Next-gen nursing: How simulation labs are advancing nursing education

Amanda Cupido: This is The Forefront, a Toronto Metropolitan University podcast that explores ideas for cities. I’m Amanda Cupido. 

So here’s the problem: nurses often find themselves in high stakes, unpredictable environments, and it’s hard to train people for that. Traditional classrooms with lectures and textbooks can only take students so far, and sending students into real-life situations when they’re still learning can be risky. 

Let’s add another layer of problems to the mix: Canada is facing a nursing shortage that just keeps getting worse, and Ontario is getting the worst of it. According to the Canadian Institute for Health and Information, the province currently needs an additional 26,000 registered nurses just to catch up to the nurse to population ratio in the rest of Canada. It’s a growing gap that’s widened by 3% since 2022. 

Post-secondary institutions need to be able to entice people to apply for their nursing programs and help them face emergencies, make split-second decisions, and deliver critical care with confidence.

Angela Kang: I was in a little route to go into the computer science route, actually, but with COVID, I actually had a couple family members pass away.

Amanda Cupido: That’s Angela Kang. She’s a fourth year nursing student at Toronto Metropolitan University’s Daphne Cockwell School of Nursing, or DCSN, for short.

Angela Kang: And I started to kind of spiral into, oh, what can I do for my family and my close ones if they do suffer from illness? And my mother was a good inspiration, because she’s also a nurse. So I think that’s kind of where it stemmed, like that passion of just trying to help people and help those around me and kind of give back to the community a little bit.

Amanda Cupido: As part of their curriculum, Angela and her peers at DCSN are using state-of-the-art technology in simulation labs instead of classrooms. They’re thrown into realistic, unpredictable simulations that help them prepare for the kinds of health care scenarios a nurse might face in real life.

Angela Kang: I remember even in year one and two when we were introduced to the nursing simulations, even having, like, manikins that can talk and you can hear all these different airway sounds. They can be hooked up to monitors. It was so incredible.

Amanda Cupido: Let me just set the record straight. These are not the same mannequins you would see in store windows. They look, feel and respond like a human would. They might even have teeth and a tongue. Angela says that working with something so realistic creates a safe space to learn without pressure.

Angela Kang: I was able to make mistakes and someone was able to capture these mistakes, and I was able to improve on them. But at the same time, it felt really real. So it felt like a patient interaction. Even the manikins themselves, they can blink, their pupils dilate. Like, it was honestly, really, really fascinating for me.

Amanda Cupido: Backed by a generous $1 million donation from the FDC Foundation, the simulation labs help give students a taste of what nursing is really like. For instance, one of the minkin’s conditions might unexpectedly take a turn for the worse, or an actor might play an emotional caregiver. Angela recalls one actor in particular who left a lasting impression.

Angela Kang: Oh my goodness, I don’t know how she didn’t break character. She was scaring me a little. She played the role of a caregiver. It was pretty intimidating, to have not only the patient, but the caregiver at bedside. And just small things, that’s just like introducing yourself not only to the caregiver, but to the patient, how you talk to them, and being able to address all the questions that come from not only the child, but also the caregiver. Being able to correct the caregiver with techniques, things like that, I guess, were very like an aspect of nursing that you don’t really consider too, too much.

Amanda Cupido: Angela says these simulations are the most exciting part of the program and the most effective at teaching important skills. The labs don’t just help her learn about medicine and health care, they teach her about critical thinking and how to regulate her own emotions.

Angela Kang: I always love getting hands-on and I can read about meningitis for so long, but once you see it on a person and once you’re in that environment, it helps you develop your priority list. I learn the best in simulations and labs, where I get to actually see what’s going on and see it on a person and be able to, I guess, correlate the emotions that I have during that simulation with the actual condition itself.

Amanda Cupido: The simulation labs also remind Angela why she’s studying to be a nurse in the first place.

Angela Kang: It’s a nice way of just feeling like, okay, I’m in this profession because of these patient interactions, and these are some things that could go wrong. And I think there is a very 50/50 of nervousness and excitement. But overall, students are genuinely excited to just be outside of the traditional learning classroom and into a classroom where it’s more intimate and it’s a lot more collaborative.

Amanda Cupido: Working in teams and watching how other students handle situations differently is another huge benefit to this kind of learning.

Angela Kang: You’re not going into a room by yourself. You get to rely on each other. And I guess each nursing student has their own set of strengths that can be put into play, which I personally really love. I can speak with students that I haven’t spoken to before and just get their input and get their experiences, and see how they would have handled the situation differently compared to me, although we’ve been through four years of nursing school together. It’s so incredible to see, just like the different mindsets.

Amanda Cupido: Now, if nursing students are relying on these labs, who’s in charge of designing them?

Kylie LeBlanc: As a society, we’re asking a lot of nurses right now, and I think we have a responsibility to prepare them as best we can...

Amanda Cupido: Meet Kylie LeBlanc. She’s one of the professional practice and simulation coordinators at the DCSN, and she’s a registered nurse.

Kylie LeBlanc: …and part of that is giving them an opportunity to work through some of these thoughts and feelings and questions and to start to, you know, flex that critical thinking muscle as many times as they can before they’re out there doing it in the real world.

Amanda Cupido: Kylie is also a TMU alum. She completed her Master’s of Nursing in 2021. She relies on that lived experience when she designs a simulation lab for her students.

Kylie LeBlanc: We have a whole part of our process that centers around psychological safety. Students can make mistakes because there’s not really people’s lives on the line, so the vibe and the energy in the room is supposed to be very warm and inviting and welcoming, and we really try and foster that.

Amanda Cupido: At the start of each simulation, students get a walk-through of the setup. Each lab has 15 hospital beds, and students work in pairs at each bed as the instructors run the scenario.

Kylie LeBlanc: They’ll go into the suite and they have typically about 20 minutes, 15 to 20 minutes, where they have a chart and they just have to engage as if it’s their first time meeting the patient. And they are either passing morning meds or they’re doing a dressing change, and then stuff comes up.

Amanda Cupido: On days when Kylie is running a simulation lab, she observes the students from behind a two-way mirror and has full control of the manikins.

Kylie LeBlanc: We’ll be kind of controlling all of their functions, so we can simulate different vital signs, blood pressure, heart rate, as well as what the students listen to when they have their stethoscope. So we can mimic heart murmurs or, you know, different pathological findings in their lungs or, you know, whatever the case might be.

Amanda Cupido: Having patients make requests, express concerns, or ask lots of questions helps the students learn how to multitask.

Kylie LeBlanc: They have a different priority than the students might have. How do you navigate that? How do you make sure you get all the tasks that you need to get done, like med passes, like your assessments, and also deal with a real person or a simulated person who’s talking to you at the same time. How do you like, marry the science with the art of nursing when you’re in a high-stress environment?

Amanda Cupido: The simulations focus on different areas of health care, giving students a chance to try out different streams of nursing in a more meaningful way than if they were simply reading a chapter in their textbook.

Kylie LeBlanc: Sometimes that’s an acute care experience. So kind of a hospital setting type situation. Sometimes it’s a community setting. We run some mental health sims. We have a birthing manikins, we have pediatric manikins. Right now, we are just finishing today, a round of simulations focused on bacterial meningitis in a pediatric population.

Amanda Cupido: Participating in specialized simulations like these helps students like Angela to discover which nursing stream they wish to pursue.

Angela Kang: Sometimes these textbooks or PowerPoints won’t really focus too, too much on the pediatric population. But having these nursing simulations where they do, and we’re able to, I guess, moreso gear focused towards how big nursing can really actually be. It’s always so nice.

Amanda Cupido: After just a few months in the simulation labs and clinical placements, Kylie says her students get a huge confidence boost. By the end of the year, they’re not just following steps, they’re really thinking through each action and understanding why it’s the right approach. And as a bonus, students can’t seem to get enough of the labs.

Kylie LeBlanc: So it’s not that we’re teaching them new content in simulation, it’s that we’re trying to get them to consolidate all of that knowledge and apply it in a situation. So for me, I think it’s more about the confidence and their ability to rationalize the thoughts. And it’s very positive, which is something I’m proud of. We by and large get very, very positive feedback from the students. They are always asking for more simulations. They’re really grateful that they engaged in the scenario at the end, even though it’s challenging, and even though sometimes it brings up difficult emotions or difficult things that they have to work through, it’s so valuable that we hear that reflected in the feedback.

Amanda Cupido: The labs are optional, but Kylie says they are almost always at full capacity. I feel like that just says it all. Kylie says the positive feedback has made her more hopeful than ever about the future of nursing in Canada.

Kylie LeBlanc: So the conversation is shifting, and there is more of an awareness of what is required to go into this really beautiful profession. And sometimes that comes out in sims and sometimes, like, they’re able to talk about some of these issues. And we do consider that in the way that we’re designing our sims. 

We always want to be a support. It wasn’t that long ago that I was sitting in their shoes. So I really have a lot of empathy for the struggles of managing living in Toronto or living in the GTA and managing what that is like, on top of being in a demanding program and going into a demanding field. I have huge respect for the students and I always really want to, you know, push them but also support them.

Amanda Cupido: And with technology advancing as quickly as it is, the next round of nursing students at the DCSN will likely have even more access to tools that leverage things like AI and VR, which will give them even more immersive, hands-on experiences before they step into real patient care.

Kylie LeBlanc: I’m very excited about AI. I think there’s no field that will be untouched by the changes that will come with AI. All of the conferences that we’ve been going to have really been covering this AI explosion that’s happening, there’s so much untapped potential there. So I think to have this conversation in even five years, two years would be very different than today, which is exciting.

Amanda Cupido: Before we go, here’s Kylie one last time on TMU’s dedication to innovation.

Kylie LeBlanc: We have a focus on innovation that is different from some other institutions, particularly because of where we’re located. Like we’re an urban, downtown university that’s right in the heart of everything. And I think that’s reflected in our student population. I think it’s reflected in the people that are a part of the staffing of our program, and I think that makes a big difference. Everyone on my team is a nurse, but everyone on my team has a very different clinical background, cultural background. We have different academic backgrounds. There’s a real wealth of knowledge there and our ideas are very welcome.

Amanda Cupido: This podcast was created for alumni and friends by University Advancement at Toronto Metropolitan University. Special thanks to our guests on today’s episode: Angela Kang and Kylie LeBlanc. 

This podcast was produced by me, Amanda Cupido, and Jasmine Rach, who also edited the show. We’re both proud grads of TMU! The team from the university includes Haweya Fadal, Meredith Jordan, and Rivi Frankle. To help fuel the research and learning coming from the Daphne Cockwell School of Nursing, consider donating to Toronto Metropolitan University. Join us in shaping a brighter future together. Visit torontomu.ca/alumni.