NLN Boise Simulation Conference 2016

Highlights of some sessions from Day Two!

Session: Innovative Strategies for Interactive Learning in a Nursing Clinical Learning Center

Presented by Jane Toon, DNP,RN; Carolyn Kirkendall, MSN, RN, CCRN; Stephanie Kemery, MSN, RN, CMSRN University of Indianapolis

Critical care based interactive learning stations. The goal was to address the fear of critical care setting and the patients which leads to a poor clinical experience as nurses don’t want  them near patients if the students look nervous.

They used faculty and grad students and alumni to facilitate the stations. It helped to have grad students and alumni- great resources for the students

The day consisted of 6 stations- each faculty facilitated, using Socratic questioning, 10 students per station. This was an all day event, 40 minutes per station, 2 objectives per station.

Sim critical care patient: set up a critical care assessment manikin- all things connected plus monitor with all wave forms. Other stations- sepsis,  EKG/rhythm strips, chest tubes, heart/lung sounds (vital sim),  mock code and drop calculations. This is not new material,  it’s reinforcement  of content. I like the idea of the assessment of the critical care patient, it’s a simple yet elegant way to teach the care of this kind of patient and something we could  use in our 6th quarter.

This is a great idea but so faculty intensive. It’s essential to a have experts. And one person who is circulating and making sure flow is working.

Session: Measuring Cognitive Load in Nursing Simulation 

Presented by Janye Josephsen, EdD, RN Bosie State University

Great  concepts, and I could see how this could connect with pre-briefing. Bringing students  into sim with no “schema” regarding what is happening can leave them overwhelmed by intrinsic and extraneous cognitive load and cannot get enough germane cognitive load.

I am excited to think about linking this kind of research with the current research/Delphi study that looks at pre-brief components recommended by certified simulation educators.  Cognitive load theory would be a great support for the need of solid pre-brief experience.

This presenter used video to show them (model) how to behave in the simulation. The idea is that giving these students a framework to build on before experiencing the simulation. Measured outcomes- pre and post knowledge survey and a cognitive load self report survey.

Presenters recommendation for reducing cognitive load for simulation:

  • pre-reading/activities (pretty standard for many simulations)
  • scaffolding/chunking (part of cognitive load theory)
  • self explanation effect (reflection on action- before the action!)
  • collective working memory (collaborative learning)



NLN Boise Simulation Conference 2016

A brief summary of my day one sessions at the NLN Boise Simulation Conference 2016


Day one:

Spent my morning at a session that introduced TeamSTEPPS facilitated by TeamSTEPPS trainers Tammye Erdmann MSEd, BScIT, RN, CHSE and Cathy Peterson, BSN, RN.

I have wanted to bring TeamSTEPPS into my lab classes and sim lab for a very long time, but I needed to learn more  about it and understand the components of it. I gained a great deal of knowledge about the processes. I think TeamSTEPPS would make a great framework for building simulation scenarios, too. The tools such as SBAR and I PASS THE BATON to set up the scenario and  patient information. Using the briefing model as a guide for developing the (pre-) brief for the students. TeamSTEPPS even has a debrief checklist.

So added to my to-do list for future development – planning/developing a communication scenario for first quarter students.

Dr. Kristina Thomas Dreifuerst RN, ANEF, CHSE: Afternoon presentation regarding debriefing across the curriculum. Great concepts. I have heard some of this before (at IMSH), but she presented more detailed guidance and examples of classroom discussion using a debriefing methodology rather than simply lecture and rapid fire questioning. Her emphasis is on Socratic questioning and the focus on why rather than what. (How is important too)

Dr. Suzie Kardong-Edgren RN, CNE, ANEF: Moving towards high stakes evaluation using simulation. This is  a hot and complex issue. Nursing faculty love to test students-sometimes too much IMHO. And skills testing is (IMHO again) a pretty big sacred cow. (funny coming from the lab instructor). While I agree we need to measure competency in nursing grads in some way BESIDES choose one of 4 answers, I don’t think the measure of a nurse is his or her ability to perform a skill while being evaluated is the pinnacle of nursing assessment.

High stakes testing in simulation can  be used in some ways for good-that is measuring how well a student can pick up changes in a patient’s status or perform the appropriate assessment. But in order to do it in a rigorous and consistent manner, the evidence, according to Dr. Edgren, shows that several elements are  necessary. A SHARED MENTAL MODEL among faculty is critical. But yet it’s the last thing most nursing programs have. You have hawks and doves  as evaluators- and the lack  of consistency can put a high stakes  evaluation program at risk. Getting all faculty on board for what the evaluation is measuring, how it is  measured and then moving on to establishing consistent  cut off scores is a lot of work.

The faculty need to review many videos to get a baseline for the “range of behaviors” and to establish cut off  scores.  In addition, it’s essential for there to be a large number of stations with different raters to ensure a balanced  evaluation.

This  process in the end needs to develop a “legally defensible model” because if a student’s nursing school career is based solely on high stakes simulation evaluation, then the program needs to be prepared for students to challenge the process- and there are litigators dedicated to helping these students out.

Personally, while I think done correctly this process could provide nursing with a valuable way to determine competency, I think that a competent nurse looks like a lot of different things in a lot of different settings. NCLEX is by no means the best measure of this but it’s what we have now. With the increase in delegation of tasks and skills -and considering that many of the skills we hold as so crucial to nurses to perform perfectly we now often rely on family members to perform in the home or UAPs in the clinical setting. Being a nurse is so much more than good sterile technique. In addition, many nursing skills take years to get “good at” with deliberate practice and experiencing variations in setting.

One school shared their process of using high stakes skills testing in their program because the students would be taught and tested on skills in the beginning of the program and then by their last quarter would  have skill decay, the practice partners were saying they had to “teach them everything again”. So they gave them a high stakes skills evaluation- meaning,  no chance for remediation or make up or retest- failure meant failure. (usually skills testing is performed until mastery is demonstrated).  That seemed like a dramatic response to that issue. Often the hospitals will say- “Oh we just want them to be able to think critically, we can teach them skills” and then turn around and complain “these new grads don’t know how to do any skills”…. but it’s all a symptom of a critical issue in nursing ed- filing the gap between what the schools are capable of (especially with the challenges of getting enough clinical placements for students, the lack  of good learning experiences for students once they at the clinical  sites and the overwhelming amount of information we need to dump into  the student’s heads in such a short time) and what the practice partners/hospitals expect from students. The advent of residency programs has greatly supported this transition (and were mostly developed in response to the high attrition rate of new nurses who leave  nursing completely in the first year), but not all hospitals can provide that. This is an issue that won’t go away soon and I think simulation will play larger role in resolving it.






Reflective Journal Entry After Visiting a Sim Lab

As part of my faculty role practicum, I wrote a reflective journal entry about meeting with a dedicated simulation faculty at a local university.


Write a one page reflective summary of experience, using the Gibb’s Reflective Cycle Model (description, feelings, evaluation, analysis, conclusion, action plan) (Gibbs, 1988).


My visit to the Clinical Performance Lab (CPL) allowed me to sit in and observe 3 simulations with undergraduate students. It was a new simulation for the program, developed by a master’s student. Along with the sim faculty, another faculty – content expert in pediatrics was facilitating the scenario.

In addition to observing the simulation, I was able to interview the sim faculty extensively about her role, her pre-briefing and de-briefing practices and all things simulation.

Often other faculty are very proficient in simulation and the  sim faculty allows them to run debrief and other aspects of the simulations. But there are some faculty who are simply not familiar with the best practices of simulation and debriefing methods or just do not have enough time and experience in simulation, in which case then, they serve as content experts to support her in facilitation. It is sim faculty’s expertise, as evidenced by  certification (CHSE) in simulation and the role as dedicated simulation faculty that allows her to make those determinations.

We talked about the pre-briefing practices at the CPL for a while also. Students will receive materials from their course instructor, some very basic and others more complex, however they are working to revise and standardize simulation preparation. As simulation is considered a clinical day, students should be as prepared for it in the same way. The onsite pre-brief consists mostly of an orientation to the simulation and scenario. The sim faculty will informally tailor the presentation depending on the experience level of the student and the type of scenario.

I  also discovered that a method of managing lots of students- presenting unfolding scenarios for a clinical group split in two as I do  is something they do there as well.

Feelings: I always love meeting and talking with other simulation faculty. We are a unique bunch of people, who are passionate about simulation and who teach in an innovative way. We share a universal set of values about the benefits of simulation and learning in a simulation setting. As a result of this experience, I came away with a strong sense of validation regarding my own beliefs and practices in simulation. My approach is consistent with that of the experts- and now with my own CHSE I am technically an expert also. I learned that even though I operate in a small, restricted simulation setting right now, I am doing as much as possible to maintain the standards of best practice.

I was able to explore this simulation center model and gain some insights that I can transfer to BC as we work to expand and grow our own simulation center. It was very clear to me that having the equipment and physical space is only part of requirements. Having a strong simulation team –with administrative, technical and operations support along with faculty who support the program policies is necessary to provide a stable and sustainable simulation center for students. I face a lot of challenges in my role at BC and while faculty support the idea of me becoming a simulation expert/director there, our resources and capabilities as provided by the college are limiting and may restrict our growth. Seeing how much this instituion supports its CPL and simulation programs shows me what can be possible if the mission of the institution supports the use of innovative teaching and learning methods like simulation.


The practicum experience was rich for me. Again, being able to connect with like-minded folks on a very personal level is rewarding. I have attended tons of conferences and there are opportunities there to network and connect, but the directed experience of the practicum allowed me to focus on my needs and gain deeper insights.

In dicussion, I found that my pre-brief practice is very similar to what they do at the CPL. I learned more about other aspects of preparation for students, including assignments and the guidelines and sim lab policy.


My overall impression of the experience for me was validating. I confirmed that my practices at BC are consistent with those of an expert simulation faculty. I was able to also gain some ideas for approaching simulation and also share some of my own practices and methods. While our programs are very different in size and resource, students  still gain a great deal  in the simulations we offer. I mentioned to that since I am just a “one woman show” there at BC, we only are able to offer a few simulation experiences for students, to which the sim faculty said something like, “It’s better to do just a couple high quality scenarios than a bunch of poorly done simulations”.


I feel it was a strong, hands-on, personalized learning experience for me. It’s tricky to explore a faculty role as this class requires, as I am already in one. So being able to step into the world of someone who serves in a dedicated simulation faculty role was nice. I wear many hats at BC and  I realized that if the college could figure out a way to support me as a dedicated simulation faculty, the program would benefit enormously.

Action plan:

I plan to integrate some of the ideas I got from my practicum experience into my program at BC. I learned about some useful evaluation tools which I hope to start using at BC. I plan to continue to advocate for my role as simulation faculty and the need for more support in our sim lab.


Gibbs Reflective Cycle


Regulation and Requirements in Simulation

Schools of nursing will be forced to bring their programs in line as simulation is defined by standardized best practices and regulatory requirements.

Description of the Issue

The use of simulation in nursing programs has evolved significantly in the last ten years and the research now supports it as a valid substitute for the traditional clinical learning experience (Jeffries, 2015). The National Council of State Boards of Nursing (NCSBN) national, multi-site, longitudinal simulation study found that substituting simulation for up to 50% of  students’ traditional clinical experience in pre-licensure nursing programs was as effective as traditional clinical learning and did not affect National Council Licensure Examination (NCLEX) pass rates or clinical practice (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). These findings led to the NCSBN recommendations for simulation programs, supported by The INACSL Standards of Best Practice: Simulation, and the NLN Vision Statement on Simulation in Nursing Education (Ackermann et al., 2013; Alexander et al., 2014; NLN Board of Governors, 2015). These publications are now being used by many state boards of nursing and other governing bodies as guidelines for best practices in simulation in schools of nursing (Hayden, Smiley, & Gross, 2014).

Clinical sites are difficult to secure and often lack opportunities for students to participate in much more than basic tasks (Ironside, McNelis, & Ebright, 2014). It is a challenge for students to get the rich learning experiences in these settings they require to become safe and competent nurses. In 2010, a national survey conducted by the National League for Nursing questioned over 2,300 nursing programs across the United States and found that a major barrier to clinical learning for nursing students is “lack of quality clinical sites” (Ironside & McNelis, 2010).  This situation has not improved much and increasingly nursing programs are looking to simulation as a way to provide students clinical experiences (Richardson & Claman, 2014).  The Guidelines established by the NCSBN study have great implications for nursing programs as programs will be required to be compliant with regulations of state boards of nursing and accrediting bodies in order to provide robust, evidence based simulation experiences to replace clinical learning.

Summary of the Literature

The most current data regarding national requirements by state boards of nursing comes from Hayden et al., (2014) in their descriptive survey of the current simulation regulatory environment.  They found that within the United States, 8 states do not allow registered nurse education programs to use simulation to replace clinical hours (Hayden, Smiley, & Gross, 2014). California, Vermont and Virginia specifically allow 25% of the clinical hours to be in simulation (Hayden, Smiley, & Gross, 2014). Florida recently increased its allowance to 50% (Rutherford-Hemming, Lioce, Kardong-Edgren, Jeffries, & Sittner, 2016).  The remaining U.S. states either have no specific amounts allowed or indicated they are planning to establish regulations (Hayden, Smiley, & Gross, 2014; Rutherford-Hemming et al., 2016).

In addition to guidance regarding amount of simulation, there are 14 U.S. Boards of Nursing have formal requirements or advisory statements for the use of simulation in registered nurse education programs. (Hayden, Smiley, & Gross, 2014).  Examples from states such as Virginia, Arizona and Washington provide specific advisory requirements which reflect both the INACSL standards and the NCSBN recommendations  (Arizona State Board of Nursing, 2015; Virginia Board of Nursing, 2013; Washington State Nursing Care Quality Assurance Commission, 2015).  For example, Arizona states, “Programs that use simulation in place of actual patient care need to do so using INACSL Standards” (Arizona State Board of Nursing, 2015). Virginia is less direct but does provide specific required components of simulation and faculty preparation that are similar to the INACSL Standards, such as clear objectives, pre-briefing/orientation and training requirements for the faculty facilitator conducting debriefing  (Ackermann et al., 2013; Virginia Board of Nursing, 2013).  The unpublished draft Washington State Administrative Code regarding simulation circulated via the CNEWS listserv lists criteria that are similar to the NCSBN recommended program and faculty preparation checklists (Alexander et al., 2014; Washington State Nursing Care Quality Assurance Commission, 2015).

Perspectives of the Issue from Education and Practice

The NCSBN guidelines were developed based on the requirements of the NCSBN study sites and, as Suzie Kardon-Egren recently stated, “Very few United States programs have the trained faculty and standardization to provide the same level of simulation used in the study” (Rutherford-Hemming et al., 2016, p. 3).  The challenge is that State Boards of Nursing are not telling programs how to meet the requirements. More states will be adopting similar requirements for simulation and nursing education program will have to carefully evaluate their plans to use simulation.  Reflecting on the NCSBN guidelines, the concern is how will programs and faculty obtain the financial and human resources necessary to meet these requirements.

Implications for nurse education

Going forward, nursing education programs will have to either revise their current simulation practices or develop new ones that meet their state requirements. As Lori Lioce stated, “Implications from the NCSBN study support and require changes in daily operations and structure of health care simulation education programs”(Rutherford-Hemming et al., 2016). This effects a large number of programs, in 2010 87% of schools of nursing used simulation in their programs and that number has been steadily growing (Fey & Jenkins, 2015; Hayden, 2010).  Major areas for programs to address are based on the NCSBN Guidelines and focus on faculty and program preparation (Alexander et al., 2014).

Faculty Preparation

The lack of properly prepared educators is considered a barrier to the expansion of the use of simulation curriculum (McNeill, Parker, Nadeau, Pelayo, & Cook, 2012). Often the training faculty receive is focused on the technology, rather than the methodology and pedagogy of simulation (Waxman & Miller, 2014). Jeffries et al (2013) recommend the creation of a faculty development program that extends beyond a single session of training and includes hands on experiences with simulation along with continued professional development opportunities. Standardized training programs such as the NLN SIRC ( are now available in addition to certification as a Certified Healthcare Simulation Educator. These can be used by nursing programs to prepare their faculty and demonstrate their level of expertise (National League for Nursing, 2015; Society for Simulation in Healthcare, 2016).

Once properly trained, faculty need to meet the other requirements of the Guidelines, such as the use of standardized, theory-based debriefing (Fey & Jenkins, 2015). Faculty will also have to work together to develop or revise simulation programs that provide “active learning, repetitive practice, and reflection” and scenarios with clear objectives and outcomes (Alexander et al., 2014, p. 41). Faculty will also develop and implement a plan for evaluation of all aspects of the simulation program, including the effectiveness of the facilitators and the simulation experiences (Alexander et al., 2014).

Program Preparation

Administrators of schools of nursing need to be prepared to provide the resources necessary, including financial, human and material, to support the Guidelines (Alexander et al., 2014). The needs of faculty and the program must be provided by institutional resources, such as funding for training and time for the development of curriculum.

Programs need leadership that understand the need for long range planning that supports the growth of simulation at their institution (Alexander et al., 2014). Nursing programs often have the equipment (simulator) to run simulations, but it was obtained through non-sustained funding like grants and donations. Programs also need sustainable income to support staff salaries, training, and equipment upkeep plus the supplies necessary to simulate a “realistic patient environment” (Alexander et al., 2014).  This is a major issue for many programs. In an international study of simulation centers, dedicated funding and adequate staffing (specifically dedicated simulation technicians) are found to be top strengths and, when lacking, they are seen as barriers to growth (Qayumi et al., 2014).  One strategy is to pool resources through the development of state consortiums and interdisciplinary simulation centers (Jeffries et al., 2013; Lujan et al., 2011; The Forum of State Nursing Workforce Centers, 2012).

Potential research areas

It is necessary to continue to pursue rigorous research of the use of simulation in nursing programs in order to support the resources needed for high quality standardized simulation. Information regarding how schools of nursing respond to their Boards of Nursing simulation requirements, including strategies they are using to meet the requirements, can guide simulation program development. As most published standards require evaluation processes in simulation programs, research that explores how nursing programs evaluate their use of resources, faculty and student performance, and simulation effectiveness can also provide guidance. Research that compares learning in clinical and simulation environments more directly lends support to funding to state mandated requirements for simulation in nursing programs (Leighton, 2015).

Studies need to demonstrate the return on investment of simulation in ways such as improved patient outcomes and safety in order to support the resource demands of simulation (Rutherford-Hemming et al., 2016).  While there is already evidence that faculty preparation influences simulation effectiveness, continued research needs to expand and examine correlations between faculty qualifications and certifications, and the student outcomes, such as NCLEX pass rates and clinical performance in order to support the amount of resources necessary to adequately train faculty(Fey & Jenkins, 2015).


Schools of nursing will be forced to bring their programs in line as simulation is defined by standardized best practices and regulatory requirements. While the NCSBN Guidelines seem very reasonable, a deeper look reveals the challenges that programs will face implementing them. The need for institutions and administration to support faculty as they work to develop simulation programs that meet these requirements is crucial. Sustainable models that include maintained funding, continued professional development and embedded evaluation are no longer optional for schools that plan to use simulation to replace clinical hours. As one participant at the 2015 INACSL Conference NCSBN Study forum stated, “…the option to use simulation today will become a mandate for simulation in the future”, so will the use of best practices in simulation be a mandate for the future of nursing education (Rutherford-Hemming et al., 2016).


Ackermann, A., Gore, T., Hewett, B., Harris, M. S., Lioce, L., Schnieder, R. S., … Martinez, P. a. (2013). Standards of Best Practice: Simulation. Clinical Simulation in Nursing, 9(6), ii–iii.

Alexander, M., Durham, C. F., Hooper, J. I., Jeffries, P. R., Goldman, N., Kardong-edgren, S. S., … Tillman, C. (2014). NCSBN Simulation Guidelines for Prelicensure Nursing Programs. Journal of Nursing Regulation, 6(3), 39–42.

Arizona State Board of Nursing. (2015). Advisory opinion: Education use of simulation in approved RN/LPN programs.

Fey, M. K., & Jenkins, L. S. (2015). Debriefing Practices in Nursing Education Programs: Results from a National Study. Nursing Education Perspectives, 36(6), 361–366.

Hayden, J. (2010). Use of Simulation in Nursing Education: National Survey Results. Journal of Nursing Regulation, 1(3), 52–57.

Hayden, J., Smiley, R. a, Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education. Journal of Nursing Regulation, 5(2 Suppl), S1–S64. Retrieved from

Hayden, J., Smiley, R., & Gross, L. (2014). Simulation in Nursing Education: Current Regulations and Practices. Journal of Nursing Regulation, 5(February), 25–30.

Ironside, P. M., & McNelis, A. M. (2010). Clinical Education in Prelicensure Nursing Programs : Findings from a National Survey. Nursing Education Perspectives, 31(4), 5–7.

Ironside, P. M., Mcnelis, A. M., & Ebright, P. (2014). Clinical education in nursing : Rethinking learning in practice settings. Nursing Outlook, 62(3), 185–191.

Jeffries, P. R. (2015). Signs of Maturity…Simulations are growing and getting more attention. Nursing Education Perspectives, 36(6), 358–359.

Jeffries, P. R., Battin, J., Franklin, M., Savage, R., Yowler, H., Sims, C., … Dorsey, L. (2013). Creating a professional development plan for a simulation consortium. Clinical Simulation in Nursing, 9(6), e183–e189.

Leighton, K. (2015). Development of the clinical learning environment comparison survey. Clinical Simulation in Nursing, 11(1), 44–51.

Lujan, J., Stout, R., Meager, G., Ballesteros, P., Cruz, M. S., & Estrada, I. (2011). Partnering to maximize simulation-based learning: Nursing regional interdisciplinary simulation centers. Journal of Professional Nursing, 27(6), 41–45.

National League for Nursing. (2015). Simulation Innovation Resource Center. Retrieved July 21, 2015, from

NLN Board of Governors. (2015). A vision for teaching with simulation. NLN Vision Series, (April).

Qayumi, K., Pachev, G., Zheng, B., Ziv, A., Koval, V., Badiei, S., & Cheng, A. (2014). Status of simulation in health care education: an international survey. Advances in Medical Education and Practice, 5, 457–67.

Richardson, K. J., & Claman, F. (2014). High-Fidelity Simulation in Nursing Education : A Change in Clinical Practice. Nursing Education Perspectives, 35(2), 125–128.

Rutherford-Hemming, T., Lioce, L., Kardong-Edgren, S. “Suzie,” Jeffries, P. R., & Sittner, B. (2016). After the National Council of State Boards of Nursing Simulation Study—Recommendations and Next Steps. Clinical Simulation in Nursing, 12(1), 2–7.

Society for Simulation in Healthcare. (2016). About CHSE. Retrieved January 1, 2016, from

The Forum of State Nursing Workforce Centers. (2012). Use of high-fidelity simulation in nursing education: Four state stories.

Virginia Board of Nursing. (2013). Use of Simulation in Nursing Education.

Washington State Nursing Care Quality Assurance Commission. (2015). Unpublished Draft of WAC 246-840-534.

Topic Proposal

I have to write an educational issues paper for one of my classes this semester at WSU. Here’s my topic proposal:

The National Council of State Boards of Nursing (NCSBN) study, a national, multi-site, longitudinal study of simulation, found that substituting simulation for up to 50% of  students’ traditional clinical experience in pre-licensure nursing programs was as effective as traditional clinical learning and did not affect National Council Licensure Examination (NCLEX) pass rates or clinical practice (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). These findings lead to the NCSBN recommendations for simulation programs, supported by The INACSL Standards of Best Practice: Simulation and the NLN Vision Statement on Simulation in Nursing Education (Ackermann et al., 2013; Alexander et al., 2014; NLN Board of Governors, 2015). These publications are being used by state boards of nursing and other governing bodies as a framework for simulation programs at schools of nursing. As a result simulation is growing to be a complex, potentially regulated method of teaching that will influence nursing students programs across the nation. My proposed topic will be a review of criteria and standards that nursing programs can use to develop robust, evidence based simulation programs that will be compliant with potential regulations and requirements of state boards and accrediting bodies.

In thinking about this topic and my approach to the issue, I think that one thing that really drives the “issue” part of it is the ability for schools of nursing to meet the various criteria that state and national agencies are setting forth. Robust, effective simulation requires extensive preparation, training of personnel, technological support, equipment resources and solid theory based teaching-learning understanding that many community colleges are not equipped to meet. And it’s community colleges that are feeling the squeeze for clinical sites the most.




Ackermann, A., Gore, T., Hewett, B., Harris, M. S., Lioce, L., Schnieder, R. S., … Martinez, P. a. (2013). Standards of Best Practice: Simulation. Clinical Simulation in Nursing, 9(6), ii–iii.

Alexander, M., Durham, C. F., Hooper, J. I., Jeffries, P. R., Goldman, N., Kardong-edgren, S. S., … Tillman, C. (2014). NCSBN Simulation Guidelines for Prelicensure Nursing Programs. Journal of Nursing Regulation, 6(3), 39–42.

Hayden, J. K., Smiley, R. a, Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education. Journal of Nursing Regulation, 5(2 Suppl), S1–S64. Retrieved from

NLN Board of Governors. (2015). A Vision for Teaching with Simulation. NLN Vision Series, (April).