They breathe, blink, give birth. Life-like dolls help train Idaho nurses, combat shortage.

Practice makes perfect: BSU nursing students practice on sophisticated mannequins

Boise State University nursing, respiratory and radiology students practice their skills in simulation labs with mannequins that talk and respond.
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Boise State University nursing, respiratory and radiology students practice their skills in simulation labs with mannequins that talk and respond.

Boise State University’s simulation center looks like a traditional hospital floor, with a nurse’s station, meeting rooms and patients in beds.

But the patients in these beds are not human. In each room is a plastic mannequin with life-like features.

“We use high-fidelity mannequins, which means they have human features and they come with software allowing the instructor to operate the mannequin virtually from the control room,” Jennifer Kepler said in an interview with the Idaho Statesman. Kepler is a simulation specialist at the Boise State University School of Nursing.

These artificial humans help train the next class of nurses, and Idaho needs more nurses. A 2018 report from the Idaho Alliance of Leaders in Nursing predicts a shortage of 5,906 nurses in Idaho by 2025.

The simulation mannequin breathes, blinks and speaks almost like a human, allowing nursing students to practice and assess their skills before needing to use the techniques on humans.

“Students use mannequins and the simulation center in their very first semester, in week two,” Kepler said. “Students mimic doing hospital rounds, so they do not know exactly what they will see with the mannequin patient until they enter the room, to give students the most realistic experience we can.”

The nursing program at Boise State University includes eight high-fidelity mannequins, which mimics humans with pulses and breathing sounds, for instance. Jennifer Kepler, operations manager in charge of simulations, oversees a simulation. She queues up the patient/mannequin symptoms and responds as the voice of the patient, to make the scenario as realistic as possible for students. Katherine Jones

Students in BSU’s simulation center enter the patient’s room one by one, with the other students in the nursing cohort watching via video and audio. In the room with the life-like mannequin, nursing students practice their clinical skills and bedside manner based on coursework objectives.

“We build scenarios with very specific learning objectives,” said Kelley Connor, a professor at the School of Nursing who integrates simulation with her in-classroom teaching. “We build our scenario stories around what we want the students to learn, connected with their classroom education. And we do a debriefing afterwards to make sure that students understand the important concepts that they’re supposed to learn from doing this scenario.”

Eight life-like mannequins

The simulation center has eight mannequins, including Noelle, who can mechanically give birth, and SuperTory, the latest robotic newborn to join the family.

To help nursing, respiratory and radiology students practice for clinical settings, Boise State has simulation labs, including one mannequin named Noelle, who gives birth. Kelley Connor, assistant professor of nursing at Boise State University, uses the labs to teach course objectives. Katherine Jones

“With these mannequins, nursing students can get needed hands-on experience,” Kepler said. “We can simulate high-risk, low-frequency events so students can safely practice their skills and learn how to appropriately react when they are in the real world.”

Nursing students at BSU’s School of Nursing can gain up to half of their required clinical hours in the simulation center. Increased simulation hours enable more flexibility for students because clinical practice hours require supervision in busy hospitals during limited hours. The Idaho Board of Nursing requires 100 hours combined between simulation and clinic practice.

By providing nursing students with greater access to in-house clinical hours through the expanded simulation center, BSU’s nursing program can accept more students each year.

“Boise State University’s nursing program has grown recently,” Connor said. “We are admitting 65 students in the fall; that is up from 60. And there’s some talk about increasing that later in the future. So we are growing.”

Increasing the nursing class at BSU could help ease any shortage.

“We have a nursing problem across the state,” said Kevin McEwan, chief nursing officer at Madison Memorial Hospital in Rexburg. “There are pockets of problems, especially with expanded health care services, in the East, North and West. Boise has its own problems, but so does rural North and East Idaho.”

Not enough nurses

There simply is more demand for nurses across the state than there is supply of recent graduates.

“There are three big causes of the Idaho nursing shortage: a reducing supply of nurses to work, an increasing demand for nurses and limited education capacity to train Idaho nurses,” said Randall Hudspeth, executive director of the Idaho Center for Nursing.

The 2018 report of the Idaho nursing workforce says that Idaho falls short of the national standard for registered nurses per 1,000 residents. The national standard is 10.35, Idaho has 9.03.

An aging nursing population is expected to exacerbate the supply-demand gap. According to the same report, in 2018, 37.5% of Idaho’s nursing workforce was older than 55.

“Idaho has an aging nursing problem,” McEwan said. “With the good economy, nurses are retiring on time and retiring early. The average age of nurses in Idaho is close to 47 years old. That is the average. There are 55- and 60-year-old nurses who are all looking to retire soon who will leave the state in need of more nurses.”

Graham Dowdy, a third-year nursing student at Boise State, places a nasogastric feeding tube into a mannequin. The mannequin can be programed to have human symptoms, reactions and interactions to make the scenario as realistic as possible for students. Katherine Jones

To keep pace with demand, Idaho will need more nurses than current programs produce.

“In order to mitigate the upcoming increased nursing shortage, Idaho schools need to increase by 40 nurses each year across the state,” Hudspeth said. “That is a real challenge for most schools, but is needed.”

Simulation centers a useful tool

Simulation centers such as the ones at Boise State University and Idaho State University help universities and colleges increase class sizes.

“There is a growing trend to decrease clinical training time in hospitals and instead do simulation hours,” McEwan said. “Increased simulation hours has not changed the competency of nurses. In fact, I think it has improved nurses because they are exposed to patients in certain circumstances that are not common in the hospitals, like heart attacks.”

The BSU simulation center is a productive recruiting tool as well.

“If we do nothing to help the nursing shortage, we will have to recruit nurses from other states,” McEwan said. “We are committed to our patients. We will have to steal nurses from other states, but that is not fair to the other states who need their nurses, too.”

Rachel Hager is writing for the Idaho Statesman this summer on a fellowship through the American Association for the Advancement of Science. She is a master’s student in ecology at Utah State University and earned a bachelor’s degree in biology at Bryn Mawr College.

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