7 Things to know BEFORE Sims Lab!

Julie Reyes, DNP, RN

It is Simulations Lab Day for the nursing students I teach in my university. As I walk to the lab to prepare for the events of the day, the hallway is lined with students listening to their ipod, cramming notes, drinking coffee and talking nervously. I smile at them and tell them they will do great....if they have prepared!

The instructors here do not want our students to fail.

Sims Lab is about learning on mannequins before we get them out to the real world. Hands on experience, teaching, learning and creating critical thinking skills in our students so they can pick up on changes in real patients.

Our students have been given two scenarios for the day that is similar to an SBAR handoff. Also included in their information sheet is a list of current medications the patient is on. Preparing for the day includes answering questions about the disease process of the patient, among other things (what is the patho tree for ICP or CHF, what nursing interventions will you use, what will be your assessment, etc).

Since the instructors do not want the students to fail, we will allow you to go through your assessment of your patient, make your decisions about patient care, and when to call for help. We will watch you think through your skills, and we will let you come to the point of being 'flabbergasted'!

It is a time of instructors stepping back and letting you learn as you go. Then, when things may be starting to go south, we step in and walk you through your thought process. "Why is this patient turning blue? Is the oxygen on? Will a nasal cannula be enough oxygen for him? Is he going to breathe on his own? What would you do to help him breathe? Should you call for help?" We also can walk you through other thought processes: "What rhythm is the monitor showing? Have you noticed any changes to his rhythm? Don't forget to glance at your monitor frequently - treat the patient though, not the monitor."

After Sims Lab, I asked my students to tell me what they wish they knew before going in to the lab today, and what advice they have for new students who are about to go to Sims Lab for the first time. Their advice is timely and useful for students who are nervous about their lab.

Don't expect your lab to go as planned, nothing ever happens that way; keep an open mind because the problems that happen in lab to your patient are not always from the diagnosed illness
Know what might be the cause of the problems given the illness the patient has or the meds he is on (KNOW your PATHO tree!) - so you have to do your prep work!
It is OK to feel nervous, and it is normal! Try not to stress because the instructors watching you are not out to fail you - they want to teach you to be the best nurse possible
Assess, assess, assess...and reassess your patient!
Delegate jobs to the help you call in - you can't do everything yourself - when you call a "code", you will have new helpers in the room. You can ask someone to go get epi, or the code cart, or whatever - you have a whole team at your disposal!
In your team of nurses, before you go into the lab assign yourself a role (med administration, chest compressions, who will call for help, etc). This will save a lot of confusion and not everyone will be trying to start an IV while the patient is not breathing
Relax, and have fun! You are not being graded on how perfect you are. This is a learning experience, and a good professor will show you how to handle certain situations; and 9 times out of 10, your gut instinct is right!

After you are done with your code, you will have a "debriefing" time. This is a time to go over what went right and what went wrong. This is a time to learn, to consider other decisions that could have been made. This is not a time to make any student feel like they are worthless or they will always (or never!) kill their patient, but to gather information and learn from mistakes.

After all, wouldn't you rather have this chance on a mannequin than on a real person?

7 Things to know BEFORE Sims Lab!

About Julie Reyes, DNP, RN

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