The Growing Importance of Simulation in Nursing Education: Dr. Pamela Jeffries, Dean of Vanderbilt University School of Nursing

Maria Pfrommer

Hi, I'm Maria Pfrommer, director of Nursing Education here at Osmosis from Elsevier. welcoming you to Raise the Line, an ongoing exploration about how to improve health and healthcare. 

I'm pleased to help raise the line today by introducing you to Dr. Pamela Jeffries, the dean and Valere Potter Professor at Vanderbilt University School of Nursing. Dr. Jeffries is internationally known as one of the pioneers using simulation and high fidelity simulation models to prepare healthcare students for clinical practice. Dr. Jeffries is also known for her work integrating educational technologies, and improving the online learning landscape in nursing education. 

Dr. Jeffries was formerly the dean of George Washington University School of Nursing, the inaugural vice president of Digital Initiatives at Johns Hopkins University, and the associate dean for Academic Affairs at Johns Hopkins University School of Nursing. Among her many other credentials, she's a fellow of the American Academy of Nursing and a member of the Institute of Medicine’s Global Interprofessional Educational Forum. 

I would like to thank you so much for joining us, Dr. Jeffries.

Dr. Pamela Jeffries

Thank you.

Maria

I've been following your career as an educator since the early days of simulation. You have just a fascinating career trajectory. I'd like to start by learning more about you and what you first got you interested in healthcare and particularly nursing.

Dr. Jeffries

Well, thanks for the question. So that goes back decades. As with any young high school student, you've got to make a career choice. Do you go to college? Do you not? Of course, I wanted to excel and go to college and get on a career path, but I was uncertain what to do.

But fortunately, I'm more service oriented. I wanted to be around people. I became interested in the hospital environment because my best friend’s father was in the hospital a lot and I'd go to the hospital with her to see her father. I was always intrigued by the busy hospital environment, the nurses, the care of patients, the compassionate care, and that led me into nursing.

Maria

Very interesting. I saw in your early clinical experience you were in critical care. What drew you to that unit and that type of work?

Dr. Jeffries 

I'm from a small community in central Indiana and I went to Ball State University for my undergrad. I came back home because I had a small scholarship, but I had to work in my community and I chose a regional hospital. At the time I was on a medical-surgical floor and I remember my first position, they gave me forty-two patients and put me in charge of a whole unit. But I grew to love the unit. I had some great support from that regional hospital, but I ended up moving to critical care because I love the fast pace. 

In critical care within the central Indiana area, we had a lot of heart patients. It's an agricultural area, a lot of farmers, a lot of industry type workers. But I grew to love the cardiovascular. It's more on the medical side. And then I went on from the regional hospital in central Indiana to Indianapolis, at the time it was Methodist Hospital, now it's IU Health. Then I got to take care of the advanced care of those patients that had cardiac catheters and all of that and I still love my cardiovascular patients.

I pivoted when I went to the academic career. I was full-time on the practice side and then went full-time academic and PRN on the practice, but never forgot about the cardiovascular patients, the families and the community.

Maria 

Interesting. What got you into academia?

Dr. Jeffries 

So that was interesting. It was unexpected. I did not have my full trajectory in my mind when I started to be a nurse. I was working on my master's in Indianapolis at Indiana University School of Nursing, and working in critical care at Methodist Hospital, and there was a part-time cardiovascular position that came open to teach cardiovascular in a med-surg course. It was going to be part time. I thought, well, you know, I'll dip my toe in the water. I'll see what that's like. But anyway, the part time ended up being a full time position, which I interviewed for and I got the job. So, I made the shift, and went into the academic area full time and just still work PRN. 

Once I got in the academic environment, I just loved it. I loved impacting the next generation of students...really helping them to formulate what our profession was like, setting them on the right stage. I felt just a great contribution to our profession in preparing those students. I ended up teaching across all programs, whether it was pre-licensure, master's, PhD. I just love the environment, the enthusiasm, the generation of new knowledge and discovery of new knowledge through our doctoral programs and I never turned back. I still love the academic environment .

Then, by 2009, I became more of a formal leader, I guess, at IU. I became an associate dean for undergraduate programs which started my leadership journey.

Maria

That's awesome, and here you are now at Vanderbilt. Can you give us an overview of that nursing program and what's innovative now at Vanderbilt?

Dr. Jeffries 

I’m really proud to be at Vanderbilt School of Nursing and leading the charge as dean here. I'm starting my fourth year. I was recruited here. Once Dean Linda Norman retired, they were on a search. I was in the Virginia, Washington, DC area but I always heard about Vanderbilt and the elite school it is and, you know, the high rankings and the wonderful programs, faculty and staff they have. Coming here to Vanderbilt has exceeded my expectations. The support and services we provide our students each and every day, our faculty are rock stars and staff...I feel we just have such a wonderful team.

The strengths at Vanderbilt, if you look at the School of Nursing, we have fourteen specialties in the nurse practitioner program, so we create that expert education for nurse practitioners. If you look at our US News & World Report Rankings, we're number four in the MSN programs. When I came in, we were eight, and we went to six, and now number four. In addition, our specialties, we're number one in midwifery, we're either ranked one, two, or three in psych and in pediatric community care. FMP is high. So we rank high. But that's a testament and demonstration of our excellent faculty and excellent education that's given. 

In addition, we have a strong research program and we’re growing that. Vanderbilt ranks 10th in NIH funding and every year we have been exceeding our research goals. So, I love the propelling forward and creating research scientists. And now, we are getting ready to create a nurse anesthesia pathway for our DNP. 

Maria

Exciting. 

Dr. Jeffries

It is exciting because within five years, 30 to 35 % of the CRNAs will be retiring so we need to give back to our community and produce that workforce. And we are working closely with Vanderbilt Medical Center. They need CRNAs so we are doing that and just hired our new director. 

So, there’s lots going on at Vanderbilt, whether it's in innovation, creativity, our programs. And one last thing, we've created a professional development arm and are doing micro learnings and micro credentialing. We're a Continuing Education provider now, and growing our intellectual capacity to expand in professional development.

Maria

Wow, that is excellent. Such great programs there. I remember meeting Dr. Norman at one of the conferences. I guess I was just finishing up my DNP. I got my DNP at Duke and my PhD online and she was interested in interviewing me for a faculty position. She was thinking about a dual doctorate program at the time. How about simulation? Obviously, I mean, with you being the pioneer in simulation, I have to ask how are you using simulation at Vanderbilt?

Dr. Jeffries

Thank you for asking. We have a wonderful simulation center led by Dr. Jo Ellen Holt, our simulation director. And we have a team of simulationists and SimOps and all that. Our faculty have really embraced simulations here at Vanderbilt. In fact, our MN master's entry, they're incorporating quite a bit of simulations into the curriculum, which of course I am fond of. I believe in that experiential learning and creating a safe, non-threatening space where our students can practice even before they go out in real practice. 

We’re also looking at innovations. We've created a space that’s got a mind lab, so we're using a lot of virtual reality and we've got holograms. That's kind of the wave of the future, using those ocular lenses, the VR, the immersion experiences. So we’re continually working on that in addition to virtual simulations where you can do just in time, anyplace. Even with our hybrid students, sometimes they can learn at their kitchen table versus coming in, and they do come for immersive experiences here in Nashville. 

The simulation is here to stay now that we've moved to competency-based education and outcomes. I feel simulation is one of the mechanisms that's gonna help faculty to see our students demonstrate those competencies needed across domains. But simulations are great. We continue to add more and more. In fact, just like everybody else, our space is tight and we're looking at alternative times and more space needed to continue to integrate our simulations, not just in the MN, but across our NP specialties as well.

Maria

I was just thinking that with the CRNA program and even in the NP program -- I've been directing nurse practitioner programs for a while now -- and we have the skill sets that we need, especially the acute care certified, and now, like you're saying with the CRNA...can you imagine intubating someone for the first time without having simulation? I think you were responsible for a lot of that implementation back in the day when it was all about educating the educator on the value of simulation. 

In that same kind of line, long before COVID, I can remember you talking about online learning. What role do you feel online learning is playing today in nursing education? And do you think the teaching and the learning experience is better than it used to be?

Dr. Jeffries

I've always been an advocate for online learning because it provides educational mobility for many. Some people can't just uproot and go to a university or propel their educational career forward. There were not a lot of positive things with COVID, but one thing it did do was propel online virtual learning forward because you had to. Even with telehealth on the healthcare side, you know, we just had to do what we needed to do to progress our students. 

Luckily, I was at George Washington University at the time, and we had a pretty substantial online program and had everything together. But the programs that didn't, they had to really move quickly to move that. I think online learning is so important for nursing education because if you look at our students, even when they're full-time students, they're still working part-time, sometimes full-time, and going to school part-time because they have families, they're breadwinners, whatever that may be. So they're doing what they can to get their education or to advance their career with a master's, DNP, or PhD. Online learning provides that flexibility and adaptability.

I've taught many online courses, developed online courses, and a lot of times with our nursing population, you'll see a lot of the educational activity at nighttime when the children are in bed or on the weekends when they have the time. But that's okay. You do what you can when you can to get your degree and to advance your career. Online learning is here to stay. I think we've advanced the best practices. There are high quality benchmarks, so when you adhere to those, you're doing a good job in providing that excellent education via online learning.

Maria

Well, thank you for all you've done between the online learning and the simulation and all of the knowledge you have shared with the nursing education community and bringing that forward. I think there's a lot of people that really couldn't even accomplish an education without having those two modalities. 

I'm interested to see -- because you're always cutting edge with the new pedagogies -- is there something on your radar that you see developing that you think could impact nursing education in the future?

Dr. Jeffries

AI is definitely a game changer with the new pedagogies. It's not only game changing now, but in the future, and we don't even know what that looks like because the technology is advancing quicker than we can even embrace and get a handle on. Our students and faculty are using AI. But how are we going to use it best? In the world of education, you can look at practice tests, you can develop outlines for lectures, you can do so many things. Students are creating practice tests using AI. You can use AI to create simulation scenarios.

The caveat is, there's still potential error in some of those AI development pieces. So you’ve got to make sure you peer review, you look for accuracy before you put it out there. But it's certainly more efficient time wise. When using AI, things can go quicker. 

I know here at Vanderbilt we have embraced AI. In fact, I think there's a vice chancellor for AI now at the university level. We're creating an AI council here at the School of Nursing because, you know, it's almost getting ahead of us because not only is there the use and the operations of AI, but what are those ethical considerations that we need to look at? Those are changing almost every day, but we have to stay up on it. 

Vanderbilt has created their own AI tool internally, called Amplify. We can put documents in it and you know it's safer to use. It's not in the worldwide cloud somewhere, but within our own Vanderbilt environment. Not that we're putting confidential information in it or anything, but we've got our own portal for that, and the use of it is going to continue to grow. What that looks like, who is to know? I feel we're already behind in it. The technologies are ahead of us.

Maria
That's very interesting. Yeah, same here with the publishing world. I

So, I work with a team that creates Osmosis videos and we love to fill in knowledge gaps. Is there a topic you think Osmosis should make a video about to fill a gap that is particularly of interest or concern to you?

Dr. Jeffries

Well, just what we talked about. If you're going to do a video, covering the uses of AI in nursing education would be important covering helping with my lectures, helping with clinical education or using Ai in simulations and maybe even finding clinical spots. I mean, there's so many opportunities to use AI. But then you move it to the student side. How are we going to advocate for students using AI? Where should we foster the use of AI with our students because it's here, it's going to be used. 

I use the analogy that back in the day, we used to do medication dose calculations and we didn't want students to use calculators because we had to make sure they knew the math. And of course now, you know, everybody uses calculators. You run more risk to use hand formulas versus the calculator. So we have to pivot. We have to be relevant in our practices and what we're doing. 

AI is being used all over. I've got a ChatGPT app on my phone. I can ask questions, or do whatever. But if you're going to do a video, I think you should cover those types of technologies because the advanced technologies are coming quicker than we can really probably spell them and use them and know how to do it.

Maria

Thank you so much. I really appreciate your insights. We have many students and early career health professionals in our audience. What's your advice to them about meeting the challenges of this moment and approaching their career in healthcare?

Dr. Jeffries

First of all, I would tell students who have a career or are approaching a career in healthcare, congratulations. What a great choice they've made. Whatever that is...I happen to represent nursing, but if it's medicine, it's physician assistant, it's social work, it's whatever that is, congratulations. It's such a rewarding, valuable career.

I'll speak for nursing. We're the largest workforce, over four million people. We're with our patients 24/7. But I can't describe anything probably more valuable than caring for patients and promoting health and getting the patients and their families and the communities back on par, because nothing's more valuable than your health, right?

Also, I would tell the health profession students to enjoy the journey. It is hard. If it wasn't hard, everybody would be doing it. But it's a rewarding career. It's very service-oriented in helping others. And it is a hard journey, but just embrace every step. If there’s something you don't understand, you need to see your faculty. You need to see your person who's overseeing the orientation on the clinical unit, whatever that may be.

Nobody wants to be mediocre. You want to be at the top of your game, whether it's being a great physician, great nurse, great nurse practitioner, whatever. But enjoy the journey and it's very rewarding.

Maria
Well, thank you for that and thank you for helping us lead the way with your leadership. Thank you very much, Dr. Jeffries, for being with us today. 

Dr. Jeffries
Thank you for having me.

Maria
I'm Maria Pfrommer. Thank you for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.