THE SHORTAGE OF QUALIFIED nurses is an ongoing concern in the health care industry. According to a 2005 U.S. Bureau of Labor Statistics report, more than one million new and replacement nurses will be needed by 2014. Contributing to the shortfall are retirements, job burnout, and a bottleneck in education programs caused by a lack of faculty. Yet community colleges are leading the charge in addressing the shortfall, educating 50 percent of all new nurses, according to the American Association of Community Colleges.
Providing hands-on experience, clinical rotations are an important part of their education. Some institutions are expanding the opportunities for both rotations and situations experienced by opening clinical simulation centers. Through these centers, students can practice their skills using sophisticated, interactive mannequins. In California, the Board of Registered Nurses allows student nurses to use simulation lab environments for up to 25 percent of their required clinical rotations.
"Clinical simulation allows faculty to standardize their curriculum by ensuring every student sees every type of patient needed to achieve competency as a practitioner," says Neil Coker, director of Simulation Teaching, Assessment, and Research (STAR) Programs at <b>Temple College</b> (Texas).
With mannequins costing from a few hundred to several thousand dollars, one would expect to find simulation centers primarily at large medical universities. But thanks to grants and partnerships, they are cropping up at community colleges as well.
The SIMS Medical Center at <b>Springfield Technical Community College</b> (Mass.) has been open for five years. The college had a small patient simulation program, which expanded to a 20,000-square-foot, 15-bed facility with funds from a federal Title 3 grant. "We used this small amount of money to take us into the future," explains Michael Foss, dean of the School of Health and Patient Simulation. The facility also received funds from the state board of education to perform training for other entities in the state.
Foss says a core group of faculty recognized the potential of patient simulation and was able to champion "the new educational paradigm."
There was already construction taking place when the grant was received, so it was simple enough to build the facility on the third floor of the new building. Ongoing funding is being partly addressed by a $125 per student per semester fee. Personnel costs are not an issue because the faculty associated with the center are already on the college's staff. A capital campaign is also under way. "No students have complained about the fee," Foss says. "They all have access to this wonderful technology."
Scenarios can include everything from checking blood pressure and giving an injection to dealing with a patient who was in a car accident. As an example, Foss describes this scenario: An EMT passed a male "patient" to nursing students, who had to hand him off to respiratory students, who took him to the X-ray lab. The faculty member in X-ray knew a simulation would take place that day, but the students were surprised and had to spring into action unrehearsed-just as in real life. Students said it gave them an opportunity to learn about the tasks performed by the other departments, since they don't usually interact. "The hope is, the fields will come to respect each other," Foss adds.
While a simulation center's building and equipment costs can be predicted at the start of a project, one unexpected expense Foss encountered was the rise in the use of expendable items such as gloves, needles, and bags. He explains that before the simulation center was open those items were just used for demonstrations in labs but now the students are using them during simulations. "We went from $10,000 a year for expendables to double that." To help control costs, the faculty salvages discarded materials such as oxygen masks and some respiratory apparatus, which are cleaned and repacked in Ziploc bags. Foss plans to get a heat seal unit, which will maintain the reality of the experience.
The Clinical Simulation Center at Temple College is a collaborative effort with nearby Scott & White Memorial Hospital and <b>Texas A&M University</b> System Health Sciences Center's College of Medicine. Partnerships offer the advantage of cost sharing, adequate utilization, and the ability to conduct multidisciplinary training, says Coker. Centers designed for a partnership also tend to evolve along with the various entities' changing needs, points out Nanda Schorske, dean of Workforce Development, College and Community Partnerships, at the <b>College of Marin</b> (Calif.).
At Temple, the president and board of trustees were interested in improving facilities for the health professionals program. Leaders at Scott & White Hospital were also interested in a simulation center, and after seeing a presentation about the Temple project, they recognized a partnership as a cost-effective opportunity.
The 9,800-square-foot facility opened in 2004 on Temple's campus and includes an operating room with adjoining scrub room, two ICU rooms, and two emergency rooms, as well as spaces that can be modified to represent a number of areas in a hospital and classrooms. The facility, which also has two ambulances, costs about $150,000 per year to operate and maintain, Coker says. Funding streams include annual contributions from Scott & White as well as King's Daughters Hospital, another nearby hospital.
Outside organizations can purchase time at the rate of $250 per four hours for six participants. Users have included physicians from Darnall Army Hospital at Fort Hood and EMS personnel from Bell and Williamson counties.
Coker says there are no universal standards for designing a simulation center. However, it is best to follow not only program accreditation standards but also state regulations for patient care areas so the environment is as realistic as possible. "Institutions designing a simulation center should contract with an architectural firm that has experience with design of clinical facilities," he suggests. Laerdal Medical Corporation, a manufacturer of human patient simulators, provided advice during the design phase.
A number of factors contributed to the development of the Marin Simulation Center on the College of Marin campus. Roz Hartman, director of Health Sciences and Nursing, explains that the California Institute for Nursing and Health Care has been examining the issues of not graduating enough nurses and graduating better quality nurses. Administrators at The Gordon and Betty Moore Foundation, a private grant-making organization in the San Francisco area, started a nursing initiative after learning of the nursing shortage in the Bay Area and in keeping with its goal of improving life in the area. Administrators at <b>Dominican University of California</b>, located in San Rafael, were interested in the simulation centers the Moore Foundation proposed, but they didn't have the space. College of Marin, about five miles away in Kentfield, did.
The two higher ed institutions, along with Novato Community Hospital and Marin General Hospital, created feasibility studies and the initial business plan, which was funded by Kaiser Permanente, says College of Marin's Schorske. "This is a true partnership," adds Hartman. "We don't get more access just because it's on our campus."
In addition to the Moore Foundation grant, partners are contributing staff, equipment, and other in-kind contributions. A kick-off ceremony was held in May 2007, with occupancy expected this spring.