The Implications of Simulation and Real-Life Learning for Novice Emergency Nurses in COVID-19

Real-life versus Simulation for ED Nurses


  • Carrie Meagher BCIT
  • Jenna McComb
  • Jennifer Burkhart



Simulation, real-life learning, novice nurse education, emergency departments, COVID-19



In recent decades, technological influences have propelled the advancement of nursing education, both in practical and theoretical andragogy. Simulation technology has become an integral component of many nursing programs and clinical practice settings. The introduction of simulation challenges current mentorship and practice-based real-life learning, alluding to the question: Is the use of simulation to educate nurses within the clinical environment a sufficient replacement for real-life learning? The recent severe acute respiratory syndrome coronavirus 2 disease (SARS-CoV-2 or COVID-19) pandemic has caused emergency departments (EDs) to re-examine educational practices, potentially replacing real-life learning with simulation technology to support novice nurses as they care for acutely ill COVID-19 patients. Many experienced ED nurses have left the profession during the COVID-19 pandemic, and novice ED nurses with minimal ED experience have been hired in their places. While their enthusiasm, skill, and knowledge are highly valued, novice ED nurses face many challenges in the complex ED environment, particularly in the rapidly changing COVID-19 pandemic. This article provides an overview of simulation learning and real-life learning and how both of these models, along with their educational strategies, may be implemented by ED nurse educators in assisting novice ED nurses transitioning to independent practice.

Keywords: simulation, real-life learning, novice nurse education, emergency department, COVID-19

Author Biographies

Jenna McComb

Staff Nurse, Royal Columbian Hospital Emergency Department

Jennifer Burkhart

Infirmière de chevet, le service des urgences de l’hôpital d’Ottawa ; étudiante à la maîtrise en soins infirmiers, Faculté des sciences infirmières, University of Victoria


Akhtar-Danesh, N., Baxter, P., Valaitis, R. K., Stanyon, W., & Sproul, S. (2009). Nurse faculty perceptions of simulation use in nursing education. Western Journal of Nursing Research, 31(3), 312-329.

Alshammari, F., Pasay-an, E., Laarni Indonto, M. C., & Gonzales, F. (2018). Translating the importance of simulation to practice: Strengthening learning outcomes. Journal of Health Specialties, 6(2), 60-67.

Arnold, T. C. (2020). Moral distress in emergency and critical care nurses: A metaethnography. Nursing Ethics, 27(8), 1681–1693.

Begley, J. L., Lavery, K. E., Nickson, C. P., & Brewster, D. J. (2020). The aerosol box for intubation in coronavirus disease 2019 patients: An in‐situ simulation crossover study. Anaesthesia, 75(8), 1014-1021.

Bowen, J., Zambas, S., Macdiarmid, R., Cook, C., & Neville, S. (2020). Integration of high-fidelity simulation into undergraduate nursing education in Aotearoa New Zealand and Australia: An integrative literature review. Nursing Praxis in New Zealand Inc., 36(3), 37-50.

Canadian Association of Emergency Physicians (CAEP). (2021, September 7). Emergency department workforce struggles amidst perfect storm.

Chan, A. (2020). COVID-19 airway management: Better care through simulation.

Dieckmann, P., Torgeirsen, K., Qvindesland, S. A., Thomas, L., Bushell, V., & Langli Ersdal, H. (2020). The use of simulation to prepare and improve responses to infectious disease outbreaks like COVID-19: Practical tips and resources from Norway, Denmark, and the UK. Advances in Simulation, 5(1), 1–10.

Doherty, K. Q. (2016). Role modeling as a teaching strategy for the novice nurse in the emergency department. Journal of Emergency Nursing, 42(2), 158-160.

García‐Martín, M., Roman, P., Rodriguez‐Arrastia, M., Diaz‐Cortes, M. d. M., Soriano‐Martin, P. J., & Ropero‐Padilla, C. (2021). Novice nurse’s transitioning to emergency nurse during COVID‐19 pandemic: A qualitative study. Journal of Nursing Management, 29(2), 258-267.

Garrett, B. M. (2020). Learning theory: Considerations for nurse educators. In K. Page-Cutrara & P. Bradley (Eds.), The role of the nurse educator in Canada (pp. 35-63). Canadian Association of Schools of Nursing.

Grant, K. (2021, July 16). Canadian nurses are leaving in droves, worn down by 16 merciless months on the front lines of COVID-19. The Globe and Mail Canada.

Harder, B. N. (2009). Evolution of simulation use in health care education. Clinical Simulation in Nursing, 5(5), 169-172.

Hussein, R., Everett, B., Ramjan, L. M., Hu, W., & Salamonson, Y. (2017). New graduate nurses’ experiences in a clinical specialty: A follow up study of newcomer perceptions of transitional support. BMC Nursing, 16(42), 1–9.

INACSL Standards Committee. (2016). INACSL standards of best practice: Simulation. Clinical Simulation in Nursing, 12(5), 39-47.

Ironside, P. M., McNelis, A. M., & Ebright, P. (2014). Clinical education in nursing: Rethinking learning in practice settings. Nursing Outlook, 62(3), 185-191.

Kapucu, S. (2017). The effects of using simulation in nursing education: A thorax trauma case scenario. International Journal of Caring Sciences, 10(2), 1069–1074.

Kolb, D. (2014). Experiential learning: Experience as the source of learning and development (2nd ed.). Pearson Education.

Lasater, K. (2007). High-fidelity simulation and the development of clinical judgment: Students’ experiences. Journal of Nursing Education, 46(6), 269-276.

Liljedahl, M. (2018). On learning in the clinical environment. Perspectives of Medical Education, 7, 272-275.

Lyneham, J., Parkinson, C., & Denholm, C. (2008). Intuition in emergency nursing: A phenomenological study. International Journal of Nursing Practice, 14(2), 101–108.

Manoochehri, H., Imani, E., Atashzadeh-Shoorideh, F., & Alavi-Majd, A. (2015). Competence of novice nurses: Role of clinical work during studying. Journal of Medicine and Life, 8(Spec Iss 4), 32-38.

Matchim, Y., & Kongsuwan, W. (2015). Thai nursing students’ experiences when attending real life situations involving cardiac life support: A phenomenological study. Nurse Education Today, 35(12), 1186-1191.

McDougall, E. M. (2015). Simulation in education for health care professionals. British Columbia Medical Journal, 57(10), 444–448.

Mok, G., Schouela, N., Thurgur, L., Ho, M., Hall, A. K., Caudle, J., Rosenberg, H., & Syed, S. (2020). Resident learning during a pandemic: Recommendations for training programs. Canadian Journal of Emergency Medicine, 22(5), 1–5.

Nelson, H., Hubbard Murdoch, N., & Norman, K. (2021). The role of uncertainty in the experiences of nurses during the COVID-19 pandemic: A phenomenological study. Canadian Journal of Nursing Research, 53(2), 124-133.

Papp, I., Markkanen, M., & von Bonsdorff, M. (2003). Clinical environment as a learning environment: Student nurses’ perceptions concerning clinical learning experiences. Nurse Education Today, 23(4), 262-268.

Spence, D., Zambas, S., Mannix, J., Jackson, D., & Neville, S. (2019). Challenges to the provision of clinical education in nursing. Contemporary Nurse: A Journal for the Australian Nursing Profession, 55(4-5), 458-467.

Sterner, A., Hagiwara, M. A., Ramstrand, N., & Palmér, L. (2019). Factors developing nursing students and novice nurses’ ability to provide care in acute situations. Nurse Education in Practice, 35, 135-140.

Sullivan, E. H., Gibson, L. E., Berra, L., Chang, M. G., & Bittner, E. A. (2020). In-hospital airway management of COVID-19 patients. Critical Care, 24(292), 1–8.

Tan, R., Yu, T., Luo, K., Teng, F., Lui, Y., Luo, J., & Hu, D. (2020). Experiences of clinical first-line nurses treating patients with COVID-19: A qualitative study. Journal of Nursing Management, 28(6), 1381–1390.

Varner, C. (2021, March 31). Hospitals grappling with nurse exodus. CMAJ News.

Weeks, K. W., Coben, D., O’Neill, D., Jones, A., Weeks, A., Brown, M., & Pontin, D. (2019). Developing and integrating nursing competence through authentic technology-enhanced clinical simulation education: Pedagogies for reconceptualising the theory-practice gap. Nurse Education in Practice, 37, 29–38.

Weller‐Newton, J. M., & McCormack, B. (2020). From Nightingale to now: Time to rethink clinical education in nursing. The Clinical Teacher, 17(5), 461–463.



How to Cite

Meagher, C., McComb, J., & Burkhart, J. (2022). The Implications of Simulation and Real-Life Learning for Novice Emergency Nurses in COVID-19: Real-life versus Simulation for ED Nurses . Canadian Journal of Emergency Nursing, 45(1).