Simulation in Nursing Education: Advancements in Regulation, 2014–2022

Background

The use of simulation-based clinical experiences in prelicensure nursing education has increased dramatically over the past 2 decades. This trend accelerated after the onset of the COVID-19 pandemic in the United States.

Purpose

To quantify advancements in the regulation of simulation use in nursing education since the publication of the National Simulation Study and its accompanying guidelines.

Methods

This cohort study included 61 of the National Council of State Boards of Nursing’s U.S.-based member and associate member jurisdictions. For each included jurisdiction, explicit simulation regulation information regarding either registered nurse (RN) or licensed practical nurse/licensed vocational nurse (LPN/LVN) programs was obtained in 2014. Comparisons were made between 2014 and 2022 nursing simulation regulations. Generalized estimating equation models were used to assess the significance of the observed changes.

Results

The number of jurisdictions with specific regulations regarding simulation use in prelicensure RN programs doubled from 21 in 2014 to 41 in 2022. Additionally, the number of nursing regulatory bodies (NRBs) that allowed a maximum substitution of up to 50% simulated clinical hours rose from 1 to 23 over the same time frame. Similarly, specific regulations regarding simulation use in LPN/LVN programs rose from 20 programs in 2014 to 36 in 2022. As with RN programs, the number of NRBs that permit a maximum of up to 50% simulation substitution for LPN/LVN programs rose from 0 to 22 during the 8-year period.

Conclusion

The impact of the guidelines that emerged from the National Simulation Study is evident. The proactive efforts of NRBs to adopt evidence-based best practices on simulation regulation before and shortly after the onset of the COVID-19 pandemic provided appropriate flexibility for prelicensure RN programs to respond to the global health crisis efficiently and safely.