Collaborative Simulation Project to Teach

Scope of Practice
Joyce Simones, EdD, RN; Joan Wilcox, MS, PMHCNS-BC; Kim Scott, MSN, RN;
Darci Goeden, MSN, RN; Darlene Copley, MSN, RN; Renee Doetkott, BSN, RN;
and Margaret Kippley, MSN, RN

Abstract

Nursing faculty from three schools of nursing collaborated to develop a simulation project to enable nursing
students to practice and apply principles related to delegation, supervision, scope of practice, leadership, and culturally competent care. A simulated five-bed hospital was
created where students were assigned to teams to plan
and care for these patients. After the simulation exercise,
students participated in a debriefing session in which they
reflected on their performance.

ew graduate RNs and licensed practical nurses

(LPNs) are expected to enter nursing practice prepared to work collaboratively in multidisciplinary
health care settings. Delegation and supervision skills are
essential abilities that graduate nurses must possess to
work collaboratively with other nurses and other disciplines.
The concepts of collaboration, delegation, supervision, and
scope of practice are routinely presented in RN and LPN
curricula at varying levels; however, the application of these
essential nursing concepts presents a challenge in the authentic clinical setting during nursing students educational experience. In an effort to provide nursing students with
Received: June 6, 2008
Accepted: May 26, 2009
Posted: December 30, 2009
Dr. Simones is Professor, Ms. Wilcox and Ms. Copley are Associate Professors, and Ms. Scott is Clinical Lab Coordinator, St. Cloud
State University, St. Cloud; Ms. Goeden is Associate Degree Nursing
Faculty, Central Lakes College, Brainerd; and Ms. Doetkott is Practical Nursing Instructor, and Ms. Kippley is Nursing Faculty, St. Cloud
Technical College, St. Cloud, Minnesota.
Funding for this project was provided by the Minnesota State Colleges and Universities (MnSCU) Legislative Initiative Grant.
Address correspondence to Joyce Simones, EdD, RN, Professor, St.
Cloud State University, Department of Nursing Science, 720 Fourth Avenue South, St. Cloud, MN 56301; e-mail: jmsimones@stcloudstate.edu.
doi:10.3928/01484834-20091217-01

190

the opportunity to work collaboratively as RNs and LPNs

in a health care setting, nursing faculty from three schools
of nursing in Minnesota partnered to create a simulation
project to enable RN and LPN students to practice and apply principles related to delegation, supervision, scope of
practice, leadership, and culturally competent care.
LITERATURE REVIEW
The literature reveals new graduate nurses display deficits in the areas of organizational and managerial skills
(Mole & McLafferty, 2004). The competencies of delegation
and supervision also are unfamiliar as well as knowledge
related to scope of practice.
The scope and standards of nursing practice are developed and regulated through national, state, and local professional and regulatory organizations as well as by individual health care institutional policies and procedures.
Much of the language within these documents is broad
based to allow for some flexibility. However, this broad language is open to interpretation and often leads to confusion
regarding licensing boundaries. Adding to the uncertainty
is the fact that the boundaries of the scope of nursing practice are in constant flux because of advances in technology,
time constraints secondary to reimbursement issues, the
increasing use of assistive personnel as the result of health
care worker shortages and cost constraints, and the need
for health care workers in underserved areas.
Boards of nursing across the nation increasingly have
been confronted with scope of practice as well as delegation and supervision issues and questions from all levels
of nursing. For example, Spector (2005) described a study
in which the National Council of State Boards of Nursing (NCSBN) assembled an expert panel that identified
163 tasks performed by LPNs. At least 25 of these tasks
appear to be outside of the scope of practice in some jurisdictions, providing evidence that even experts in nursing
practice are unclear about professional licensing boundaries. Davidson, Bloomberg, and Burnell (2007) reported a
case study in which RNs were asked to perform procedurCopyright SLACK Incorporated

Simones Et al.

al sedation, a task historically performed by physicians,

demonstrating the blurring of RN practice boundaries.
Hudspeth (2007) discussed whether the use of advanced
practice nurses who had not graduated from an accredited adult or family psychiatric mental health nurse practitioner or clinical nurse specialist program in mental
health settings were practicing within their scope. These
examples provide substantiation of the current confusion
related to practicing within ones scope across all levels of
nursing practice.
There is a lack of information regarding how nurse educators teach concepts related to scope of practice, delegation, and supervision. These concepts typically are threaded through nursing curricula when instructors discuss
standards of nursing practice and state nurse practice acts
in a traditional classroom setting; however, opportunity
for application of these concepts usually is absent. Nurses
in the clinical environment are faced with high patient
acuity levels, shortened patient stays, and staffing shortages. These factors, combined with the fast pace of practice settings, too many students, and decreasing clinical
sites, have contributed to a stressful clinical environment.
As a result, it is not feasible for RN and LPN students to
practice skills related to scope of practice, delegation, and
supervision in an authentic clinical environment.
The introduction of affordable, portable, and multipurpose human patient simulators in the 1990s transformed
health care education (Jeffries, 2007) and provided one solution to the issue of lack of opportunity for nursing students to
practice necessary nursing skills in the clinical setting. Simulation is gaining popularity among nurse educators and is
being used increasingly as a teaching-learning strategy and
evaluation method in nursing education (Jeffries, 2007).
A review of the literature reveals the use of human
patient simulators and live actors to create a simulated
clinical environment in which students learn, practice,
and perform nursing skills essential for competent nursing
practice. Herm, Scott, and Copley (2007) described the creation of a simulated clinical environment using SimMan,
a human patient simulator, to evaluate nursing students
clinical competence, critical thinking, and decision making
ability. Eaves and Flagg (2001) described a simulated medical unit developed by the U.S. Air Force to assist nurses
practice the delivery of competent care in a war-time environment. Nine moderate-fidelity mannequins and two
live actors were used to create the simulated medical unit
in which nursing students were able to practice technical
skills, sharpen critical thinking ability, and exercise delegation skills. Mole and McLafferty (2004) related their design
of a simulated clinical setting in which teams of 10 to 12
nursing students cared for 5 patients on a surgical ward to
practice organizational, managerial, and clinical skills.
However, there is little evidence or literature on the
use of simulation to teach delegation and scope of practice
concepts, particularly a simulation scenario using both RN
and LPN students simultaneously to teach these concepts.
Several other nursing programs throughout the state were
contacted to identify how concepts related to delegation, suJournal of Nursing Education Vol. 49, No. 4, 2010

pervision, and scope of practice were taught, and no models

of simulation exercises to teach these concepts were found.
BACKGROUND
It is essential that all professional and practical nurses
have knowledge of their states nurse practice act, which
provides the legal definition of the scope of practice for each
level of nursing personnel. The practice of professional
nursing includes the function of delegating nursing activities to other nursing personnel and to provide supervision,
an essential component of the delegation process. The Minnesota Nurses Association (2005) has published delegation
guidelines for professional nurses based on the Minnesota
Nurse Practice Act (2005). Specifically, these delegation
guidelines (Minnesota Nurses Association, 2005) state:
In a decision to delegate to another person, the Registered Nurse should consider the following: The assessment
of the patient or client; the capabilities of the other workers;
the complexity of the nursing task; and the ability of the RN
to supervise the delegated activity and its outcome. (p. 3)

To provide both RN and LPN students with an opportunity to apply concepts related to delegation, supervision,
and scope of practice, a regional collaborative simulation
project was developed from grant funds awarded by Minnesota State Colleges and Universities. Nursing faculty
from baccalaureate, associate degree RN, and LPN programs collaborated with health care clinical staff from the
region to develop a simulation exercise to help prepare RN
and LPN students for interdisciplinary culturally competent care within their defined scopes of practice. In Minnesota, all nursing students are required to complete 117
Minnesota Board of Nursing Abilities (MBNA) prior to
graduation. The two MBNAs related to delegation and supervision were incorporated into the simulation project.
Support for the collaborative simulation project was
provided by the Minnesota Board of Nursing prior to submitting the grant proposal. This support continued with
ongoing collaboration and guidance by the Minnesota
Board of Nursing throughout the implementation and
evaluation phases of the project.
GRANT FOCUS
The main foci for the grant were:
l Scope of practice.
l Leadership acquisition.
l Delegation and supervision.
l Cultural competency.
These concepts are included in nursing curricula at
various levels in theory courses; however, there is limited
opportunity for application of these principles, and even
less opportunity for RN and LPN students to work together in a clinical setting during their nursing educational
experience. These concepts were identified as the foci of
the grant for the following reasons: there is a strong link
between scope of practice and safe clinical practice, there
is a blurring of accountability and definition of roles, there
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are different nursing care delivery models used at various

clinical agencies, students cannot legally delegate in their
clinical practice in their unlicensed role, and there is a
lack of diverse populations in this region. Creating a simulation exercise integrating each of these concepts would
enable students to have an opportunity to practice these
important nursing skills in the simulated clinical setting
prior to entering practice.
GRANT PHASES
The collaborative simulation project became a yearlong project. There were four phases to this project:
l Faculty development and resource allocation.
l Simulation development.
l Project implementation.
l Evaluation of student learning outcomes.
Faculty Development and Resource Allocation
Two to three faculty members from each of the partnering colleges were designated to work on the collaborative
simulation project. A total of eight faculty members from
the partner schools received summer salary to create a simulated learning experience that would enable RN and LPN
students to work together to provide care for a group of diverse patients to apply concepts related to scope of practice,
delegation and supervision, and culturally competent care.
To achieve these outcomes, collaborating faculty determined that the setting for the simulation scenario should
reflect a nonspecialized unit of a rural community hospital
and integrate a team nursing model. This type of a health
care setting was selected because caring for a group of patients with diverse ages and diagnoses is more likely and
therefore believable.
Two directors from the Minnesota Board of Nursing reviewed the project and provided consultation. They attended
a planning meeting with the simulation group to provide additional input and feedback on the project. Assistance and
input from nurses in the community also was solicited.
To educate nursing faculty and facilitate collaboration
between regional health care partners and the schools of
nursing, a simulation workshop was held for professional
development in the field of simulation in nursing. The
invited conference presenter was Pam Jeffries, a nationally recognized expert in simulation and also a practicing
nursing faculty who could identify with faculty concerns of
incorporating simulation into practice.
The day-long conference was attended by more than 40
participants from the three partner schools and area industry partners such as nurse educators from local hospitals
and long-term care facilities. Nurse educators attended at
no cost and received continuing education credits. The industry nurses in attendance expressed great interest and
support for the project and the desire to work on future
projects. Evaluations of the conference were positive.
The day after the conference, Pam Jeffries met with the
eight faculty members who had been designated to work
on the collaborative simulation project to provide consul192

tation and assistance in designing simulation experiences

that are evidence-based and incorporate postsimulation
guided reflective learning. She provided a template that
was used for the development of the case studies and scenario progression timelines.
The project received valuable technological assistance
from a student worker with expertise in information technology. In addition, the information technology support
staff and nursing laboratory coordinators were available
for assistance. Digital camcorders or ceiling mounted pan
and tilt cameras were purchased for each partner school
so the simulation exercises could be recorded for analysis
of student performance and for review during debriefing.
Simulation Development
Development of this simulation scenario required the
creation of online just-in-time learning modules, the development of individual patient scenarios within a larger simulation scenario, the development of an evaluation rubric,
and the need to conduct several practice runs. This 4 to 6
month period was the most intense and time-consuming
phase of the project.
The designated project faculty members from the partner schools met five times as a group and also conducted
conference calls to plan and implement the project. A welldefined breakdown of workload was established. Each faculty member was assigned responsibilities and timelines
for completion. To facilitate communication among the
partners and share the information related to the project
development, a shared Web site that could be accessed by
the faculty members from each of the schools was developed for project management. All meeting minutes, case
studies, scenario timelines, and evaluation forms were included on the Web site.
Just-in-Time Learning Modules. An important component of the developmental phase was the creation of
just-in-time learning modules. The purpose of the learning modules was to ensure that all students, regardless
of which school of nursing they were from, came to the
simulation experience with a similar knowledge base related to the concepts to be applied during the simulation
exercise. The learning modules consisted of online tutorials to prepare students for the simulation experience, including theory and application exercises on scope of practice, delegation and supervision principles, and cultural
awareness. Faculty members from each partnering school
developed content, discussion, and other learning activities related to scope of practice for RN and LPN roles in
Minnesota. Links to the Minnesota Office of Minority and
Multicultural Health related to health care disparities for
American Indians, African Americans, Asian Americans,
and Hispanics and Latinos were included on the Web site
as resources for students and faculty.
Scenario Development. The simulation project required
the creation of individual patient scenarios within a larger simulation scenario consisting of an acute care setting
whereby RN and LPN students worked together as a team
to care for multiple diverse patients. Five individual paCopyright SLACK Incorporated

Simones Et al.

Table 1
Collaborative Simulation Grant Evaluation Rubrics
Overall scope of practice evaluation
Student #1
(Charge RN)

________________________________________________________________________________________

Student #2 (RN)

________________________________________________________________________________________

Student #3 (LPN)

________________________________________________________________________________________

Student #4 (LPN)

________________________________________________________________________________________

Student #5
(Recorder)

________________________________________________________________________________________

Faculty________________

Date _______________________________

Critical elements
Met ____

Not met ____

Practice within scope of practice for state of Minnesota

Met ____

Not met ____

RNs effectively delegate and supervise health care team

Met ____

Not met ____

Team work evident to provide quality patient care

Met ____

Not met ____

Team demonstrates appropriate prioritization of patient care

Met ____

Not met ____

Team demonstrates use of effective communication skills

Met ____

Not met ____

Team demonstrates ability to obtain appropriate assessment data

Met ____

Not met ____

Team demonstrates consistent clinical decision making based on assessment findings

Comments:

tient scenarios were developed, and each reflected a different racial and ethnic group to add diversity to the learning experience. The goal was to increase students cultural
awareness and sensitivity, and then have them apply this
knowledge in the clinical setting. The individual patient
scenarios included: a 7-year-old Native American child
(and parent) with asthma, a 62-year-old Hispanic woman
with diabetes, a 70-year-old African American gay man
with a cerebrovascular accident, a 32-year-old Somali
postpartum mother and baby, and a 70-year-old Caucasian woman recovering from surgery.
To ensure accuracy and cultural sensitivity in each of
the patient scenarios, experts were sought to provide input. The director of the American Indian Center provided
useful information related to the Native American pediatric patient. A local hospital provided information regarding different racial and ethnic groups served in the area. A
member of the gay and lesbian community provided input
into one of the scenarios, and additional consultation was
received from the Somali and Hispanic communities.
Props and supplies were incorporated to create an authentic hospital experience. These included a hospital documentation system, a medication administration system,
a change of shift report, care plans for the five simulated
patients, specific orders for the patients, and a mix of real
actors and manikins. In addition, scripts were written for
Journal of Nursing Education Vol. 49, No. 4, 2010

the actors who role-played the various patients to ensure

consistency of the simulation experience for students.
Evaluation Rubric Development. After the individual
patient scenarios were developed, faculty determined two
separate evaluation rubrics were needed. One rubric was
designed to reflect team performance related to scope of
practice, delegation, supervision, teamwork, prioritization
of care, and communication (Table 1).
The second evaluation rubric was designed to reflect individual student performance in the caregiver role. Faculty
identified critical behaviors students were to demonstrate
for each of the five patients within the simulation scenario,
and these elements were used to create the second evaluation rubric (Table 2). The critical behaviors identified were
different depending on whether students caring for patients
were RNs or LPNs. Critical behaviors within the individual
patient scenarios related to identification of low blood sugar
and implementation of appropriate nursing interventions,
identification and treatment of a patient with respiratory
distress, identification and treatment of a patient in pain,
identification of fall risk and implementation of appropriate
interventions for a patient attempting to get out of bed, and
communication with a non-English-speaking patient. An example of a critical behavior specific to scope of practice could
include the LPN reporting signs and symptoms of hypoglycemia to the supervising RN. The RN then would decide how to
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Table 2
Sample Form to Evaluate Students Critical Behaviors Toward Patients
Registered Nurse
Met

_____ Not met

_____

Knocks before entering; introduces self

Met

_____ Not met

_____

Identify assigned patient by reading identification (ID) bracelet before initiating care

Met

_____ Not met

_____

Provide for privacy

Met

_____ Not met

_____

Wash hands before initiating direct contact with patient

Met

_____ Not met

_____

Elevate head of bed

Met

_____ Not met

_____

Assess oxygen saturation and other vital signs

Met

_____ Not met

_____

Reapply oxygen

Met

_____ Not met

_____

Assess lung sounds and respiratory effort

Met

_____ Not met

_____

Reassess or delegate reassessment of oxygen saturation and vital signs 1 minute after oxygen
reapplied

Met

_____ Not met

_____

Call respiratory therapy (if appropriate)

Met

_____ Not met

_____

Communicate with child and parents to decrease anxiety

Met

_____ Not met

_____

Teach regarding patient condition, no smoking in hospital

Met

_____ Not met

_____

Teach regarding asthma medications and therapeutic regimen

Licensed Practical Nurse

Met

_____ Not met

_____

Knock before entering, introduces self

Met

_____ Not met

_____

Identify assigned patient by reading ID bracelet before initiating care

Met

_____ Not met

_____

Provide for privacy

Met

_____ Not met

_____

Wash hands before initiating direct contact with patient

Met

_____ Not met

_____

Elevate head of bed

Met

_____ Not met

_____

Check oxygen saturation

Met

_____ Not met

_____

Reapply oxygen

Met

_____ Not met

_____

Report to RN

Met

_____ Not met

_____

Complete delegated tasks and report back to RN

proceed within his or her scope of practice. Decisions would

be made such as notifying the physician for follow-up assessment, medication administration, or delegating additional
tasks to the LPN with clear instructions on what information to gather and the time frame in which to report back.
Trial Run. Faculty conducted a simulation exercise trial
run using nursing faculty who were not involved in the grant
project and therefore had no knowledge of the scenario to
identify any problems prior to going live. During the first
trial run with volunteer faculty, it became evident that the
individual patient scenarios were too complex for the time
frame and student ability, and that timelines needed to be
established so that all five patients would not exhibit symptoms simultaneously. Therefore, revisions were incorporated
to make the individual patient scenarios more manageable.
Two directors from the Minnesota Board of Nursing observed the second trial run of the simulation scenario with
members of the partner schools and LPN students who
were about to graduate. Their feedback about the project
and goals was positive.
194

A third trial run of the simulation scenario was performed with graduate RN and LPN students. The scenario
went well and required only minor changes for smoother
logistics, such as more authentic props.
Project Implementation
The RN and LPN students from the different sites were
brought together for the simulated clinical experience. The
nursing science laboratories were set up as patient care
units, with the five patients being role-played by faculty
and community members.
The scenario progression time line started at Station
1, the report room, where a nursing team of two RN and
two LPN students prepared for patient care. The RN students determined how the team would be organized by
making patient assignments, taking into consideration
the role and abilities of each of the nurses on the team.
The team was allowed 30 minutes to receive morning report on the five patients, make assignments, and complete
patient care worksheets.
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Simones Et al.

Station 2 was the simulated hospital unit, where RN

and LPN students worked as a team to provide care for
their five patients. Students were allowed 20 minutes
at this station, after which time was called regardless of
whether students had completed all of the indicators on
the evaluation rubric.
The students then were directed to Station 3, which consisted of a 30-minute debriefing session with a faculty member guiding the team of RN and LPN students to reflect on
their performance. According to Jeffries (2007), debriefing is
a critical component of any simulation experience because it
allows students to express feelings about their performance
and to receive support and feedback from faculty and peers.
This process of guided group reflection leads to new insights
from which students learn. Table 3 provides a list of questions that were developed for the debriefing component of the
simulation exercise to provide faculty direction and promote
consistency of the debriefing experience.
Evaluation of Student Learning Outcomes
Evaluation of student performance required the use of
multiple faculty evaluators, as it was not feasible for a single
person to effectively evaluate the individual performance of
four to five students at different locations as well as the overall team performance simultaneously. Therefore, a faculty
evaluator was placed at each patient station. These evaluators used the rubric that was developed to evaluate individual performance to record their observations (Table 2).
In addition to an evaluator at each patient station,
one faculty member from the leadership course from each
participating partner school observed the team dynamic
throughout the entire process of the simulated experience,
from the report room to the debriefing station. During report, the faculty evaluator documented discussion related
to patient delegation and evaluated appropriate and inappropriate delegation of patient assignment. During the
simulation run time, the faculty evaluator observed and
documented student performance with regard to patient
care decisions, delegation and supervision according to
scope of practice, leadership skills, team work, and cultural competence using the team evaluation rubric (Table 1).
The student team was directed to the debriefing station,
where they completed a written evaluation of the simulation experience using the debriefing questionnaire (Table
3). While the students completed their written evaluation,
the team evaluator conferred with evaluators from each
patient station and received feedback related to individual
student performance prior to joining the student team in
the debriefing area. The feedback helped determine whether the delegation and supervision MBNAs were met. The
faculty evaluator then facilitated the debriefing session,
using the feedback provided by all of the evaluators.
RESULTS
Student Satisfaction
Students perceptions strongly supported learning by
this hands on method. Many reported that it felt difJournal of Nursing Education Vol. 49, No. 4, 2010

Table 3
Guided Reflection Questions for
Simulation Debriefing
1. What did you do well in this scenario?
2. Delegation focus:
What was your thought process leading to the delegation
decisions?
3. Prioritization focus:
What data did you use to determine patient prioritization?
4. Collaboration focus:
What collaboration efforts were made in providing care
throughout the scenario?
5. Cultural aspects focus:
How did the cultural diversity of the patient impact your
decision making?
6. Did you have sufficient knowledge and skills to manage
this scenario?
7. Were there any assignments that you were unprepared
for or that you felt were outside your scope of practice?
8. If you answered yes to question 7, what would be your
next step?
9. If you were able to do this again, what would you do
differently?

ferent to think on their feet. Students noted they did not

have the experience and comfort in working together as
RNs and LPNs. Students also noted scope of practice decisions are not implemented readily or easily without further practice. Students enjoyed the opportunity to care
for groups of patients and work collaboratively with one
another. A typical educational strategy for students prior
to this experience had been total care for one or more patients, without working in teams.
Student Performance
According to Jeffries (2007), simulation is used more
often as a teaching strategy in nursing rather than as an
evaluation method. In addition, simulation as an evaluation of student competence has not been rigorously tested
for validity or reliability, although it is being used increasingly to measure progress toward programmatic goals
(Jeffries, 2007). This collaborative simulation exercise
was used both as a teaching strategy and as an evaluation
strategy. It also provided an opportunity for students to
apply concepts of delegation, supervision, scope of practice, and culturally competent care in a situation that
closely resembled the authentic clinical setting.
The evaluation rubrics provided a means of documenting student performance to allow feedback to students
about their performance as a team and as individuals during the debriefing session so learning could occur. Therefore, the elements on the evaluation rubrics of critical elements were graded as met or unmet.
Individual performance varied greatly among students.
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Some students performed all or many of the critical behaviors identified on the evaluation rubric for their assigned
patients, whereas other students omitted the behaviors and
interventions outlined on the rubric. Many students omitted basic nursing care functions, such as knocking or handwashing, in light of directing their attention to the patient
needs and perhaps some anxiety. These observations validated the need to continue to focus on and reinforce basic
nursing principles. In contrast, when reviewing evaluations
of team performance, it was discovered most team members
performed their duties within their scope of practice, RNs
were able to delegate appropriately, and team members
were able to communicate effectively. These findings were
consistent with students perceptions of their performance.
When asked to identify what they did well in the scenario, the RN students thought they were able to do a good job
of delegating and prioritizing. They also believed they were
good communicators. The LPN students stated they were
efficient in completing the tasks assigned to them, and they
worked cooperatively with the RN students. Considerations
that influenced the delegation process for the RN students
were primarily the capabilities and preferences of the staff
with whom they were working. The LPN students believed
they were not delegated enough tasks. When they had to
make decisions about prioritization, RN students based
their decisions on report and the acuity of the patients.
The LPN students used airway, breathing, and circulation
as a guideline, along with safety considerations. Focusing on collaboration, both RN and LPN students indicated
they collaborated well to meet patient needs. Considering
the cultural aspects of the scenario, the RN students expressed feeling culturally competent, but they found having
a non-English-speaking patient difficult. The LPN students
also identified the non-English-speaking patient as a major stumbling block to good patient care. Both RN and the
LPN students felt they had sufficient knowledge and skills
to manage the scenario. They also believed none of the assignments were outside their scope of practice.
When asked what they would do differently, RN students identified the need to perform more thorough assessments, and they suggested more time be allotted. The LPN
students also expressed a need for more time. Both RN and
LPN students believed they needed more practice to build
confidence. All of the students reported the scenario was
a positive experience, and they suggested having several
scenario experiences in a semester. Based on student feedback and performance, it is evident this simulation exercise
validated the benefit of more comprehensive threading of
delegation and supervision and other leadership principles
throughout students nursing education.
Barriers
Barriers were identified throughout the project. Scheduling the RN and LPN students and the nursing science
laboratory time for two 8-hour days to conduct the simulation project was challenging. Recruiting adequate role-players and faculty to assist with evaluation of critical elements
on the performance evaluation tool proved to be difficult.
196

Contacts were made with the social work department to

participate in the project, but this not possible at the time.
Ongoing communication will continue to include the social
work department in future student collaborative experiences. There was difficulty with grant reimbursement of different agency partners for purchases, faculty stipends, and
work completed. Due to technology of the shared Web site,
e-mail, and conference calls, the distance coordination was
not a barrier as anticipated. The enthusiasm for the project
resulted in full attendance at all scheduled meetings.
Modifications
Modifications involve refinement of the evaluation tool
to allow more objective measurement of delegation, supervision, and leadership skills throughout the scenarios. It
would be beneficial if each patient rubric would include delegation and supervision principles, collaborative team behaviors, and other leadership skills. It is not feasible for one
evaluator to observe each of these components. The validity
and reliability of the evaluation tool should be established.
A similar simulation exercise could be used earlier in the
curriculum and then repeated as a means of measuring
progress toward the acquisition of knowledge related to delegation and supervision, scope of practice, teamwork, and
culturally competent care. In addition, to use the simulation
exercise as an evaluation method, each of the performance
indicators on the evaluation rubrics could be pointed and
weighed, and mean scores could be obtained for more quantitative data from which to evaluate student performance.
Actual video clips could be used or group debriefing.
Future Plans
Plans call for the collaborative simulation project to be
an ongoing component in the senior courses of each partner school. The collaborative faculty had the opportunity
to present a PowerPoint presentation of the simulation
project to the board members of the Minnesota Board of
Nursing using video clips of the simulations. The response
to the project by members of the Board was overwhelmingly positive. The project findings were disseminated to
a variety of technical and community college faculty at a
regional conference. The digitally created simulation scenarios are available to faculty on the college Web site.
Future plans also include the development of additional
scenarios with the same foci and key components but different patients so that scenarios can be rotated from year
to year or implemented twice in each programs curricula.
Plans also include collaboration with allied health and social work disciplines to design new learning activities and
simulation scenarios that promote greater emphasis on
interdisciplinary learning.
CONCLUSION
The faculty from the three partnering schools worked
effectively together in creating this project. There was
excitement and creative energy with the team members,
who all believed the simulation project was innovative
Copyright SLACK Incorporated

and would positively impact student learning. The greatest benefit of the simulation project was the opportunity
to collaborate with faculty from the partner schools to
create the simulation learning outcomes, learning activities, case scenarios, and evaluation methods. This provided a forum for rich discussion about the issues related
to the Minnesota Nurse Practice Act, the scope of practice for the RN and LPN role, an appreciation of the complex issues faced in practice, and the value of simulation
in educating nurses for practice. In addition, there was
an enhanced understanding and appreciation for the different nursing education programs and the importance
of continuing to work together to provide joint clinical
learning opportunities as part of educating future nurses. The project provided students with the opportunity
to learn more about the scope of practice and how it is
applied in nursing practice.
The simulation project was appreciated by the three
partnering schools. It provided a unique opportunity to
work in a collaborative manner on important issues in
nursing education that will transfer into nursing practice
in the region. The project faculty team has maintained
ongoing enthusiasm and belief in the value of the project. The mock simulations and the implementation of the
learning simulation along with the feedback from students
and others have added to the strength of commitment to
the importance of the project. Furthermore, as a result of
the learning that occurred for both students and faculty,
plans are in the works for future collaboration with in-

volved faculty to create simulations that can be integrated

earlier in students educational experiences.
References
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