Episode 7: Deb Tauber, MSN, RN - Simulation in Nursing Education & Professional Development

Welcome to episode 7 of the Nursing Strategies for Success podcast with guest Deb Tauber. Deb has been a nurse with over 25 years of experience, and she happens to be a simulation expert. With simulation being at the forefront of nursing education and clinical professional development, Deb is here to share with us some strategies for success with implementing simulation in both the academic and the professional clinical spaces. So let's welcome Deb to the show. Welcome to the Nursing Strategies for Success podcast, brought to you by The Nurse Speak, a show where we rally some of our nation's greatest nurse leaders educators, experts, and advocates to tackle some of our greatest challenges that the nursing profession faces. My name is Damion Jenkins, and I'm your host for this show. So sit back, relax, and get ready to learn that nurses can do anything. Okay, thank you so much, Deb, for joining us on today's episode of the Nursing Strategies for Success podcast. Why don't you take a moment to introduce yourself to the listeners? Let them know a little bit about who you are, where you started in nursing, and where you are today.

Thank you, Damion Jenkins. Thank you so much for having me on this podcast. I'm really grateful to have this opportunity. And I'm just so excited to share my journey with you all.

Awesome. So excited to have you. Thank you.

Thanks. So my name is Deb Tauber, and I'm the founder of Innovative Sim Solutions, which is a company that focuses on using simulation to improve medical outcomes in healthcare. And I'll start out with my journey, which is kind of unique. I graduated from Loyola University in Chicago many, many years ago, and I worked at Loyola in the ICU in the telemetry unit for about 3 years, and then I was drawn to the emergency department. I got into emergency medicine in the early '80s. At the time, there were no trauma centers, so the patients would just go to the closest hospital. And in mid-'80s, like in 1985, there were studies in California that if you brought patients to the level trauma centers, the outcomes were better. So we started out as a level 3, then we went to level 2, and then ultimately a level 1. And during that time, I was the clinical educator for the department, so I had great opportunities to help people grow and develop. In the meantime, I had 4 kids. And because I had 4 kids, when a kid would come in, they'd say, "Taver, take this kid. You're good with kids." So naturally, I, you know, got really good with pediatrics and became kind of known for that. So I taught a lot of courses like ENPC, Emergency Nurse Pediatric course, and PALS, and courses like that. And we utilized simulation to some extent in those courses. However, I didn't really realize that we were utilizing it. So I went to, um, in about 1995, went to a different hospital. And then in the early 2000s, my position was eliminated. It was the financial crisis, so they eliminated my education position. So I went to, um, a nursing home, and I became the, uh, like the director of nursing for an assisted living nursing home.. And I did that for a couple years, and it gave me an incredible perspective on how end of life could be different between emergency medicine, where everyone thinks everything's going to be okay, right? And then helping people to make mindful decisions on end of life care. So after that, my daughter, who is now a nurse, was going to nursing school. And she said, Mom, you know, I'm in this nursing school and it feels different. And so I went and applied and got a position in the simulation department where I was introduced to simulation. And I found it absolutely fascinating to watch students learn because you would actually put them in the environment And then, you know, you would videotape them and they would see what they were doing. They'd talk about it and they would really learn. You could actually, I'd like to kind of say that we watched the lights go on because all of a sudden you see this thinking and you understand where it's coming from. And if you create a safe environment, they'll ask questions. And after I became, so after I was at the school for a couple years, they promoted me to the national manager. And I had an opportunity to open simulation centers up from sea to shining sea. So I went from California to Florida to Texas to Vegas to Atlanta, Georgia, Nevada, all different places, Chicago, Tinley Park, Addison. And I got to help with, you know, setting up the simulation centers and then training the faculty. Which was a difficult challenge because at the time some of the faculty would just say, well, this is the way we've always done it. And they didn't want to embrace simulation, which is such a fantastic opportunity for people to learn. Yeah. So I did a lot of that. And then, um, in 19— in 2017, I opened Innovative Sim Solutions, and a lot of my clients were presidents from the different colleges that I'd been to, and they would call me out to do training for their faculty. And then when the pandemic hit, I wasn't traveling as much. I actually have a client in Hawaii, um, so I wasn't traveling as much. So we kind of— we flip-flopped what the company was doing, and we did some courses in telehealth And, um, they're online courses for sale. So we have one on telehealth, like what it is, it's about the etiquette of it, and then, um, one for 4 hours of CE for a nurse if you want to start your own telehealth program. And then, uh, I started doing the similar ones that I was doing on the ground at the different campuses. I put into an online format So you can take the course for 4 hours of continuing ed, and it really walks you through what simulation is. And I think people get stuck. They really don't understand that it's a tech— now it's a technique, it's not a technology. They see the stimulators, they think, oh my gosh, this is, you know, this, this thing is going to break or whatever, and they get stuck. But the way that we present the material, it opens their eyes to what simulation is.

Awesome. So that brings up a lot of questions, especially with what you mentioned about the pandemic and the challenges that that has posed and how your company has shifted from helping institutions open up their own sim labs because they're not doing in-person classes and they had to switch to online environments. And so you switched to do some telehealth. Development. Um, so that's already identifying a problem that needed to be met, but I want to back up a little bit and talk about where it was along the way that you identified that simulation was the next thing for nursing education to really improve those outcomes with meeting the learning objectives of the programs in addition to preparing safe and effective nurses. And you mentioned briefly, and I was going to interrupt you, but I wanted you to finish, that the nurses said, well, this is the way we've always done it. So they were a little hesitant to embrace simulation because it wasn't something they did before. Well, I'm not sure how long it's been since you've been out of the classroom, but I have recent experience with nurses still saying the same thing.

I'm shocked.

That has not changed. It has not changed. They still say, well, this is the way it's always been done. Even when I had innovative ways to try to improve critical thinking thinking in our nursing students and try to redevelop the curriculum to incorporate more critical thinking strategies and met with resistance because again, no one likes change and no one really wants to work harder than we have to. And I get that, but we can't keep doing the same thing and expect different outcomes, right?

Oh, exactly.

So, so let's talk about where it was for you where the light bulb went off and said simulation is where it's at, and that way you invested, you know, creating a business to focus around simulation?

Thanks, Damion Jenkins. That's a great question. So I can tell you that when I first started it at the college I was at, they gave me a box and it was a pediatric box, and I had very resistant faculty. And I opened the box and they said, you're good with kids. And I said, well, this isn't a real kid, this is a a simulator. So I put together the simulation. So I was one of the, the pioneers at this organization to start using simulation. So I did the simulation and the faculty was very resistant and we did it several times. The learners loved it. A lot of people were in the sim lab, loved it. And one day after we'd been doing it about 3 or 4 months, the faculty member who was very resistant came running down the hall saying, I thank you so much, my scores have gone up, and I really attribute that to the simulations that you've been doing on asthma and fluid and electrolyte imbalances. Nice. Because the concepts came together. Now, when you ask me the question about what did I see, I remember when I was in the emergency department and someone would be struggling, right? Someone would be struggling, they wouldn't be It wouldn't be understanding their role. And if I would have used simulation to train them or to actually make hiring decisions, like put them in a sim prior to— if you got 5 candidates, who has the ability to prioritize, to delegate, to respond quickly? You know, you can have different, you know, who can communicate well, who is going to use empathy and and compassion in dealing with the patient. All these, these, you know, people now, they're so— students now are so eager to, you know, just text something. I'm going to put your Foley in. You have to go into a patient's room and you have to communicate with them and help them to feel that they're cared about. And recognizing that it's not what's the matter with you, it's what matters to you as a person and utilizing patient-centered care. So I think I recognized that simulation was a way to incorporate the 6 CUSN competencies into nursing education and really help the learners focus on how important those aspects of clinical care are. Does that answer the question pretty well?

Oh my God, so, so, so well. And I hope everyone listening is getting this. I'm seeing, you know, the educator and the entrepreneur within me is seeing so much potential for organizations to adopt simulation as part of the hiring screening process, which I know for a fact many institutions, if not most institutions, don't do that. They don't embrace simulation as a tool for determining candidacy for positions. And I can see how this would really level up the game. So anyone out there who's trying to figure out, How can we hire people that are more competent to meet the needs of our patient population? I think this is a great opportunity for you to embrace simulation as part of the hiring process and have all of the candidates go through some form of simulation. Because truly, you never know what you get unless you put them to the test, right?

And, you know, hiring decisions are so challenging too. And when you get someone who you hire within your organization and they end up not being a good fit, it's hard for both. It's hard as the employer to say you're not a good fit for this position, and it's hard for the employee because it feels like a rejection, like I'm not good enough. I didn't, you know, it's, you know, a form of shame and embarrassment. So one of the other things I'm truly blessed to have the opportunity is, is I serve for the Society for for Simulation in Healthcare, which is my kind of charitable, that's what I do my time in. And I do a lot of, excuse me, cough here. I do a lot of accreditation. I serve as the chair of the risk management subcommittee. And we have actually had so much more, so many more centers going for accreditation in this past May than we've had in any of the years in the past. So people are, embracing simulation, recognizing its value, and wanting to be accredited for simulation.

Wow, that's great. So are these organizations academic in nature or are they clinical in nature?

Both. They're both.

That's great. That's really good to know.

There's schools, there's medical schools, there are hospitals, and they're doing their in situ, which if you're interested in learning about simulation, you can go to the website and under the tools section, there's resources and there's speakers that talk. And there are also Um, they're also embedded into the courses.

Very good. Awesome. Yeah, so yeah, we'll definitely include your website and a lot of the resources and how people can connect with you in the show notes of the course— I mean, of this podcast— so that people can access the courses if they're interested and check you out. Um, but I wanted to, you know, just kind of piggyback on what you were saying about the academic and clinical settings now embracing simulation. Most of my nursing career is in the Baltimore, Maryland area, and I know some hospital groups are better than others when it comes to embracing simulation in the clinical setting and investing in the technology, the space, the educators to run all of that, and some aren't as good. I can say that there's still such a huge need for simulation as part of onboarding, as part of annual competencies, and I think it should be included in the hiring process as well. I know as an agency nurse and traveling and doing contract work across the nation, some places required that I did competency exams or skills before they would approve my contract. Whereas full-time employment where I was becoming part of an institution, they didn't. And so I found that really interesting, that for agency nurses they wanted to, to prove that they were competent, but for regular staff they didn't need to. So, you know, again, the entrepreneur in me thinks that that's a waste of money. If you're gonna do it for one nurse, you should do it for all nurses. And so, you know, I really think this is a great opportunity for institutions and the clinical side to embrace simulation as a part of, again, that hiring panel channel, kind of just putting your candidates to the test to make sure that they are well equipped for the setting that you're considering hiring them for. Um, because not everyone is equal in their skill set or their ability, and certain areas like emergency medicine requires a different skill set than, say, med-surg or maternal newborn, right? So they're all different paces, they're different personalities, there are different thresholds for how much stress someone can handle. So it really does— there's different personalities for the different roles, and I think we should focus on strengths-based assignments. And so put people where they're gonna shine and, you know, take people out of areas where they're not gonna do well. So I think simulation could be an awesome opportunity for that. Great. So let's segue here into, you know, the next phase So you identified how important simulation was. You know you had met some resistance when you were trying to really move forward with simulation. You got some validation from some faculty that simulation was working, and obviously you have over 25 years of experience. So we know we have validation for experience. So let's— for simulation and why it works. And I think most people, especially nursing students now and faculty working And education now knows simulation is important. So let's talk about what's next. What's coming? What's going to be expected? You kind of foreshadowed a little bit regarding telehealth or vSim, right? Especially in situations like the pandemic. So let's talk a little bit about what people can expect with the future of simulation.

No, I think you've kind of nailed it there. So I've actually recently contracted with a guy by the name of Lance Bailey. He is the founder of Healthy Simulation. And so he does a lot of webinars and stuff on virtual reality and augmented reality, which is, you know, really kind of finding its place in healthcare now.

Right.

Um, the courses actually talk a little bit about those. They don't go into it too deeply, but, um, you know, for 4 hours of continuing ed, you can, you can cover a lot of ground and it really has helped people learn about the things that are coming down the path. And so yesterday, just yesterday, um, my husband had a sore throat. And so I took the camera, took a picture of a sore throat, sent it to my neighbor, the doctor, you know, no, don't take him in for this, right? So we're doing telehealth, we're using it. And, you know, the pandemic has created a great segue for people to not have to go into the, you know, into the hospital or into clinics all the time for their aches and pains. And I hope— I'm hoping that we can see a lot more with, you know, mental health and therapy, uh, having not having to leave, but being able to remotely get counseling. I think it's a great opportunity.

Yeah.

Because the pandemic has just led— all of our lives are just being flooded with anxiety.

Mm-hmm. Yeah, so telehealth is definitely something that I thought about 20 years ago when I would have to go to the doctor for something so simple, like you know, a cough or, you know, an abscess on my leg. And I've always thought to myself, why can't I just take a picture of it and send it to my doctor? Do they have to really poke at it? You know, do they really have to put their stethoscope on my chest? Like, I don't— you know, and I understand a lot of it is liability. If you didn't check, you know, then you could be missing something. But really, for certain things, a lot of our decisions are made based on clinical judgment. And so if a physician or a nurse practitioner or even a nurse is thinking, hmm, I really can't make a determination via telehealth, then sure, they have all the right to say, we need you to come in. And I think that's fair. But I've always wondered why we didn't tap into telehealth sooner. But now the pandemic forced us to. And also schools, I know, had to invest on a turn point, like real fast, they had to go ahead and buy vSim packages that they weren't ready to purchase. And so, you know, a lot of companies, I'm sure, sunk a lot of time and money into creating vSim so that their students could get that patient care experience and use the critical thinking and things like that. And so is that something that your company is looking to do, or are you doing that? Are you developing vSim type software?

I worked with— I've worked with the different companies, little bits and pieces, and I talk about the different platforms in the courses.

Right.

I think though, once again, the faculty have really struggled with— some of them, not all of them, some of them, the early adopters, they do, and they struggle with the technology. So I think that— and I understand, it's my understanding that the NCLEX scores are are, uh, have been lower more recently.

The pandemic, again, because people have lost a lot of opportunity to connect the dots, they've missed clinical time, they've missed lab time, they've gone from in-person instruction to online instruction. So really they lost a lot of opportunity to develop those critical thinking skills. And so, you know, all across the board, NCLEX scores did drop, um, and we anticipated that to happen. And even still Now with the Delta variant, schools are going back, they're backtracking again to figure out how are this— how are the students going to get the clinical experiences that they need so then they can successfully pass the NCLEX and be safe to enter into practice. So it's a— yeah, it's a challenge.

The course, um, the course that I designed that we just put up on sale for, for Healthy Simulation is actually a clinical simulation for instructors, and it really talks to how do you parlay pre-conference, clinical, post-conference, pre-briefing, simulation, debriefing. And what do you do if you get to your clinical site and the Joint Commission's there and they say you can't do anything? What do you have to help your learners? And there's many things that you can do with them. You just need to think outside the box. And for some people, it's more difficult to do. I've always been a big fan of, you know, Nothing changes until something changes. And when everyone thinks alike, no one thinks a lot. So I like, you know, I'm creative and I like to be on that front line of doing things differently. So, but the course actually has a lot of, you know, things that you can kind of pull out of your back pocket to do in place, in lieu of clinical, if the event occurs that you can't be there. And honestly, there's so much litigious situations right now that are, you know, keeping the learners, even if they are in the clinical environment, from being able to have those hands-on experiences of, you know, putting Foley's in or starting IVs or giving medications. So in the simulated environment, they have the opportunities. And many of you know, as educators, you— if your students are in a big hospital and there's 8 or 8 of them and there's only one of you, they can hide, and you might not see them the whole 12 hours. In simulation, that is absolutely not true. So you have the opportunity to see your learners and then to kind of understand what they're thinking, why they're thinking.

Yeah, I mean, I think that's really important to point out. Um, with many years of clinical experience myself as an instructor bringing students into the healthcare setting, you know, every instructor is different, even every professor is different, and what they may focus on is what's important, or maybe even their teaching style. And sometimes it can be challenging for us to create learning opportunities when we're being told no, right? When a nurse doesn't want to have a student, or a patient refuses to have students, or maybe the Joint Commission comes in and says, you know, they start asking students questions and then the, you know, facility administration is like, you gotta go, you gotta get out of here., or instances like COVID, 'cause we had students at the facility I was working at when COVID first hit, and we had to make the tough decision to pull all of the students out, and I had to send that lovely email to everyone saying, "Sorry, but your students can't return. We're suspending clinical rotations." And of course, the instructors are left with, "Well, what are we gonna do to fill in the gaps?" And so I think having these resources for the nurse educators is very important because it does give opportunity for us to seize the moment and still create these learning opportunities for our students so that they get what they need so they can be successful. 'Cause that's really our job as educators is to create strategies for success so that whomever we're helping, whether they're at the student level or the professional level, they're getting their learning objectives met and they're developing the tools and skills and attributes attributes that they need to be successful. So I think that's really important. So I, I really love that you've invested into simulation. I do believe it is the future of education. I see one day us not really needing to go into class. Um, we can really learn through electronic means. We can still have people facilitating the learning on the other end of the screen. The hands-on clinical care I think that's always gonna be an important component of healthcare professional development. But yeah, vSim or even simulation with mechanical devices, you know, sim individual people, right? These kinds of things are still helpful 'cause it gets that tactile learning down pat, helps with that muscle memory, helps with the problem solving in a safe environment where if you make an error, you're not hurting anyone. It's just a simulation mannequin, right? So I think this is all really great. Deb, thank you so much for sharing these strategies with us, letting us know that you've identified this as such an important role. So, you know, just off the top of your head, do you see any like big breakthroughs with simulation in the near future that educators should be looking out for?

Susie, AI and carding, they're repeating the NCSBN study. So there's a lot of opportunities for organizations to get involved with the study and see where the future— because there was recently a literature review done by Dr. Kim Layton, was led by her, and they found that there's not a lot out there to say that clinical is providing the outcomes that we should have. So they're repeating the study. Dr. Egansuzie does a little video on my website, and she also is in one of the courses. So, um, you know, I think that the pandemic has created a great opportunity for us to look at what we're doing. Does it make sense to continue it this way, or is it now time to change? And sometimes we just have to break it, right, and then put it back together.

That's so interesting. And I actually, again, as an instructor bringing students into the clinical setting, always question the true value of having so many hours done in the clinical setting, considering that majority of those hours are so restricted. And it's because the healthcare institution is placing restrictions on what students can do, the school is placing restrictions on what the students can do, the assignments have to be very structured so you can maintain organization and so that the instructor can oversee what's happening with a 8 students. And so in an entire, you know, 8 or 12 hour day, you may have had 2 students or 3 students give meds, maybe 2 or 3 students do some assessments. You're not really covering a tremendous amount of ground in that time. And I always was wondering about whether that was— whether it was as necessary to have them in clinical for that much time when we're only focusing on such little things. So I always thought 2 hours of high-focused or high-intention clinical training would be better. And then we can spend time developing case studies, doing the critical thinking analysis, talking about what could have been done differently, things like that, where the learning, I believe, truly happens.

So, and you know what's fascinating, Damion, is they did the NCSBN study. I think it was released in 2014, and they said 50% of simulation is as if 25 to 50% of simulation is as effective as clinical. Now, the different states adopted and adapted for this. So for example, the state of Illinois said you could only do 25% of your clinical in simulation.

Mm-hmm.

And 1 hour of simulation counts for 1 hour of clinical. However, in the next door neighbor state, Wisconsin, they say you can do 50% of your clinical in simulation and 1 hour of simulation equals 2 hours of clinical. So yeah, if you're a compact state, you know, you— hey man, do your stuff in Wisconsin because you're not gonna have to do as much clinical.

Yeah, right. Yeah. And so, you know, and this can be a whole nother podcast topic, and I hope I get someone who wants to talk about this, um, but the fact that the states are so different.

Yes.

Um, but nursing same across the board. And so this really kind of stems into how nursing as a collective needs to be governed by nursing and not by business people and not by legislators. It needs to be run by nursing. And so hopefully in the, in the near future we'll get there. And that's a whole nother topic that we can talk about later. I do know, in fact, that I'm going to be interviewing Leanne Meyer, who is talking about bringing nursing to the forefront, having us become our own autonomous profession outside of being paid by large institutions. And so I'm sure she has lots of great ideas about that. So I'm looking forward to that. So thank you so much, Deb. Where can the listeners find you and access any of the resources that you may have if they're interested in learning more?

Thank you so much, Damion Jenkins, for this opportunity. It's— I'm just humbled and honored to have the opportunity to talk to everyone. And please, please, please reach out to me if you have questions, because I wouldn't want you to have to go through all the things that I went through to get where I'm at. I mean, I got pretty beat up trying to push simulation to people who didn't want to have anything to do with it. So you could reach out to me directly at deb@innovativesimsolutions.com. And the website is innovativesimsolutions.com. And once again, we're partnered up with Lance Bailey and HealthySim, and you can see some of the courses are on sale on my website, and then HealthySim has some too.

Awesome.

And then once— always more than helpful, you know, more than willing to help somebody get started or get through with, you know, a tough question or how do I do this, and I'll be more than glad to help you.

Awesome. Thank you for that. So anyone who's listening, if you're interested in learning more about simulation, adopting simulation, learning more about how you can optimize learning experiences for your students or your staff, because I really think this is an opportunity for clinical settings outside of academia to embrace simulation as part of the onboarding process and ongoing professional development, I highly, highly recommend I recommend that you do that. What other platforms are you on, Deb? Are you on Facebook or Instagram or Twitter or any of those?

I'm on Facebook, Twitter, and Instagram. I'm not— I'm mostly on— more of my stuff is on LinkedIn. I put a lot of stuff on LinkedIn, and I've been— we're kind of working towards that this quarter to try and get things out there. In fact, we're working on a little constant contact to put out this week.

Okay, awesome. So on LinkedIn, it's just your name, right? Yeah, and then for Facebook, how do they find you? What's your, um, name on Facebook? Is it the same or is it under your company's name?

Uh, under the company Innovative Sim Solutions.

Okay, and what about Instagram?

Innovative Sim Solutions.

Twitter?

Innovative Sim Solutions.

Perfect.

So, and I have, like I said, I do a lot of posts. I have a big following on LinkedIn, but my— the company doesn't, and we're working on that.

No problem. So social media is hard to manage. It really is a whole nother side job, something that if you don't have the capacity, you should definitely send out someone else to take care of for you. But you know, you and I can offline about that if you need to. But hopefully we'll talk about that as well, because that's another big hot topic that everyone should embrace, because it really helps spread the message. So awesome, Deb. Thank you so much for being on the show with us today. I hope, um, that you enjoyed this conversation, and I look forward to collaborating with you in the future, um, when we get a chance to meet up. So thanks again for being on the show. I appreciate you.

Thank you, my pleasure. Thank you, thank you.

Take care.

Bye.

And that concludes episode 7 of the Nursing Strategies for Success Podcast with guest Deb Tauber. We hope that you've enjoyed all of the strategies that we've shared with you today. You can find all of Deb's contact information, website, and social links in the show notes of this podcast. And as always, if you have any questions for me, feel free to go over to thenursespeak.com/contact and get in touch with me today. I would love to have a conversation with you. So until next episode, take care, be well, and remember that nurses can do anything.