NCSBN study shows similar educational outcomes when half of hard-to-find clinical hours are replaced with clinical simulation

nursing schoolIn a city like Baltimore, part of a major medical region, competition for clinical placements makes finding open slots for nursing students a constant challenge. So a study showing that up to half of those clinical hours can be replaced in a high-quality simulation lab with no drop-off in learning is welcome news for the Johns Hopkins School of Nursing (JHSON) as well as nursing schools across the nation.

According to a study by the National Council of State Boards of Nursing, students in such programs enter the profession just as ready for clinical practice as peers from more traditional programs.  

“This is a game changer, as we thought it would be,” said Pamela Jeffries, PhD, RN, ANEF, FAAN, vice provost for digital initiatives at Johns Hopkins, JHSON faculty member, and president of the Simulation Healthcare Society. “We’re committed to providing our students with the greatest knowledge and preparation using the best tools that are out there. Our sims are top-notch, and we’re constantly improving them. It’s great to have a confirmation that we’re going about things the right way.”

JHSON was one of 10 sites across the U.S. to participate in “The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education,” the most comprehensive research to date examining the use of simulation in the nursing curriculum. (JHSON provides a much smaller percentage of sims for its students, expanding them only for purposes of this study.)

The school recently reaffirmed its commitment to the technology by hiring a full-time Simulation Labs director, Nancy Sullivan, DNP, RN, who has spent 39 years in emergency department/trauma/critical care settings and has served 11 years as a nurse educator for new graduates. In addition, Cynthia Foronda, PhD, RN, CNE, who focuses on innovative technologies in teaching, including virtual simulation, came onboard in 2013.

“This study is groundbreaking for the simulation community,” says Foronda, who is researching the use of virtual simulation to improve interprofessional communication. “In a time where we only speculated that simulation was as effective a teaching strategy as clinical practicum, we now have strong evidence. This is great news for students, patients, and educators to support practicing and learning in a safe setting.”

Many nursing schools currently supplement and enhance clinical practice with simulation rather than substitute for it. The NCSBN study means the Hopkins School of Nursing can create even more innovation with its sims, easing the pressure on finding clinical placements that can sometimes cut students off from peers and fuller immersion into medical settings. In a controlled sims environment, students also learn the teamwork and communication they will need in healthcare settings.

The study began in the 2011 fall semester with the first clinical nursing course and continued throughout the core clinical courses to graduation in May 2013. In all, more than 650 students completed the study requirements. Students were randomly divided into three groups:

•    Traditional clinical where up to 10 percent of clinical time was allowed in simulation
•    25 percent simulation in place of traditional clinical hours
•    50 percent simulation in place of traditional clinical hours

Students were assessed on clinical competency and nursing knowledge. They also provided ratings on how well they perceived their learning needs were met in both the clinical and simulation environments. NCLEX passage rates were unaffected.

Study participants were then followed into their first six months of clinical practice. The study found no meaningful differences between the groups in critical thinking, clinical competency, and overall readiness for practice as rated by managers at six weeks, three months, and six months.

Programs participating along with JHSON:

College of Southern Nevada, Las Vegas, NV
Florida International University, Miami, FL
Ivy Tech Community College, Indianapolis, IN
Johnson County Community College, Overland Park, KS
Pennsylvania College of Health Sciences, Lancaster, PA
Metropolitan Community College-Penn Valley, Kansas City, MO
The University of Southern Mississippi, Hattiesburg, MS
University of South Carolina, Columbia, SC
Washington State University, Spokane, WA

Learn more about

JHSON pivoting curriculum to Stay Ahead of the Storm
Simulation labs at JHSON


The Johns Hopkins School of Nursing is a global leader in nursing research, education, and scholarship. The School and its baccalaureate, master’s, PhD, and Doctor of Nursing Practice programs are recognized for excellence in educating nurses who set the highest standards for patient care and become innovative national and international leaders. Among U.S. nursing schools, the Hopkins Nursing graduate programs are ranked #1 by U.S. News & World Report. For more information, visit