Effectiveness of a 2:1 immersive simulation instruction model and traditional clinical experiences for baccalaureate nursing students

Background Clinical experiences are vital in nursing education, providing a crucial link between theory and practical application. Immersive simulation, in which each scenario is structured with well-defined objectives per best practices, has been shown to be an effective teaching strategy and can improve student outcomes. Purpose This quasi-experimental comparative design study examined differences in standardized testing outcomes before and after implementation of a 2:1 immersive simulation to clinical experience model within the university's traditional BSN and hybrid accelerated BSN programs. The results indicated statistically significant differences in HESI RN Exit Exam scores and NCLEX-RN pass rates following implementation of the 2:1 immersive simulation:clinical experience model, as well as statistically significant differences between institutional NCLEX-RN outcomes and national benchmark data in most years. Methods A quasi-experimental comparative design was used to examine the differences in dependent variables (Health Education Systems, Inc [HESI] RN Exit Exam scores and NCLEX-RN pass rates) between students who participated in the program either before (2013 to 2017) or after (2018 to 2023) implementation of a 2:1 immersive simulation ratio. Scores were also compared between the institutional and national averages. Results The difference in HESI RN Exit Exam scores before and after implementation of the 2:1 immersive simulation model was statistically significant ( t 4167 = 25.56, p < 0.0001). Differences between the institutional and national NCLEX-RN pass rates were statistically significant for all years except 2018, when the immersive simulation ratio model was implemented. Specifically, in 2015, 2016, and 2017, the national average pass rate was significantly higher. In all other years, the institution's pass rate was significantly higher. Conclusion Traditional clinical experiences in combination with a well-structured immersive simulation program at a 2:1 hour ratio was associated with improved student outcomes when comparing HESI RN Exit Exam scores and NCLEX-RN pass rates. The 2:1 model was also associated with higher NCLEX-RN pass rates compared with national averages.