Simulation to Replace Clinical Hours in Nursing: A Meta-narrative Review

Background: Continuingly increasing numbers of undergraduate nursing students on clinical placement have led to industry partners feeling stretched and fatigued. This can lead to inadequate supervision and education for the students. Substituting a percentage of the required clinical hours with simulation provides students the experience they crave and industry partners a chance to slow down. Method: A metanarrative review method was used as outlined by the RAMESES guidelines. Results: A total of 104 articles were screened and 12 included in the final sample. Studies conducted in the United States and United Kingdom showed that a percentage replacement of clinical placement hours with clinical simulation shows no significant difference to student outcomes in relation to clinical skills and knowledge, and student confidence. Conclusion: The total number of clinical placement hours required by each university for studies is unclear. Higher numbers of clinical placement hours are seen in the United Kingdom, and a diverse spread of clinical hours in the United States, which impacts how the findings can be applied to Australia. Simulation can be used as an adjunct to clinical placement hours, yet regulations need to be defined around the simulation modality used, how many hours of simulation compared with clinical practice is sufficient to maintain proficiency of students, and the assessment or measurement tool used to ensure quality.