In summary

Policymakers should modernize nursing education regulations to allow for an increase in simulation time in clinical education for students.

By Garrett Chan, Special to CalMatters

Garrett Chan is the president and CEO of HealthImpact, a nonprofit California nursing workforce and policy center, garrett@healthimpact.org.

The devastating impact of COVID-19 on California’s health care workers has been widely reported. But not only has the pandemic strained the existing health care workforce, it also has interrupted the progress of students who are working to enter the profession and who could provide desperately needed help.

Fortunately, with a modest change in regulation, these students can become graduates and join health care workers in administering the COVID-19 vaccine and caring for patients across all practice settings.

Our current crisis has put the spotlight on a workforce preparation problem that was hiding in plain sight: an outdated regulation that limits simulation in clinical education, despite rigorous research supporting its efficacy.

Left unchanged, we risk a reduced health care workforce and a deterioration of the quality of care every Californian deserves in a time where we need more health care providers even before the COVID-19 pandemic occurred. 

The ripple effect of the pandemic on the workforce pipeline has widespread effects even after the governor ends his declared disaster. Fortunately, a solution is available to California policymakers: modernizing nursing education statutes and regulations to allow an increase in simulation time in clinical education for nursing students.

We know how effective simulation-based training can be. Today, we are using simulation-based education to achieve learning objectives that will support nursing students entering the profession. According to the California Simulation Alliance, a HealthImpact program, virtually all our state’s nursing programs report successfully using the limited simulation allocation to improve critical thinking, decision making, priorities of care, teamwork and in direct patient care. Simulation education supports nursing students by helping them become ready for practice upon entry into the profession.

Last spring, as the pandemic began accelerating throughout California, hospital systems suspended in-clinic training for nursing students. It was the right decision at the time. California needed to allocate resources to prepare for a situation similar to New York City, which saw an overwhelming influx of COVID-19 patients. 

At the same time, the decision had the unintended consequence of preventing students from fulfilling the state requirements necessary to graduate from nursing school. Compounding the problem was the lack of flexibility in the California Code of Regulations to allow simulation learning at the level required to keep students on track to complete their studies. 

If simulation learning sounds familiar, it is because other high-risk professions including airplane piloting, firefighting and medicine, all utilize simulated scenarios to develop their performance and obtain licensure.  

Not only did these rules effectively keep students in a holding pattern in the spring of 2020, but also they ran counter to research showing simulated training is comparable to in-person rotations. In evaluating learning and clinical performance, a National Council of State Boards of Nursing study found no difference in the quality of training between students who received up to 50% simulation and those that received 10% or 25%.

Fortunately, last year lawmakers passed Assembly Bill 2288 that allows more simulation experiences to be utilized for nursing education during governor-declared emergencies. However, due to the ongoing need for graduates and the vigorous science that supports simulation, lawmakers need to go one step further and allow simulation experiences in non-disaster times. It is an easy fix that will bring enormous benefits. 

The COVID-19 pandemic is the greatest shock-test of California’s health care system in modern history. Long-simmering problems – a shortage of health care workers, a lack of workers representing the state’s diverse populations, and a barrier preventing nursing school students from graduating and entering the workforce – have escalated to full-blown crises.  

Fortunately, a solution is available to California lawmakers that provides both short- and long-term solutions: a workforce development strategy that encompasses innovation, collaboration and coordination.

Policymakers, workforce centers and nursing educators can break through these barriers to provide the care our residents need today and tomorrow. If we want a 21st century health care system for our state, it is time that we utilize all our resources. Only then can we ensure we have the pipeline necessary to create a healthy California for all. 

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