The nursing profession today is faced with a rising demand for care for an aging Baby Boomer population while simultaneously experiencing shortages related to a lack of educators, workforce geographic distribution, and high turnover. The American Association of Colleges of Nursing (AACN) reports that nursing schools are struggling to expand capacity to meet these increasing demands.
Nursing is a profession that requires not only technical skills, but also soft skills such as critical thinking, decision making, empathy, confidence, teamwork, and smooth communication. These skills are essential for collaborating with other healthcare professionals in providing safe and high-quality patient-centered care. Additionally, they are vital for coping with the challenges and stresses inherent in the nursing role.
Many nurses, especially younger nurses newly entering the workforce, have had limited opportunities to hone the communication and collaborative skills that contribute to productive workplace relationships — shown to influence job satisfaction, workplace commitment, and career longevity. Younger generations of nurses often have less experience collaborating in-person and may be more accustomed to digital forms of communication. With one-third of the nursing workforce reaching retirement age in the next dozen years, availability is diminishing for informal mentoring and on-the-job training opportunities, which are crucial for developing interpersonal skills.
The Covid-19 pandemic has also led to fewer in-person training and collaborative learning opportunities. Without deliberate efforts to develop communication abilities, novice nurses may struggle with team efforts such as coordinating patient transfers, tracking treatment and medicines, executing provider orders, and facilitating shift handoffs. Poor communication during these activities can lead to treatment delays, redundant or missed tasks, and compromised patient safety.
Changing relationships
Nursing collaboration isn’t only about nurses reporting to providers. Reflecting on my own experience since graduating from nursing school in the late 1990s, there was a distinct hierarchy within the doctor-nurse dynamic. Today, we’re breaking that barrier down. It’s an interprofessional team, where doctors and providers rely on the care team — including physical therapists, case managers, and pharmacists, as well as nurses — to provide critical input about the patient to help direct the plan of care. Collaboration also involves communicating appropriately and empathetically with patients and their families in care decisions, along with administrators and other staff.
Nurses often serve as the primary point of contact between patients and their medical teams, acting as the eyes and ears of busy providers who may only have time for a brief snapshot of the patient’s condition. I see it happen all the time with patients, where the provider enters the room, asks, “How are you feeling today?” and the patient says, “I feel fine.” Then as soon as the provider leaves, the patient shares with the nurse, “I’ve been having a pain in my abdomen for three days.”
Patients often feel a bit more relaxed with nurses they’re around all day than with their providers, so the nurse may be privy to vital cues about the patient’s condition. They can act as an advocate for patients when collaborating with nursing colleagues and clinical professionals, ensuring that important details on patient history, current treatment strategies, and any changes to a patient’s status are shared and accurate.
This is why it’s so critical that nurses are able not only to communicate empathetically with the patient, but also clearly communicate with other members of the healthcare team. Effective communications and teamwork result in more efficient care, fewer errors, lower costs, and improved satisfaction for the patient, as well as improved learning opportunities, higher satisfaction, and reduced anxiety among nurses.
Practice, practice, practice
As a result of medical practitioner shortages, there’s more pressure than ever to manage higher patient loads. Nurses have more responsibility now for conducting basic triage to gather assessments and develop hypotheses around root causes to relieve pressure on shorthanded providers. As a result, novice nurses may also take on more responsibility with critically complex patients. But how can less experienced nurses develop their soft skills in terms of judgment, communication, and teamwork for better patient outcomes?
In my years as a nurse educator, I loved nurturing my groups of eight to ten students in a clinical setting and providing opportunities for them to practice their skills. After a time, I realized that nurse learners were usually relegated to observer status when the patients became unstable. That’s an understandable move to avoid risking patient safety, but it inadvertently restricts students’ chances to engage in critical decision-making, take proactive measures, and effectively communicate with healthcare team members during urgent care scenarios. If the nurse learner were to make a mistake, there would be no time to discuss it or re-do it, or for the learner to figure out on their own how to correct it.
Like the old joke about how to get to Carnegie Hall, becoming a confident and capable nurse in a high-stakes situation requires practice, practice, practice. In a November 2023 survey of 957 nursing instructors done by my company, we found that 31% expressed concern over their ability to train nurse learners for high-acuity, low-occurrence events.
A way to address this gap is to provide opportunities for realistic simulations and hands-on experiences. Simulations can involve virtual reality (VR) software programs, manikins, standardized patient actors, or a combination of methods. Simulations allow nurses to practice and improve clinical reasoning, teamwork, and resilience in a realistic, controlled, high-pressure but safe environment. That’s the value of simulation; it’s a chance to make mistakes, analyze and reflect on performance, determine the possible fixes, and build muscle memory without real-world consequences from errors.
Unfortunately, demand exceeds the available capacity in many nursing institutions. In fact, 84% of the nursing instructors we surveyed affirmed their nursing program has denied acceptance to qualified applicants because of a lack of simulation facilities and resources.
This alarming statistic underscores a critical bottleneck in addressing the nursing shortage, highlighting the urgent need for investment in and expansion of simulation-based educational infrastructure. By enhancing simulation capabilities, nursing programs can not only accommodate more students but also equip them with the essential skills required to meet the complex demands of the healthcare industry.
Sample VR scenarios
In VR, nurse learners are immersed in simulated collaborations with realistic virtual patients and healthcare colleagues. Compared to traditional training methods, immersive VR simulations can be accessed anytime and anywhere, reducing the need for personnel and physical equipment in special labs beyond the VR headset and handheld controllers.
Here are a few examples of practice scenarios that could be simulated in VR to help nurses improve their teamwork and communication skills:
- Conducting assessments on patients experiencing rapid deterioration
- Ensuring timely interprofessional communication regarding changes in the patient’s condition
- Coordinating treatment protocols
- Providing therapeutic communication, support, education and advocacy to patients
- Communicating key information during a shift change report
- Collaborating during patient admission, discharge, or transport
- Managing de-escalation of agitated patients or family members
- Administering compassionate palliative care at the end of life
A 2023 Pennsylvania College of Technology study found that full-immersion VR simulations decreased nursing student anxiety levels about communication skills. Multiplayer VR platforms can foster collaborative skills by allowing learners to function in virtual teams. Learners get real-time feedback, reflect on their own performance, and participate in debriefing opportunities with other students and instructors.
Transformative technology
Virtual reality simulations have the potential to provide a transformative solution to many of today’s challenges in nursing education, improving on-the-job competence, coordination, and resilience. To increase satisfaction and longevity in the workforce, McKinsey research found that nurses need more time and opportunities for training, peer-to-peer teaching, and feedback.
VR has shown to be a cost-effective supplement to in-person clinical experiences in educational institutions of all sizes. Realistic simulations in a safe environment help nurse learners develop the clinical judgment skills essential to delivering safe and quality care to patients, and to improving Next Generation NCLEX nursing licensing examination scores.
Forward-looking nursing schools may want to follow the recommendation of a new study in Taiwan, that communication simulations in VR “should be arranged as early as possible in fundamentals of nursing practice courses.”
Photo: Nikada, Getty Images
Christine Vogel, MSN, RN, CHSE, CHSOS, is a lead nurse educator at UbiSim , where her passion for innovation in nursing education drives her to design, pilot, and evaluate evidence-based immersive virtual reality (VR) simulations for nurse learners. With a distinguished career that extends over 25 years in nursing, including more than a decade dedicated to academic roles, her work is inspired by a commitment to enhance the educational journey of nurse learners and improve patient care.
