47CHAPTER 6
Building and Maintaining a Learning Resource Center
Traditionally, nursing programs have taught and practiced technical skills in a “nursing lab.” As time has passed and technology has evolved, these labs have expanded to include computer stations, web access, and computer-based learning platforms for skill acquisition. Today, nursing labs often contain all the resources needed for teaching and learning nursing skills through integrated processes that include mock-ups of a hospital. In addition, the technology in the nurse’s practice setting is growing and expanding at an exponential rate. Computers are used for fully computerized charting and for interfacing with all departments and personnel. For many hospitals, test results and orders are delivered via computer. In addition, many nursing stations—once essential as a place for nursing documentation—have been replaced with individual workstations on wheels, called WOWs, for each nurse for each shift. Each clinical placement for the student presents faculty and students with technologic challenges that change every semester; new computerized equipment and care systems abound. It has become essential that any nursing lab, frequently called a learning resource center, includes the latest state-of-the-art equipment for patient care as well as patient care delivery systems. It is no longer adequate for students to just show up and perform basic nursing tasks; it is essential for students to become an active part of the simulated learning environment in order to learn.
To that end, nursing programs are finding that the traditional lab is inadequate to meet the needs of today’s students. Technology has become a necessary means to support, deliver, and evaluate nursing competencies. Skill-based education is still essential and can be delivered through static and computerized learning modules. However, preparation of students for a complex health care environment requires that students are educated not only in skills, but also in communication, safety, and collaborative care. Varied levels of technology assist in this endeavor. Whether static, low fidelity, medium fidelity, or high fidelity, all should be available to assist students in meeting learning objectives.
ENVISIONING A CENTER
Many programs have worked diligently to expand, room by room, from a nursing lab to a learning resource center. These centers include simulation labs, static skill labs, resource libraries with nursing references, and, ideally, a computer lab. Several programs have benefited from large grants that allowed architectural design and construction of the ideal environment. In either case, creating a vision and a plan are essential. Other schools have creatively used available space to alter the methods with which they provide simulation education. However, no amount of planning guarantees a smooth transition from lab to center.
48The needs of a program shift quickly with enrollment changes, which challenges simulation practice space and classroom use. As enrollment increases and expansion of program courses extend into summer and intersession time periods, lab spaces need to be easily accessible to meet the needs of a variety of courses. The flexibility of the space is of utmost importance. The objective of providing a multifaceted learning experience must be the foundation of any learning resource center endeavor.
The vision for the center should not be a one-person quest; although, often that is exactly how the journey starts. Faculty buy-in is crucial! Otherwise, the human patient simulators (HPSs) may become nothing more than “very expensive paperweights” (J. Novotny, 2008, personal communication). Communicating the need campus-wide is an additional challenge. Just as no man is an island, no department exists alone. Many departments will be involved in the successful implementation of a learning resource center.
When considering the needs of the faculty, students, and curriculum, envisioning the center requires outlining areas of importance. These areas include space issues, equipment needs, technology, support personnel (lab, information technology [IT], and students), funding, and faculty development. One way of prioritizing these needs is to create a “wish list” to help identify what is realistic, given situational factors.
When creating a wish list, consider dividing it into the following sections:
• Grand wish list: Things you would get if you had unlimited funds.
• Desired wish list: Items that the faculty specifically request for courses.
• Realistic wish list: Items that match the actual funding and budget for purchase-order development based on a prioritization of the grand and desired wish lists.
Space issues, lab layouts and consideration of needs, and flexibility of space may include the following:
• Furniture that is easily mobile (stackable, rolling)
• Storage units for equipment and other resources
• Computer technology to meet multiple needs including wireless and cloud capabilities to capture and replay learning interactions
• Interchangeable classrooms for lecture, computer-assisted instruction, small-group interaction, health assessment, technical skill performance, group presentation, and simulation scenarios.
LEARNING RESOURCE ROOM AND OPERATING ROOM CENTER ESSENTIALS FOR SIMULATION LEARNING
No two nursing labs or learning resource centers are ever the same. When conceptualizing your center, important considerations include the following:
• Available space (e.g., is it shared with other university programs?)
• Large lab room versus multiple smaller rooms or areas
• Determination of the number of specialty rooms or areas, such as medical–surgical, intensive care unit (ICU), operating room (OR), pediatrics, women’s health, home care, long-term care
• The relevance of lab needs to the present nursing curriculum (e.g., how many classes at a time will need the space, at what points in the semester, and during what time frames)
• Incorporation of other components or threads, such as communication, palliative care, leadership, delegation, and documentation
• Specific equipment needs
• A vision that incorporates input from faculty, administration, and students—buy-in is crucial at all levels
• Availability of lab personnel to assist with setting up and running the scenario
• Use of volunteers to role-play (visual and performing arts students, members of the AARP, retired doctors and nurses, health communication faculty or majors, other students and faculty)
• Faculty resources for curriculum development and planning (Center for Academic Excellence, Scholarship of Teaching and Learning Centers)
• Use of other departments and colleagues on campus, such as Business to help with the development of a plan for sustainability
• IT and media support
Early in the process of developing a center, one HPS may be used for multiple purposes, but over time, we have found it best to designate specialty areas in order to focus on specific learning experiences. Setting up simulation labs so that the specialty-specific simulation area is self-contained may be preferable (e.g., a pediatric area should have all pediatric equipment needed for scenarios and teaching). Should the rooms be separated by larger distances (e.g., separate buildings), one might find it necessary to duplicate equipment for both areas. Ideally, the simulation area should be a classroom-size area with a cart or cabinets that have room for all necessary equipment. If possible, having a classroom nearby with projection capability to record and project real-time scenario enactment from the simulation rooms would be ideal. In this situation, the larger classroom could function as a learning environment to allow the knowledge transfer from simulation to the classroom and, eventually, from the classroom to hands-on care. In a separate venue, the participants in the simulation need time for debriefing of the scenario during which a small group can sit to discuss specifics about its role and how things might go differently.
In addition, having a resource area, where copies of textbooks and references are available so that students can readily access the information needed to meet their learning goals during the simulation, is helpful. Often, when students have an opportunity to “redo,” this reference area facilitates the processing of an unsuccessful scenario. Students can search for solutions on site and use the computers available.
Props that enhance the “realness” of the scenario are helpful as well, such as stretchers; charts; a crash cart; a defibrillator; EKG machine; and intravenous (IV) solutions, lines, and machines. The room or area should feel real as much as possible to enhance the authenticity of the scenario. Students should feel less like they are “playing pretend” and more like this simulation could really be happening. Of course, once the simulation starts, it often takes on a life of its own. In order to further enhance the realness, the setup needs to be efficient. The key to successful scenarios is to be able to set up quickly and dress the HPS for success with wounds, a Foley catheter and IV, medications, a chart, and equipment nearby. One idea is to put together grab and-go packets or plastic bins for each scenario so that assembly and takedown time are minimal. The packets or bins should be nearby in a cabinet or treatment-type cart for easy portability. Technical materials, such as video and sound equipment and various computers, should not be noticeable. Many programs use control rooms with a one-way mirror or have the scenario controller behind a curtain. However, with the addition of the personal digital assistant and now tablet remote access on some HPSs, the person controlling the scenario can be nearby or in the scene making rapid click-and-go adjustments to the scenario as it progresses.
Considering the high expense of these medium- and high-fidelity HPSs, having a plan for downtime usage becomes important as time passes. Often, HPS use is somewhat seasonal depending on course rotations, so making the most of using the HPS is key. Partnering with outside agencies for staff training, updating skills, accreditation standards, and/or new staff competency training allows collaboration with local key groups. Using the simulation lab as an income-generating entity during low usage times is always a possibility, as is donating use of the 50facility to agencies that have gone above and beyond accommodating student placements. Also, in the summer months, the simulation labs and learning resource center can be used for accelerated programs, graduate courses, and continuing education programs.
KAREN’S FIRST STORY: WESTERN CONNECTICUT STATE UNIVERSITY
At Western Connecticut State University (WCSU), our first lab expansion involved many individuals, from the dean to the chair of university computing, to maintenance, purchasing, and accounts payable, just to name a few. The second expansion involved the president, purchasing, multiple assistants and secretaries, and university computing technicians as well as several faculty members. Phase III of this expansion project resulted from a federal nursing initiative (U.S. Department of Education, 2008) negotiated by the university provost, and we needed many departments’ help to renovate a space and to set up and maintain a lab. With a drastic increase in enrollment, expanding access to all levels of simulation is the primary goal. Having one or two people leading the way who have good relationships with all departments will facilitate the progress of the project, but an entire team working together during the implementation helps. Resources needed include working with Laerdal Create-a-Lab® and the university architect to develop the final layout. Often, there is no time for a new building, so making the most of the space you have, using fresh paint and minor renovations (e.g., removing old cabinets, replacing countertops), and rewiring for equipment is best when time is of the essence. Labs may need to be set up during times when classes are not in session, such as the summer months. Although having a vision is crucial, be open to other ideas to get what is needed, even if it may look very different from the initial picture in your mind.
Dollars, Donations, and Finances
Funding new resource centers and expansion projects is costly and challenging. Most facilities have written multiple grant applications and met with various successes and failures. Securing money from many sources is often necessary. It may take several months to years to secure adequate funding. In the case of WCSU, the simulation journey began to take shape after 2 years of grant writing. Three entities came together to finance the first HPS: the vice president of academic affairs; the dean’s office; and the director of university computing, whose generosity provided the bulk of the money. Within 2 years, a new simulator and space were needed to provide more access to simulation. The timing was perfect, because a new science building on campus left the old building empty. With the backing of the university president, a five-room astronomy suite was designated as the new lab, and with cleaning, renovation, and electrical work, the space was made usable for us. Because the new science building was being finished, we had contractors on campus doing other work, so they were able to help with our renovations. In addition, another grant came in that year from which funds for equipment were secured. The lab was ready for the fall semester. Much more work was needed to upgrade the lab over time, but the space is an excellent area for an assessment lab, a simulation room, a seminar room, a pediatric lab, a classroom space with Internet access, and a resource room.
Individual faculty members have secured small grants for simulation projects, with funds for equipment embedded in the grant. This money was used to set up individual stations for each HPS. A crash cart or treatment cart works best to store the equipment needed for simulations. Each high-fidelity HPS began by residing in a hospital bed. These beds made it difficult to move the HPS. Stretchers work best to make the HPS movable. Some faculty have taken the HPS “on the road” by using wheelchairs. There are anecdotal reports that one HPS made it to graduation and made a speech. The more movable, the better for taking to class and doing mock codes in 51interesting places. Hospitals may donate minimally broken stretchers that are too dangerous for patients but are fine for an HPS.
Faculties have also secured summer curriculum funds in order to have focused time for scenario writing and setup. In addition, faculty have used faculty funds to attend training conferences, obtain time release for research studies using the new simulation equipment, and encourage colleagues to get outside training. In addition, it was necessary to train the university technology staff to help with upgrades and troubleshooting.
Of course, the best-case scenario is when a very large grant or donation is secured to cover all aspects of a learning resource center.
KAREN’S DAVENPORT UNIVERSITY SIMULATION EXPERIENCE
In June 2011, I had the privilege of joining Davenport University’s College of Health Professions as the dean. This college was in the process of building three state-of-the-art simulation labs on three different campuses. When I arrived, the Grand Rapids lab was complete and awaiting some updated simulators. Within days of my arrival, I was asked to give approval for the plans for a newly constructed lab in Midland, Michigan, that was to be fully stocked and ready to start when the students arrived. By the fall of 2011 we held a ribbon-cutting ceremony for that Midland campus. At the same time, renovation of a fundamentals lab into a simulation lab was in progress in Warren, Michigan. We held the ribbon cutting for that lab in spring 2012.
Each lab contains a fundamentals area and a simulation lab complete with a control room and access to a computer lab. Each lab was fully funded by the university. Davenport’s visionary president, Dr. Pappas, set a goal that every campus that had nursing programs would be outfitted with a state-of-the-art simulation lab. With the support of the provost, Dr. Rinker, we were able to achieve this goal. From that endeavor, we have secured additional funding from donors who became interested in purchasing the most updated equipment. This spring, Laerdal SimMoms® arrived on each campus. We have since witnessed several “births.” Simulation expenses are now part of the yearly budget process on each campus. It is indeed exciting to have the full support of the administration as we move forward. As we built a new campus, we were able to equip it with a higher level of simulation labs available for the nursing students and health profession students.
Unique to Davenport is the role of the simulation, clinical, and lab coordinator. Each campus has a full-time faculty member in this role. These faculty members receive release time for this role (although not nearly enough). These coordinators work together to set the simulation goals for all four campuses and programs. Each orders supplies and facilitates scheduling of simulation experiences. Each will attend Drexel’s Simulation Certification program within the next year to reaffirm their role as simulation experts.
For me (Karen), this is the realization of a dream that all students have access to the highest level of simulation experiences as a given, not as an additional educational experience. At the ribbon cutting, students spoke highly of the versatility of the simulation experiences and how simulation helped them achieve educational goals. In an excerpt from a speech by a Davenport student given at the Warren ribbon cutting, Jonne Toliver stated:
It is very important in my learning experience to make a connection between theory concepts and clinical practice. This is the place where clinical thinking skills are built. In a simulation, you will be surprised how much knowledge you have retained because you have got the chance to experience it in some form or another. This is the place where mistakes are made, not because I don’t understand the material, but because this is my first real-life experience seeing a condition. After the first encounter, I have baseline knowledge about what to expect if I ever see that again. This is the place where anxiety and fear come to the surface because of inexperience, but I am relieved to know in the back of my mind that this is a controlled environment that I have the opportunity to learn without any pressure. This is the place [where] I can get feedback from my 52instructors, because when I reach a professional level I am the one that is responsible. This is the time for me to make safe adjustments to my technique before entering my career.
The transition from experiencing a lab with minimal variability to a simulation lab with infinite possibilities is a true accomplishment for Davenport University. Technology is an entity that surrounds us and this nursing lab implements the use of something that nurses use every day (J. Toliver, personal communication, April 23, 2012).
As is evident in Jonne’s speech, although we set out believing that simulation would assist the students to learn nursing, it is the students who know the full value and make all of our simulation journeys worthwhile, no matter how we get there!
DIANA AND SUZANNE’S STORY: FAIRFIELD UNIVERSITY SCHOOL OF NURSING
For the Fairfield University School of Nursing (SON), the vision for the integration of simulation-focused learning developed over time and required support from a variety of individuals and groups. As is sometimes the case when the stars align and all the right pieces fall into place, we were fortunate to have that happen for us. In early 2005, there was a decentralizing of the development office at the university, which led to the SON receiving a designated development officer—the foundation relation officer. At about the same time, a nursing student graduated after working her senior year in the nursing lab and, at the pinning ceremony, handed the dean a check for $40,000 to purchase an HPS. Finally, a friend of the SON set up a Distinguished Lecturer Series and challenged the school to “plan for its future.” The direct relationship with the development office, in addition to the formation of the Distinguished Lecturer Series, led to the formation of a SON Advisory Board (Appel, Campbell, Lynch, & Novotny, 2007). The nursing faculty worked on a vision and project plan for the learning resource center, with the core of the project being to recognize the gaps in present nursing education and the benefits of simulation-focused pedagogy.
Administrative support from the academic vice president, dean of the SON, and foundation relations officer led to the development of the 5-year Learning Resource Center Project (2006–2012), with Suzanne as the project director and Diana as the director of the Robin Kanarek Learning Resource Center (LRC). Diana’s role was key to the integration of the project, as were nursing faculty input and enthusiasm. A university-wide committee was formed to get feedback and to gather ideas in all areas, including upgrading classrooms, adding new technology, purchasing simulation equipment, educating faculty and students in the use of the new equipment, using students for role-playing during scenarios, using health communication specialists, gaining input for development of scenarios, and requesting interdisciplinary guidance. Key to this vision was a plan specific to faculty development for this paradigm shift.
In addition, the university was going through changes, with a new president after 25 years as well as the development of the Center for Academic Excellence. The Center provided university-wide support to promote the development of best practices in the scholarship of teaching and learning. Faculty and staff, including input from media and IT departments, provided support and buy-in for the new project. In less than 3 years, the SON Advisory Board raised $1.06 million for the 5-year LRC project.
From the project’s initial conception in 2005, the facility renovation was completed in the summer of 2006. Two simulation rooms were created with control from a central, double-sided mirrored room placed in between them, and within the university, the spaces became designated as exclusive for SON use. These rooms were converted into specialty areas (an intensive care and an OR) and three larger SON classrooms were renovated with state-of-the-art technology, wireless systems, and faculty computer consoles and audiovisual capabilities. The larger classrooms were remotely connected to the simulation rooms so that groups of students could observe classmates interacting during scenarios. In addition, two of the larger classrooms were equipped with the capability to record the class with live streaming of the audio, video, and PowerPoint slides available on the Internet. They were used to include students in class who were studying 53abroad, to prerecord nursing courses if a faculty member was at a conference, and to work with faculty in other countries by presenting and sharing content.
From Then, Until Now
Over the years, simulation-based pedagogy has been incorporated much more fully into Fairfield’s nursing curriculum. To that end, a director of simulation was hired in 2015, and now works collaboratively with the LRC director. Not only have most faculty members attended simulation workshops and developed course and content-specific scenarios, but six faculty are pursuing certification via the Certification in Healthcare Simulation Education (CHSE) examination. Additionally, the school is seeking accreditation as a simulation center through the Society for Simulation in Healthcare, an organization with an interprofessional focus.
In 2016, the Fairfield University SON was named “The Marion Peckham Egan School of Nursing and Health Studies” and a new building broke ground in early spring 2016. Currently under construction, the new building will house state-of-the-art simulation areas, including three high-fidelity simulation rooms with corresponding control rooms and an integrated audiovisual capturing system, two operation rooms, a medication room, mental health interview rooms, health assessment and skills laboratories, and separate spaces for debriefing.
Since 2009, when the first edition of this book was published, many positive changes have occurred at Fairfield University. Government grants have allowed for equipment, IT assistance, and curriculum integration of simulation in the graduate program. A grant from the Health Resources and Services Administration (HRSA) had learning objectives to (P) Promote Healthy People 2010 and Healthy People 2020, (R) Reflect on practice, (A) Acquire advanced practice registered nurses (APRN) skills, (T) Treat vulnerable diverse elders, (I) Intervene with maximal outcomes for older adults, (C) Communicate best practices in gerontology, and (E) Educate elders/families (PRACTICE). This project addressed the preparation of advanced practice nurses to improve their assessment and management expertise in a primary care setting when working with diverse older adults through the use of simulation. An additional HRSA grant for the Comprehensive Anesthesia Training Through Simulation Project followed and allowed for a state-of-the-art anesthesia simulation laboratory to be built, and, with the new building, it will be expanded to several rooms in an operating suite. Our generous donors and friends of the Egan School have allowed us to embark on a fabulous new endeavor and we are exhilarated to begin using our future simulation and teaching spaces.
THE UNIVERSITY OF BRITISH COLUMBIA SCHOOL OF NURSING PERSPECTIVE, VANCOUVER, BC, CANADA
Leadership and Vision
When the LRC was first established in the University of British Columbia (UBC) School of Nursing in the 1980s, it was state of the art and fortunate to have leadership that identified the need for an LRC coordinator and dedicated staff; that commitment has continued. The leadership included seeing the LRC as a resource, a place for faculty development and student learning, and the vision to include a means of sustainability—paid staff and personnel. Within the UBC SON context, the LRC has expanded to work with faculty, including clinical instructors, and has been able to leverage the work accomplished there in proposals to the dean, university, and province for subsequent funding to build and support the necessary resources. Over time, the increasing complexity of nursing education with the commitment to transition the LRC to increase innovation and the use of technology, such as simulation models, has meant an increased need for faculty development, staff capacity building, and purchasing and maintenance of more highly complex systems. In addition, as a school with a long history of research and scholarship, known for its leadership within Canada and the 54world, and situated within a research-intensive globally recognized university, UBC School of Nursing leads with its expertise in curricular pedagogy and innovation and looks carefully at the integration of new methods of teaching.
The Canadian and provincial context in British Columbia is worth reflecting on for a moment. Nursing education is funded through the provincial government, Ministry of Health (120 bachelor of science in nursing [BSN] seats and 15 nurse practitioner [NP] seats) and subsidized by the university and faculty. With increasing costs of living (especially in Vancouver, BC) and faculty or staff salary increases yet decreasing provincial and national support, ongoing sustainment of equipment, staffing, and new technologies is a challenge. In addition in Canada, health care is provincially funded and more connections between the health authorities (regional systems governing acute, primary, and community care) and secondary education around health professional development and capacity building will require persistence within the professional collaborations to do it well. For example, in the health authorities, there are challenges as to who “owns” the simulation rooms (UBC Faculty of Medicine) and the equipment (health authority), and it is challenging to identify allocation of resources (time, space, staff) and coordination of events that are respectful of everyone’s needs. Careful planning and identification of who is involved in the development, objective setting, facilitating, and debriefing of simulations, in labs or in situ, is imperative and it is key to have nurses on committees doing this planning. Several provincial groups support simulation in health professional education, such as the Simulation Technology Working Group (STWG) and the BC lab educators, who began as nursing faculty and staff but are broadening to include educators in the health authorities as well. These groups are exploring opportunities to coordinate the efforts, needs assessment, and tracking of different centers in the province. A centralized Provincial Simulation Committee, a group of simulation champions in the province came together monthly to create opportunities to connect and explore the interconnections of simulation and simulation resources across the educational institutions and health authorities.
Collaboration with practice partners and other schools of nursing in the province is a key goal, as well as is working with the community partners to share resources. At UBC, the health disciplines are situated in a research-intensive university in a publically funded system, so some of the ways we leverage funding is through our scholarship of teaching and learning. The original funding for purchase of HPSs came from the Teaching and Learning Enhancement Fund (TLEF), which was awarded to support the capacity of the school of nursing to implement the pedagogy of simulation. Subsequent TLEF’s expanded this scholarship by working with practice partners in the health authorities. The goal is to continue to model this for future benefit. As you will find repeated throughout this book, there is an interest in the use of simulation for interprofessional education. Because the UBC School of Nursing is one of 18 in the province, many of the other schools of nursing have received provincial support to build state-of-the-art LRCs. In contrast, at UBC the majority of other health professions are based only at UBC (17 health disciplines), including medicine, pharmaceutical sciences, dentistry, physiotherapy, occupational therapy, and the like. As we focus on interprofessional education provincially, the UBC School of Nursing can be a leader bringing together multiple groups at UBC, the Health Authorities, as well as other universities and allied health groups. We recognize the need to go beyond individual schools to seek out opportunities for collaboration to further research, share resources, provide interprofessional learning, and enhance the caliber of practitioners to improve patient health and well-being.
Recognizing that the evolution of simulation and its integration into the nursing curriculum requires more than technicians—it needs faculty with expertise in supervising students—train-the-trainer models of incorporating faculty engagement have been implemented. Nurses have the expertise and capacity to be leaders in simulation pedagogy, without specific mandates from the Ministry of Health and Medicine, which tend to focus on acute care, trauma, and high-stake situations. UBC School of Nursing is reaching out to demonstrate what nursing brings to the table of interprofessional education, both in academe and the practice sites, including the use of standards; integration into pedagogy; the development, facilitation, and debriefing of scenarios that reflect the complex and holistic nature of patient health and well-being. Nursing also brings skill to 55team building and nontechnical skill development and pedagogically has been using an experiential approach to teaching for decades. Examples of the UBC School of Nursing interprofessional education (IPE) involvement over the past 5 years have included: integrated simulation with UBC Health (17 health disciplines on campus); medication reconcilation, including pharmacy, medical, and nursing students (RN and NP); participation in the UBC Health Connect—students from the 17 health professional programs are brought together for a 2-hour period in class sizes of 40 and put in interdisciplinary groups of six to eight to manage a case and reflect on preclass videos/situations. In addition, a full-semester program in which a group of interdisciplinary students follows a “health mentor” through experience with chronic illness and interface with the health system also allows IPE. These opportunities bring students together and encourage interprofessional knowledge and understanding, allowing students to demonstrate respectful communication, learn about each other’s roles in interactive scenarios, and participate in team-building exercises like the Health Care team challenge.
Lessons learned from building and developing basic lab facilities for the LRC at the UBC School of Nursing and continuing to meet the needs of educating our nursing students are that there are many players and making strategic alliances and connections that fit the mandate of the school continues to be a priority. Focusing on our strategic goals (e.g., research, practice–academic collaboratives, sharing resources to leverage facilities and resources and personnel) and recognizing the possibility that they could overlap helps us to stay on track. Since immigrating to Canada, Suzanne has seen many similarities with needs where she emigrated from for adequate use of simulation, experiential learning, and new technology. There is still the need for curriculum integration, faculty development, and turning our learning centers into innovative simulation centers that embrace new technology and new ways of learning. The UBC School of Nursing has built itself up from within, identified operations that work, and applied for TLEF and endowment funds for faculty development (see Chapter 5 for description at UBC). In the meantime, health authorities have built simulation centers that are beginning to increase in use. Our strength has been focusing on things that could make the difference as to whether we have the best space and identifying the right mix of staff and expertise for positive learning experiences. Collaborating around resources and research—to demonstrate the efficacy of the use of simulation—helps us to use it in the most effective way. There is still a need to examine the translation of knowledge to the behavior in clinical practice and for safe high-quality patient outcomes that enhance patient health and well-being. We continue to evolve and do not lose sight of the vision of why we are doing what we are doing. There are wonderful opportunities for growth; the UBC School of Nursing is situated to take a global perspective on the looming shortage of health professionals and faculty, the complex nature of health professional education and continuing professional development, and the complex environment with multiple players. Prioritizing and focusing on what can be accomplished and managed within our own context while providing support to colleagues and recognizing there are no quick and easy solutions—even as we use some specific strategies—allows us to continue to move forward. The traditional learning center needs to come together with the complexity of the practice environment it mirrors.
MAINTENANCE AND UPDATING/UPGRADING: CHALLENGE OF CONTINUOUS FUNDING
Of course, the good news is that simulation within a learning resource center can quickly become a well-used learning tool. This technology is often sought after by students picking colleges, matriculated students needing practice, and remediation and community agencies interested in the simulation for staff training and professional development. The bad news is that even the best HPS will need occasional maintenance and upgrading. When planning a learning resource center with simulation, it is wise to plan for the technology help you will need to maintain the HPS. At WCSU, a few staff in the University Computing department were interested, intrigued, and therefore very helpful whenever a technology issue arose. However, with 56our level of simulation expanding to what will be four high-fidelity HPSs, University Computing is currently working to hire a nursing department technologist who will be responsible for all the technology. Many programs have talented lab assistants who are very helpful with the simulation but need technological help when it comes to upgrades and maintenance. I (Karen) have been known to say repeatedly, “I have my PhD in nursing, not computers!” That being said, I have enjoyed the challenge of learning the technologic aspect of simulation, but not all faculty share my enthusiasm. In addition, there are the challenges of ordering replacement supplies and the inevitable crash of one of the HPSs who drowns in a simulated blood transfusion that springs a leak or a rogue intravenous line that infuses into the bed and not the HPS. In those cases, and to address the inevitable technology issues, purchasing a maintenance plan and extended warranties and securing replacement HPSs is wise. Most simulator companies will have those options available at purchase. Funding those yearly costs can be a challenge and should be planned for when building and planning a learning resource center. Ideally, as is true at WCSU, the very generous director of University Computing picks up those costs every year. At Davenport University, these expenses are budgeted in each campus’s yearly budget.
At Fairfield University, maintenance and warranty plans have been purchased. One of the unanticipated extra expenses had to do with rewiring for the new HPS model. Initially, the HPS was wired to connect to the control room so that a microphone in that room could switch back and forth and the instructor’s voice could come from the room (with directions for students) or from the HPS (with responses from the patient to the students’ questions). With the advent of new technology that directly connected the HPS to a touch-screen monitor, rewiring was necessary and has caused many headaches. Even newer HPSs will incorporate wireless technology, although with the concrete used in our 1970s nursing building, it is possible that wireless technology may not work from the control room to the simulation rooms. Some of these expenses are just not easily anticipated, and future planning for the inevitable is prudent.
The newer grants being processed and funded at Fairfield University include these expenses for IT support, lab support to run the scenarios, and technology upgrades. This adds additional administrative work to the faculty receiving the grants and needs to be carefully considered in their workload and future assignments. Other challenges include changes that occur at the university level, including but not restricted to changes in the course management system vendors, incorporation of university-wide portfolios as the portals to student learning, and continuous upgrading of classroom and faculty technologies (e.g., computers) to keep pace with the technologic advancements. Sometimes, learning to work with what you have, recognizing its potential, and visualizing how it fits in your curriculum are key, without thinking you have to have the newest and the most up-to-date materials. Purchasing the newest things on the market is a risky and time-consuming endeavor as shown in Table 6.1.
CONCLUSION
We recognize the variety of programs, needs, and resources for each school of nursing. The complex factors of a university’s strategic plans and missions, administrative support, outside funding opportunities, and the like are beyond the breadth and depth of this book. However, we hope that through sharing our stories, we have given you some insight into potential problems that may arise as well as ways to best meet the challenges associated with this paradigm shift. Throughout this book, other authors have shared their stories about how they are using simulation, the type of environment in which it is used, and what needs specific to their disciplines are most helpful for the successful integration of simulation.
Change is never easy, and finding a champion to lead faculty, students, administration, and staff down this path makes a big difference in how a learning resource center is perceived and how likely it is to succeed. The take-home message is this: Persist, go slowly, think outside the box, and garner the support of those around you to create a vision of how things will work best for you, your faculty, your university, and your students. But, most important, have fun! Share your stories. Laugh, learn, and embrace the process. The potential for growth is limitless. Good luck!
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