As the University of Wyoming (UW) team looks to enhance their nursing education experience, they have added a HAL 3201 high-fidelity patient simulator to their program. Limited clinical training sites, lack of qualified nursing faculty, and nurses leaving the profession because of the COVID-19 pandemic have contributed to a nursing shortage across the United States. Using simulation-based training will help UW train nursing students who fill the frontline provider and educator roles needed to reduce the nursing shortage.
The effects of the nursing shortage during the pandemic
Nurses fulfill an integral role in the support and delivery of quality healthcare. Hospitals adequately staffed with nurses experience decreased medical errors, lower patient morbidity and mortality, and far less job burnout than hospitals with high patient-to-nurse ratios. However, a nursing shortage has affected the U.S. since 2012, requiring 1.2 million new registered nurses (RNs) by 2030 to address the shortage.
The COVID-19 pandemic has exacerbated the existing nursing shortage; up to one in five healthcare workers have left their jobs due to overwork, stress, and trauma caused by the pandemic . Moreover, a 2021 NSI Nursing Solutions report found the RN vacancy rate increased to 9.9% in 2020, and 62% of hospitals have an RN vacancy rate above 7.5% due to the pandemic.
As in other states, the pandemic caused many nurses in Wyoming to quit or retire early. Over ten hospitals reported critical staffing shortages by October 2021, meaning they cannot serve the needs of every patient, possibly leading to some patients not getting life-saving treatment. High patient-to-nurse ratios cause fatigue and stress, which likely results in more errors, and the quality of patient care suffers.
Travel nurses are highly sought after to fill nurse vacancies caused by the pandemic. As a result, travel nurse salaries have climbed, often earning more than staff nurses and creating an unsustainable burden to hospital budgets. Additionally, the turnover rate for staff RNs has increased during the pandemic, costing hospitals between $3.6 million to $6.5 million per year.
Many hospitals in Wyoming strained to provide care to patients during the initial surge of COVID-19 infections in 2020. Staff shortages put additional pressure on the state’s hospital system when cases surged in the summer through winter of 2021. As a result, Wyoming’s hospital association, medical society, and nurses association have asked state lawmakers to address these shortages. Until then, hospitals across the state will continue to experience declining patient outcomes.
Simulation can be used to train more nurses
Before the pandemic, nursing schools across the country worked on solving the shortage by increasing enrollment and graduation in nursing programs. Maintaining a strong pipeline of new nurses into the workforce is critical to filling vacancies. However, in 2020, baccalaureate and graduate nursing programs had to turn down over 80,000 applicants due to lack of faculty, clinical sites, classroom space, and budget constraints2.
In 2017, the Wyoming Department of Workforce Services reported that a nursing shortage would affect the state within a decade. Lack of funding for education and low wages for educators are critical roadblocks to training and recruiting additional faculty needed to expand nursing programs in Wyoming. Moreover, the pandemic forced universities to stop in-person clinical hours, delaying graduation for many clinicians, nurses, and other healthcare providers just when they were needed most.
In response, the U.S. government created several coronavirus relief funds to provide financial assistance to universities and hospitals. The Provider Relief Fund, the Higher Education Emergency Relief Fund (HEERF I & HEERF II), and American Rescue Plan (ARP) include provisions for education and training that can address roadblocks to expanding nursing programs. Among them is funding that can be used to cover the cost of patient simulators.
Simulation-based training provides participants with opportunities to learn procedural and cognitive skills in a hands-on and safe environment. The simulated session requires thinking critically, working as a team, and communicating effectively, which helps develop the knowledge and experience needed to avoid errors and ensure better patient care.
The pandemic severely limited clinical opportunities for students. However, simulation-based training can be used to supplement clinical instruction. In fact, the National Council of State Boards of Nursing (NCSBN) published a study that found that up to half of traditional clinical hours can be replaced with time spent practicing on a simulator.
Thus, nursing programs can invest in workforce training and development tools like patient simulators and skill trainers to ensure students gain clinical hours and experience. This is especially important in areas with limited clinical faculty. An educator can facilitate clinical hours for large groups of students without depending on overburdened local hospitals.
Participants will learn and practice various clinical skills in their nursing program, thereby avoiding gaps in their knowledge and delays in graduation caused by students waiting for clinical sites and opportunities to open up. This will help reinvigorate the nursing pipeline by placing more highly-trained nurses in hospital and academic positions where they are gravely needed.
Improving healthcare in Wyoming through simulation
In response to the pandemic, the Fay W. Whitney School of Nursing at the University of Wyoming has used simulation to ensure they could continue clinical hours and help rapidly train new RNs to fill staff vacancies in hospitals across the state. The allocation of scarce resources demonstrates their belief in the efficacy of this modality of training for their nursing program.
According to Sherrill Smith, Dean of the School of Nursing, “our students are entering health care settings that are more complex than ever. Our ability to use the most up-to-date simulators is crucial in helping them to be prepared to care for complex patients — in an environment that is safe and facilitates their confidence and competence.”
The HAL® S3201 will help facilitate realistic patient care scenarios for nursing students, including the management and care of COVID-19 patients. HAL supports the use of a real mechanical ventilator, and his intuitive respiratory controls allow users to adjust lung compliance, airway resistance, gasping, etc., to simulate various respiratory conditions.
Before the COVID-19 pandemic, respiratory illnesses were already a significant public health issue in the United States. Infections like pneumonia accounted for about 2.8% of all hospital stays and were a leading cause of death . These illnesses can be complex to treat and can progress rapidly. However, morbidity and mortality decrease if the patient is cared for by a highly experienced care team that can quickly identify complications and perform effective interventions.
Incorporating HAL into the curriculum will allow the nursing program to provide students with hands-on experiences working in these high-stress emergency scenarios. Students apply what they have learned in the classroom and practice advanced techniques and procedures under the supervision of an experienced educator. HAL’s vitals and physical symptoms will respond to their interventions in real-time, so they experience the realities of working with time-sensitive cases.
The nursing program also uses Gaumard’s VICTORIA® S2200 and Newborn TORY® S2210 to train their nursing students on labor and delivery skills. Giving birth accounts for up to 10% of all hospital stays in the U.S.8, chances are very high that a nurse will assist in the labor and delivery process, especially those working in rural areas where lack of adequate staffing requires nurses to take on more tasks.
VICTORIA’s lifelike physiology and features allow her to simulate the progression of labor and a range of obstetric events so that nursing students can develop the assessment skills needed and recognize the signs and symptoms of possible complications. They can also monitor VICTORIA’s vital signs using real equipment, familiarizing themselves with the tools they will use in the real world.
An important aspect is that the students have the opportunity to work as a team to provide support for VICTORIA during and after childbirth and monitor the newborn immediately after birth. This helps them develop the skills and confidence needed to communicate and work effectively, avoid errors, and quickly respond to complications. Hence, students can transition into the workforce with greater ease and confidence.
Simulation helps UW address healthcare needs in rural communities
Adding HAL to the nursing program will also help facilitate training for students in the Bachelor’s Reach for Accelerated Nursing Degree (BRAND) Program, an accelerated distance-learning RN program developed by UW to provide Wyoming with additional professional nurses. Students now utilize multiple formats in their education, from online learning to hybrid courses and hands-on clinical experiences with simulators to learn and develop the skills they need to provide safe and effective patient care.
This program is especially beneficial for students in rural communities apart from the university’s nursing school campus. Traveling long distances can prevent some students from starting or finishing their education. Some students relocate to urban areas to begin their education and find employment, draining rural hospitals of valuable RNs. Indeed, only 16% of RNs live in rural areas, meaning staffing shortages have a more significant impact in these communities and are only made worse by the pandemic .
The BRAND Program allows students in rural areas to remain in their communities and acquire their degree. Dean Smith explained that UW can address critical workforce needs in these areas through clinical partnerships with rural hospitals, allowing them to “grow their own” BSN-prepared nurses without relocating the students to the main campus in Laramie, WY.
Simulation will help the students develop and hone various skills needed to address health disparities seen in rural communities. This ensures that rural hospitals have the same access to the nursing pipeline as urban hospitals, ensuring that highly trained healthcare professionals fill vacancies across the state.
The nursing program’s mission is to help students achieve success and improve the quality of Wyoming health care and beyond. The funding provided to the program is critical to its growth and ability to provide high-quality education to its nursing students. The pandemic adversely impacted nursing programs when nurses were needed the most. Despite the many challenges, UWs investment in innovative technology like simulation has enabled the School of Nursing to continue its mission and address critical needs in the state’s healthcare system. A new generation of nurses will receive training and help improve outcomes in the state and reduce the nursing shortage.
To read the full article, visit the UW News page.
 Annamaraju, Pavan, et al. “Nursing Shortage.” StatPearls Publishing, https://www.ncbi.nlm.nih.gov/books/NBK493175. Accessed 2 Feb. 2022.
 “The 2021 American Nursing Shortage: A Data Study.” USAHS Blog, University of St Augustine for Health Sciences, https://www.usa.edu/blog/nursing-shortage. Accessed 2 Feb. 2022.
 Yong, Ed. “Why Health-Care Workers Are Quitting in Droves.” The Atlantic, https://www.theatlantic.com/health/archive/2021/11/the-mass-exodus-of-americas-health-care-workers/620713. Accessed 2 Feb. 2022.
 Andrew, Scottie. “Traumatized and tired, nurses are quitting due to the pandemic.” CNN, https://www.cnn.com/2021/02/25/us/nurses-quit-hospitals-covid-pandemic-trnd/index.html. Accessed 3 Feb. 2022.
 Neisloss, Liz. “Travel nurse salaries driven up in the pandemic, creating ‘unsustainable’ hospital costs.” GBH News, https://www.wgbh.org/news/national-news/2022/02/03/travel-nurse-salaries-driven-up-in-the-pandemic-creating-unsustainable-hospital-costs. Accessed 3 Feb. 2022.
 Plescia, Marissa. “The cost of nurse turnover by the numbers.” Becker’s Hospital Review, https://www.beckershospitalreview.com/finance/the-cost-of-nurse-turnover-by-the-numbers.html. Accessed 4 Feb. 2022.
 Jeremias, Sofia. “Staff shortages plague Wyoming medical providers.” WyoFile, https://wyofile.com/staff-shortages-plague-wyoming-medical-providers. Accessed on 3 Feb. 2022
 Pfuntner, Anne. “Most Frequent Conditions in U.S. Hospitals, 2010.” Agency for Healthcare Research and Quality, https://www.hcup-us.ahrq.gov/reports/statbriefs/sb148.pdf. Accessed on 4 Feb. 2022. PDF.
 Oba, Yuji & Hariharan Regunath. “Community-Acquired Pneumonia.” StatPearls Publishing, https://www.ncbi.nlm.nih.gov/books/NBK430749. Accessed on 7 Feb. 2022.
 Wright, Aallyah. “Rural Hospitals Can’t Find the Nurses They Need to Fight COVID.” Pew Charitable Trust, https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/09/01/rural-hospitals-cant-find-the-nurses-they-need-to-fight-covid. Accessed 3 Feb. 2022.