Ethical Considerations of Replacing Clinical Hours With Simulation in Undergraduate Nursing Education: Means to an End, or an End in Itself?

In the current health-care environment, undergraduate nursing programs are expected to provide high-quality clinical experiences for students despite increasing difficulty accessing clinical placements. Expectations for newly graduated nurses have increased in the last few years, with an emphasis on "work-ready" graduates. At the same time, the availability of a variety of clinical practicum placements has decreased in some areas, increasing the difficulty of meeting the increasing numbers of nursing students required for future workforce planning, a situation exacerbated by the ongoing COVID-19 global pandemic. Nursing educators are caught between industry requirements for clinically prepared students and the regulatory requirements of their educational institutions. One solution being espoused internationally is substituting simulation for clinical practicum hours. Simulation offers many advantages, especially for patient safety, providing students with opportunities to link theory to practice in a controlled environment. This article discusses the ethical considerations of substituting simulation for clinical hours in undergraduate nursing education. Is this substitution justified as a means to an end or an end in itself?