A New Normal For Nursing At Ohio State

The nursing shortage is only expected to intensify in the U.S. as baby boomers age and the need for healthcare grows. Many factors compound the problem, including the shortage of nursing graduates each year.

Nurse educators have identified challenges that affect their ability to educate the future generation of nurses. Nursing executives have also proposed ways to survive the nursing shortage until new programs can graduate nurses that can help reduce the patient-to-staff ratio.

The Ohio State University (OSU) has developed several unique programs they anticipate will increase the number of students who graduate who are fully prepared to take the NCLEX and take their place alongside other bedside nurses across the country.

OSU’s nursing school has rethought nursing education. Wendy Bowles, Ph.D., APRN-CNP, CNE, is an assistant dean of baccalaureate programs at The Ohio State University College of Nursing. She was present at the National Press Club in Washington D.C. when the results of a study by the National Council of State Boards of Nursing were released.

Bowles was the lead qualitative researcher for the study that examined how COVID-19 affected nursing education programs. The data showed that nursing students had lost personal connection and mentorship opportunities during the pandemic, which had a significant impact on their education.

The data highlighted the need for the future of nursing education to embrace change and noted that hybrid learning is here to stay. In a 2023 article for OSU, Bowles describes two of the new programs that have embraced technology, disruptive models, and hybrid learning for nursing students.

Yet, she explained, these are just the beginning of reimagining and rethinking how nursing schools can develop an environment where nursing students have access to necessary resources and effective, evidence-based teaching practices. Three of the nursing professors responsible for leading these innovations spoke with NurseJournal in an exclusive interview.

Stephanie Justice, DNP, RN, CHSE, is an assistant clinical professor at The Ohio State University College of Nursing and the key individual behind the extended reality (XR) simulations lab. Justice’s expertise lies in moulage techniques for medical and emergency training, for which she has presented regionally, nationally, and internationally.

The college of nursing received a three-year, $1.5 million grant in May 2022 from the American Nurses Foundation for a project entitled “Disrupting nursing education using extended reality (XR), artificial intelligence (AI), and machine learning (ML).”

In collaboration with Dr. Mike Ackerman, director of the College of Nursing’s Center for Healthcare Innovation and Leadership, they transformed the computer lab into the XR lab using 1,000 square feet of open space for virtual reality experiences. Justice noted that the software has allowed students of all abilities to have more experience with patient care, using their clinical judgment and clinical reasoning skills.

“There was a concern for students with disabilities due to the use of a head-mounted device (HMD), but most students have been able to tolerate the headset well; the HMD has been well-tolerated by students with cochlear implants and a student with limited vision in one eye,” she said.

The software allows students to provide care without the backup of a faculty member or clinical preceptor to prevent errors. In the virtual setting, the student functions as the nurse. The virtual reality program also has other benefits.

“One area where VR is unique is it allows the learner to experience life from a different perspective,” Justice explained. “Our community health students participate in a homelessness scenario in which they learn about the life of a homeless woman and how she became homeless. The students gain a new understanding of the homeless population and develop empathy.”

The lab was not created to replace either clinical experiences or traditional high-fidelity simulations. Instead, it prepares students for entry into practice by offering opportunities to improve clinical judgment, function in the role of the nurse, and understand disease processes.

After each experience, the students go through a debriefing survey that collects feedback which the school is using to determine future plans for the software. Justice reports that the nursing school is on target to scale the program by 2025.

In the physical world, you are locked in an escape room until you can find the clues you need to solve puzzles that open the locks so you can escape. Tracy Taylor, DNP, RN, and Kady Martini, DNP, RN are clinical assistant professors of practice at The Ohio State University College of Nursing and the individuals behind the creation and development of the college of nursing’s virtual escape rooms.

OSU’s college of nursing began using the virtual escape room in the spring 2020 semester. The original plan had been a hybrid-type, but once the COVID-19 pandemic was declared, school instruction was altered. The team moved forward in developing the escape room in an all-virtual format.

Since returning to the classroom, the school has continued using a virtual escape room. Initially, the program was developed on a Google platform. However, the program included some activities and puzzles that were not available, so it was reimagined on a new platform called G-Develop that allows students to use an avatar-animated escape room with more complex puzzles.

The virtual escape room is based on the seven steps of evidence-based practice (EBP). The steps begin with cultivating a spirit of inquiry with the nurse asking clinical questions, searching for the best evidence, appraising that evidence, integrating the evidence with clinical expertise, evaluating the outcomes, and finally disseminating the results to colleagues and other healthcare organizations.

“Students must demonstrate and apply knowledge of EBP. The questions range from fill-in-the-blank and searching in the Health Science Library to seeking and finding information in a virtual environment,” explained Martini. “The last puzzle guides students through building a synthesis table and making an evidenced-based recommendation to break free.”

So far, student feedback has been positive, and students have used words like “engaging” and “exciting” to describe the escape room experience. The virtual escape room puzzles are built similarly to questions in the NCLEX, which may help students prepare for the test.

“Students must use the learned knowledge and skills from the course, apply the skills to move forward and break free, which is similar to some of the new format questions in the new NCLEX,” Taylor said.

Martini and Taylor worked together to create and develop the puzzles and challenges built into the virtual escape room game. They then worked closely with a web designer for coding and creation of the avatar.

The virtual escape room helps students review the content and skills needed to prepare for nursing practice. The games incorporate EBP in a problem-solving approach, which helps nurses integrate this into their clinical practice.

Although the pandemic helped create an environment that promoted a swift transition into online learning, the escape room was already in development before the pandemic began.

“COVID allowed us to trial the escape room in a complete digital format using the Google platform and Zoom breakout rooms,” said Martini. “This impacted us as educators to explore further new technologies, online platforms, and instructional methods to deliver EBP knowledge and skills in a virtual environment.”

Nursing schools across the country are developing creative and innovative programs to augment nursing education, engage more students, and fully utilize their resources to graduate more students.

OSU offers nursing students the opportunity to improve their clinical reasoning and critical thinking skills well beyond what they may encounter during their in-person clinical experiences. By orchestrating clinical experiences, students can be assured they are well-prepared to take their places in the nursing profession.