The model widely used to educate nurses "was developed in the early 1930s," said Christine Tanner, a professor at Oregon Health and Sciences University School of Nursing in Portland. "And, despite enormous changes in health care and nursing practice, it hasn't changed substantially since then." Tanner, along with Pamela Ironside, an associate professor at Indiana University School of Nursing in Indianapolis, organized the National League for Nursing (NLN) Think Tank on Transforming Clinical Education, a group of opinion leaders in nursing education that met in April 2008 to explore how educators and practitioners can collaborate to better prepare nursing students for today's health care challenges. A report of the meeting was just released and can be found at http://bit.ly/17gzNy.

NLN chief executive officer Beverly Malone explains that with the current model, "we're turning away qualified applicants because we don't have enough places for students to practice, and we're asking them to work in clinical situations they've never encountered before." Among the pressing issues the group discussed were the shortage of clinical training sites, the importance of imparting an understanding of systems at the prelicensure level, and the best ways to provide interdisciplinary team training.

So how might these issues be addressed? Simulation provides some of the answers, said Tanner. Besides offering an opportunity for the learner to perform procedures on a mannequin that responds to medications and complains if a catheter is inserted incorrectly, simulation training enables students to experience how system breakdowns lead to errors. If there's a drug error, explains Tanner, the student should be asking whether it's related to a problem with the charting system. Said Malone, "It's a way of looking at the whole and not just the parts."

Tanner also believes simulation is valuable in fostering interdisciplinary communication-teaching medical and nursing students how best to speak to each other, preparing nursing students to report a concern in a way that'll get the physician's attention. "We've learned," said Tanner, "that nearly 95% of recent graduates have never talked to a physician about a patient. Then we expect them to know how to make a report and get the orders they need. That's crazy."

The NLN, said Malone, would like to see students offered intensive clinical experiences throughout their years of study, not just near the end, and more hospital units on which all staff are dedicated to nursing education. In the best-case scenario, adds Tanner, students on a dedicated unit are "from a single school, so the staff knows the curriculum and the faculty."

Maribeth Maher