Growing the emerging field of simulation in healthcare

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Teaching/learning strategies

Growing the emerging field of simulation in healthcare

After reading this article, you will be able to:

  • Discuss how various simulation modalities can be incorporated into staff development practice

by Mary Holtschneider, RN-BC, BSN, MPA, NREMT-P

Author’s note: I have worked in staff development and academic teaching as a nurse educator in various roles for the past 12 years, and I am now member of the editorial advisory board for Briefings on Evidence-Based Staff Development.

I recently served as the simulation center director at the Duke University School of Nursing in Durham, NC, where I developed my passion for simulation learning modalities and collaborated with the School of Medicine on interprofessional team training using the TeamSTEPPS program. Prior to that, I served for nine years as the Heart Center staff development educator at Duke University Health System.

Growing demand for simulation training

Simulation in healthcare is often considered an emerging field. In the past 10–15 years, we have seen a variety of companies produce different technological teaching equipment, including computerized human patient simulators (HPS), smaller task trainers for specific hands-on skills, computer interactive devices, immersive learning or “serious games” computer platforms, and virtual reality programs. During this time, there has been a growing enthusiasm for this technology in healthcare professional schools, particularly in nursing and medicine. Although academic centers have generally led the way in simulation use and application, recently, hospitals and health systems have also begun to develop their own simulation programs and centers. 

Implications for staff development educators

As staff development educators have witnessed, current nursing students from all levels of programs are being exposed to simulation modalities while in school. Many schools have sophisticated centers with well-trained and enthusiastic faculty members. New nursing graduates have come to expect that the institutions they work for will also employ these teaching methods, although that is not always the case. Many hospitals struggle with the startup costs of simulation equipment and educator training.

Even with the cost issue, these methodologies are extremely important to implement if institutions wish to remain competitive. Having a solid simulation program at an institution where the equipment and infrastructure are in place, along with well-trained and enthusiastic staff development educators, can only be a plus for staff recruitment and retention.

Some hospitals are controlling costs by partnering with local healthcare professional schools. Regional simulation centers are growing around the country, and sharing of resources can help control costs for all involved. In addition, it can have the added benefit of bringing together diverse learners who might not otherwise interact. 

Multi-environment simulations can also be done in these centers, such as an emergency medical services transport to the ED, followed by a transfer to the ICU, and then a transfer to the OR. 

An extensive list of healthcare simulation centers and their associated Web pages can be found at Other resources on simulation and simulation centers can be found at the Society for Simulation in Healthcare (SSH) Web site at

However, the question still remains about how to use low-cost simulation alternatives if an institution is not yet able to invest in higher-cost technology. Since some of the high-fidelity (more lifelike) HPSs can cost tens of thousands of dollars, staff development educators can start a simulation program by using some of the lower-fidelity, but still good-quality, simulators. 

For example, there are lower-cost simulators that have breath sounds and heart sounds and can generate pulses and blood pressures. Although they do not have all of the bells and whistles of a large-scale HPS, they can definitely work well for organizations on a tighter budget. 

In addition, there are many task trainers on the market that are much more technologically advanced than the old-style IV arms that have been used in the past. Some of the major manufacturers of such simulation equipment can be found on the International Nursing Association for Clinical Simulation and Learning Web site at

Another simulation modality that is low cost but very effective is the use of role-play, in which learners are given a scenario and must act in a designated role, such as charge nurse, new graduate, or resident. This can be done as a tabletop exercise with a mannequin and other low-cost props. 

With effective facilitation, participants can learn communication, teamwork, and an appreciation for the roles that others on the team play. 

A solid simulation program does not have to mean that only high-tech devices are used, as simulation is simply a tool that educators can use to meet the identified learning objectives.

National Simulation Alliance

Over the past few years, it has become evident that many healthcare disciplines have been developing simulation learning modalities, often in silos, and could benefit from sharing resources. In fact, it might come as a surprise to many educators that there is not an agreed-upon set of definitions for simulation-related terms.

Four years ago, SSH convened the first Simulation Summit, which brought together representatives from more than 30 multidisciplinary organizations with an interest in simulation. 

This led to the formation of a national Simulation Alliance, on which I represent the National Nursing Staff Development Organization. The Alliance has started the process of defining important terms relevant in the simulation field, as well as fostering collaboration among different groups with a common interest in simulation. 

As this field grows, having a working alliance will serve to help organizations share resources and not reinvent what is already out there, including ways to implement not only high-end simulation centers, but lower-cost alternative simulation activities.


Holtschneider, M.E. (2008). “NNSDO Update.” Journal for Nurses in Staff Development 24(4): 192–193. 

Huang, Y.M., Pliego, J.F., et al. (2008). “2007 Simulation Education Summit: Simulation in Healthcare.” The Journal of the Society for Simulation in Healthcare 3(3): 186–191. 

Jeffries, P.R. (Ed.) (2007). Simulation in Nursing Education: From Conceptualization to Evaluation. New York: National League for Nursing.

Sinz, E. (2007). “2006 Simulation Summit: Simulation in Healthcare.” The Journal of the Society for Simulation in Healthcare 2(1): 33–38. 


Adapted from Briefings on Evidence-Based Staff Development (formerly The Staff Educator), March 2010, HCPro, Inc.