In the UK, clinical placements are a significant source of practical experience and equip students with the skills required for nursing. The COVID-19 pandemic resulted in a shortage of clinical placements available to students. To address this problem, the Nursing and Midwifery Council (NMC) introduced emergency standards allowing higher education institutions (HEIs) and their practice partners to deliver up to 600 hours of simulated practice learning within the 2300 practice learning hours students must complete (NMC, 2024). The emergency standards have now been made a permanent standard.
The University of Bolton prides itself on being an inclusive HEI; 17% of students undertaking the BSc Adult Nursing programme are known to have a disability, which may require reasonable adjustments and supportive strategies to enable them to reach their full potential within the nursing degree programme. The team used a blended learning approach to facilitate and support equality, diversity, and inclusion – this is a strategy combining traditional teaching and simulation with different online learning (Li et al, 2019). Using a combination of patient-focused case studies, group work, acute and community clinical skills development, screen-based simulations, virtual reality (VR), escape rooms, face-to-face simulations and a nurse simulation course facilitated by an external company, we have created a 3-week simulated placement.
The university's clinical skills and simulation team were asked to create a 3-week placement alongside their allocated teaching commitments. Implementing a simulation-based placement comes with high costs and requires training for staff to enable successful outcomes. Due to capacity issues, alternative solutions were sought to enable quality and meaningful simulation for students. A collaborative working relationship was established with The ATACC Group, which offers first aid and medical rescue training courses – including a Nurse Trauma and Critical Care (NTACC) course, which delivers advanced hospital trauma education specifically designed by nurses for nurses.
The external company was approached initially to deliver an NTACC-equivalent course to first-year nursing students on their first placement when a staffing shortage meant the team could not facilitate 2.5 days of the placement. This was only supposed to be an interim measure, however, evaluations were incredibly positive, and it became the most popular element of the programme. The course has now been reduced to be delivered over 2 days – like many HEIs, we are trying to cost save wherever possible – but its popularity hasn't changed.
The initial creation of the nurse simulation course consisted of aligning the skills and competencies required for first-year nursing students and exposing them to facilitated simulations in a novel way. The course was designed to cover the conditions and surgical procedures the students would explore throughout their 3-week simulated placement. These included chronic obstructive pulmonary disease, angina, diabetes, cholecystectomy, hysterectomy and fractured neck of femur. The primary purpose was to expose students to medical situations they may not have experienced in practice and to increase their competency and confidence in performing A-E assessments, completing the National Early Warning Score (NEWS2) and escalating appropriately using the SBAR approach (situation, background, assessment, recommendation), which has frequently been identified as an area requiring improvement.
The course includes some concise ‘blast’ talks and recaps of knowledge of conditions and how these should be treated in emergencies. The second part of the course is about putting the recapped theory knowledge into practice by running facilitated simulations. Actors and props provide ‘real-life’ scenarios, encouraging students to apply their skills and knowledge and develop their confidence. The final part of the course exposes students to a trauma scenario where they are put in groups and have to use their knowledge and skills in an emergency, displaying leadership and teamwork.