Tag Archives: scenario-based tools to teach nursing delegation

“Friday Night at the ER” is also Simulation and – your school needs it!

It’s been more than a year since I posted in this blog, but the all-time top two entries are still attracting views. the first is “Myths about becoming a nurse practitioner – things to consider about grad school in nursing”  http://wp.me/p1Kwij-au and the second is “part 1: Secrets of a Nurse’s Brain – six steps to success at clinical practice, or anywhere!

I mostly blog about Global Health nursing and Nepal healthcare these days since I no longer live in Hawaii. go to http://www.joeniemczura.wordpress.com

Friday Night at the ER and Scenario-based education strategies

These days one of the trends in nursing education is to adopt scenario-based learning. Most often this turns out to include investing in a skills lab upgrade so as to incorporate much more sophisticated training manikins that require use of a computer as well as a trained operator who can make the manikin breathe, talk or have a cardiac arrest. These are wonders to behold, and supported by marketing from the main company that sells them. Over time, this approach has built an eco-system of professional journals, conferences, web pages and user networks to support dissemination of wisdom about how to provide simulation. Your simulation site can get certified, and there is a book of Standards you can use for ideas.

I’ve been in favor of scenario-based education for a long time, probably ever since I became an EMT in 1975. (was still in nursing school at the time). The American Heart Association uses “megacode” scenarios to advance psychomotor skills and I always enjoyed the game aspect of this approach. In Nepal, I use scenario-based education to promote better critical care response. Minimal lecture, lots and lots of role play.

Scenario-based education is more than just the fancy manikin.

In 2002 I was hired by a school of nursing that suffered a dismal NCLEX first-time takers pass rate and decided to replace some faculty members. Voila, because of my prior management experience I was now teaching the Management and Leadership class with a specific mandate to focus on delegation skills.  I re-wrote the course outline to include activities for this. I was determined to teach it in a manner that reflected the real world.

“Delegation is very boring as a lecture topic, up until that exquisite moment when you realize that you are in legal trouble and could lose your license if you do it improperly, then all of a sudden it is crystal clear and very exciting” I used to say.

Friday Night at the ER is a key vehicle to teach concepts of nursing administration firsthand, that go on all the time, but which nobody ever explains to the new RN. The processes in the game board are extremely well-designed to illustrate the ongoing slog of bed-control and patient flow-through decisions, and players get to apply them. The scoring reflects the financial incentives associated with these processes. Sometimes schools of nursing will assign each senior to shadow a house supervisor for a day to get exposed to these things, but this is a hit-or-miss prospect; Friday Night at the ER guarantees that each participant will get the feel of being a house supervisor.


One game board. Best played in a rally format with may game boards. Like Monopoly, there are many twists and turns and the outcome depends on certain skills possessed by the players.

It’s a game board. And each board accommodates four (maybe five) players. Do the math. A cohort of thirty will require six or more game boards. We had a cohort of fiftysix, and divided the experience into two halves, with eight boards each day. To fully implement it at your school requires buying a set of game boards (I took this to another large school of nursing and once they committed they bought eight game boards) and it requires logistical set-up ( lot of small pieces need to be set out on the board, like Monopoly). Also, the way we did it required an all-day scheduling commitment, taking about six hours to include two de-briefings along the way. A strong recommendation? don’t try to squeeze it into just one three-hour class sessions. Do it in lieu of a clinical day.

If you adopt Friday Night at the ER?

Facilitator: Like the manikin-based approach to simulation, the facilitator of Friday Night at the ER does a better job if they also have real-world experience as a mid-level manager, because they have a better idea of the relative value of insights  available during an open-ended event such as Friday Night at the ER.

Debriefing: the academic nursing journals and websites devoted to manikin-based scenario learning are amply stocked with testimonials as to the need for debriefing, as a means to frame the experience. Like using a manikin, it’s possible to do the experience and not actually learn anything or gain insight. De-briefing is absolutely critical. If you adopt Friday Night at the ER,  you need to include ample time for this, and the students need to commit to the idea that they can’t run out of the class as soon as the last score is tallied up.

Integration: Friday Night at the ER is billed as “discovery learning”  and the company that sells it will tell you not to pre-warn the participants in advance as to how to “win” or to share the scoring system, etc.  This presents a challenge, because it’s harder to “sell” people on the merits of playing. In addition to the usual suspension of disbelief required for good simulation, Friday Night at the ER is more fun and experiential when you all learn as a team ( that’s why it is used by non-nursing and non-health care teambuilding consultants – it forces people to communicate and problem-solve.)

Having said that, since the game applies principles of delegation and illustrates they way a health care organization works, you can prepare the students to play it as part of a sequence of learning about delegation, the Nurse Practice Act, etc. I wrote a four-part sequence of blog entries to describe the how I taught delegation, right here on this blog.

Where to get Friday Night at the ER

go to http://blearning.com/

Disclaimer: I am not associated with the company in any way not am I being compensated for this full-throated endorsement in any way. I am merely a satisfied user since 2003. I have led this exercise about forty times I think. (memory is a bit fuzzy). I am very experienced in use of scenario-based education for critical care, especially debriefing.

While we are on it, the company needs to grow their followers on Twitter. go to @TheERGame and you will find them. pass the word!

My other blog entries on this topic

The first was part 1: Secrets of a Nurse’s Brain – six steps to success at clinical practice, or anywhere! This one addresses personal organization to promote personal accountability, the first step to understand delegation.

The second was part two: checklist culture and your role in quality

The third was How to teach delegation and the Nurse Practice Act, part 1 dec 29 2013 This one explores how delegation is defined in (most) state Nurse Practice Acts.

Another was teaching delegation and the Nurse Practice Act, part 3 Jan 1 2014 This one will show you a free resource from NCSBN that is absolutely critical for every school of nursing to teach, and for every future NCLEX test-takers to read.

And finally, to teach delegation part 4 – getting “street smart” Jan 3 2014 How an organization made up of individually-accountable nurses will support legal practice.

Here is my offer to consult with you on delegation issues in the curriculum

As you can see from the above, I believe strongly that delegation can not be “integrated” into the curriculum as some sort of subliminal brain telepathy. Subtlety does not become it, delegation needs to be laid right out there and preached. And, delegation is not well delivered when presented by a “talking head” as a dry academic experience.   In the paper “Working Well With Others” from the National Council of State Boards of Nursing (NCSBN) a key statement is:

“The strongest set of delegation rules will not work unless the nurse possesses the interpersonal communication skills to enforce them” (paraphrased).

The best way to hone interpersonal skills is to use them and get feedback.

Please note: the Friday Night at the ER site lists experts you can hire. UPDATE: at first glance I thought there weren’t any  nursing educators, but I have been gently reminded (below)  that there are two – Dr Mary Dolansky at Case Western, and Dr Carol Durham at UNC. They come highly recommended.

Dr. Mary Dolansky’s  page is https://nursing.case.edu/about/directories/faculty/dolansky/


Dr. Carol Durham’s faculty webpage is http://nursing.unc.edu/people/carol-fowler-durham/

I plan to ask Breakthrough Learning to add me to their list. If your school’s aggregate NCLEX scores show the need to buff up the area of delegation,  I will happily work with you to revise the senior-year curriculum, including coming to your school to help you do it (for a fee). Alas, I do not own any of my own game boards. You would need to buy or rent these on your own.



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