Stop Prelicensure Student Abuse in Simulation

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The misuse of simulation can result in scary unhelpful experiences with traumatic consequences especially in younger healthcare providers, such as nursing students. A call to action to avoid the major negative associations with simulation.

In collaboration with

The problem

A post on LinkedIn prompted a discussion on, let’s call it what it is, abuse of nursing students in simulation, by either uninformed, untrained but well-intentioned simulation educators or faculty, or worse, intentionally abusive educators or simulationists. Some educators were heard to say they used “shock and awe, toughening up the students for the real world”. For many, the patient died in every scenario. One simulationist wrote «I had to upgrade my term of “sim baggage” to “Sim PTSD”, these poor students were tortured, every bad practice you’ve ever heard of rolled up into one group. Just shameful».

Hospital educators wrote too, about seeing no win scenarios for new hires. 

During COVID, many educators were thrust into simulation with no preparation. For some, this has continued, with little to no training. And the results are clear. 

There is an underlying problem: the art and science of education is not valued. The cognitive science of education is helping us understand the best way to structure educational experiences, but how many faculty (full time and adjuncts) read and apply research? Educators have a moral responsibility to use current evidence, just as we do for patient care. 


For educators

Unskilled sim facilitators are dangerous to our future healthcare workforce. We do not want to inflict training scars that will carry over into clinical practice. Simulation education is imperative! High-quality free courses and certificates are available. Simulation courses should be required in every graduate nursing education program. Professional & faculty development should be the norm with a spirit of inquiry and lifelong learning. Build a continuous improvement culture across nursing education and clinical practice with peer feedback as a norm. 

For deans and directors

Every dean and director needs to see a simulation. Leaders must hold educators accountable and support peer feedback that incentivizes best practices. Not every “good” educator should work in simulation: past training scars leak out at unexpected times and can damage students in simulation.

For accrediting bodies

Nursing accrediting bodies should request documentation demonstrating application of the simulation standards and the use of the National Council of State Boards of Nursing (NCSBN) simulation guidelines for prelicensure nursing education programs on-site visits. Seek student and faculty feedback on their simulation experiences. Identifying faculty who have expertise in simulation and encouraging them to run for seats on state boards of nursing and accreditation body board of commissioners or to sit on relevant accreditation committees.

For simulationists and simulation organizations

Is it time for a “if you see something, say something” or a “no more untrained simulationists” campaign? Individual or joint simulation organization position papers calling for a requirement of training and validation for simulationist skills are essential to consider. 

For simulation manufacturers

Simulation manufacturers should commit to sharing information about simulation educational opportunities. Maybe there should be a sticker on every simulation device that states “WARNING. May cause psychological harm. To be used ONLY by trained educators/instructors.”

What if we do NOT do this? 

The psychological ramifications are substantial and may contribute to the current high burnout in nursing. How we respond as educators to students during a simulation impacts how they grow and feel toward nursing and education as well.


Elizabeth Wells-Beede

Elizabeth Wells-Beede

INACSL Board of Directors View all Posts
Suzan Kardong-Edgren

Suzan Kardong-Edgren

Past President of INACSL View all Posts

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