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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Volume 1, Issue 3 

Marie Gilbert
Magnet LogoDemystifying Simulation

Marie Gilbert, MAEd, BSN, RN
Clinical Education Specialist



On January 15, 2009 US Airways Flight 1549
crash-landed in the Hudson River after colliding with a flock of birds. The Captain, Chesley “Sully” Sullenberger, was hailed a hero, but when interviewed he modestly stated, “I was just doing what I’ve been trained to do.”

Imagine the same scenario in healthcare. You’re suddenly exposed to your own ‘bird strike’. our patient has started to deteriorate rapidly and you know you need help. You remember some of the actions you need to take, but as your anxiety rises you begin to second guess yourself. You’ve never been in this situation before; will you remember what to do?

For many years high hazard professions such as aviation, nuclear power and the military have instituted simulation-based training to maximize training safety and minimize risk (Ziv et al, 2006). Imagine the outcome of US Airways Flight 1549 if simulation was not part of aviation training.

High-fidelity simulation is now rapidly growing in healthcare, and many organizations are integrating this method of education into a wide variety of pre and post licensure education.

So what is “Simulation”?

Simply stated, simulation is used as a strategy, to mirror, anticipate, or amplify real situations in a fully interactive way. Simulating real-world medical emergencies can help medical staff prepare for actual events (Agency for Healthcare Research and Quality, 2009).

Simulation can vary in fidelity, the higher the fidelity the more realistic the experience is. Children’s Hospital has partnered with the Department of Nursing at California State University Fresno (CSUF) to introduce high fidelity simulation into pediatric curriculum for staff and students at both organizations. The Laerdal SimBaby, affectionately known as ‘Simone’ resides at Children’s and will be used by CSUF nursing students during their pediatric rotation. When not in use by CSUF, Simone will be used by Children’s staff to improve code readiness.

Simone can breathe and has palpable pulses. You can listen to breath and heart sounds. The team can assess, plan and implement treatments. Following the scenario you get the chance, as a team, to debrief. Often we know what to do, but putting that knowledge into practice is difficult if we don’t get to ‘practice’.

Part of practicing is making mistakes; we all know we learn from our mistakes. Using simulation allows us to make mistakes safely. In reality if we make a mistake a child may be harmed or even die. Simone however, is very forgiving. She allows us to make mistakes and learn. She has the potential to make our practice safer. The National Quality Forum, a nonprofit organization committed to healthcare quality measurement and reporting, has endorsed simulation-based training as a priority area for new safe practices (National Quality Forum, 2008).

Simone has already been successfully introduced into the Focused Pediatric Resuscitation class. Additionally, August saw our first ‘Save Simone’ Mock code/RRT open labs. Many staff had the opportunity to attend and the feedback was very positive. Simone will be visiting many units so as many staff as possible can practice emergency scenarios and team work.

More information regarding the use of simulation and mock codes will be posted on George and communicated via email. Any ideas or suggestions would be welcomed.

At the end of the day, whatever our own ‘bird strike’ may be, we want to feel comfortable that our patient’s outcomes will be optimized because we could ‘just do what we’re trained to do.’



Agency for Heathcare Research and Quality (2009). Acute Care/Hospitalization Simulation exercise for hospital resuscitation teams pinpoints training and patient safety issues retrieved from on August 10th 2009

National Quality Forum. (2008). Safe practices for better healthcare: 2009 update. Retrieved August 7th 2009, from

Ziv A., Wolpe P.R., Small S.D., and Glick S. (2006) Simulation-Based Medical Education: An Ethical Imperative. Simulation in Healthcare 1(4) pp 252 – 256


In This Issue
Seasons of Change
Change and Transition
Career Path to Success
Decreasing Medication Errors Through Reporting of Unusual Occurrences
Demystifying Simulation
Breastfeeding: Improving the Health of Baby and Mom
Addressing Parent’s Fear of the MMR Vaccine
NICU Nursing in Nepal