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How the Pandemic Made Simulated Learning Indispensable for South Carolina's Nurses of Tomorrow

Scott Morgan
South Carolina Public Radio
Two floors above where first-year sim students nervously learn how to administer injections, a smaller clutch of USC nursing students learn about blood pressure. These simulated environments allow future nurses to make mistakes without consequence and master skills in both the mechanical and communication aspects of a profession that sorely needs them but has little time at the moment to train them in real-world situations.

At the University of South Carolina’s College of Nursing, hundreds of nurses-to-be are getting the chance to figure out the many and varied intricacies of their future jobs.

It’s an environment that encourages mistakes on rather realistic mannequins and on real people posing as patients. Mistakes here are a learning experience. Not really consequential. Certainly not fatal like they would be in a hospital.

Most of these nursing students are a little too jittery to be working on real illnesses and emergencies at the moment anyway. Hadley Meckes, a junior, got startled by her mannequin the first time she got up to it because the instructors made the thing moan in pain when she touched it.

For a second, she thought she’d hurt it, then remembered it wasn’t a real guy. It’s a moment that bears how seriously these students take their education and how realistic that education is.

At the moment, it has to be realistic and immersive like this. Simulation training isn’t new, but in the pandemic it’s become vital. Before COVID-19, students like Meckes or her classmate Dallas Bass would be spending some time in a real hospital, learning the ropes with seasoned healthcare workers.

But South Carolina’s hospitals are stuffed past capacity with COVID patients right now. They don’t have time to mentor future nurses. In fact, instructor and family nurse practitioner Andrea Neilan, says she and her class were booted from their hospital learning environs in 2020 because the needs of the pandemic superseded the hospital's ability to help nursing students learn.

Part of the reason is that nursing is not all just giving shots and hooking up equipment. It’s also about the ability to relate to patients.

This is what the director of clinical simulation at USC, Dr. Crystal Murillo, says is the most vital aspect for students to learn.

“I can teach anybody how to do the mechanics of the job,” she says. It’s the cultural sensitivities, the ability to start and guide conversations, and the ability to listen to what a patient is saying that determines how good a nurse is, and that's a much more immersive process (especially, Murillo says, for young adults who grew up more comfortable with texting than in-person impromptu conversation).

The clinical simulation division under Murillo’s watch is especially focused on understanding the kinds of people South Carolina nurses will see. This, she says, is a rural state, not one with major cities like Chicago. Most people whom nurses will see in the course of their practices will be small-town residents; rural; often poor; often religious; often of color.

To understand how to communicate with real South Carolinians, Murillo diversifies the pool of actor-patients as much as she can. She also made sure to use part of her division’s $1 million grant funds to get mannequins that were not just white (like 96 percent of mannequins in the country’s simulation labs, she says, citing a study she worked on herself).

She admits it might sound silly to some that the color of a mannequin matters, but she says it does. It’s a form pf representation that gets overlooked in healthcare, where she says people get hung up on everyone being just one race – human.

Yes, we are, but Murillo says treating everyone as if they’re the same can have disastrous medical outcomes. Even individual races are not monoliths, she says. And if African-American mannequins help to get students used to different kinds of people whom they’re most likely to treat, well, then African-American mannequins will be part of the simulation division’s stockpile.

Non-white-guy mannequins also help in diversifying nursing recruits, she says. The American Association of Colleges of Nursing says 80 percent of nursing recruits nationally are white. In a state like South Carolina, where more than a quarter of the population is African-American, that can be problematic – mostly because, Murillo says, “70 percent of medical errors are related to breakdown in communication. Those factors like cultural differences, perspectives, norms – all of those things play a part.”

The lessons are sinking in for students like Dallas Bass, who says she’s already learned to appreciate that in some cultures, the idea of a female patient seeing a male doctor is not welcomed. It’s not something she used to know, but is something she’s learned to open her eyes to – and in a safe environment where she can get something wrong and know that her patient will not suffer for her error.

Listen to the story above to learn more about how USC’s simulation program is paving the way for tomorrow’s nurses in South Carolina.

Scott Morgan is the Upstate multimedia reporter for South Carolina Public Radio, based in Rock Hill. He cut his teeth as a newspaper reporter and editor in New Jersey before finding a home in public radio in Texas. Scott joined South Carolina Public Radio in March of 2019. His work has appeared in numerous national and regional publications as well as on NPR and MSNBC. He's won numerous state, regional, and national awards for his work including a national Edward R. Murrow.