Featured Article| Volume 26, P18-23, January 2019

Integration of Simulation to Prepare Adult-Gerontology Acute Care Nurse Practitioners


      • By 2025, there are projected eight million people over the age of 65 years, many of whom will need acute care health care providers.
      • The increased demand on Doctor of Nursing Practice programs has created a taxed system that uses an archaic apprenticeship model to educate nurse practitioner (NP) students.
      • Thoughtfully scaffolding simulations in NP curricula offers an unparalleled learning opportunity for NP students to independently perform, without direct supervision, as an NP.



      The nation’s demographics and health care needs are changing, concurrent with the demand to double the number of doctorally prepared nurses by 2020. This combination has intensified challenges associated with finding quality clinical placements and appropriate preceptors for nurse practitioner (NP) students. Purposefully integrated simulations offer alternate experiences and expose students to deliberately crafted and consistent learning opportunities.


      Scaffolded simulations were integrated within an Adult-Gerontology Acute Care Nurse Practitioner Program over the course of six semesters.


      Analysis is currently underway, but preliminary data show that simulation experiences helped to develop assessment, critical thinking, and decision-making skills. The students also felt better prepared to communicate with other health care providers in this new role.


      Although resource intensive, simulation provides an unparalleled opportunity for NP students to independently perform, without direct supervision, as an NP. Presenting an example of simulation integration can aid other educators seeking to develop a similar program.


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        • Alexander M.
        • Durham C.F.
        • Hooper J.I.
        • Jeffries P.R.
        • Goldman N.
        • Kardong-Edgren S.
        • Tillman C.
        NCSBN simulation guidelines for prelicensure nursing programs.
        Journal of Nursing Regulation. 2015; 6: 39-42
        • American Association of Colleges of Nursing
        Re-envisioning the clinical education of advanced practice registered nurses.
        (White Paper retrieved from)
        • American Association of Colleges of Nursing
        Fact sheet: The doctor of nursing practice (DNP).
        (Retrieved from)
        • Aronowitz T.
        • Aronowitz S.
        • Mardin-Small J.
        • Kim B.
        Using objective structured clinical examination (OSCE0 as education in advanced practice registered nursing education).
        Journal of Professional Nursing. 2017; 33: 119-125
        • Federal Interagency Forum on Aging Related Statistics
        Older Americans: Key indicators of well-being.
        2016 (Retrieved from Washington, DC. Retrieved from
        • Giddens J.F.
        • Lauzon-Clabo L.
        • Morton P.G.
        • Jeffries P.
        • McQuade-Jones B.
        • Ryan S.
        Re-envisioning clinical education for nurse practitioner programs: Themes from a national leaders' dialogue.
        Journal of Professional Nursing. 2014; 30: 273-278
        • Gore T.
        • Thomson W.
        Use of simulation in undergraduate and graduate education.
        AACN Advanced Critical Care. 2016; 27: 86-95
        • Haut C.
        • Fey M.
        • Akintade B.
        • Klepper M.
        Using high-fidelity simulation to teach acute care pediatric nurse practitioner students.
        The Journal for Nurse Practitioners. 2014; 10: e87-e91
        • Hayden J.K.
        • Smiley R.A.
        • Alexander M.
        • Kardong-Edgren S.
        • Jeffries P.R.
        The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation inPrelicensure nursing education.
        Journal of Nursing Regulation. 2014; 5: S2-S64
        • Institute of Medicine
        The future of nursing: Leading change, advancing health.
        (Retrieved from)
        • Jeffries P.R.
        • Rodgers B.
        • Adamson K.
        NLN Jeffries simulation theory: Brief narrative description.
        Nursing Education Perspectives. 2015; 36: 292-293
        • LeFlore J.L.
        • Thomas P.E.
        Educational changes to support advanced practice nursing education.
        The Journal of Perinatal & Neonatal Nursing. 2016; 30: 187-190
        • Mann K.
        • Gordon J.
        • MacLeod A.
        Reflection and reflective practice in health professions education: a systematic review.
        Advances in Health Science Education. 2009; 14: 595-621
        • Meakim C.
        • Boese T.
        • Decker S.
        • Franklin A.E.
        • Gloe D.
        • Lioce L.
        • Borum J.
        Standards of best practice: Simulation standard I: terminology.
        Clinical Simulation in Nursing. 2013; 9: S3-S11
        • National Task Force on Quality Nurse Practitioner Education
        Criteria for evaluation of nurse practitioner programs.
        (Retrieved from)
        • Paterson C.
        • Chapman J.
        Enhancing skills of critical reflection to evidence learning in professional practice.
        Physical Therapy in Sport. 2013; 14: 133-138
        • Rosen M.A.
        • Salas E.
        • Silvestri S.
        • Wu T.S.
        • Lazzara E.H.
        A measurement tool for simulation-based training in emergency medicine: The Simulation Module for Assessment of Resident Targeted Event Responses (SMARTER) approach.
        Simulation in Healthcare. 2008; 3: 170-179
        • Rudolph J.W.
        • Simon R.
        • Dufresne R.L.
        • Raemer D.B.
        There's no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment.
        Simulation in Healthcare. 2006; 1: 49-55
        • Rudolph J.W.
        • Simon R.
        • Raemer D.B.
        • Eppich W.J.
        Debriefing as formative assessment: Closing performance gaps in medical education.
        Academic Emergency Medicine. 2008; 15: 1010-1016
        • Rudolph J.W.
        • Simon R.
        • Rivard P.
        • Dufresne R.L.
        • Raemer D.B.
        Debriefing with good judgment: Combining rigourous feedback with genuine inquiry.
        Anesthesiology Clinics. 2007; 25: 361-376
        • Rutherford-Hemming T.
        • Nye C.
        • Coram C.
        Using simulation for clinical practice hours in nurse practitioner education in the United States: A systematic review.
        Nurse Education Today. 2016; 37: 128-135
        • The INACSL Standards Committee
        INACSL standards of best practice: simulationSM.
        Clinical Simulation in Nursing. 2016; 12: S5-S50
        • The National Organization of Nurse Practitioner Faculties
        Nurse practitioner Core competencies content.
        (Retrieved from)
        • Wyatt T.H.
        • Krauskopf P.B.
        Should simulation count toward nurse practitioner student clinical practice hours?.
        The Journal for Nurse Practitioners. 2014; 10: 538-539