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The 5 Steps of Nursing Education Simulation: Preparation and Simulation

June 20, 2024

By Sim2Grow Staff

Part one of a two-part series on the critical sequence of a successful nursing simulation. 

Simulation in nursing education isn't just about replicating real-world scenarios; it's a structured process aimed at honing clinical judgment and skills essential for safe patient care. Broken down into five crucial steps, simulation offers a dynamic learning experience for students to practice clinical judgment and set the foundation for a successful nursing career. 

Join us as we delve into the first three steps in this initial installment. We explore each step through the lens of a key med-surg simulation we practice to teach parenteral medication administration for a patient with an admitting diagnosis of pneumonia.

Step 1: Prep Work

Preparation is the cornerstone of effective simulation. Both faculty and students should complete the prep work required before participating in a simulation activity. 

Faculty meticulously plan scenarios, ensuring they align with course objectives and foster clinical judgment. We recommend faculty complete the following steps:

  • Identify the need for simulation within a course: In our scenario, the need for simulation stemmed from a course outcome focusing on students' ability to safely care for patients requiring parenteral medications, such as those with peripheral IV access.
  • Choose measurable learning objectives aligned with the course: Simulation activities must have clear, measurable objectives to guide the learning process effectively. For our simulation, objectives included demonstrating the correct administration of parenteral medications, such as setting up a primary IV for infusion, administering a secondary IV medication, and delivering an IV push medication.
  • Develop and pilot the scenario: Rather than relying solely on skill check-offs, we crafted scenarios that mirrored real-world clinical situations. This approach allowed students to apply clinical judgment rather than relying solely on rote memory. We modified scenarios from textbooks to align with our objectives and piloted them with adjunct faculty to refine the simulations and ensure consistency. 
  • Develop and provide student prep: Providing students with preparatory materials is essential for achieving learning objectives. We tasked students with reviewing a list of potential medications for the simulation and bringing a list of their mechanisms of action. This pre-simulation preparation ensured that students were ready to engage fully in the learning experience.

Preparing students for simulation is crucial to ensure they derive maximum benefit from the experience. Here's how we approached student prep work:

  • Mandatory prep work: We assigned reasonable tasks to students, such as watching a video, reviewing specific textbook pages, or compiling a resource list to bring to the simulation. This pre-simulation preparation, referred to as the "Ticket to Simulation," ensured that students arrived adequately prepared to engage in the learning activities.
  • Optional Prep Work: In addition to mandatory tasks, we offered optional prep work to further enhance students' readiness for simulation. Before the first simulation of the semester, students were encouraged to watch a custom-made Simulation Orientation Video. This additional resource provided valuable insights and set expectations for the simulation experience.
  • Simulation Behavioral Contract: To maintain a conducive learning environment, we recommended the use of a Simulation Behavioral Contract. This document outlines ground rules and behavior expectations, ensuring smooth operation during simulations.

Step 2: Prebrief

As students gather in the simulation lab, prebriefing sets the stage for a safe and immersive learning experience. By adhering to established guidelines and avoiding lecture-style presentations, students feel empowered to engage fully in the simulation.

Here's a breakdown of essential do's and don'ts for an effective prebrief session:


  • Convey expectations: Clearly communicate expectations to all participants, ensuring everyone understands their roles and responsibilities.
  • Review basic assumptions: Revisit the fundamental principles guiding the simulation, fostering a shared understanding of the simulation environment and objectives.
  • Emphasize safety and learning: Remind faculty and students that mistakes are opportunities for growth, cultivating a safe environment conducive to learning.
  • Present or review fiction contract: Introduce or review the Simulation Behavioral Contract, outlining ground rules and behavior expectations to maintain a productive learning atmosphere.
  • Maintain confidentiality: Stress the importance of confidentiality regarding simulation activities and patient scenarios, safeguarding the integrity of the learning environment.
  • Orient students: Familiarize students with the simulation space, equipment, and any procedural modifications, ensuring their safety and readiness to engage.
  • Deliver clinical story: Provide a comprehensive patient report, contextualizing the simulation scenario and enhancing students' immersion in the learning experience.
  • Identify learning objectives: Clearly articulate the student-facing learning objectives, aligning expectations with the desired outcomes of the simulation.

The prebrief session should be structured and consistent across the program, ensuring students know what to expect and facilitating a seamless transition into the simulation scenario. Consider recording the prebrief to ensure consistent delivery of information, regardless of the facilitating faculty member.


  • Forget to collect the "Ticket to Simulation": Ensure students have completed mandatory prep work, such as reviewing materials or bringing necessary resources, before proceeding with the simulation.
  • Lecture: Resist the temptation to deliver lectures during the prebrief; instead, focus on setting expectations and preparing students for active participation.
  • Use fidelity-diminishing language: Refrain from using language that diminishes the seriousness of the educational experience, maintaining a professional and respectful tone.
  • Allow unacceptable behaviors: Enforce standards of behavior consistent with clinical practice, promoting professionalism and respect in the simulation environment.

In our simulation example, adherence to these do's and don'ts ensured consistency and effectiveness, fostering an environment where students could engage fully and derive maximum benefit from the simulation experience.

Step 3: Simulation

The simulation phase demands unwavering consistency in order to maximize learning outcomes. Here's a breakdown of essential practices and pitfalls to avoid during this critical stage:


  • Preparation and timing: Set up the simulation space well in advance and adhere strictly to the schedule. Timeliness is crucial, as falling behind schedule can disrupt the flow of the entire day's activities.
  • Adherence to protocol: Run the simulation exactly as piloted, following the predetermined learning objectives meticulously. Consistency ensures that each student receives the intended learning experience.
  • Consistent prompts and documentation: Plan for and apply prompts consistently throughout the simulation, maintaining fidelity to the scenario. Document observations and outcomes on standardized debrief forms for accurate assessment and feedback.


  • Scenario alterations: Avoid changing the scenario between groups, as this can lead to inconsistencies and undermine the educational value of the simulation.
  • Breaking role immersion: Unless absolutely necessary, refrain from allowing participants to step out of their assigned roles during the simulation. Maintaining role immersion enhances the realism of the experience.
  • Permit "pretend" scenarios: Resist the temptation to permit "pretend" actions during the simulation. Encourage participants to approach tasks as they would in a real clinical setting, promoting a realistic learning environment.
  • Allow observers to disengage: Prevent observers from disengaging by assigning specific observation tasks. Active participation enhances the learning experience for all involved.

In our simulation example, meticulous preparation ensured smooth execution of the simulation activities. We prepared an ample supply of consumable items and provided observer worksheets to enhance engagement. With multiple simulations scheduled, staying on track was imperative, facilitated by the use of large timer clocks to maintain schedule adherence in each room.

In our next post, we’ll cover the final two steps in depth, and offer some concluding thoughts.