better, 1-2 maybe three key objectives that we're focused on at a time. You know, I mean, I think you know, even kind of going back to some of the the newer practices that we're seeing just in online education with microlearning, I mean it kind of goes along with that, right. We can't absorb all the things if too much is thrown at us at once, so I really love that idea of keeping it. Almost. Mini in a way so that they can. You know, really just focus and master one thing versus all the things that we're.

Katie Knox

Yes, yes, related to those evidence based practice projects or quality improvement projects that you have residents do whenever a resident comes up to you and has this grand scheme of something to do and you sort of like, shake your head, go oh, let's just take a slice off of that. Think about that for simulation, just take a slice of it and and try it. I know there's a lot of hesitancy. It seems like a big job to develop a simulation, but remember, you can keep a simulation and run it again. So, after you develop it and run it, you can edit it. You can get feedback from your participants. What worked in that, what didn't work. They always seem to give you plenty of feedback and debriefing to let you know what you could change. It is a lot of upfront work, but with any sort of learning tool that you develop in the active learning that you have, it is a lot of work up front. But remember that you can keep it and. You can run it again and try it again. So, I think it's well worth the time invested to develop a simulation.

Nicole Weathers

So I think that is just such good advice. So thank you Katie so much for for sharing that. So you know, as you know, we work with many leaders and educators and practice who are facilitating residency programs. So, you know, the focus of residency isn't necessarily on specific skills, but we all know that new nurses often want and in some cases do need more time focused on clinical skills scenarios. Those, etcetera. So if one of our listeners wanted to start integrating simulation into their nurse residency program, where do you suggest they start?

Katie Knox

I would start with a needs assessment. So what is it that you need to add that would be appropriate for a simulation? So what do you need to focus on? The needs assessment often comes in a very strange way. That's not a formal needs assessment. I'll give you an example of where I started when I had a small group of nurse residents and we were talking in our small group. And one resident was talking about administering IVIG, which is intravenous immunoglobins, and another resident had not yet administered that. So they were talking about, oh, what sort of monitoring do you need? And what did the patient have? Why they needed the IVIG and the conversation sort of snowballed. And it was clear from the conversation that there was a knowledge gap there, and I knew that any of the residents in my group could administer IVIG based on where they were working as a nurse, the resident who had administered it shared as much as they could. But they said, you know, I really, I think I did it right. I don't know for sure, so I was ready when the group met again, so we did it tabletop simulation using IVIG as sort of the focus area. So you could do this with any sort of medication or any policy and procedure, for example, something that is clear that your residents need a little bit more work with. So I gave them a scenario of a patient who needed IVIG so that kind of opened up. What type of patient would need this medication? From there, we sort of split up to check resources, so we looked at the policy for IVIG administration. We looked at the administration guide provided by pharmacy. We looked up typical dosing and then we looked up patient education resources. So all in all this took maybe 20 minutes or so for them to look up the information. So I sort of split them up into groups and had them look on their computers and then we brought them back and then we talked about what we learned so. In my mind, in a chronological way makes sense. So I said, OK, here's your patient scenario. The patient was ordered IVIG, where do we start? So they shared what they learned. We wrote some key points on the on the whiteboard and that was our simulation. So I also had bottles or pictures of bottles of the medication and some tubing so they could see what the filters look like, what the medication looked like. They match the IVIG types with those needed filters and those who didn't. We talked about the patient weight being really important because that's how the dosing is based. And then I threw some curveballs in it, IVIG is really particular what sort of fluid runs with it. D5NS as opposed to NS. So I talked about, you know, what if the patient has a low blood pressure and you need to bolus fluid, which which type would you use? So, it wasn't a fancy simulation. It was really a thinking exercise with visual aids. I have a coworker who always calls it a head game, so it's using your brain to really work through the patient scenario. But based on that broad definition of simulation, it really fit into the simulation. I helped to guide and experience that replicated the real world event in an interactive manner. So because they were working in pairs, they could really talk with each other about it and then we came back and sort of debriefed and walked through chronologically what we would do. I think it was important for that residency group to have time to think about what if they received this order, what would they do? Because on the unit, if they were working and this order came through their computer, they wouldn't have time to do all that? So we're sort of prepared them for what If this happens to you? So we know that nurses are strapped for time on the unit and if we can give that protected time for them to do an activity like this that really is beneficial to them, so they're really grateful at the end they they hoped that they would be have a patient with a IVIG order. So it was something different and something that we hadn't done yet with that group. So I thought it was beneficial for them.

Nicole Weathers

What a great example and a couple of things. First, I love that you said, you know, do a needs assessment, but it doesn't have to be like a complex formal maybe needs assessment, just a simple conversation with a new nurse about some of their experiences and where maybe they've ran into challenges is all of the Needs Assessment that you maybe need to do, I also like that you pointed out that this was something that you kind of developed a little bit in real-time. So oftentimes I get questions about like what clinical skills should we be talking about when and do you have scenarios we can use and you know all of those things. And while I would love to like, be a encyclopedia of here are, you know, you know. Thousands of things that you can use, it really should be based in their individual practice setting and the things that they need to know. You can't always anticipate that this is exactly the thing that they're gonna need me to go over at this point in their orientation. At this point in their residency. So, the fact that you know, you kind of sounds like you have sort of a basic structure for like obviously this is how simulations are. And then I just fit in maybe the the pieces as they come up in that new grads experience.

Katie Knox

Right. I there are a few simulations that I have that are standard that I run in a standard way, but there are also some simulations that you can fit in based on the needs assessment, you know X is the problem. So we take that and then we put that in the simulation and create a different scenario based on on the issue that they're having or the questions that they're having. So yeah, this was really done in time and really based on a specific need of a group. There are a few simulations that you can develop that you know everybody will benefit from, such as care for the deteriorating patient or an emergency situation. I think all residents encountered those at different points.

Nicole Weathers

And those are the ones that they're worried about, right? Like, those are the ones that they are anxious to experience and always speak up like they want more hands-on with some of those situations.

Katie Knox

Yes, and those are the really the high impact, low probability events. They don't happen very often, but they do cause so much stress for those new residents even talking about it in small group really helps people prepare themselves for it because they want to know, you know what, what did you do? What was your role and who came? And then what was the outcome of the patient and and talking about it and that sort of helps also debrief the resident who experienced that. So I always encourage you know, if a resident did experience that on their unit, let's talk about it because maybe they didn't have the chance to debrief it on the unit because. Somebody hit their call light and needed a water in the next room right after your code event. So. Giving that time and letting them talk about it and helping the other group members visualize what can happen, I think that helps decrease stress too. So even if we don't do the simulation at that moment where they can get their hands on, at least they're talking and thinking about it too.

Nicole Weathers

Well, and as you said, it's your way of doing a needs assessment. So you can kind of decide based on what the group is saying like do we need to build in a formal simulation on this or maybe we just need time with the code card so that they can open it up and they can look through it and they can find where things are. So I think yes, it helps that resident who experienced that, it helps the group begin thinking about it and it helps you do that a little bit of an informal needs assessment to see what you might need to add in. So that is such a great example. So that kind of brings us to my next question for you. So you know, when I was in the hospital. You know, I did actually price out high fidelity simulators. And when I did, I found out that they are rather expensive, or at least they were almost 10 years ago. So many organizations don't have access to simulation in their area. Most don't have the financial resources to put in a beautiful state-of-the-art simulation lab. Although everybody would maybe like to have that. So you gave this example of the tabletop simulation, but what are some other ways that you can kind of do simulation on a budget?

Katie Knox

Yeah, I that's really important. I have this skill where creativity just sort of seeps from every pore in my body. So I know a lot of people don't have that skill, but it's really being creative and creative. Creativity is key and how to develop a simulation when you don't have much money. You really think about where the corners can be cut and where they can't be cut. So along with that needs assessment. Figuring out, OK, do I really need to have a Foley catheter, for example. Do I really need the bag? And do I really need? To have it in. Is that the main objective or can I have a picture of a Foley and tape it to the bedside like is is the objective to assess the amount of urine the color? Is it a Coty thing that we're working with? So think about where you can cut corners as far as your costs go. My favorite example of a low cost simulation is a fall simulation that I developed to help my nurse residents review a policy and procedure about when a patient experiences a fall. Unfortunately, this happens a lot. Your patient falls and there's a whole set of things that you need to do after the fall occurs. So. I developed the simulation. I did use a mannequin. It was a relatively old mannequin, not a fancy mannequin. I think it was in a back cupboard somewhere. I placed it on the floor next to the patients bed. So if you don't have a mannequin you could have a nurse volunteer to do this for you to be on the floor. I had ergonomic equipment help available for the nurse to get the patient back into bed, so it's kind of twofold. They're working with the policy and procedure, and then they were also reviewing the ergonomic equipment. I also had a nurse play a family member of the patient. I gave that family member a script of questions to ask, so I try not to have a family member go rogue, be dramatic and crazy with the nurses. That's not really the goal. The goal, again is to what do you do after a patient falls? How do you communicate with that patient and family member? So. That was just really two objectives that I had for that simulation, so I had to think about what behaviors I expected from the nurses. What did I want them to accomplish for this simulation? So again, the policy and procedure, what do you do after patient falls? So there's checking for injuries. There's checking vital signs checking. Glucose assessing for head trauma reporting documenting the fall, getting the patient back into bed. So we had the ergonomic equipment to help us out with that. Communicating with the patient and family member and then debriefing, we talked about the factors that might have contributed to the patients fall. So I had to create a a scenario to go with the simulation and that didn't cost any money. Again, you can talk to somebody in clinical practice. If you need to, but usually we can all think of a scenario. Think about the false risk assessment, so maybe complete one of those and have the patient at risk for falling. Think about the patients background assessment, maybe their medications that might contribute to a fall and put that all in a scenario. The participants can read that scenario at the debrief, so they're able to understand what's going on with the patient and then when they go in, in the simulation, they find the patient on the floor and you can also give them a copy of the policy and procedure so they can follow step by step and do all the things that they need to. After they realize that the patient has fallen, that's a pretty short simulation. It can be about 10 minutes or so. And then after that, the debriefing should last twice as long, so about 20 minutes. We talk about the policy and procedures. Sit down. Your job as a facilitator is really to ask open-ended questions of your participant. You ask questions like what was going through your mind when you came in and saw the patient on the floor. So they can explain maybe an emotion that they have, maybe it brought them back to a similar fall that their patient experience. Give them the chance to talk about their experiences, either with that simulation or their experiences in clinical care with a similar similar simulation. So in that debriefing, make sure you go through the objectives. Did they do all the things that they needed to after the patient fell? How did they assist the patient getting back into bed? Did they use ergonomic equipment that was available, or did they just pull on the patient and throw them back into? Then think about how they communicated with the patient. I always take notes during the simulation, so I have a few, maybe direct quotes even. That said, you know you said this to the patient, you know, tell me about your rationale for saying that or something like that and then. Talk about the factors that contributed to the to the fall. So maybe those medications, maybe we, there's a reason we do the fall risk assessment. What did they score? What are some other things that we should have had in place for the patient so they didn't fall. So that gives them an opportunity to talk through those things. That's a really simple simulation. It doesn't take very many resources. It takes a little bit of creativity to make it happen in a space you might have to find a room that's not being used by a patient or even you can use a cart for this too. So if you don't have a bed. Available you can use a patient transport. Part. So just think about those objectives and what you need to. Make those objectives happen for the simulation.

Nicole Weathers

I love that. That's a great example and I think one that, like you said, any nurse, any nurse, whether they're new or not, actually is probably going to encounter a patient fall. And so not only do you get to talk about, you know, the skills as far as the procedure goes, like, what do I do when this happens, but then also, you know, your response to that and I love. Like that, debrief where you're really getting them. Thinking right, you're working on those critical thinking and clinical judgment skills, which are, you know, sometimes hard for us to develop without some intentional focus like this. So I think that that is such a good example and it's such and you gave great examples of how you don't need to have something fancy to do that like you even talked about. Using a a real life person, right? So maybe it's a a nurse that volunteers to be the patient. Do you use real patients? A lot? Is that something that you guys have used in the past?

Katie Knox

We tend to have larger groups of nurse residents, so we getting everybody a role in simulation for us is a little bit tricky. So we will have nurses play the role of a patient often and they have some really good questions. I'm always really, really surprised and like even have you had a patient? To ask you that question before so they come up with some really great questions. If we don't have mannequins available, we will use a nurse as the patient or somebody participating. It is really important to give them a script however, so. You don't, and I think I must have had too many bad experiences with people not having a script and asking. Questions that have no relation to what's going on, so especially to have an experience, a simulation experience that's really guided by the objectives you need to to have a script for anybody who's playing a role in simulation. So I think that's important to do in my academic part of my life. Have a lot of simulated patients. So nurses, especially in psychiatric mental health that are learning to interview people, we do use patient real life people for that. So we use actors who are trained to be patients that portray different maybe signs and symptoms or of a psychiatric disorder and things like that.

Nicole Weathers

Great advice. I think you know. Sometimes we think being overly dramatic is beneficial, but like you said, it can kind of take away from the focus of you know, the objectives of what we're actually trying to do here. So great advice on the. So Katie, we have talked about so much today. You know, you shared with us the background of simulation being around for much longer than I honestly ever anticipated. The fact that like even from since the 1960s, which is, you know, really not all that long ago. But, you know, even some of our more complex simulation has been around since then. You've talked about the benefits of simulation. The research, the fact that up to 50% can be. Replaced for, you know, our undergraduate students and still have same patient outcome. So I think that is just an interesting point that you made today and I appreciate you sharing that with us. As far as best practices, keeping it simple right that was I think #1 and then making sure that we're doing that debrief. Because sounds like a lot of the actual learning takes place during that debrief time, so making sure that. The keep time or make time to do that, so that has been great. You talked about the needs assessment you talked about doing SIM on a budget. You talked about examples like tabletop scenarios or you using pictures of equipment in place of equipment. So so many great takeaways. I think from today. So before we go, I have one last question to ask you. When it comes to, let's say, nurse residency transition to practice, maybe even bringing simulation into these situations, what is one thing you often see organizations doing wrong or maybe wasting resources on that really isn't making a difference?

Katie Knox

This is a hard question, Nicole. I when I got this script in the outline, I didn't. I haven't filled this question in, so I'm going to go shoot from the hip here and I would say maybe wasting resources or have. Thing. Misdirected ideas about what nurse residents need. Too often I see a. End approach to OK this month we're doing this and this month we're doing this and it doesn't exactly match what the nurses need at that time. So that informal needs assessments that we talked about earlier, I think is really important and it's. It is difficult to be flexible in a nurse residency program, but that's what we know about learning and teaching is that people need what they need, when they need it, and to be relatable, they need it at a time when they feel like, you know, they don't have the resource and they need the resource right then. So. I would say. Not having a flexible approach to residency and offering just in time training when it's needed. I know, I know it can be difficult, but I think that residency programs and transition to practice really need to be aware of that and and try to make those. Flexibility efforts, if at all possible.

Nicole Weathers

So good. I mean having yes, we can have a plan, right? Like this is what we maybe want to do, but sometimes we have to make a pit stop and a little bit of a detour and maybe we have to go on this little tangent and then maybe bring it back on course. So I think that is such good advice. I think that that whole immediacy with adult learners is huge. Like. Yeah, it's great that I'm learning about this quality stuff, but I just had this situation with this patient and I need someone to. Talk to me about that so. So.

Katie Knox

Yeah. And I guess that's. Where having a small group discussion is is important and you can address those things in the small. Group so I. Mean maybe it is a quality discussion plus some time to debrief about whatever happened during the last since the last time you met. So. And I think part of my flexibility comes from being an educator. Too. So in particular with undergraduate nursing students, if they're. Is an issue in the room. You're going to have to address that issue before any learning can occur. So I think I've done this more than once where it has been a pit stop. Definitely an unplanned pit stop, but you know, no learning can occur until it's been addressed so. I think I've done that more times than I can count on two hands, so I hope that other people feel. Flexible enough to offer to offer the learning when the learners need it.

Nicole Weathers

Such good advice, Katie. Thank you so much for your time today talking to us all about simulation. As always, it's been a pleasure. Any last thoughts before we wrap this up? No, I just thank you to your listeners for what they do and what they offer.

Katie Knox

To those in transition to practice, I think it's really important work and I'm grateful for all of your listeners and what they do and grateful to you too, Nicole and your team for what? You do, so you're welcome. And thank you for the opportunity.

Nicole Weathers

Wait before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program. Work one-on-one with residency program experts to make sure your organization is residency-ready. Our clinician well-being course is an asynchronous online course that aims to enhance the well-being and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work. Supporting Nurses is another asynchronous online course for preceptors, mentors, and coaches to learn the skills they need to support any new hire. Both of these offerings can be used as a stand-alone professional development opportunity or to augment any nurse residency program. And we can't forget about the program that started it all. The Online Nurse residency Program. This includes a comprehensive curriculum designed to support new graduate nurses, applying all the knowledge they learned in school to their practice; we focus on professional skills and personal well-being competencies, and new graduate nurses even get the opportunity to create real change in their own organization. Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. You can learn more about all of these programs and more of what we offer using the links in the show notes below.