Date of Degree


Document Type


Degree Name





Keville Frederickson

Subject Categories



Critical Care; High Fidelity Patient Simulation; Knowledge Application; Newly Licensed RN; Nursing Orientation; Transition to Practice


The Institute of Medicine (IOM) reported that over 98,000 deaths occur in hospitals from medical errors in the United States. In a follow-up IOM report, it was noted that nurses have a direct impact on patient morbidity and mortality and are often the last line of defense for patient safety. The challenge for nurse educators in hospitals is to ensure that as newly licensed nurses enter the workforce, orientation outcomes reflect acquisition of knowledge and skills, which are applied in practice. When newly licensed registered nurses are hired into critical care units, this puts them in a position where they have to learn basic competencies as well as the specialized practice of critical care. One teaching strategy adopted in acute care hospitals is use of high fidelity patient simulation as a way to address the competency gap of these nurses and improve patient safety and outcomes. However, little is known about the practice application of the skills and knowledge used by nurses who complete such orientation. This qualitative exploratory study analyzed newly licensed nurses' description of knowledge and skills used in critical care practice following critical care orientation using high fidelity patient simulation. Data collection consisted of individual, semi-structured, guided interviews based on the Nursing Education Simulation Framework. A sample of 8 registered nurses participated in the interview and completion of a demographic questionnaire. Content analysis was performed using Krippendorf technique. The 8 themes that emerged are consistent with previous research studies that point to the steep learning curve faced by newly licensed nurses in critical care. Implications for nursing practice include expanding high fidelity simulation to specialty practice, developing interdisciplinary orientation and to proactively address the continued experience of culture shock.

Included in

Nursing Commons