Implementing Virtual Simulation Education into a Nurse Refresher Program: Accelerating the Re-Entry of Experienced Nurses to Practice


Experienced nurses re-entering the workforce offer a solution to a critical nursing shortage unmet by new graduates alone. Yet, re-entry is often delayed due to a lack of clinical training resources. This quality improvement project piloted virtual simulation, an evidence-based educational intervention, to accelerate clinical completion. The purpose of this quality improvement project was to determine whether replacing a portion of traditional clinical hours with virtual simulation education would enable RN refresher students to satisfy clinical learning outcomes, maintain self-efficacy, reduce preceptor training hours, and complete the course in less time.


From June 2020 to June 2021, Charlotte Area Health Education Center offered virtual simulation to eligible RN refresher students to replace up to 50% of traditional clinical hours as a solution to reduced clinical opportunities amid COVID-19. Guided by the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care, the team reviewed the evidence, vetted simulation products, and consulted with simulation experts to decide which product to pilot. Four virtual simulation online modules from Shadow Health were chosen. The project compared course completion time, the number of precepting training hours, satisfactory rates of clinical learning outcomes, and post-clinical self-efficacy scores between those using virtual simulation and those not.


Ten (n=10) Charlotte AHEC RN refreshers completed traditional clinical hours, and twelve (n=12) used a combination of SIM and traditional clinical hours to satisfy the clinical requirement of the program. Using independent t-tests, there were no significant differences in age, experience, and length of practice break between the two groups. 100% of students in both groups satisfactorily met clinical learning outcomes. Self-efficacy scores increased among SIM users by 19%, but the increase did not demonstrate a statistical significance, p=.068124. Preceptor training hours decreased by 42%, reflecting a significant reduction, p=00001. Course completion time was reduced by 22%, demonstrating a significant improvement, p=.048298.


The initial results of this quality improvement project demonstrate that vSIM education can be an effective pedogeological tool used to prepare re-entry nurses for their transition back to practice. Incorporating vSIM into RN refresher programs can reduce course completion time while maintaining clinical learning outcomes, increasing self-efficacy, and decreasing preceptor training hours. NC AHEC RN Refresher program plans to continue offering vSIM as an option to replace a portion of traditional clinical hours while monitoring key performance indicators such as course completion time, preceptor training hours, satisfactory clinical learning outcomes rates, self-efficacy, student satisfaction and employment orientation time.