Share this article

Multi-Patient Simulation at Michigan Nursing School Helps Re-Create the Real World

Evan Castillo
Updated March 28, 2024
Edited by
    Learn how multi-patient simulators better prepare nursing students for the field from two nursing experts at Grand Valley State University.
    Michigan Sim Hero ImageCredit: Kendra Stanley-Mills. Nursing student Amarachi Oboh kneels in front of 'Janet,' an actor posing as a patient, during a pilot simulation in the at Grand Valley State University.
    • The school recently received a $1.5 million grant from the U.S. Department of Health and Human Services to support its multi-patient simulator.
    • The initiative is unusual because it simulates scenarios involving three or more patients, while standard simulation protocols usually involve one or two.
    • The simulation tests students’ prioritization skills between caring for patients with low to high levels of acuity.

    Nursing schools are working to better prepare students for nursing careers through accurate multi-patient simulations that mimic how a nurse prioritizes handling three or more patients at a time.

    Grand Valley State University’s (GVSU) Kirkhof School of Nursing in Michigan recently received a $1.5 million grant from the U.S. Department of Health and Human Services to support its multi-patient simulator. The simulator hires and trains actors, also known as standardized patients, to portray patients with specific medical conditions. Nursing students care for these patients as if it were a real-world scenario.

    NurseJournal spoke with Dr. Sherri Fannon, associate professor and the co-coordinator for nursing simulation for undergraduate and some graduate programs at the school, and Dr. Barbara Hooper, an associate professor who’s been with Kirkhof for over 15 years, to learn how multi-patient simulations powered by actor-patients can improve nursing students’ preparedness for the workforce and increase nurse retention rates.

    Sherri Fannon, Barbara Hooper, and Christina Quick
    Kirkhof College of Nursing faculty members (l-r) Sherri Fannon, Barbara Hooper, and Christina Quick. Image courtesy of Grand Valley State University.

    Students begin their first semester in traditional simulations with nursing mannequins to learn assessment skills before moving into the multi-patient simulators, where students experience more accurate nursing scenarios.

    “There’s a huge gap in the literature about the fact that students don’t have opportunities to take care of more than two patients typically at one time, at one given time,” Fannon said. “And so by doing it with real patients, it provides that real rich experience very similar to what they’ll experience when they actually go into practice.”

    Patients will also provide feedback on their experience with students, which she said validates the students’ good practices and helps them work on their therapeutic skills.

    One scenario tests students’ prioritization skills with mild, moderate, and highly acute patients. For example, nursing students care for one patient acting as if they are going through alcohol withdrawal and are highly anxious and agitated; one patient who’s a human trafficking case with bruises and ligature marks; and a patient who needs discharge, antibiotics, and some education before leaving.

    After prioritizing care, students must learn how to delegate to other members of the care team. One works as a nurse and the other as a nursing tech — then, halfway through, they switch.

    “This simulation is helping to prepare them for their getting ready to go into their senior clinical immersion where they work 160 hours with a preceptor somewhere,” Hooper said. “We lose nurses within the first year of entering into their professional practice because of stress and anxiety. And some of that stress and anxiety actually comes from the inability to understand how to prioritize and multitask.”

    Fannon hopes these simulations will decrease nurse attrition rates and increase retention in their career path. Even though it’s difficult and stressful, students learn in a safe environment and come away with fresh insights.

    When students don’t ask for help, nurses make errors that impact patient outcomes, Fannon said. The multi-patient simulations are nurturing a culture of asking for help.

    “Just building that awareness so they’re not taken aback like, ‘Oh, I didn’t realize I was going to have to do this much, or it was going to be this taxing, or I’d have to figure out this much,'” Fannon said. “I think just by opening their eyes to that helps them to better manage. I mean, we all can manage better if we know what to expect.”

    The Kirkhof College of Nursing’s simulation department hires and trains actors to serve as simulated patients in six multi-patient scenarios. The department works with faculty to train six actors on case needs, learning objectives, supplies, dialogue, and the factors or attributes that actors need to emphasize in a given simulation.

    GVSU tries to hire the same actors to portray the same cases so actors can improve and know what to expect from students. Twice each semester, GVSU moves 110 students through the multi-patient simulations. The GVSU simulation initiative is governed by a task force of 12-14 faculty members, volunteer “coaches” from a partner hospital, patients, observers behind a monitor, and 12-18 students at a time, adding up to around 36-50 people to execute one simulation.

    GVSU couldn’t sustain the multi-patient simulations without grant, partner, and university leadership support.

    “You need that support from your leadership and not only leadership within the university but also your practice partners, because if you have that support, then something like this, when the grant funding runs out, the likelihood that it will not sustain is very low,” Fannon said. “I mean, we are planning that it will be sustained moving forward, and I believe that to be true because of the support that we have. I think our practice partners are going to see the students that have engaged in this and the difference in their practice when they start in their institutions.”