A Wise Nurse's Journey Through the Looking Glass...


How I found myself on the wrong side of the glass and my journey back to simulation 

by Amy Wise, RN

Like a lot of you, I stumbled into simulation. I began as an educator in a community college teaching skills, and as clinical instructor for LVN students. Minding my own business one day it just happened, I walked past a simulator and my world changed. I fell head over heels in love with a teaching modality that used all the parts of my nurse and geek! I was fortunate at the time to have a dean who was innovative and cutting edge.  That dean placed trust in another nurse and me to take the lead and develop a sim program that "would rival the universities that surround us."

I met my cohort 12 hours before we were to spend a week together in California, learning best practices from the California Simulation Alliance. By the end of that trip, we were hooked! We came back with a passion and a plan on how we were going to put our students first — giving them the tools and training to rival any program and the knowledge base to do it. At the time, I was an LVN with an Associates degree in Paramedicine, not exactly who you would expect in nursing education, but there I loved what I did. We split the ADN/LVN responsibilities, and in our first incarnation, I would be the LVN coordinator and take the technology role. She would coordinate the ADN and take the lead because well, she had the degrees to support it. This was the first time I hit what I call the "paper wall," where degrees outweigh accumulated knowledge and experience. I understand that my colleague was the better choice for this role, and I was happy with my simulators, technology, and LVN students. We worked well together, left brain and right brain, making fantastic learning experiences for students and faculty alike. 

We quickly learned we would need to have not just the buy-in of faculty in our division but our administration as well. We invited anyone and everyone we could to watch what we were doing, giving tours of our tiny room, presentations at in-service, whatever we could.  Showing that simulation may be expensive, but we have something at the time that wasn’t being offered or executed the way we were doing it. Being housed in the history and math building, we "commandeered" a few rooms over the summer.  We placed requests to have headwalls hung and cameras installed, hoping that they wouldn’t want to tear it all out come the fall semester and lose what ground we had made. We acquired a third person, someone who could balance us out and keep track of what we were doing for administration and grant purposes. This person was the organizer and driver we needed to remind us and help tech all of the sim we had. The three of us continued to grow out the little program from ADN and LVN; now, we were offering simulation in the classroom to support academics and EMS simulation to round us out! During this time we did more apologizing than asking, and it paid off. 

Once we hired a fourth, the sky was the limit. This person rounded out our team, bringing along a male nurse perspective and pediatric experience needed to broaden our simulation offerings. In the years we all spent together we were unstoppable. We designed and built a new simulation center, won international recognition for our Standardized Patient program and presented at numerous conferences spreading our love of simulation and teaching others how to use best practices to make the best possible learning experiences for students. 
During all of this time, I went to every conference I could, technology and education both, read every journal, gathering all knowledge available on the evidence-based delivery of simulation. I taught myself how to maintain the simulators and fix them when they stopped working as we had no funds for warranties or maintenance. I learned how to program the scenarios for evidenced-based purposes and how to make realistic moulage, helping the student suspend reality and become completely immersed in the experience of clinical simulation. There was still one thing I was lacking, the pieces of paper. I didn’t think it mattered so much, until everything started to crumble before us.

It started when the dean who had been so supportive of our program moved on to another role. The new dean didn’t have the enthusiasm and support for simulation and this quickly started to impact our program. We didn’t see the grant monies like before and the only time we were valued was when we were asked to put on a dog and pony show to woo donors. This lack of support trickled down through the department and one by one the team moved on to more supportive employers. It was at this time that I realized that perhaps those pieces of paper really were important.  

I spent a year after our director left running things and trying to keep it all together. I handled the budget, scheduling, ran sim, and everything there is to do on an operations side because frankly I knew it had to be done. I had a great team at the time, and we made it work with every roadblock that was placed before us. I had started my road to the degrees I needed, going to nursing school in the program in which I provided simulation. Probably not the best idea but you can’t beat free when it comes to nursing school.  

Then it was my time to go. With one semester left in nursing school and fall semester about to start, it was no longer possible for me to stay in the role. It was a tough few months having to be a student in a simulation program that I had loved working in, but I persevered knowing that it would be worth it once I had that piece of paper. I finished and passed the NCLEX and became a Registered Nurse. However, this wasn’t enough. See, in Academia, what is respected and honored is the "papers": BSN, MSN, NP, DNP, and understandably so. My plan was that an ADN would work until I could get the rest, continue in my LVN curriculum, with my EMS students and earn respect and get the degrees to move up, I hadn’t planned on going anywhere. All of a sudden I was on the outside of the glass looking in. I have the knowledge, experience, and even a fellowship under my belt, but without the BSN, MSN, or above, I can't get inside the glass any more. 

I started applying for simulation jobs at the end of the semester, naively thinking that my professional reputation and my Curriculum Vitae would speak for itself. It didn’t. Recruiters were very impressed with the writing on the page, found me very personable and knowledgeable, but there was always something missing. That's right, the damn degree. I made it close to getting back inside the glass a couple of times making it to some final interviews. But it would inevitably end up with that fateful call, "they/we loved you and thought you were great! Unfortunately, we had to go with another person who had the degree we were looking for", leaving me heartbroken all over again. 

I started my BSN as soon as I graduated and will finish this winter. Now I get "congrats on the BSN, call us when you have your Masters," but instead of it getting me down, I use it to fuel the fire to finish getting the degrees. I still read the journals, I always stay up on the technology, and I consult using my knowledge and expertise to make others' programs the best they can be and reminding them to put the students first. 

There are some supportive employers out there who will recognize passion and ability without the papers, but they are rare and hard to find. If simulation is where your career path is headed, work towards earning the degree(s) you need to protect yourself from changing circumstances and to open doors to promotions and other opportunities.