A few years ago we noticed that there was no structured curriculum for simulation in the PICU, but there was in other care areas. There is compelling evidence that simulated based education (SBE) is an effective way to assist learners with new concepts, develop clinical skills, and enhance critical reasoning capacity. SBE allows providers to receive consistent training in safe settings without the risk of injuring patients (Cook, et al, 2011). We wanted to provide this learning opportunity for our nurses.  We took the low fidelity simulations that existed in orientation, updated them and built upon them to compliment the learnings from the critical care residency curriculum.  We partnered with the Simulation and Research Center, to become trained in debriefing and trained to use high fidelity simulators.

As we were implementing these simulations into orientation, the pandemic made everything come to a halt. We were faced with a low patient census, low acuity, no in-person educational opportunities and a large number of nurses needing training for the new critical care building opening in November of 2021. Once it was safe to start in person training again with COVID restrictions, we provided the 36 nurses with simulation that was missed during orientation. In addition, PICU nursing leadership asked senior nursing to develop an action plan to meet the needs of these clinicians. High fidelity simulation and clinical coaching were two of the interventions implemented from this support group.  A needs assessment was conducted to build simulations to cover topics that nursing identified that needed more education and training on. Every nurse with less than 2 years of experience (56 nurses), received this training supporting the needs identified in the assessment. They also received planned mentored days with a clinical coach, which involves a senior expert nurse coaching bedside nurse’s 1:1 on nursing care and critical thinking. We are currently evaluating these interventions, to build additional programing for continued needs.

As things start to get back to our new normal, every nurse, as part of their orientation goes through multiple high fidelity simulation days focusing on safety, medication administration, nursing process and critical thinking.  This provides them a safe space to ask questions, practice skills, care for specific patient populations they might not have the chance to care for during orientation and run through crisis scenarios such as codes.

In addition to nursing simulation, an interdisciplinary team training curriculum was created and implemented.  This is a four hour training that is mandatory for all staff to attend, that focuses on processes in the PICU, the reasoning behind our medical interventions and communication between team members (RTs, MD, APRNs, Fellows and nursing).

Moving forward and into the critical care building, there will be simulation provided focusing on orientation to the new space, normal care processes, patient move and crisis training. These will begin in the early fall.

Through anonymous evaluations of the simulations provided, nursing has reported increased confidence after simulation. They have reported improving various nursing concepts, as well, such as time management, prioritization and safe medication administration. They have reported satisfaction from these days. Here are some quotes directly from our nursing staff, “I have appreciated having the opportunity to practice high stress situation in a low stress simulation”, “days like today is nice”, “I don’t see these patients much and I appreciate the safe environment to learn about these complex patients” and felt it was “safe to ask questions”.  We hope to continue this program in the future and keep building upon the foundation we have started.