Utilizing Virtual Simulation in Undergraduate Nursing Programs

by Karen Haidemenos, MSN, RN | June 22, 2020

Clinical simulation used to be solely known as practicing on a mannequin in a simulation lab. In recent years, clinical simulation has evolved to encompass so much more and has become a vital and innovative addition to undergraduate nursing curricula. In today’s classrooms, simulation is about creating real life scenarios, in a virtual environment. Virtual clinical simulation engages students on a higher cognitive level, increases knowledge retention, and directly impacts self-confidence. (Tschannen, et al, 2012). It is also the future of Next Generation NCLEX (NGN).

How Can Institutions Effectively Use Virtual Simulation?  

The decision to incorporate virtual simulation (VS) into institutional curricula is a crucial step to taking your program to the next level in terms of preparing nursing students with the critical thinking skills they will need to not only pass the NCLEX, but also for developing the level of clinical judgment needed to succeed in real-world practice. 

All simulations should begin with a prebrief so the students know the expectations, followed by the simulation scenario. At the completion of the simulation, trained faculty should conduct a debriefing.  

Debriefing is often considered the most important aspect of the simulation. Students have the opportunity to evaluate their thinking and learn from the experience. Educators have the opportunity to guide or redirect the student leading to changes in future practice. Students must always feel safe and comments should always be respected. This will lead to the development of sound nursing judgment.  

The International Nursing Association for Clinical Simulation and Learning (INACSL) is always a great resource for nurse educators as INACSL provides best practice criterion for the use of simulation, guidance about the value of prebriefing and debriefing, and other digital assets.

How Can Educators Increase Student Engagement Using Virtual Simulation in Undergraduate Nursing Curriculum?

One of the most valuable aspects of incorporating virtual simulation into undergraduate nursing curriculum is the versatility that it offers when it comes to student engagement. As educators, you will have a new opportunity to make learning fun and interactive while building higher-order cognitive skills.

For example:

  • Virtual simulation can include synchronous and asynchronous activities, offering students the chance to practice both in real-time with instructors and classmates as well as on their own. 
  • Educators can set up online discussion boards that are utilized by the students for prebriefing activities. This level of interactivity and communication reinforces the level of collaboration needed in patient care.
  • Cases can be supplemented with additional learning opportunities in the form of related case studies, articles, and discussions.
  • Students are very creative when it comes to technology and gaming, so the use of virtual simulation is a great opportunity to involve the students in leading various activities. Students can role play fulfilling the roles of family, Licensed Practical/Vocational Nurses and Unlicensed Assistive Personnel. This activity will strengthen their communication skills as well enhance their knowledge and practice of delegation roles.  

How Can i-Human Patients by Kaplan Help Students Prepare for NGN?  

National Council State Board of Nursing (NCSBN) has developed the Clinical Judgment Measurement Model which takes the student from identifying client needs, to making clinical decisions based on those needs, and evaluating the outcome of their judgment. The student must do this by layering in cognitive activity such as recognizing, interpreting, and analyzing cues.  

Our i-Human Patients program features 56 cases specifically designed for RN/PN students. Cases feature 230+ diverse patient “avatars” designed to engage with and test students’ critical thinking and clinical judgment skills, and  are intentionally aligned with NCSBN’s clinical judgment task model to prepare students for Next Generation NCLEX success.

Students will start a simulation with an Electronic Health Record (EHR). The goal is to master identifying and recognizing cues by taking what they know and turning it into how they apply care for the client. Throughout the simulation, multiple choice questions will evaluate if the student has identified key findings.  Students will focus on what they learned from the EHR, applying their clinical judgment as they move through the simulation. 

During the i-Human Patients simulation, students will characterize findings and apply clinical judgment to arrive at their conclusion. Extended drag and drop items may ask the student to complete steps taken to treat a client or enhanced hotspot items would have the student highlight findings that require follow up.  The prioritization of actions addresses needs such as what action must be completed first, what is the cause of the condition or symptom and what are the risk factors. This type of critical thinking will be required when answering new NGN item sets.  We can never start too early practicing for the new NGN NCLEX exam!

How Can Remediation Help Both Students and Educators?

After the assignment is completed, educators can review the accuracy and efficiency of questions asked by the student during the debriefing session. Armed with the data that identifies areas of students’ strengths and weaknesses, they can tailor their remediation efforts accordingly.

Students can only complete the i-Human Patients cases one time―so how can they remediate?  Students receive expert feedback every step of the case.  The expert feedback will help direct the student as they navigate the case.  Students can review key findings and start formulating patterns leading to effective critical thinking and nursing judgment. After reviewing a case, educators can assign a second case to evaluate student knowledge, growth and areas of improvement.

Virtual simulation links theory to practice by means of reflection, critical thinking and improved clinical practice. Practice makes perfect!  Students need as much  practice as possible to ensure they are competent to pass Next Generation NCLEX and to be safe practitioners when they enter the nursing profession.  


Bowman, K. (2017).  Use of online unfolding case studies to foster critical thing.  Journal of Nursing Education, 56 (11), 701-702. 

Culha, I., Active learning methods used in nursing education. (2019).  Journal of Pedagogical Research, 3 (2) 74-86.  http://dx.doi.org/1033902/JPR.2019254174.

Dickison, P., Haerling, K.A., & Lasater, K., (2019).  Integrating the National Council of State Boards of Nursing Clinical Judgement Model into nursing educational frameworks.  Journal of Nursing Education, 58 (2), 72-78

Dickison, P., Luo, X., Kim, D., & Woo, A. (2016). Assessing higher-order cognitive constructs by using an information-processing framework. Journal of Applied Testing Technology, 17(1), 1-29.

Duff, E., Miller, L., Bruce, J. (2016). Online virtual simulation and diagnostic reasoning: A scoping review. Clinical Simulation in Nursing, 12(9), 377-384.

Muntean, W. J. (2012). Nursing clinical decision-making: A literature review. https://www.ncsbn.org/Clinical_Judgment_Lit_Review_Executive_Summary.pdf

Muntean, W. J. (2015). Evaluating clinical judgment in licensure tests: Applications of decision theory. Paper presented in the annual meeting of the American Educational Research Association in Chicago, IL.

National Council of State Boards of Nursing (NCSBN). (2018). The Next Generation NCLEXÒ Usability Studies. https://www.ncsbn.org/NGN_Spring18_English.pdf

Saintsing, D., Gibson, L.M., Pennington, A. W. (2011). The novice nurse and clinical decision-making: How to avoid errors. Journal of Nursing Management, 19(3), 354-359, doi: 10.1111/j.1365-2834.2011.01248.x.

Tschannen, D., Aebersold, Mi., McLaughlin, E., Bowen, J., Fairchild, J. (2012). Use of virtual simulations for improving knowledge transfer among baccalaureate nursing students. Journal of Nursing Education and Practice, 2(3), 15-24.

Verkuyl, M., Lapum,J., St-Amant, O., Hughes, M., Romaniuk, D., McCulloch, T..  (2020).  Exploring debrief combinations after a virtual simulation. Clinical Simulations in Nursing 40, 36-42.

Verkuyl, M., Arack, L., McCulloch, T., Liu, L., Betts, L., Lapum, J. Hughes, M., Mastrilli, P., Romaniuk, D..  (2018). Comparison of Debriefing Methods after a Virtual Simulation:  An Experiment.  Clinical Simulation in Nursing. 19, 1-7.  

NCLEX® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names are the property of the respective trademark holders, none of whom endorse or are affiliated with Kaplan.

Karen has more than 35 years of nursing experience. She received her Master’s degree in Nursing Education from the University of Rhode Island, Bachelors of Science in Nursing degree from Rhode Island College, and her diploma from St. Joseph Hospital School of Nursing. Her love for nursing education began in the hospital setting with staff development involved within the Emergency Department and Maternal Child Health. In 2007, she made the transition into academia, focusing on curriculum development. Her greatest nursing achievement was the development and implementation of the first new nursing program in Rhode Island in over 40 years. Karen joined the Nurse Consultant team at Kaplan Test Prep in 2012. She currently services the Northeast territory and enjoys assisting faculty members with the utilization of all Kaplan resources into their individual curricula. Karen has lived in Rhode Island her entire life with her husband, four children, and grandchildren. Most of all she loves to be called “Nana”!

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