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The simulation at the end of the S1 semester is a dreaded event.  You hear tales that trickle down the grapevine starting as early as J1 semester.  How stressful it is.  How you’re expected to know how to do everything all on your own.  How you have to help mentor younger nursing students and assume total care of a patient the entire time.

This is your b/f upset that you're blowing him off b/c you're too busy worried about your S1 simulation

This is your b/f upset that you’re blowing him off b/c you’re too busy worried about your S1 simulation

Well, by the time this sim reached me it had been tweaked a bit.  Seniors were no longer paired with two J1s all on their own.  There were 2 seniors and 2 J1s in every group.  That already takes off a butt load of stress.

The set up:  10 seniors (paired up, so 5 groups of 2) enter a mock ER room with 5 patients.  The J1s had already done a head to toe assessment.  The seniors had 5 minutes to visit each patient, gather all the relevant data and make a decision on who was a priority.  Who should we see first?

This is difficult because it’s the ER.  Most people need to be seen and there are a ton of potential problems, right?  For example, one kid obviously had appendicitis.  This may make you place him at the top of the priority list b/c you’re thinking, “Oh no, it could rupture!”  If at any point you have to preface your priority with “if” or “it could” then you’re probably going about it wrong.

When prioritizing, focus on what is acutely happening.  Even if vitals are stable and the patient doesn’t look “scary”, that does not mean they aren’t a priority.  We had a head injury, sepsis, meningitis, appendicitis and a woman with chest pain.  Guess who’s the #1 priority?

Winner: The quiet, calm lady with no SOB but some chest pain. 

People can trick you!

People can trick you!

You then break out in groups (2 juniors, 2 seniors) and take care of one of the patients you saw in the ER.  This is done in a more private simulation room (set up like a hospital room).  My group was assigned to the appendicitis kid.  You document vitals, I&O, do assessments, talk to mom, call child life, call for labs/med problems, call the MD with changes, pull/give meds, carry out all orders, and handle any other unexpected items that happen to come up.

Key with this and any other simulation: stay calm and use your resources (this includes your brain).  Ask questions if you’re not sure.  Remain calm.  Don’t get worked up or so stressed that you start making silly mistakes (or worse, freeze up and do nothing).

At the end of the day, it wasn’t as bad as the tall tales, which was a relief.  I still stand by my statement that simulations are pointless and a waste of time (I don’t care what evidence based articles say about the positive effects!)