Can Healthcare Simulation Better Prepare Nurses for the Field?

• Healthcare simulation could be the next way educators help improve core competencies for soon-to-be nurses. 
• Virtual reality companies like UbiSim believe their products can bridge the knowledge gap. 
• However, concerns about VR sickness and data privacy must be considered. 

When Christine Vogel first transitioned from nursing school to the bedside 25 years ago, she didn’t feel prepared. 

“It was very nerve-wracking,” Vogel told Nursing CE Central. “I felt at times during my first year, ‘Gosh, am I really cut out for this? I did not expect all of these things.’” 

Vogel is the lead nurse educator at UbiSim, a nursing-focused virtual reality and simulation company that was recently named a TIME best invention. Filling those gaps became an integral part of her own career when she transitioned to teaching in 2009. And as someone who’s dual-certified as a healthcare simulation educator and a simulation operations specialist, simulation has been key to her mission. 

NCLEX Competency and Healthcare Simulation 

NCLEX pass rates for first-time, U.S.-educated students were around 91% for 2024, but studies show that competency doesn’t necessarily align with the higher pass rates. 

The Online Journal of Issues in Nursing published a study in 2021 that includes data suggesting fewer than 10% of new nurses are prepared from a clinical judgment perspective. Two years later, Behavioral Sciences published a study on preparedness during the COVID-19 pandemic. More than 50% of study participants told researchers their education didn’t prepare them for what they ultimately experienced. 

Vogel said that with NCLEX rates being “so high but the readiness being so low,” there’s a need for practice through virtual reality simulation and competency-based education. 

“The NLN [National League for Nursing] has a push toward competency-based education for all schools of nursing,” Vogel said. “And so no longer is it just the test to progress. They need to show that they are able to perform each of these competencies at increasing levels.” 

In April 2023, the National Council of State Boards of Nursing did update its exam — known as Next-Generation NCLEX — to include competency-based questions. 

Healthcare simulation scenarios, particularly at UbiSim, incorporate underrepresented groups like those experiencing homelessness or substance abuse. Scenarios also can be tailored to the student’s level of experience, which Vogel said can help “supplement” knowledge gaps in nursing education. 

“Educators are doing a fantastic job, but nurse learners just aren’t learning the way that they used to,” Vogel said. “They’re not learning from the book or the PowerPoints. They need these experiences to build competency.”

Multiple studies have shown that new graduate nurses feel underprepared for the bedside, noting a “lack of skills training” and an “academic-practice gap.”

“While nursing students were able to meet some expectations, such as value and ethical codes, there is still a distance between expectations and reality,” authors of a 2024 BMC Medical Education study stated. “Especially, evidence-based care was identified as one of the weaknesses of nursing students.” 

Adoption of Virtual Reality Simulation

More and more universities are implementing virtual reality and healthcare simulation into their curriculum, but Vogel said there can be some hesitancy in getting started. 

“The evidence shows that sometimes there’s a faculty reluctance. But once faculty get in the headset and they see their students in the headset and see those ‘aha’ moments, they really want more of this immersive technology,” Vogel said, “and they really start thinking about how to use this in the best way to increase their student competence.” 

And for those students, Vogel said they “feel like they’re with their patient.” 

“They forget about the world around them,” she said. “They’re able to pick up tools and their stethoscope and listen to the patient. Their patient is looking at them and giving them eye contact. You don’t get some of those things with a mannequin.” 

Nurse Education in Practice published a study in 2024 that found VR training “enriches students’ cognitive, emotional, and psychomotor skills,” among other benefits.  

However, with new technology comes new concerns, like “VR sickness” and data privacy. 

Other ethical considerations with VR include informed consent and the accuracy and quality of content. 

The Bottom Line

Despite increasing NCLEX pass rates, new graduate nurses don’t always feel prepared for the bedside. But healthcare simulation technologies can help bridge the knowledge gap. Experts in the healthcare simulation industry believe the technology gives students a more realistic experience to ensure they have the needed competencies for a career in nursing. 

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