Recommended Citation
Janssen L, Resch L, Lauf N, Roalin C, Zidek S. Clinical Judgment at Full Gallop: The Power of Hospital-Based Simulation. Presentation at: ANPD (The Association for Nursing Professional Development); March 25, 2026; Louisville, KY.
Presentation Notes
Presentation at: ANPD (The Association for Nursing Professional Development); March 25, 2026; Louisville, KY.
Abstract
Inputs: Clinical judgement is one of the most heavily examined topics in nursing research. The pandemic added complexity, forcing academia to pivot from classroom to virtual delivery, canceling and restricting clinicals, replacing patient care with simulation, and transitioning to remote skills labs. This accommodating curriculum resulted in declining NCLEX pass rates, new graduate learning gaps, decreased confidence, and stifled clinical judgement. Academia and health care organizations are recovering, and clinical judgement remains a top priority for nursing students and graduates. Our hospital has a unique opportunity to inspect clinical judgment firsthand through a partnership with a local baccalaureate nursing program and dedicated simulation time. Our hospital-based simulation team, in collaboration with the college, designed evidence-based simulations geared to provoke clinical judgment. Certified simulation facilitators developed best practice scenarios and debriefing that focus on the process of thinking, decision making, and reflection. Traditional academic simulation is often task focused, checklist-based, and is performed under high-stakes testing environments. This partnership is crucial as it allows us to assess and spark clinical judgment in undergraduate nurses, better preparing them for safe patient care.
Throughputs: NPDS (Nursing Professional Development Specialists) and simulation specialists collaborated to develop the research protocol. The NPDS drove the study data collection, meeting closely with the preceptors of the new nurses. NPDs developed a training video for the preceptors and engaged the leaders to allow time for preceptors to review the training. Our IRB approved study compares clinical judgement scores from new graduates from both traditional, academic simulation and hospital-based simulation groups. We use the Lasater Clinical Judgement Rubric (LCJR,) based on Tanner’s clinical judgement model which assesses noticing, interpreting, responding, and reflecting. Historically used in undergraduate simulation assessments, the NPD team uniquely applies this tool in patient care with preceptors observing new nurses. Scores from 24 new graduate nurses were analyzed using a mixed-design repeated measures ANOVA, and we found that the hospital-based simulation group had higher mean scores at both baseline and at eight weeks compared to the control group. Interrater reliability (IRR) was assessed, and Cronbach’s alpha was 0.917, indicating strong internal consistency among preceptors. These findings support that hospital-based simulation enhances clinical judgement in new graduate nurses.
Outputs: Integrating simulation into new nurse transition can accelerate clinical judgement, shorten orientation, and reduce patient errors through sound decision making. Confident nurses in transition are linked to better judgement and retention, leading to cost savings for organizations. The team aims to partner with area nursing schools and use the LCJR as a handoff from academia to bedside to guide judgement progression. Although not standard practice with preceptors at the site, the LCJR could drive goals and provide feedback for new graduates, further strengthening judgement and competency. The NPD team added a post orientation survey for new graduates to reflect on their simulation exposure and its impact on clinical judgement. We are enrolling a third cohort and will report findings to leadership to create recommendations for new nurses, simulation use, and the LCJR.
Document Type
Oral/Podium Presentation