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ADVANCE Perspective: Nurses

Practice Makes Perfect

Published October 7, 2011 2:31 PM by Candy Goulette

Whether you’re a musician, a language student or a healthcare provider, there’s no such thing as too much practice. Repetition helps make actions second nature, but it’s especially important when you’re tackling something new for the first time. This is why I’m such a big proponent of simulation labs for nursing. They give nursing students a way to see, learn and practice responding to procedures they might not experience in the clinical setting. They also (and this is an important part) allow these students an opportunity to respond incorrectly without harming a real patient. That safe environment lets students learn from each other and from their own mistakes. Those are lessons that stay with you.


But sim labs are not just for students. Experienced nurses can and do benefit from them as well, in learning new procedures, brushing up rarely used skills and practicing the team work that something such as a code requires.


Fortunately for nursing students, virtually all nursing programs these days either have a sim lab on campus, or have access to one in a cooperative arrangement. Students can observe clinical scenarios complete with blood and gore, interact with the “patient” and gain confidence in their knowledge. Unfortunately for practicing nurses, while some health systems also see the benefit sim labs can have for their staff, not many have taken the big step of installing them in their hospitals. These nurses are on their own to learn new skills or practice those they don’t often use.


That’s why I was so excited to see three hands-on “skills labs” on the schedule at last month’s Emergency Nurses Association conference in Tampa, FL. What a great opportunity for nurses to practice new skills before having to use them.


In a pre-session on intermediate and advanced wound repair techniques, advanced practice nurses and NPs learned about wound repair techniques, including running, subcuticular and mattress sutures in a didactic presentation. Then they were given cuts of meat (picture a boneless beef rib roast here) with a variety of slashes and gashes and an assortment of suture and needles to repair them. They practiced the different kinds of sutures for several hours with two instructors circulating throughout the large room giving advice and guidance. If they messed up, they could do it again – and again – until they got it right.


Other nurses attended a session on subcutaneous infusion in children, reviewing rehydration therapies in kids with mild to moderate dehydration. In addition to going over a competency checklist and policy for subcutaneous infusion, nurses had a chance to practice this skill.


The next day, Vidacare sponsored a pre-registration required cadaver lab in two, 3-hour sessions for ED nurses and another, 1-hour condensed session for TNCC nurses. Nearly 250 nurses took advantage of the opportunity. While the company used the lab to introduce its EZ-IO intraosseous infusion system, it also used the time to give the nurses a hands-on look at anatomy. Nurses, set up at about 10 per table, were able to actually see the disease process in the cadavers at their table. At one, a large tumor was seen in a person who had died of lung cancer. You could see how the tumor pressed on the lung and the chest wall. Realizing how difficult it must have been for the person to breath, one nurse said she would apply what she was seeing to similar patients in her ED. It was an a-ha moment, where the head knowledge she already had became real when she saw and was able to touch the patient. Vidacare also offers the cadaver lab at the annual conferences of the American Association of Critical Care Nurses and the Infusion Nursing Society, and will be sharing these skills with ED docs for the first time at this year's American College of Emergency Physicians conference.


In each session, while the nurses practiced, they talked, with each other and with instructors, sharing information and situations from their own EDs. So, not only were they learning new skills, but they were sharing best practices, finding solutions to problems or difficult situations in their EDs, and networking – all important for job satisfaction, and, ultimately, quality patient care.


And I think that’s the part of practicing that gets overlooked. With the focus of nursing care on the patient, every time you augment the nurse’s arsenal, you impact patient care. Give them more tools, they’ll provide a more well-rounded experience for the patient. Sim labs and hands-on skills labs affect that bottom line in a very positive way.


Kristi Burdick, DNP, MSN, FNP-BC, an assistant professor at the Northern Michigan University School of Nursing, knows how much simulation can affect student learning. She also knows students – and new graduates – use social networking more than the majority of practicing nurses. For that reason, she’s set up a “virtual sim lab” on Facebook for anyone who wants to be part of the experience. Simply “friend” Noelle Marie Upton (Burdick’s sim persona) and join in. For more information on Burdick’s sim ideas, email her at


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