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Health care in America is at a crossroads: An aging population and an influx of Americans now receiving coverage through the Affordable Care Act (ACA) are demanding more from the health care system. The more than 75 million baby boomers will need more medical attention as they age, and more than 12 million Americans are newly insured through the ACA.
But while the need for health care is growing, physicians likely won’t be able to fulfill demand. More doctors are drifting away from primary care, and medical schools simply can’t produce the volume of doctors needed.
Enter nurse practitioners (NPs) and physician assistants (PAs), who are rising to the challenge and adapting to the changing health care environment. Both NPs and PAs have been filling in the gaps left by a void of primary care physicians in under-served areas of the country. In fact, the number of NPs doubled in the past decade, rising to more than 205,000 by the end of 2014.
The growth in NPs — and the added responsibilities placed upon them — has some schools expanding their graduate nursing programs to online education, either to augment the campus experience or to help fill shortages by providing more convenient education opportunities. These schools are asking themselves an important question: How can we create an online curriculum that teaches the right skills and knowledge while identifying and correcting any gaps in learning?
The expanded role of nurse practitioners
In the past, NPs played the role of wellness coordinators, and treated common recurring and chronic, but stable, illnesses. Now, the job is growing more complex: In some areas of the U.S., doctors are leaving primary care behind because of low reimbursement rates, high administrative costs, and the resulting need to see too many patients for too little time to make the economics work. They are being replaced by clinics staffed by NPs. In this role, NPs treat patients with both acute and chronic ailments, many of which are treated with a blend of medications. NPs might see between 20 and 30 patients per day at a clinic, challenging their ability to deliver positive outcomes and proper health care treatments to all.
Today, it’s hard to differentiate the role of physicians, physician assistants, and NPs, according to Linda Steele, program director for MSN Nurse Practitioner Specializations at Walden University’s School of Nursing. As such, schools must expand training for NPs to address increasingly complicated questions from patients and employ the critical thinking skills necessary for accurate diagnoses. To ensure NPs are ready for their added responsibilities and to accommodate the growing graduate nursing classes, schools are using online programs that train NPs in the detective work of medical diagnosis through the use of simulation.
A flexible option for the next generation of NPs
Throughout the country, higher learning institutions are integrating online programs to complement their bricks-and-mortar classroom experience to meet demand from growing numbers of students, many of them non-traditional. In some cases, these programs exist primarily online without a physical classroom environment, bringing students to campus only once or twice a year.
“The root cause of the rise in online education programs for NP degrees is necessity,” said Steele. “Typically, nurses enrolled in these programs work irregular schedules and outside of the typical 9-to-5 workday. So as a result, asynchronous, online learning offers tremendous flexibility for these students, and allows them to work 12-hour shifts while earning their degree.”
That dichotomy has pushed educators to find new ways to develop student competencies and measure their achievement and understanding. How can they hone and refine the critical thinking skills that allow medical professionals to accurately diagnose patients? And just as important, how do educators in online programs gauge the critical thinking and clinical encounter skills of students on the other side of a computer screen?
Using online simulations to teach diagnostic skills
Simulation is a staple of nursing education at all levels. Much of it has been mannequin-based learning to date, a format focused on teaching psychomotor skills and team-based response to emergencies. Another type of simulation uses actors — known as standardized patients — who portray symptoms and undergo live examinations to teach communications and interpersonal skills. Both mannequins and standardized patients only touch upon developing critical diagnostic competencies. On-campus, and especially online students who only visit campus once or twice a year, need consistent practice in asking questions, reviewing a patient history, investigating symptoms, interpreting tests and physical exams, and identifying afflictions.
To fill this need, nurse practitioner schools such as Walden University’s School of Nursing are using cloud-based training platforms that feature virtual simulation, allowing students to build critical thinking skills and provide them with the understanding of how to react in a real-world environment. These programs, which offer a complete virtual active learning experience, use dynamic patient simulations and provide continuous feedback, and are being adopted in more NP programs throughout the nation, especially as online programs continue growing.
Bricks-and-mortar schools too are using virtual patient simulation both in the classroom and online. These platforms simulate a wide range of health issues and illnesses, and replicate the medical history interview, physical exam, and diagnostic process while providing educators the opportunity to observe students’ learning and assess their decision-making and clinical judgment, Steele said.
These types of programs help graduate nursing students attain the same experiential competencies online as they would on campus but with the flexibility to accommodate their schedules. There’s no need to pencil in time with a high-fidelity mannequin or a standardized patient. While online simulations complement both these learning tools with development in critical cognitive competencies, virtual platforms are unique in that they allow students to hone their diagnostic skills and clinical competencies from anywhere at any time, reporting results to instructors, who can then track student progress. The end result is a mastery of the critical thinking skills that can improve treatments and decrease the misdiagnoses that affect one in 20 U.S. adult outpatients.
With a growing number of insured patients overwhelming the health care providers in many areas, the ranks of NPs continue to expand to meet the need. But to accommodate the ensuing surge in graduate nursing students, online programs are needed to offer working nurses the ability to advance their careers and shoulder more responsibility for patient well-being.
As these online programs grow and mirror the current demand in the health care market, it will be increasingly important for NP and PA students to develop critical thinking and decision-making skills while receiving constant feedback and assessment to ensure they’re trained and capable of improving patient outcomes. The increased adoption of these virtual training tools will foster a more well-rounded education for such students throughout the U.S.
About the Author
Norm Wu has extensive experience as an engineer, entrepreneur, and operating executive in healthcare and technology. He currently serves as CEO of i-Human Patients, which develops virtual medical training products and services, including its flagship i-Human Patients® platform. For more information, visit www.i-human.com.