Simulation-Based Education for Registered Nurses Transitioning into Adult Intensive Care Unit Practice: A Scoping Review

Transitioning into ICU practice can often be challenging for nurses new to the ICU. There must be a rapid development of competence in highly technical care, including but not limited to advanced hemodynamic monitoring, invasive mechanical ventilation, continuous renal replacement therapy, sedation and management of analgesia and multiple intravenous medications. In addition, RNs need to manage time-critical clinical deterioration, and coordination of complex interprofessional work in an environment where errors can have immediate adverse patient consequences. Although SBE is widely used to support nurses transitioning into ICU practice, evidence remains mixed regarding its effectiveness, particularly in relation to clinical skill outcomes and nurses’ readiness for ICU practice. For this review, clinical skill outcomes refer to performance-based or competency-assessed outcomes indicating proficiency in ICU-relevant technical clinical tasks following SBE. This scoping review will map the design and delivery features of SBE programs implemented to facilitate newly employed RNs transitioning into adult ICU practice, and will summarise the reported outcomes (e.g., assessed competence, perceived readiness, knowledge, confidence, clinical decision-making, and retention). Inclusion criteria: Eligible studies will include registered nurses who are new to adult ICU practice worldwide, including newly qualified nurses and experienced nurses transitioning from other clinical settings. Studies must report SBE designed to facilitate transition into adult ICU practice, including simulation laboratory-based training (e.g., sessions conducted in a dedicated skills lab or simulation centre), high-fidelity manikin-based simulation, in situ simulation conducted in the clinical environment, and/or hybrid simulation, defined as activities that integrate two or more simulation modalities within the same learning event (e.g., a manikin-based scenario combined with screen-based simulation). The review context is adult ICU settings globally, recognising that unit terminology varies across jurisdictions and that labels such as “ICU”, “critical care unit”, and “intensive therapy unit” may be used interchangeably to describe comparable high-acuity services (Christensen & Liang, 2023). Methods: Databases including CINAHL, MEDLINE, Embase, and PubMed (as key sources expected to yield the most relevant evidence), supplemented by grey literature searches of Google Scholar. The search will be conducted in January 2026. It will combine controlled vocabulary and keywords relating to simulation-based education, adult ICU/critical care, and nurse transition, using Boolean operators and database-specific filters. Searches will be limited to English-language publications from 2015 to 2025. All articles identified in the search process will be uploaded to Covidence. Duplicates will be removed. A two-phase screening process (title/abstract, then full text) will be conducted by two independent reviewers; disagreements will be resolved through discussion, with arbitration by a third reviewer as needed. A data extraction tool located in Covidence will capture study characteristics, participant and setting details, SBE modality and design features, and reported outcomes. Two reviewers will independently extract data from each included study using a structured tool in Covidence. Findings will be presented as a narrative summary of the mapped intervention characteristics (e.g., modality, setting, fidelity, facilitation/debriefing, and assessment approach), supported by simple numerical summaries (e.g., frequency counts of studies by modality and outcome domain). Reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), using tables and figures to present the mapped results. Any deviations from this planned approach (e.g., refinements to eligibility criteria or extraction fields following piloting) will be documented and justified in the final report. Data Extraction: Data will be extracted using a piloted tool [Appendix II] that captures SBE intervention characteristics, reported outcomes, and nurses’ transition-related experiences (e.g., confidence, self-efficacy, perceived preparedness, stress/ transition shock, role adaptation, and sense of belonging), as reported qualitatively and/or quantitatively. Results (For Reviews ONLY): This review will describe the range of SBE approaches and outcomes reported for nurses new to ICUs, and identify evidence gaps, rather than statistically pooling results to estimate a single overall effect. The final report will provide a synthesis of interventions and outcomes and identify gaps in the existing literature. Conclusions (For Reviews ONLY): The review will inform the development of future SBE interventions and transition support programs, potentially contributing to increased competency in ICU nursing and improved workforce retention. Keywords: Adult intensive care, critical care, educational interventions, in-situ simulation, intensive care unit, manikin-based simulation, novice nurses, nurse transition, orientation, preceptorship, readiness for practice, scoping review, simulation-based education, transition shock.