The nursing community has voiced concern regarding the precedent set when a former Vanderbilt University Medical Center nurse was found guilty of criminally negligent homicide and abuse of an impaired adult after admitting to inadvertently injecting a patient with the wrong drug.
RaDonda Vaught’s conviction has sparked conversation among health care providers regarding the inevitability of mistakes in the field. In a joint statement on the sentencing, the American Nurses Association and the Tennessee Nurses Association, called it deeply distressing.
“Health care delivery is highly complex. It is inevitable that mistakes will happen, and systems will fail. It is completely unrealistic to think otherwise,” the associations wrote in the statement. “The criminalization of medical errors is unnerving, and this verdict sets into motion a dangerous precedent.”
For Kristen Zulkosky, director for the Center for Excellence in Practice at the Pennsylvania College of Health Sciences, the case highlights an important advancement in health care education that the college has particularly doubled down on in the last two decades.
The Lancaster-based college’s Center for Excellence in Practice is the first and only health care simulation-based education facility in the region. The center features 24 rooms including an intensive care unit and specialized equipment such as anesthesia machines and gas columns.
Pennsylvania College of Health Sciences has been a leader in the simulation-based education space, having participated as one of 10 facilities across the country chosen by the National Council of State Boards of Nursing for a landmark simulation study in 2011.
The study concluded in 2013, finding that simulating a health care environment for educational purposes could substitute up to 50% of traditional clinical experience for prelicensure nursing students.
Before the college took to integrating simulations into its curriculums, students had to take what they learned to the bedside.
The simulations allow nursing students to make mistakes without harming patients. It also allows those students to give medications and treat like a nurse, something they never get the opportunity to do when still students, said Zulkosky.
“This is an immersive experiential opportunity where they can apply what they learned in the classroom to real life,” she said, noting that nursing educators are worried that the Vaught case could set a bad precedent for health care providers and scare potential students from joining the workforce. “We are trying to give students the opportunity to practice in a safe environment and make critical decisions.”
Improving the simulation experience
Advances in the simulations over the years have made the programs more immersive, allowing students to suspend their disbelief and work like they are in a real situation, said Christine Hutchinson, operations manager at Penn Medicine Simulation Center in Philadelphia.
“Realistic experiences give learners the opportunity to build comfort levels and therefore confidence,” said Hutchinson.
The Penn Medicine Simulation Center works with the Pennsylvania College of Health Sciences’ on the Philadelphia Area Simulation Consortium PASC, a collective of local SIM programs working across system lines.
The Pennsylvania College of Health Sciences purchased its first simulator in 2006—a mannequin that could blink its eyes with a chest that could rise and fall.
Interested in the opportunities that growing a simulation program could provide, Zulkosky, who has been with the college since 1996, decided to do her dissertation on using simulations in the classroom.
Today the college is considered a destination for its Center for Excellence in Practice, which includes a 20,000-square-foot simulation area.
“I have been to multiple simulation centers, and they are nothing like the one we have,” said Zulkosky. “People come to our lab for tours, and they are blown away. This is a big financial investment. Our college is very good at providing the funds to buy the simulators and run the department.”
For programs like the Center for Excellence in Practice, it is vitally important to continue to evolve simulations alongside the changing health care landscape, said Hutchinson.
“Currently, workflows, educational delivery methods, clinical advancements, pandemic conditions, staffing shortages, sim content, prebriefing and debriefing methods and faculty educational goals are all factors we factor and refactor with updates continually,” she said.
Building today’s labs
Zulkosky works with the college’s departments to formulate simulations that can be used across the school’s many disciplines. While one course may have seven required simulations, another may ask students to repeat two over their time at the school.
The center held a number of simulations in April ahead of the end of the college’s spring semester including Hearing Voices, where students listen to an audiotape that simulates what it would be like to have Schizophrenia while doing a series of mock tasks and activities.
The center’s five-hour-long Interprofessional Simulation was held on April 14. The college teams up with Lebanon Valley College for the simulation, which sees students from different professions communicate together.
The Interprofessional Simulation takes students through the full scope of caring for a patient from injury to emergency room, to operating room and finally recovery.
“The students learn to communicate with one another, and they learn each other’s roles,” said Zulkosky.
Finally, at the end of April is the Multi-patient Simulation, in which three simulation scenarios run at once and students need to treat each patient according to their needs.
The Center for Excellence in Practice has the ability to create new simulations based on the needs of the current health care space. The Multi-patient Simulation is an example of the school offering students an experience that they will certainly see out in the field when they graduate but may not during their clinicals.
“Usually, students don’t have to deal with high numbers of patients and then decide who their most critical patient is,” said Zulkosky.
In each of the simulations, the students then have a chance to debrief with their instructors. In some instances, the students can then try those simulations again.
“Instead of learning leadership and prioritization only in the classroom, I think these experiences will stick with them more in their long-term memory,” she said.