History repeating itself….

In March the Nursing and Midwifery Council in the United Kingdom announced changes to standards for pre-registration nursing programmes, which were reported in the nursing press as ‘historic”. The term historic can have all manner of meanings ranging from important (momentous, remarkable, significant) to old (ancient, past, bygone) or simply full of history.

Amongst the raft of changes was the decision not to raise the cap on simulation hours from 300 hours from a total number of 2,300 clinical practice hours to the anticipated 1,150 hours i.e. a maximum of 50% of clinical practice hours being undertaken by simulation. Instead, the NMC decided to completely remove the cap on the hours that can be spent in simulation activities. Not surprisingly there has been some disquiet expressed about this decision and the NMC response is reportedly that they will monitor universities’ use of simulation. But if we look at the situation from an evidence based perspective, the decision by the NMC is difficult to challenge.

Historically simulation has been used for a long time in nursing programmes, with little evidence to support the type or amount of simulation learning and, it could be argued, with little or no control over the quality of simulation learning experiences. Early findings from a systematic review we are currently undertaking suggests that the evidence for an accreditation standard ratio, or proportion, of simulation hours to clinical placement hours is scant. While we are still synthesising international RCTs of the substitution of clinical placement hours with simulation hours across health disciplines, trial interventions favour replacement of 25-50% simulation to clinical placement, but determining the proportion for replacement seems arbitrary.

Application of these replacement proportions is made even more tenuous by the lack of evidence to support the mandated number of clinical placement hours in the first place, and that evidence gap is also the subject work by the ESS Collaborative. Perhaps our efforts will provide solid ground to inform standards for clinical placement hours and the use of simulation and, in doing so, we can stop history repeating itself.