In this day and age with technology expanding, shortages of nursing faculty and an insufficient number of clinical sites, there has been an increase emphasis on the use of simulation to improve clinical learning.  Simulation consists of task trainers, computer based programs and high fidelity mannequins.  These high fidelity mannequins are full sized, can demonstrate selected signs and symptoms, and can respond to the actions of students.  Simulation was designed to imitate the clinical environment and provide the opportunity for students to demonstrate knowledge and skills learned within the nursing program.  This has many advantages for both the participants and observers.  Factors that have contributed to consider the use of simulation are concerns about patient safety, medical error, and to provide specific clinical experiences for students.  However, one must consider the disadvantages of simulation not only for the student but for the faculty and school as well (Nagle, McHale, Alexander, & French, 2009)

The use of patient simulators is very costly.  High fidelity simulators can cost from $40,000 to $90,000 and last for about 3 years.  The costs do not stop there, but has continuing expenses such as maintenance, space requirement, technician support and faculty training.   Educators have to be trained because a poor design can lead to a poor experience for students.   Another barrier is student to faculty ratio which can make it difficult to implement and use simulation as a teaching method.  There is also a limit for the number of students who can work with the simulators at a time and this requires a substantial amount of faculty involvement for each student, making it very time consuming.  Time consuming in creating scenarios, setting up the lab, and planning for role plays (Huston, 2013).  Simulation also places a dependency on the availability of instructors instead of having that hint of independence students get in clinical.

Simulation may cause students to experience anxiety when observed by faculty and peers.  Student anxiety associated with the use of patient simulation is a potential limitation to its effectiveness.  Especially, if students are being evaluated and assigned grades for their participation in scenarios, anxiety may increase.  Students might not perceive scenarios as being real and there has to be an idea of realism to accomplish learning objectives.  The realism of any simulation depends on many factors such as the environment and description of the scenario   (Durham & Alden, 2008).  Another limitation is the failure of simulators to express nonverbal communication such as frowning.  This limits our effective communication skills.  We communicate with patients in so many ways in which simulators lack by words, gestures, facial expression, eye contact and the use of touch.  Nurses need to be proficient not only in clinical skills but in communication skills.  Physical signs such as change in color and swelling are also not possible.  In addition, students are unable to perform neurological assessments and assessment of reflexes (Stanford, 2010).

Hospitals are limiting ways in which students can contribute in the health care setting with giving medications and participating in procedures.  The clinical setting does not have the aspects of certainty and control to promote an environment for learning.  The instructor cannot ensure that each student receives the same experiences.  Therefore, simulation can cover those missing aspects.  Mannequins can be programmed to display certain heart, lung, and bowel sounds.  Students will also be able to assess pulses, visualize pupil responses and respirations.   Simulation provides realistic patient scenarios to improve learning with time to reflect, promote collaborative problem solving and feedback.  This helps students to analyze and explain reasons behind an action and explores other approaches to a clinical situation.  Simulation contributes to patient safety and enhances outcomes of care in a safe and supervised manner without putting a patient at risk.  When it comes to costs, as production and market competition increases, simulators are becoming more affordable (Huston, 2013).

Today’s healthcare environment requires developed problem solving and decision making skills.  Scenarios with hands on opportunities help students connect theoretical concepts with evidence based practice.   Students can develop critical thinking skills, as well as prioritize patient care in a nonthreatening setting without the possibility of harming a real patient.  This promotes students to learn how to work as a team and become engaged learners (Partin, Payne, & Selmmons, 2011).  In simulation instructors can observe every action of the student instead of having to watch over many students at a time in real clinical practice.  Faculty can ensure that every student gets the experience of specific critical learning.  During simulation students experience the full consequences of their decisions which will have a positive effect on the students learning and retention of what they learned.  Students usually respond very well and report having an increase in competency and self confidence.  Dartmouth-Hitchcock Medical Center is a great example of how positive simulation can affect nursing students.  In 2007, Dartmouth-Hitchcock Medical Center began a 12 week nurse residency program for new graduates using patient simulation to address issues of hospital orientation time.  The end result of the program reduced time of orientation for new graduates.  They were better prepared for skills as a new nurse in a hospital (Huston, 2013).

Certainly there are many good arguments on both sides of this issue.  However, one will need to consider which side has more benefits than costs.  I definitely oppose the use of simulation to replace all hospital clinical experiences.  Although, simulation has some benefits, it just does not replace the experience of working with a live patient or the responses of a real patient (Brickoff & Donner, 2010).
                                                                              References

Brickoff, S. D., & Donner, C. (2010, September). Enhancing pediatric clinical competency with high-fidelity simulation. Journal of Continuing Education in Nursing, 41(9), 418-423.

Durham, C. F., & Alden, K. R. (2008). Enhancing Patient Safety in Nursing Education Through Patient Simulation. In R. G. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2628/

Huston, C. J. (2013). Professional Issues in Nursing: Challenges and Opportunities (3rd ed.). : Lippincott Williams & Wilkins.

Nagle, B. M., McHale, J. M., Alexander, G. A., & French, B. M. (2009, January). Incorporating scenario-based simulation into a hospital nursing education program. Journal of Continuing Education in Nursing, 40(1), 18-27.

Partin, J. L., Payne, T. A., & Selmmons, M. F. (2011, May-June). Students’ Perceptions of Their Learning Experiences Using High-Fidelity Simulation to Teach Concepts Relative to Obstetrics. Nursing Education Perspectives, 32(3), 186-188.

Stanford, P. G. (2010, July). Stimulation in Nursing Education: A Review of the Research. The Qualitative Report, 15(4), 1006-1011.