BEST IN CLASS
How Two Nursing Schools in Texas Meet Learners Where They Are
The School of Social Work and Smart Hospital at UTA. Photo courtesy of The Shorthorn: Eduardo Gonzalez
Gabi Nintunze, Texas Nurses Association
Copy Editor, Texas Nursing Magazine
THE NURSING SHORTAGE IN TEXAS has been top of mind for TNA for the last few legislative sessions. One of our legislative priorities for this session is investment in nursing education, a key way to support the nursing workforce and bring more nurses into the field. According to the Texas Center for Nursing Workforce Studies’ projections, there will be a shortage of over 56,000 RNs by 2036. It’s good news, then, when a new school of nursing opens its doors, or a new avenue of continuing education becomes more accessible to nurses in underserved areas.
For this issue of Texas Nursing Magazine, we visited two nursing education programs to shine a spotlight on some of the exciting things happening in nursing education around the state. Here are two programs that are doing their best to meet their students where they are and ensure they’re ready for whatever comes next.
Mama Anne
Mama Anne is one of dozens of lifelike, customizable mannequins that allow nursing students at the University of Texas at Arlington to get acquainted with what they might see in a hospital bed in their near future.
UT Arlington's Mobile Sim Lab
Roughly the size of an RV, UTA's mobile sim lab houses two patient bays with monitoring areas in the middle, microphones on the ceiling, 360⁰ camera viewing, and a two-way mirror in the viewing room.
University of Texas at Arlington
In the mobile simulation van, all eyes are on the patient in the hospital bed. As the program starts up behind us, Dr. Jill Whitfill, MSN-Ed, RN, Assistant Professor of Clinical Practice, Rural Simulation, introduces us to Mama Anne. She’s one of dozens of lifelike, customizable mannequins that allow the students at the University of Texas at Arlington to grow accustomed to what they might see in a hospital bed in their near future.
When we arrived, the mobile sim lab, roughly the size of an RV, was parked beside the smart hospital. Inside were two patient bays, one on each end, and monitoring areas in the middle. With microphones on the ceiling, 360⁰ camera viewing, and a two-way mirror in the viewing room, it’s a safe space for students to learn, and a well-appointed place for instructors to simulate everything from a hemorrhage to a heart attack.
The first demonstration was a speedrun through childbirth. Dr. Whitfill sets up the desktop in the maternal health bay and talks us through the settings she can engage: dilation, speed of delivery, contractions that you can feel when your hand is against the mannequin’s stomach, and much more. I jumped the first time Mama Anne blinked—not quite lifelike, but certainly startling!
“Texas is 48th in women’s healthcare overall in the U.S.,” said Dr. Jennifer Roye, EdD, MSN, RN, CSHE-A, CNE, PNAP, Assistant Dean for Simulation and Technology. “So, we’ve got some growing to do.”
The mobile lab is one way UTA is working to bridge the gap. Beyond training students, a major goal of the lab is to get out into rural communities to offer training to healthcare workers in those areas—the first lab of its kind in the U.S. to focus on rural nursing.
And the trips out have already begun: “We had a grant and went out to Jacksboro and did some maternal emergency simulation training with their med-surge nurses. It went over very well, and that was just the beginning. We want to take the training on the road to rural Texas, and now that we’ve got Mama Anne, we don’t have to do it virtually.”
Mama Anne doesn’t break a sweat—the baby comes out smoothly, the placenta following shortly after. “That’s nothing,” Dr. Whitfill jokes. “We could have ‘blood’ all over this floor.”
The mobile simulation lab is fully equipped for simulated childbirth and maternal health on one side of the lab and acute-care incidences on the other. Video courtesy of UT Arlington.
On the other side of the mobile lab, an oxygen and a blood pressure monitor are hooked up to an acute-care patient. He has eyes that can dilate as needed, tear ducts, a flexible jaw for intubation, and plenty of room for breaks, sores, and other temporary medical conditions to be applied with the help of a moulage technician. Just like with Anne, this mannequin can be carefully monitored and adjusted for use with students and can present with a wide range of medical emergencies, HALO[SB1] (high acuity and low occurrence) events, and traumatic injury.
“The main goal for the center has always been to increase access to healthcare in rural communities across Texas. This helps increase that access by taking it to them,” said Aspen Drude, Manager of UTA’s Center for Rural Health and Nursing. The mobile clinic would help improve access to advanced training in rural areas, which in turn would expand access to essential care for communities that need it. “It really is about their needs though, which means going in and talking to hospitals and clinics, asking them what they need, what is prevalent in their community, and then, how do we use this unit to create something that helps them with that?”
Dr. Whitfill was also optimistic about customizing the mobile lab for a broader range of community uses, including Interprofessional Education and high school education: “[High school students] would get to experience the healthcare field, so perhaps they’d come to UTA and fulfill that desire and curiosity. And with that opportunity, maybe we’d get more nurses!”
On campus, the smart hospital itself is full of even more innovative approaches to healthcare education. Classrooms that look like hospital wards, with mannequins in their beds; limbs that work to train nurses on needle use; child-sized dummies for pediatric care. And, of course, the virtual reality rooms.
“When we built the smart hospital, ‘flexibility’’ was my favorite word,” said Dr. Roye. “We need to be able to make this whatever we need to. And what we can’t replicate in these rooms, we can replicate in our VR headsets.”
The virtual reality headsets can simulate direct patient care, and the headsets can go with them on the road to supplement the training offered.
All of it goes back to making sure nurses are as prepared as they can be when faced with the unexpected—and for the mobile lab, that the resources they have are resources that can be shared.
St. Edward's University, Austin, TX
St. Edward’s University, a little green island in the middle of downtown Austin, opened their School of Health Sciences last year. A ribbon cutting in January of this year marked the grand opening of the nursing program and new facilities, and the first cohort is expected to graduate this August, after completing an accelerated program.
“The goal is to fire them up, and then send them out into the world and let them change it,” said Jesica Naiman, PhD, RN, COI, professor and Simulation Learning Research Center Coordinator. Their brand-new simulation lab was built to do just that: preparing students for what’s to come with innovative learning models, and giving them the tools they need to enter the field with confidence.
We started our tour in one of the flexible classroom spaces, and then headed into a control room. The control room has a clear view into both classroom spaces and houses the technology systems. The instructor creates an adaptable lesson for students on the other side of the two-way mirror. Cameras and microphones inside the lab let the instructor know how students are doing, and programmable equipment gives the instructor control over the scenarios in which students learn.
“We’re able to use the microphone and speak for the patient and can change patient outcome based on student actions. So, if they give them the wrong medication, we can put them in cardiac arrest, that sort of thing.”
Some mannequins are able to speak, either with pre-programmed phrases or by a speaker connected to the instructor’s headset. Video courtesy of St. Edward's University School of Health Sciences.
The high-fidelity mannequins can also “speak,” offering indications of other problems at hand—either in their own recorded voice, or in that of an instructor, armed with a tablet and a microphone.
“All kinds of things can happen when you don’t do what you’re supposed to do as a nurse, and we can safely show them what can happen. Then we can record it, and go back and talk about it, and say, ‘Yeah, you had your IV fluid running at 500 ml. Of course they’re going to go into congestive heart failure, they’re on a beta blocker.’ We can go through all of that with them and sit down and walk them through it in a safe way, which is so nice. I wish we had this when I was a student.”
Most students’ first time in the lab is a little overwhelming, but they get comfortable quickly; the lab space is combined, with no separation between classroom and lab.
This allows for the nursing students to be fully immersed: first, the instructor lectures. Then, they turn to practical skills with the help of the mannequins. After that, they return to lecture and discuss what they’ve learned. That way, the lessons are reinforced immediately.
The mannequins allow students to practice working with children, adults, expectant mothers, and more, and allow for increasingly complex scenarios the further they get along in their nursing education. This, in turn, might serve to prepare them for career longevity.
According to an article from the American Nurses Association, nearly 18% of nurses leave the profession within their first year, with one of the most commonly cited causes being stressful working conditions. While no program can prepare its students for everything, having a safe environment in which to explore a wide range of potential scenarios may leave them feeling more capable and confident by the time they graduate.
The mannequins [at St. Edward's University] allow students to practice working with children, adults, expectant mothers, and more, and allow for increasingly complex scenarios the further they get along in their nursing education.
Lab space is combined, with no separation between classroom and lab.
This allows for the nursing students to be fully immersed: first, the instructor lectures. Then, they turn to practical skills with the help of the mannequins.
The simulated scenarios can run between 10 and 30 minutes, depending on what’s happening with the patient. Toward the end of their program, students will have a half day in which they have to manage four patients in the simulated hospital. That scenario was constructed to give them the chance to simulate a shift before heading into a clinical setting for their practicum.
The simulations and the environments that the students work in are closely based around a similar set up that their clinical partners use, in large part to try and reduce the adjustment period for new nurses. For Dr. Naiman, this is another aspect of their practical education. “I really hope that it shortens the amount of time that it takes for a novice nurse to become a competent nurse, and that we're able to reduce the anxiety and increase the confidence and the ability for students to critically analyze what they're doing in the hospital setting.”
St. Edward’s labs are still growing, and are designed for interdisciplinary simulations between the health science programs. As their School of Health Sciences grows, students will have more opportunities to learn with members of other departments and engage in the broader Austin community, both aspects of preparation that go beyond the typical classroom model.
A Strong Head Start
St. Edwards’ and UT Arlington’s new programs highlight the ways that nursing schools are looking to do their part to alleviate the nursing shortage, by making it possible for more nurses to enter a changing field with confidence. That can look like hands-on learning that starts at the beginning of your education, high-fidelity simulations that allow for more creative and impactful lessons, VR headsets that put you in the middle of the action, or training that meets nurses in underserved areas and allows them to continue the work they do, without worrying about travel costs and inconvenience.
As the nursing profession changes, so too does nursing education; as technology changes, so does the scope that education can cover. Hopefully, that means a strong head start for our future nurses—and good news for a healthier Texas. TN
Blood-draw station
Infant mannequin patient in the simulated hospital
