Creating a Virtual Clinical Learning Experience in Leadership and Quality Improvement

Concurrent Session 1

Session Materials

Brief Abstract

The presentation showcases a think tank project creating a virtual clinical learning experience (e-simulation) that will develop competencies needed to be successful and have a positive impact on healthcare outcomes.  The use of Wordpress and an unfolding case study created an accessible, affordable, replicable and effective virtual clinical learning experience.


Deborah Merriam DNS, RN, CNE is passionate about quality and excellence in nursing education. Her areas of interest in nursing research include the use of social media to enhance the community of learning, best practices in online teaching, and characteristics of quality and excellence in nursing education. Her professional achievements include poster, podium and publication/ presentations as well as a Faculty Service Award. She has experience in facilitating learning in both the traditional and online learning environment.
Master's in Nursing Education student with a desire to helping and teaching others.

Extended Abstract

The presentation showcases a think tank project creating a virtual clinical learning experience (e-simulation) focused on leadership and quality. There is a need for virtual clinical learning experiences such as e-simulation accessible to students 24/7 that will help them develop the competencies needed to be successful and have a positive impact on healthcare outcomes.  The use of Wordpress and an unfolding case study created an accessible, affordable, replicable and effective virtual clinical learning experience that will be of much interest to other nursing schools facing similar difficulties in finding clinical placements for their students.


Porter-O’Grady (2003) stated that it is the individual that caused change within the organization, and not the organization that created change for the individual.  The aging nursing leadership within the ever changing realm of health care, demonstrates a need to prepare an intergenerational workforce of nurse leaders who will fill the gap left as aging nurse leaders retire (AHA, 2014; Dyess, Sherman, Pratt, & Chiang-Hanisko, 2016).  An integral part of an RN to BS program is a six credit course focused on nursing leadership, NUR 417: Professional Practice II that currently requires students to observe a nurse leader for 15 hours and nurse focused on quality improvement (QI) for 7.5 hours. It is challenging to find adequate clinical sites for observations related to leadership and quality improvement (Kidd, Morgan, & Savery, 2012). Although there are many available virtual clinical learning experiences in other areas of nursing practice, there is a lack of virtual experiences or e-simulations focused on leadership and quality improvement to meet the need for clinical experiences.  Implementation of a virtual clinical learning experience will ensure that all students consistently participate in an engaging learning experience to help them strengthen leadership, system thinking and quality improvement competencies in order to have a positive impact on health care outcomes.

Baccalaureate prepared registered nurses (BSN’s) are being called upon to take more active leadership roles within healthcare systems at an increasing rate. With this rise in leadership roles and responsibilities within the workplace, there is an increased need for leadership content to be embedded within nursing education programs (Morrow, 2015). Prior to graduation, BSN students must understand how to participate within interdisciplinary teams in the capacity of a leadership role and manage the plan of care of patients and families in a collaborative and creative way (Pepin, Dubois, Girard, Tardif, & Ha et al., 2011). Students must now possess the ability to communicate within teams in an effective way, as well as reason on a moral and ethical level before they graduate (Holmes, 2011). Nursing students should be exposed to and have an understanding of various leadership models and theories which can be utilized within various healthcare settings and models. In order to achieve this understanding of leadership within the workplace, nursing students must be given the opportunity to actively participate in various leadership roles and organizational level experiences during their undergraduate programs to gain knowledge, ability, and the skills of leadership competencies (Pepin et al., 2011).

Registered nurses returning to school for their baccalaureate in nursing (BSN) bring experience and knowledge with a higher level of thinking. Although clinical expertise maybe present, system level thinking is lacking (Phillips et al., 2016), leaving educational opportunities to improve and develop leadership skills among this group. Evidence-based leadership and QI competencies were identified to guide the construction of the learning experiences. Health care organizations strive to improve quality and safety practices; however little headway has been noted (Clark, 2013). In spite of a multitude of safety campaigns, 400,00 deaths annually have been attributed to medical errors (Leapfrog Group, 2014). As noted by (Phillips et al., 2016[JF1] ) the Systems-Level Awareness Model cites levels of thinking that progress from basic nursing care to system level lead with specific competencies that nurses must achieve with specific objectives. These include, organizational awareness, communication, and levels of leadership skills. When nurses are able to recognize patterns at the system level, they are equipped to appreciate and comprehend how individual patient care directly impacts outcomes (Phillips et al., 2016).  There is a need for new teaching strategies that have been developed to assist with system level practices that are accessible, feasible and replicable and evidence-based. This virtual clinical learning experience is designed to evoke system level thinking among the nursing team using a multi-sensory interactive and engaging e-simulation. Several techniques within the learning domains are utilized to promote critical thinking techniques with problem solving measures reinforcing key course concepts.

 With the use of the Internet and Trailing Edge technology, e-simulation utilizing a virtual clinical learning approach is a feasible and accessible way to facilitate interactive and engaged learning as the evidence base grows on its effectiveness (Cant & Coopoer, 2014). However, creating and maintaining equipment and software for a simulation center can be costly.  This project uses a logical hierarchy setup on a WordPress CMS, utilizes open source media storage and can be done for virtually no or little cost, with the exception of resources and time. After collaboration with the Center for Excellence in Teaching and Learning, Wordpress was chosen as the housing structure for the unfolding case studies as it provides the structure and ability for students to progress through the scenario. Using Trailing Edge technology to deliver virtual clinical learning is of much interest to other healthcare educators seeking to foster virtual clinical learning at a very reasonable expenditure of time and money. Virtual learning allows students to be connected to educational experiences 24/7, allowing them to practice skills whenever and wherever they desire as their schedule allow. The virtual simulation in leadership will not only strengthen the student’s clinical judgment and their decision making skills, it will also further enlighten the student on leadership and how every role in nursing is a leadership role from the bedside nurse to the vice president of nursing.

Think Tank Project

This think tank project was a collaborative effort to create virtual clinical learning experiences.  Student researchers developed scripts for an unfolding, realistic health care scenario which were videotaped using student actors and edited to be suitable for mobile devices.  The unfolding experiences were constructed as interactive learning where participants view a brief video (3-5 minutes), have a task to research and then return to the unfolding case study to participate virtually using cascaded decision making and system thinking to apply related concepts and principles. An algorithm was developed by the team that delineated progression through the unfolding case study. Participants had the opportunity to respond to questions after viewing a scenario that leads to several outcomes. As the educational pages unfold, the participant’s organizational awareness is being taught, thus allowing for the registered nurse to direct changes necessary to improve patient outcomes.   An evaluation tool was also developed to assess the effectiveness of the scenarios.  It is anticipated that additional scenarios with increasing complexity will be added in the future.

Demonstration of Virtual Clinical Learning Experience

This presentation will describe the process of developing, implementing and evaluating the virtual clinical learning experience, as well as demonstrate the ease of navigation through the unfolding case study.  It is anticipated that this innovative think tank project will be of much interest to other nursing schools facing similar difficulties in finding clinical placements for their students.  The use of Wordpress, videotaping brief scenes in a format accessible to a mobile device and installed plugins to provide interactive learning provides an affordable and effective way to meet the gap of leadership virtual clinical learning experiences that other schools will be able to replicate.




American Hospital Association (AHA). (2014). Managing an Intergenerational Workforce: Strategies for Health Care Transformation. Retrieved from

Dyess, Sherman, Pratt, & Chiang-Hanisko. (2016). Growing nurse leaders: Their perspectives on nursing leadership and today’s practice environment. The Online Journal of Issues in Nursing, 21(1), 11 pp. Retrieved from

Cant, R., & Cooper, S. (2014). Simulation in the Internet age: The place of Web-based simulation in nursing education. An integrative review. Nurse Education Today, 34, 1435-1442. doi:10.1016/j.nedt.2014.08.001

Clark, C. (2013). Leapfrog hospital safety scores “depressing”. Healthleader Media

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Holmes, A.M. (2011). Transforming education. Nursing Management. 42(4), 34-38

Kidd, L., Morgan,  K., & Savery, J. (2012). Development of a mental health nursing stimulation: Challenges and solutions. Journal of Interactive Online Learning, (11)2, 80-87.

Leapfrog Group (2014). Hospital safety score reveals hospitals becoming safer, but danger to patients lurk ( Retrieved from:

Marrow, K.J. (2015). Leadership curricula in nursing education: A critical literature review and gap analysis. Journal of Nursing Education, 54(7), 367-371. doi: 10.3928/01484834-20150617-02.

Pepin, J., Dubois, S., Girard, F., Tardif, J., Ha, L. (2011). A cognitive model of clinical nursing leadership. Nurse Education Today, 31, 268-273. doi: 10.1016/j.nedt.2010.11.009

Phillips, J.,  Stalter, A., Dolansky, M., & Lopez, G.  (2016). Fostering future leadership in quality and   safety in health care systems  thinking : Journal of Professional Nursing, 32(1), 15-24. doi10.1016/j.profnurs.2015.06.003

Porter-O’Grady, T. (2003). A different age for leadership, part 1: New context, new content. Journal of Nursing Administration, 33(2), 105-155.