Surviving Nursing School Sim Lab

Posted in Med Surg

Nothing produces anxiety and dread quite like nursing school sim lab. Sure, your exams can be terrifying if your’e not prepared, but sim lab is different…and what makes it different is that it’s happening in real time IN FRONT OF YOUR PEERS! The fear of looking like you don’t know what you’re doing, actually doing the wrong thing, “killing” your simulated patient, and looking unprepared in front of your professor are all very valid…but with a little advance preparation and the right attitude, you can turn a dreaded experience into a valuable learning opportunity. Here’s how:

First of all, what is nursing school sim lab?

Sim lab (or simulation lab as it’s actually known) is a very popular learning modality in nursing school. In sim lab, you’ll have a simulated patient who, depending on the complexity of the mannequin, will talk, breathe, have a pulse, have breath sounds, bowel sounds, heart sounds, reactive pupils….pretty much everything you’d expect from a “real” patient. This patient will have veins you can insert an IV into, urethras that can be catheterized, lungs that can be intubated and stomachs that can be decompressed with an NG tube.

What happens in nursing school sim lab?

In sim lab, your patient will have some kind of problem and you, the awesome nurse, have to figure out what it is and how to intervene appropriately. You’ll have all the equipment, meds and supplies available that you need to treat and monitor your patient. This can include telemetry monitors that show ECG rhythms and other vital signs including BP and oxygen saturation level. You’ll also have medications, fluids, oxygen, IV supplies,

You will be grouped with fellow students and basically walk into a patient’s room while the patient starts to fall apart right in front of you. That’s pretty much sim lab in a nutshell!

How to survive nursing school sim lab

First of all, relax. Even if you harm your simulated patient, you’re not going to fail the lab. Sim lab is simply a learning and practicing environment. So take a deep breath and relax. You’ve got this.

Next, you might be wondering what it is you’re supposed to do in sim lab. You’ll be grouped with three or four other students and provided a quick briefing before the simulation begins. This can include the patient’s past medical history, the situation that brought them to the hospital, and details about the problem they are currently experiencing. As you go through the simulated experience, if you can remember to use the nursing process, you are going to do great. Here’s how that might look.

To begin, your patient will be lying in bed and possibly saying something like, “I don’t feel well.” The very first thing you’re going to do is ASSESS the patient. It’s the first step in the nursing process, and it’s your first step here. If no one else steps up to the plate to lead the simulation, then by all means consider this your invitation. Delegate to a classmate the task of putting the patient on the monitor and obtaining a set of vital signs. Consider the patient’s main problem and perform a focused assessment. This can involve listening to lung sounds, observing their work of breathing, palpating their pulse, looking at their pupils, or even conducting a quick neuro exam.

Next, you want to diagnose the patient’s problem. This is where your nursing diagnoses come into play. Is the patient’s O2 saturation 78% and you don’t hear lung sounds on one side, then you might diagnose him with “ineffective gas exchange.” You also need to know how this correlates to a medical problem so you can intervene appropriately. For example, in this instance it looks like the patient has had a pneumothorax, which has a very specific treatment. In the sim lab, you would get on the phone and call the physician using SBAR communication.

Here’s an example of how this might look: “Hi Dr. Oliver. This is Maureen on 4-East. I’m calling about your patient Reynolds in 5412B. He is complaining of severe shortness of breath, O2 saturation is 78% on RA and I don’t hear lung sounds on the right. He recently had a bronchoscopy and I’m concerned about a possible pneumothorax. Would you like a STAT chest x-ray?” For more info on SBAR communication, check out this post.

What’s next in the nursing process? Plan! Come up with a plan and then implement it. In nursing school world, these are two separate steps, but in real life they happen almost simultaneously. In this case, you’ll definitely want to get some oxygen on your patient and sit them up into high-Fowlers position. You could also ask one of your team members to get the chest tube supplies while you wait for the x-ray technician to arrive at the bedside.

And then it’s time to move on to the next step in the nursing process, which is evaluate! This means reassessing your patient to see if the interventions have helped. In this case, you’ve applied high-flow oxygen and sat the patient up. You would expect to see at least a little bit of improvement, though in this case, the thing that’s truly going to help the patient is getting the chest tube placed.

Now, of course, your patient may develop other problems as you go along, which is why continual assessment is key. And, there are some cases where you get sidetracked and don’t actually recognize their key problem right away. In cases like this, the patient will continue to deteriorate until they reach critical failure, which could ultimately result in cardiac arrest. If this occurs, follow your BLS algorithm and continue thinking through the potential causes.

Get this on audio in podcast episode 86.

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