As New York hospitals struggle to hire enough health care workers, a new state law will allow nursing students to complete up to one-third of their clinical training through simulations such as practicing on high-tech mannequins.
The measure will help increase the supply of health care workers by “expediting training and allowing more capable nurses into the workforce,” Gov. Kathy Hochul said in a statement when she signed the legislation last week. The law takes effect in November.
Nursing school deans said state-of-the-art simulations are a helpful addition to in-person training as schools face difficulties finding enough hospital placements for students to complete their required clinical training. Undergraduate nursing programs typically mandate 600 or more hours of clinical experience, such as shadowing a nurse at a hospital. Many hospitals shut down their student training programs when the COVID-19 pandemic hit New York in 2020, and some have not fully recovered.
“We’re turning away qualified nursing students because … we don't have enough training sites,” especially in pediatrics and obstetrics, said Patricia Bruckenthal, dean of Stony Brook University's School of Nursing, where nearly 200 nurses earned bachelor’s degrees this spring.
WHAT TO KNOW
- New York will need an additional 39,000 registered nurses by 2030, according to a 2019 report by the American Journal of Medical Quality.
- Hospitals have cut back on training programs for nursing students, and schools face difficulty finding enough clinical sites for their students.
- Simulations such as high-tech mannequins can help students learn clinical skills, the nonprofit National Council of State Boards of Nursing found.
New York is joining 31 other states that allow simulated training for nursing students, state officials said. During the pandemic shutdown, the state Education Department started allowing nursing schools to use online experiences or simulations to substitute for in-person work, after reviewing each school's plans. The agency will continue to require schools to submit any simulation plans for approval.
Practicing in a simulation laboratory “allows every student to encounter a patient-care experience that we feel is essential for them in developing competency,” said Marcia R. Gardner, dean of Molloy University's Barbara H. Hagan School of Nursing and Health Sciences. “Not every student, for example, is going to take care of a newborn in respiratory distress. But in our simulation lab, we can make sure that every student encounters a newborn in respiratory distress so that they can apply their knowledge and use their skills.”
Simulations let students do challenging, hands-on work, but on mannequins instead of patients facing life-threatening emergencies, nursing school deans said. The most advanced mannequins include technology that can mimic seizures, uncontrolled bleeding and other symptoms. Students and instructors communicate through audio devices implanted in the mannequins, with staff playing the role of a patient in distress.
Not everyone believes the new legislation is the right approach.
Working with mannequins is “wonderful” at helping students practice their skills, said Maureen White, executive vice president and chief nurse executive for Northwell Health, the state’s largest health care provider. However, she said, “I don't think it was ever meant to replace the human interaction that I believe these students need in the clinical areas.”
Higher turnover rates
Recent graduates are less prepared for hospital nursing jobs than previous graduates, White said. That forces hospitals to spend more time “acclimating” the new nurses, and it is contributing to a rise in the number of nurses leaving jobs within the first year, White said. First-year nurse turnover rates jumped from 16% in 2021 to 23% last year at Northwell hospitals, she said. Nationally, almost 33% of new nurses left hospital jobs within a year, according to a study released in March by NSI Nursing Solutions Inc., a Pennsylvania-based recruiting firm.
Indeed, new nurses “need mentoring,” and hospitals and nursing schools must collaborate on ways to meet their needs, said Deborah Hunt, dean of Adelphi University's Dr. Betty L. Forest Dean College of Nursing and Public Health, which offers high-tech mannequins as well as virtual reality training. Hunt said the new legislation “gives us freedom and flexibility, but it also maintains the significance of our actual in-person clinical experiences.”
A 2014 study by the nonprofit National Council of State Boards of Nursing found that with well-trained faculty and “realistic” equipment, simulation could be an effective way for nursing students to amass up to 50% of their required clinical experience.
A simulation can feel surprisingly high-pressure, with instructors and other students observing while a student performs tasks such as suctioning simulated mucus from the airway of a pediatric mannequin that is crying “nonstop,” said Ashley Dumeng, 27, of Babylon, who graduated this spring from Molloy and plans to do a fellowship as a critical care nurse. Such experiences, combined with in-person work with patients, “really helped solidify a lot of our skills,” she said.
Hospitals are "desperate" to hire more nurses, said Wendy Darwell, president and CEO of the Hauppauge-based trade group Suburban Hospital Alliance of New York State. Even before the pandemic, New York was expected to need an additional 39,000 registered nurses by 2030, according to a 2019 report by the American Journal of Medical Quality. In an effort to increase the health care workforce by 20% over five years, last year New York launched a $1.3 billion program that provides recruitment and retention bonuses for certain health care workers.
Allowing students to use simulations for a portion of their clinical training, Darwell said, "is not a cure-all, but it provides some more flexibility that we think can be helpful, particularly at a very tough time.”