Prelicensure Nursing Clinical Simulation and Regulation During the COVID-19 Pandemic

Background: During the COVID-19 pandemic, many boards of nursing (BONs) in the United States issued emergency orders to allow prelicensure RN nursing programs greater flexibility regarding simulation use. Purpose: To understand how state BONs adjusted their simulation regulations to support prelicensure nursing programs and how prelicensure nursing programs in turn drew upon this revised guidance to safely deliver clinical education during the early stages of the COVID-19 pandemic. Methods: Simulation-related BON regulations were reviewed before and during the pandemic and classified by the degree of change. All active U.S. prelicensure RN programs were then surveyed in the summer of 2020 about prior and anticipated (fall 2020) simulation usage. Data from each phase were then merged to determine how jurisdictional changes informed simulation substitution levels at the program level. Wilcoxon signed-rank tests were used to determine the significance of identified trends. Results: Early in the pandemic, nearly half (n = 24) of states issued emergency orders to allow for the expanded use of simulation-based education (SBE) in prelicensure nursing programs. A total of 526 prelicensure RN programs participated in the survey, yielding a 32.8% response rate. Most programs increased their use of SBE, with the most pronounced changes occurring in jurisdictions in which emergency orders modified or waived existing clinical substitution thresholds. Conclusion: Proactive BON emergency orders and policies provided the necessary flexibility for prelicensure RN programs to maintain the continuity of prelicensure RN students' education early in the pandemic when many clinical sites imposed significant onsite restrictions.