Blog - Mary Fey & Penni Watts: Getting Nursing Schools Ready for INACSL Endorsement | DTBR #6

In this special episode led by Mary Fey, Dr. Penni Watts, President of INACSL, joins us to discuss what we learned helping two nursing schools achieve INACSL endorsement, and how other nursing programs can get there: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

What does high-quality simulation look like in practice—and how do nursing programs know they’re achieving it? Using CMS’ recent work with the University of Maine System as a case study, they discuss how endorsement becomes less about recognition and more about creating a disciplined process for reflection, alignment, and improvement.For nursing leaders focused on competency-based education and workforce readiness, the conversation offers a practical perspective on building simulation programs that scale while maintaining quality. Topics include continuous improvement, faculty development, stronger partnerships with clinical organizations, and moving simulation from isolated events into an intentional curriculum that better prepares learners for practice.ALPS for Health Professions Schools: <a href="https://harvardmedsim.org/alps-applied-learning-for-performance-and-safety/">https://harvardmedsim.org/alps-applied-learning-for-performance-and-safety/</a> <h2></h2> <h2>Full interview transcript:</h2> Mary Fey: Everybody, my name’s Mary Fey. I am the associate director for the Division of Applied Learning for Performance and Safety at the Center for Medical Simulation, and today we are doing a special episode of the Dare to be Ready podcast. And our guest today is Dr. Penni Watts, who is the president of the International Nursing Association for Clinical Simulation and Learning. And also with me today is James Lipshaw, who is the producer of Dare to be Ready. So Penni, it’s great to see you. Penni Watts: Good to see you, Mary. I’m excited to be here. Mary Fey: Good. All right. So let’s talk about this thing. So, the Center for Medical Simulation had some recent experience helping a couple of campuses at the University of Maine System, obtain their INACSL endorsement. I’ll talk about that a little bit more in a minute, but, first, Penni, I wonder if you could just give us an idea of what the INACSL endorsement process is all about. Penni Watts: I will. So the endorsement process through INACSL is really, a designation recognition of programs that have excellence in doing simulation and adhering to the cornerstone standards of best practice. And we have the healthcare simulation standards of best practice. It’s a long word, a long acronym. but these are the four cornerstones, which are pre-briefing, debriefing, facilitation, and professional integrity. So the entire packet and documents and exemplars really focus around those four cornerstones. And applicants will provide exemplars and documentation showing how they adhere to, those criterion within the, four cornerstone standards. So it’s really a process of, doing a self-assessment of the program and working through, what are we doing well, what do we need to work on, and then providing that documentation and exemplars. And of course, this goes to every program’s unique, too, and how do you, manage to adhere to those criteria and those standards. Mary Fey: Yeah. Yep. And you know, Penni, I, I, I love that you say it’s really a self-evaluation because, I would say that as we were working with the University of Maine System, that’s really what I found the most valuable about this application. You know, of course, we all want the stamp of approval at the end, but the process itself was so kind of revealing about, what are our strong suits, where do we need to, to do a little bit more. And, just to fill in a little bit more information about the work that we did with University of Maine System, it’s a four campus, nursing school. And two of the campuses, University of Maine at Augusta and University of Southern Maine, which is in Portland, are the two campuses that did achieve INACSL endorsement this cycle. Now, the two other campuses, University of Maine, which is in Orono, and the Fort Kent campus, they’re still in data gathering mode because one of the things about endorsement is you need to have two years of evaluation data of a simulation. So those two campuses are still, really working at it. And I, you know, the other thing I also want to highlight that we discovered in the process that was we used the shorthand of pre-briefing, but it’s actually preparation and briefing. And it really caused us, I mean, we were already doing this, but it really caused us to ask that really important question of how do we know our learners are ready to be in this sim? And, you know, this is the Dare to be Ready podcast, and so I really found that the INACSL endorsement process was really very much about readiness of the program to do great sim. Mary Fey: It had us think about the readiness of our learners to be there. And, you know, through that whole process, so many strengths were revealed in, in both of these campuses, which I really loved. I actually started out the process a little bit nervous about, [00:04:00] gosh, are we going to be able to do this or not? And by the end I was like, “Look at these schools.” They are doing such great sims. So talk a little bit more about this idea of endorsement as doing good sim, because I think that contrasts it somewhat with accreditation from the Society for Simulation in Healthcare, which is different. Could you talk about those two differences a little bit? Penni Watts: I will. And I am a long time, previous site reviewer for accreditation for SSH and been very involved in that, and now more involved with endorsement, specifically in my role here. Accreditation is program evaluation. There are standards related to, training of your facilitators, processes, policies, and there’s a very large document about the entire program, sustainability, those type things. Penni Watts: And endorsement is, in a nutshell, truly doing good SIM. But part of that endorsement is, how are you achieving those standards? And, and where do you fit your program in with being excellent in those standards? So there truly should synergy between both, but they’re very different. They complement each other. But truly the endorsement process is, how are you preparing your students? Yeah. What is your debriefing process? Now, that doesn’t mean accreditation does talk about debriefing and pre-briefing. And the endorsement is specifically about these four cornerstone standards, how are you achieving them, but also the process that goes along with how you are continually improving, because there’s no perfect SIM program around. But how are you getting better, and what is your process when you recognized, not a failure, but an opportunity for improvement, what was your process for making that SIM better? Where in the standard did you not achieve it? And what are you doing to maintain the good debriefing, and specifically the professional integrity, which I was very excited was included as, a cornerstone standard. [I used to teach that, SIM design, was one of my favorite standards, because I start that with novices. And I changed a couple of years ago to where I start with professional integrity. because it truly starts with, that mutual respect, setting the groundwork and the foundation for the relationships between the facilitators, the faculty, the learners and that whole system. Mary Fey: So, you know, I want to pick up on what you said there about professional integrity, Penni, because I had the same thought. When I looked at the four cornerstones, I thought, “Why is that one in there?” What I love so much about professional integrity is it’s about professional integrity of the faculty and the students. And I love the way both are held to that high standard for how we conduct ourselves in each other’s presence for the purpose of learning. And one of the things the folks at, University of Maine, Augusta are thinking about doing, we didn’t get it done before the endorsement, but we’re going to get it done, is they had a sign that was, sort of what we expect from you in the lab that was intended for the students. Mary Fey: Now they’re going to turn it into, “Here’s what we expect from you. Here’s what you can expect from us.” Penni Watts: Oh, I love that.   Mary Fey: That’s what the professional integrity standard does, is it shows that we both can have expectations of each other and hold each other to those high expectations throughout the process. So I really, I loved that, that professional integrity was part of it too. Penni Watts: It was. And, you know, professional integrity also includes that safe learning environment, fostering that trust and respect, and it talks about adhering to the healthcare simulationist code of ethics. Through SSH, which is on their website. Anyone can access that. About putting all of this together and setting up that environment that frames learning as well as facilitation in the best way we can for our students. So I love that idea. I’m going to have to take that back to my team. Mary Fey: I love how we always help each other, right? That’s what some people do. That’s going on my list. Penni Watts: Absolutely. Absolutely. Love it. Mary Fey: So, Penni, you know, one of the things that I’d really like us to talk about here is, is, you know, of course, as soon as University of Maine campuses got endorsed, I went right on the website because I wanted to see our name in print. And one of the things I noticed is there’s such a wide variety of different kinds of schools. You know, some are like the big, you know, University of Alabama at Birmingham big dog kind of schools, and some are like little tiny community college that I’ve never heard of. So can you talk a little bit about, like, who gets endorsed, what kind of schools are they, and how does endorsement address the needs of, like, the big guys, and also the needs of the little guys? Penni Watts: I think that’s a great question. The standards itself, and there are 10 standards currently, and right now, endorsement focuses on the core four, which we think are just foundational to everything. Penni Watts: These are applicable to all SIM programs, whether it’s an n of 1, which I have been or a huge hospital SIM center. Currently, we have 77 programs endorsed since our pilot in 2022. We have international schools. We also have academic health science centers like us, a very big institution. we have small schools, academic programs, community colleges, large academic facilities, hospitals, and international groups that are going through endorsement as well. So it’s applicable really at any level because SIM, AR, VR, standardized patient, the standards relate to all of them. I know there are other standards for SPs and other things, but related to good SIM, they all interconnect. Any sim program can apply. We have such great sim going on with maybe just a sim educator and a specialist running students through. But it goes to, how do you implement it? How do you evaluate it? How do you work with your faculty and your staff to implement? So, I mean, it’s, it’s a continuum of programs from very small to very large, going through that endorsement process. Mary Fey: We’ve been, of course, thinking about this at CMS. You know, the process of helping the University of Maine, it was just so rewarding for so many different reasons. And I think because there’s just so much good sim going on out there, let’s recognize it. There is. But as I was thinking about it, I think, you know, our approach is going to be, when I say our, I mean the Center for Medical Simulation’s approach is going to be, you know, to go in and do an initial assessment of a school. And I know you’ve got some, documents on the website that can help people do a self-assessment. But our thinking is, go in and assess a school. And I’m thinking there’s probably going to be kind of two camps that schools fall into. One is, you know, they’re really there, and really what we need to do is, and what we did at the University of Maine, was, like, actually help them write the application to make sure that it’s you know, in good order and accurately portrays the program. So I think there are some schools that we’ll be able to go in, do an assessment, say, “Boy, you know, you’re 90% of the way there, we’re going to help you,” which would be a shorter engagement. And then I think there are also other schools who, for whatever reason, might not have their sim program operating, you know, quite like the well-oiled machine as others. And I think in those circumstances, it’ll be more like the process at the University of Maine, which actually took us about two years, to really go in there, did an assessment of all four campuses. And then we actually used the Core Four to guide the whole consulting job at the University of Maryland. And the first thing we did was said, we need to standardize preparation and briefing across the four campuses. Yeah. And that was our first one. And, you know, for thinking about the idea of readiness and are the students ready to be in the sims, we applied the SimZones framework as part of the assessment process. And then we started to put the, the Core Four in place. And then we did a lot of faculty development around debriefing. So that one really took us two years. And so I’d just like to get your thoughts on that idea of, sometimes it’s an assessment, they’re there, write the application. That’s going to take us, I don’t know, maybe a year. And then other schools it may take three years. And I don’t think there’s anything wrong with either one of those. I just, I think the Core Four kind of guide us in making those assessments. So what are your thoughts there? [I do think, and I sort of relate it back to the CSSE-A, you know, when you think you’re there and you do a self-assessment, and you take time to start pulling things together that you’ve done and you’re like, “Well, I really haven’t done that,” or, “I really have done that.” I think every school is at a different place. I know several years ago we might have been doing a lot of sim and doing a good job. We were not ready just because we had so many moving targets, the curriculum was changing. So I think every group may be different, and I think even if you don’t go for endorsement, going through the process, which I think you should, always makes the program better, the learning better, the facilitation better. Which I know is always a gap sometimes for people because it’s very- … onerous sometimes to get all your people up to speed in order to run effective simulation. So, it doesn’t make you good or not good that it might take you a while longer, but you may be really strong in a couple of areas, but really, man, we haven’t focused on this. We need to do a better job of, you know, evaluation, or we really haven’t, focused on that professional integrity and really looked at the relationship between facilitators and learners. So I think people going through it, you know, and I know when we have done, this program as we were heading into it thinking we had our things together, I think we had to postpone it six months because we said “Wow, we’re busy right now. We didn’t really get a great chance to focus on this. We’re doing it. Let’s take a step back.” So it’s an opportunity to get better. That’s what it’s about, is working, looking at quality. How do we get to being excellent at the level that we can be? How do we commit to that and that ongoing quality improvement? Penni Watts: And continually evaluating the work that we do, and I think that’s something that comes out of some of these, like endorsement. We need to continually look at that process of how are we evaluating going back. Kind of like debriefing, plus delta, whatever method. You’re going back and seeing how do we do better, the next time around. Mary Fey: Right. Penni Watts: Yeah. Or, and, and, and, the, and the implementation of simulation. Mary Fey: Yeah. Which is getting more and more and more important as we move into competency-based education. Absolutely. because I think Sim [00:15:00] is only going to become more important, and it’s- Yeah Mary Fey: more critical now than ever to make sure- It is … that we’re doing it the right way. . James Lipshaw: Mary, I’m also thinking that that matches so closely with our SimZone’s approach and how we talk about readiness, which is you need to have a plan for continuous readiness- Uh-huh. Yes … in place to go along with your fundamental skills and your situational readiness. James Lipshaw: Yeah. How are you going to continue to get better and continue to train? Mary Fey: Yeah. And James, that’s exactly the thing that takes isolated Sims and creates a simulation curriculum. Penni Watts: Yes. Mary Fey: Because it’s all connected, and it builds, and it’s scaffolded across. So, totally agree that has everything to do. Penni Watts: And I think that mapping, which we’re working on, I think everyone is, and looking at the mapping of it- You’re identifying the gaps, but also the consistency to make sure everyone’s on the same page- Yeah Penni Watts: about where do learners start and how are we building. and I know faculty, they’re kind of all focused on their area, and it’s hard. My course. Mary Fey: Right. Penni Watts: . Yeah, it is. And it’s hard to [00:16:00] really see that bigger picture of what is the ultimate goal of all of this. Yeah. It’s getting them ready for clinical and being able to transition in a more efficient manner and getting them ready for the workforce. Penni Watts: Yeah. and I think that mapping and so forth, and looking at your sim and these processes will help you get even closer to that as well. . The endorsement process, I think, will help you get closer. Mary Fey: Oh, absolutely. No question. James Lipshaw: And I think it’s a great place to highlight the work that those University of Maine campuses are doing, Mary, around aligning their curriculum and standards with discussions with local community health systems and hospitals about what do your nurses need the first day that they’re on the job and making sure that those things are aligned for exactly that, that transition to- full practice. Mary Fey: . Yeah. I, I think schools that partner with their clinical partners more closely have much stronger sim programs because, again, it’s about readiness for real-world practice. And- … they’re the ones [00:17:00] that know what new grads need and what they don’t need, for sure, because they see them practicing every day. Yeah. Penni Watts: I mean, we’re very fortunate, as an academic health science center, we’re very aligned with the hospital. Yeah. And we meet frequently and are always in touch- … about the needs of our learners and preceptor engagement and adjunct clinical faculty, and how does it all work together. So we’re lucky in that. I mean, we’re not perfect, but we have a great alignment, and there’s ongoing conversation- … about our learners in clinical at the hospital. and that’s not just our UAB hospital, because I’m at UAB School of Nursing. It’s also with other hospitals in the area. I know our, our associate deans for our graduate and undergraduate programs communicate often and meet regularly to figure out. And, and a lot of our simulation work has come from those conversations and the needs assessment, um- … that is being done, so. Mary Fey: Yeah. Keeps it real. Penni Watts: Yeah. Keeps it relevant. It does. Does. Mary Fey: All right, Penni. Anything else you want to say about endorsement that we haven’t covered so far? Penni Watts: Well, I’m excited that very soon, I will be in Oklahoma, and we’ll be celebrating, several, I forget the number, I should have had that here with me, endorse programs as well as re-endorse programs. And it’s very exciting that people are really wanting to do better some, and really… being excellent in their work, which shows in the learning, of their students. No, I appreciate the opportunity, and appreciate your work in helping folks get to that point, and just doing better and improving what we do. Mary Fey: Yeah. Well, thanks so much for joining us today. And I have to say, you know, after helping the two campuses at the University of Maine System through this process, I am excited to help more schools. Because I saw the quality improvement that happened as a result of the process. . And, I’m, I’m a real believer, so let’s work on getting more schools endorsed. Penni Watts: Yes, we appreciate it. Yes, let’s go.

What does high-quality simulation look like in practice and how do nursing programs know they’re achieving it? Using the Center for Medical Simulation’s recent work with the University of Maine System as a case study, Mary and Penni discuss how endorsement becomes less about recognition and more about creating a disciplined process for reflection, alignment, and improvement.

For nursing leaders focused on competency-based education and workforce readiness, the conversation offers a practical perspective on building simulation programs that scale while maintaining quality. Topics include continuous improvement, faculty development, stronger partnerships with clinical organizations, and moving simulation from isolated events into an intentional curriculum that better prepares learners for practice.

ALPS for Health Professions Schools: https://harvardmedsim.org/alps-applied-learning-for-performance-and-safety/

Mary Fey & Penni Watts: Getting Nursing Schools Ready for INACSL Endorsement | DTBR #6

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