Regulation of Simulation Use in United States Prelicensure Nursing Programs

Background: Simulation usage has proliferated throughout nursing education. Although nursing programs have sought integration of simulation to substitute traditional clinical learning hours, the variability of regulations between states raises questions about consistency of learner outcomes. Methods: The Boards of Nursing (BONs) of the United States and the District of Columbia were queried by internet, phone, and email to discover regulations and guidelines for the use of simulation in nursing education. Results: More than half of the BONs reported regulations for simulation use, but they varied greatly. Some had regulations defining a percentage of traditional clinical hours that could be replaced with simulation. A few BONs specified an equivalent ratio of hours between simulation and clinical, but most did not. Some BONs described requirements for simulation instructors, but few provided specific criteria. Conclusions: This search revealed great variability in how BONs are defining and regulating the use of simulation in prelicensure nursing education including the amount of traditional clinical hours that can be replaced with simulation. Because a description of measured learning that occurs during traditional clinical learning hours is lacking, inconsistency in regulation will persist.