Simulation Specialist, Dr. Christine Heid

Today’s guest is someone whose work sits right at the intersection of education, innovation, and human connection.

Dr. Christine “Christy” Heid is a nursing educator, simulationist, innovator, and healthcare advocate with more than two decades of experience.

As a Nursing Simulation Specialist, she brings an invaluable perspective as both a nurse educator and simulation expert who has personally experienced the challenges institutions face in preparing nurses for clinical practice. A recognized innovator in nursing education, she created the Heid ATE Guide for Clinical Teaching and Learning©, which is an Innovative, Progressive Tool to facilitate the Development of Clinical Judgment Skills for real-world nursing Practice. Brilliant.

But wait, there’s more. Christy has led a multi-site research project funded by an OADN Foundation Grant. She has held roles as a consultant, course developer, and faculty member, contributed to national committees, and published research on simulation and clinical judgment.

In this episode, we talk about how simulation is transforming nursing education, what it really means to build clinical judgment, and why innovation is as much about empathy as it is about technology. Her work reminds us that innovation and empathy aren’t opposites; they’re partners.

I wish, as a young nursing student in 1983, that Christy had been in my life. We didn't have simulations. We didn't have nursing simulation specialists. We had to practice on each other. Yeah, I'm not kidding. So we've come a long way and I was so happy to meet Christy.

In the five minute snippet: Put on your boxing gloves. For Christy's bio, visit my website (link below).

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Transcript

[00:00] Michelle: Today's guest is someone whose work sits right at the intersection of education,

[00:05] innovation and human connection.

[00:09] Dr. Christine 'Christy' Heid is a nursing educator, a simulationist, an innovator,

[00:16] and a healthcare advocate. With more than two decades of experience as a nursing simulation specialist, she brings an invaluable perspective as both a nurse educator and simulation expert who has personally experienced the challenges institutions face in preparing nurses for clinical practice.

[00:37] A recognized innovator in nursing education,

[00:40] Christy created the Heid ATE Guide for Clinical Teaching and Learning,

[00:45] which is an innovative, progressive tool to facilitate the development of clinical judgment skills for real-world nursing practice.

[00:55] Brilliant.

[00:57] But wait, there's more. Christy has led a multi site research project funded by an OADN foundation grant.

[01:05] She's held roles as a consultant, course developer and faculty member,

[01:10] contributed to national committees, and published research on simulation and clinical judgment.

[01:18] In this episode, we talk about how simulation is transforming nursing education,

[01:24] what it really means to build clinical judgment, and why innovation is as much about empathy as it is about technology.

[01:32] Her work reminds us that innovation and empathy aren't opposites,

[01:37] they're partners.

[01:38] I wish,

[01:40] as a young nursing student in 1983,

[01:44] that Christy had been in my life.

[01:47] We didn't have simulations. We didn't have nursing simulation specialists.

[01:52] We had to practice on each other.

[01:55] Yeah,

[01:56] I'm not kidding. So we've come a long way and I was so happy to meet Christy. In the five minute snippet:

[02:04] Put on your boxing gloves.

[02:22] Well, good morning, Christy. Welcome to the podcast.

[02:25] Christy: Thanks, Michelle, for having me. I'm excited to be here.

[02:28] Michelle: I'm excited for you too. And I want to thank you first for reaching out to me.

[02:34] I just think it's absolutely wonderful when I meet a nurse who says,

[02:39] you know what? I have a really niche job or I have so much to offer your listeners. I would love to come on your show and be a guest. And I want to remind my listeners that anybody can do that.

[02:54] You can go to my website,

[02:55] theconversingnursepodcast.com and click on "Be My Guest" and put your bio in. And I read every bio.

[03:03] So thank you so much again, Christy, for reaching out because I think you do have so much to offer.

[03:11] Christy: Well, thank you. I think it's always an opportunity for us to learn how many different roles we play as nurses.

[03:17] Michelle: Right.

[03:18] Christy: We all heard that day one.

[03:21] Michelle: I have learned so much in the three and a half years that I've been doing this that I never knew existed.

[03:27] Every interview has been a learning opportunity for me as well.

[03:33] So we're just going to jump in. You've built a career at the intersection of nursing education,

[03:39] simulation, and innovation.

[03:42] So for those meeting you for the first time, how do you describe what you do?

[03:47] Christy: That is a great question, Michelle. So a lot of times I think of my role as an educator,

[03:57] as a nurse,

[03:59] and as someone who's looking to find a way to connect our passion to our career,

[04:08] so helping nurses everywhere become nurses and find their passion in nursing itself. So I've always seen myself as someone who can help you get where you want to go or maybe help you figure out what that might be, dream a little bit bigger, I think.

[04:26] Michelle: Well, as nurses, we need that, really, whether we're starting out or whether we've been in it for a while, and we're changing specialties.

[04:35] Everybody needs a nurse like you that can help them get where they need to be. So thank you for that.

[04:42] So let's talk about innovation.

[04:44] So you've been in nursing education for over two decades, which is incredible,

[04:49] and the field has definitely evolved in those decades.

[04:54] Christy, what first inspired you to move into education and then eventually into the world of simulation?

[05:02] Christy: I recall back in my earlier formative years, if you will, in nursing education,

[05:09] where I had experiences that were not always supportive, let's say,

[05:15] and it's through no fault of anyone individually. It was just the culture. You know, over 20 years ago, you know, we had this saying, you know, nurses eat their young.

[05:25] And unfortunately, I experienced that as well. And I had to,

[05:29] as they say, grow a thicker skin.

[05:31] And I felt like that was a challenge to take this compassionate profession and say, we need to harden ourselves because,

[05:41] you know, we're not always supportive of one another, or we're trying to be, but we're weighed down by so many of these other things happening in our practice settings.

[05:53] So I was always interested in helping support my colleagues and also learn myself how can I create a better experience for those that are coming up behind me.

[06:09] And so I would often find myself in these situations where we didn't know how to do something, but we were going to figure it out because the patient needed that.

[06:19] And so working with our providers and other nurses,

[06:25] We can find that solution. We used to say we MacGyver it, right? Like, we can find a way to make that work.

[06:33] And I just had a knack for working with my colleagues wherever they were,

[06:39] if they were experienced and this was a new area they were practicing in, or if they were right out of school and they never done an IV before on a real person, let's say.

[06:50] And so as I was practicing, I found that I really wanted to make use of not just my two hands,

[06:58] but also the hands of my colleagues. And I thought,

[07:02] what is a way that I can help influence those outcomes not just with, among patients, of course, but also the nurses so that they can stick with the practice.

[07:13] Right. Find their niche and really,

[07:16] do the best work that they were meant to do. So pretty shortly after I had been practicing for a few years, I was approached by one of our local educators and she said, have you ever thought about practicing?

[07:31] In education teaching?

[07:34] And I said,

[07:35] well, not really, but,

[07:38] you know,

[07:39] tell me more. And so that's kind of how it began.

[07:42] And so I was able to work in a host of different programs in my area and then kind of move beyond that. And, you know, currently I have this opportunity to work with hospital and college and nursing program leaders all around the world, really, which is really an exciting opportunity.

[08:03] Michelle: Very exciting. And you know, I think some of the best teachers are those victims, unfortunately, of the eat your young culture.

[08:13] I hope that's changing. I've talked to quite a few nurses now, and I think that that is softening a bit. But I know it is still a problem,

[08:22] but I think to have experienced, you know, bullying and then to turn that around and say,

[08:29] I don't want any of my colleagues, any of my students to suffer the same way that I did.

[08:38] I just think that is a real strength and superpower of nurses. And it sounds like that's exactly what you did.

[08:47] Christy, do you remember a moment early on, like maybe it was with a student or in a simulation when you thought,

[08:55] this is exactly where I'm supposed to be?

[08:59] Christy: Oh, that's a great question, Michelle. And I instantly recall a period when I was teaching,

[09:06] I would teach didactic simulation and clinical. So I got to see kind of the full clinical experience while practicing in a healthcare setting because I never wanted to kind of let go of that.

[09:19] You know, that's what we do, right? We take on multiple hats, if you will.

[09:23] Michelle: Yeah.

[09:24] Christy: So I recall at the simulation I had done an activity and I used a lot of different types of simulation.

[09:32] So we would combine role play, we would provide combine screen based simulations, mannequin based,

[09:39] and we could even incorporate task trainers, for example, in the classroom even.

[09:44] And I recall after a simulation during the debrief, because, you know, that's when the learning really happens, right? That's when those AHAs happen.

[09:53] And I was talking to my group,

[09:57] and one of, I had asked a question. I don't even remember what the question was, but it probably was something along the lines of,

[10:04] how can you take something that you've learned here today to change your practice tomorrow in clinical?

[10:11] And one of the students, she stood up and she wasn't, you know, the most,

[10:16] The loudest student. She wasn't the most confident student.

[10:19] She was kind of your typical student that unless you're paying attention, she can kind of fly under the radar.

[10:25] And I remember her standing up and saying,

[10:28] well, I feel a lot more comfortable teaching my patient.

[10:32] It was probably somebody with COPD, because we did that a lot.

[10:37] And I said, oh, really? You know, can you tell me a little bit more?

[10:41] She said, well, we were able to talk about this in the class,

[10:44] and then I was able to practice it here.

[10:47] And then in clinical the other day, we had a patient, and now I feel like I could go in and I could actually teach my patient.

[10:54] And I think I had all the feels at that moment. I was just brimming with joy and with pride in what she was saying.

[11:01] And that's when I truly felt like I was in the right place. I was doing what I was meant to do in that moment and helping her really exude the confidence to perform or to care for the patient the way that she wanted to.

[11:18] Michelle: That is so cool. I got the chills when you said that,

[11:22] because that's why we do what we do, right? Those kind of experiences really keep us going.

[11:29] So. Wow, what a great story.

[11:32] I want to talk about something that you created, Christy, and this is the Heid ATE Guide for Clinical Teaching and Learning.

[11:39] And ATE is Assess, treat, and evaluate.

[11:44] Can you tell us the story behind that?

[11:47] Christy: Absolutely. Thank you so much for asking, Michelle. This was a passion project and has been for over a decade.

[11:55] So the HEID tool, as we call it in short,

[11:59] was designed from,

[12:02] As anything in nursing necessity. Right.

[12:05] So as we were in, I was working with a group of learners. They were in their Fundamentals of Nursing course,

[12:12] so very early in the clinical experience.

[12:15] And we were at a smaller community hospital.

[12:18] So as you know, patients aren't exactly filling every room. Sometimes, you know, we find in some community hospitals at times,

[12:27] not so much during the pandemic, of course, but prior to that time, we wouldn't always have patients, we might have, you know,

[12:34] 10 patients on the floor, and by the end of the day, they might all be discharged. And that's exactly what was happening.

[12:41] And so I was trying to find ways to,

[12:45] to engage them in thinking. We're trying to develop critical thinking skills here, clinical reasoning.

[12:51] And one of the things that I was finding is I looked down the hallway, I was, you know, checking in on everyone, and we had multiple hallways that we would be down,

[13:01] and every student was at a computer in the hallway. That's where they were kept.

[13:06] And I was kind of saying, okay, well, let's, let's see, what's going on here. And I would ask them about their patients and they would say, oh, let me look.

[13:17] And I was like, well, have you talked to your patient? Oh, no, I was getting the information out of the chart first. And I said,

[13:23] okay, well, let's, let's try something.

[13:26] Let's go talk to the patient. And they're like, well, I don't, I don't know how to do that. I don't, I don't know what to say, you know, and so we, we started a process of, of kind of role playing these conversations.

[13:37] And after,

[13:38] clinical, we were kind of talking about this and, and they, I felt that,

[13:43] you know, we would look for our students and we wouldn't find them in the patient's rooms. They were out on these computers or they were looking in charts, or they were, they were somewhere else.

[13:52] And, well, the best place to learn is right there with the people that you're caring for.

[13:58] And so I kind of went home that weekend and I thought up, you know, how do I translate what we do? And in simulation,

[14:06] that process of understanding the patient through dialogue, through discussion, through assessment,

[14:14] and kind of make that real and clinical. And so ultimately came back and we said, I said, let's try something. If it doesn't work, we don't have to do it again, but I just want to try something.

[14:26] And of course, I had to say, you're not all going to fail for trying this with me.

[14:31] You know, we're still going to achieve the learning objectives.

[14:34] And ultimately, what it resulted in was a process of helping them kind of build that critical thinking process and help provide a tangible worksheet, if you will, that replaced the 14 pages of clinical prep that they were in the computer trying to complete with a simple, you know, one page,

[14:55] front and back document that allowed them to kind of hone in on what was important,

[15:02] prioritize that, establish those interventions and then think beyond that.

[15:06] So just as we did in simulation and said what are you going to take from this to clinical in the real world it was taking now where is the patient going to go next and how are you going to help them achieve whatever their goal is?

[15:20] You know, if that's improved health and wellness, if that's remaining independent in their home or if that's just having quality of life in the, the days, weeks, months they might have left.

[15:33] And so that was kind of how it all began with a bunch of students and fundamentals.

[15:39] Michelle: That's brilliant, I will say. And you know, it's a hard ask Christy to,

[15:46] For students because I'm thinking back as you were recounting that story, I'm thinking back to my student days and you wanted to know everything about your patient before you go in and see them.

[15:58] Right. You think that that's going to help with a better communication or maybe a better assessment.

[16:07] And a lot of students don't have those skills, those people skills, and they feel very uneasy.

[16:14] What if the patient asks me something and I didn't get that out of their chart?

[16:20] And as a nurse,

[16:22] you know, working on the unit, I would see those students because I worked at a teaching hospital, so we had a lot of nursing students and I would see them doing that exact same thing just like buried into the computer or buried in the book where I would have to come and say,

[16:39] hey,

[16:41] come in this room, we're doing this procedure. Or you know, oh no, I don't know what to do, that panic. So the fact that you developed a tool that can be used by students to really quickly and succinctly get these things that they need to know,

[17:03] again, it's brilliant. And I imagine it's just helping so many students.

[17:08] Christy: Well, thank you. I mentioned it's also built for educators.

[17:13] So the questions, the prompts, the visual process that you walk through and it's a four step process meant also for novice educators because I was finding that I was joyfully helping my colleagues and as I was the coordinator of the course, I would help train the clinical faculty that were teaching clinical in my course as well.

[17:39] And the simulation team, we kind of worked all across the place.

[17:43] One of the things that I found was that a lot didn't have that experience with teaching.

[17:49] They had been the student and they had taught patients,

[17:53] you know, they taught family members.

[17:56] But many of them were not as familiar with teaching learners and they thought a lot about it was just, well, I'll just teach them how to do what I do.

[18:04] And we know that, that there's more to teaching than just mimicking what they see in a practicing nurse. So it kind of gave them a tool as well to say I don't have to know everything day one.

[18:16] But I know nursing,

[18:18] I've always said this, I know nursing. So no matter where you put me, I know nursing and I can figure this out.

[18:23] And so as far as educating the students, I wanted to give them language as well. And one of those things is what we call just-in-time teaching,

[18:33] where it's getting at that moment of learning and making that difference there. So asking the questions that don't scare the student but help them develop that thinking process that is already innate in the educator, they just might not know how to verbalize it.

[18:51] That was kind of part of what we were trying to do as well.

[18:54] Michelle: I think it's again on both of those levels, helping the educators and helping the students. I think it's so necessary.

[19:01] What have some of the responses been from the nursing educators after using this tool?

[19:08] Christy: Oh, that's so great that you asked. We've had the opportunity to work in several different programs and oftentimes they find that it's very helpful in defining or framing that process without limiting them in their teaching.

[19:27] One of the things that,

[19:29] we heard quite a bit, was how the educator was able to develop critical thinking without guessing at it.

[19:40] So helping the learner develop that process without figuring out, well, I don't know how, I think that way, I just do was what we would hear and it kind of gave them a process that, that really helped them relate,

[19:55] put into words, if you will, what it was that, that they were doing and just created a better experience for, for students and faculty in those, in those programs.

[20:06] Michelle: Anything that can do that is just something that's so valuable.

[20:12] Yeah. On so many levels.

[20:14] I want to talk about research because I'm a big fan of research.

[20:19] And you led a multi-site research project that was funded by an organization that I had no idea what it was and it's the OADN and that's the Organization for Associate Degree Nursing Foundation.

[20:34] What was the project about and what did you learn through that experience?

[20:40] Christy: Oh, this takes me back a little, Michelle, because we did this right during the, right.

[20:46] I guess during the highest peak of the pandemic.

[20:49] So this was kind of a challenge for us. But what was cool about it? So the study was between two Midwest colleges and that were using the high tool in their clinical education courses.

[21:02] And of course we intended to visit schools and extend this to our community colleges and transition to practice programs.

[21:12] But unfortunately with the pandemic, we were kind of limited in our ability to do that because as you can imagine, they were inundated with patients in the hospital setting and then in the, in the community college setting, they were trying to find a way to teach clinical without going to clinical.

[21:29] Yes. So what happened was we ended up finding a way to transition the Heid tool to the online clinical experience.

[21:42] And so what we did was we combined simulation based education that,

[21:47] you know, virtual reality or screen-based simulation,

[21:52] or even taking the Zoom into the SIM lab and recording it, you know, for students, or having a live feed that they could then direct the actions of the SIM staff.

[22:04] These were all things that we were doing at the time.

[22:06] And what we did was then create a structured process for engaging in those steps that I mentioned, those four levels of building that thought process and that, that experience for a simulated online clinical day.

[22:22] And so what we found was that it created some of that structure that faculty desperately needed because they're like, what do we do right in this space? What do we do when they're all going online?

[22:32] We're used to having them at the bedside. You know, I can just pull out some equipment, we can practice how to set up the IV pump, you know, we can talk about how to, to approach the, the, the teaching of this new medication or whatever.

[22:44] And so we were able to embed many of those features of an effective simulation debrief in that virtual environment. We'd combine peer learning where they could partner up their peer to peer and instruction a big part of our, our process.

[23:02] And then we would have a synchronized, facilitated group debriefing with that faculty member as well.

[23:09] So what we found was that they were able to continue to develop those clinical judgment skills, practice that process while they were at home,

[23:20] you know, trying to learn this from afar.

[23:23] So that was one of the big things that came out of that experience.

[23:27] Not exactly the study we intended to develop,

[23:30] but worthwhile endeavor nonetheless.

[23:33] Michelle: Wow, that's amazing. I mean, we all had to get creative during COVID right? And that's certainly an innovative approach to creativity and to facilitate learning when you couldn't actually be there with patients.

[23:51] Wow, that's amazing.

[23:54] So you're also published and you also publish research on clinical judgment, which is one of those concepts that, it sounds straightforward,

[24:06] but it's actually very nuanced, right?

[24:10] Michelle: How do you define clinical judgment? And why is it such a critical skill for nurses?

[24:17] Christy: So clinical judgment, I feel, has,

[24:20] in the last five years, really taking a central focus in nursing education and practice.

[24:28] We know that clinical judgment is something that you don't enter nursing school with those skills.

[24:34] It involves application to a clinical context, and it requires us to make a decision to act or not act, depending on everything that was going on. And that takes more than just foundational knowledge. It takes the ability to apply that knowledge to that patient or family situation as a member of a healthcare team.

[24:57] So part of the process of developing clinical judgment for me has always been first taking what we know about critical thinking or problem solving at a very fundamental level.

[25:08] And I always gave the anecdote of a person who gets a flat tire and has to reason their way through how to deal with the flat tire,

[25:18] calling AAA,

[25:19] you know, pulling it out of the trunk of your car, as my dad expected me to do,

[25:23] and, you know, kind of moving forward with your day and moves then into that clinical setting.

[25:30] So how do we then take that problem solving into a clinical situation,

[25:34] you know, with a patient, with their family member, with the other members of the team caring for that individual,

[25:40] and then to get to that clinical judgment is really taking some of that responsibility for the patient's care and for their outcome. What outcome are we trying to strive for?

[25:51] So for me, clinical judgment has been essential to that process. And it's not something that every student develops in the same amount of time and is one of the most, if not the most, critical element for a new nurse entering practice.

[26:07] And so that's kind of where I've kind of focused now, as we're doing that transition piece, is how do we ensure not only that we've got that clinical judgment skill developed, but that we can take it into a variety of settings and apply that.

[26:24] So, as I said earlier,

[26:25] nursing is nursing. Just, you know, wherever I'm at, it's still nursing. And when I think about it, it's not so much the tasks that I'm performing, it's the judgments that I'm able to make given the context I'm within.

[26:38] And so I rely on my colleagues to help me in those situations because I know better than to think that I know everything,

[26:45] you know. So when I enter a situation, I want to,

[26:49] I learn from those that are already there, including the patient that I'm caring for.

[26:56] So I think that kind of is one of the exciting things that we're seeing now in And a study we actually conducted here at UBISim on practice readiness,

[27:07] and it talks about, you know,

[27:09] practice ready, not really so helping. What we were looking to understand was that gap between nursing education and employer expectations.

[27:21] Michelle: Clinical judgment is one of those things that, like I said, it just sounds like.

[27:26] It sounds kind of easy,

[27:29] but it's obviously not. And to teach that is just,

[27:34] you know, I've had students that have come to me or nurses that are newer and said, you know, how did you know what to do in that situation?

[27:43] And it's like,

[27:46] I didn't always have an answer for them.

[27:49] It's like, well,

[27:51] I just knew it because I've experienced this, you know, many times before,

[27:57] or, you know, I tried this, and it worked.

[28:01] So for me, as an experienced nurse, to try to communicate to a newer nurse about how to use your clinical judgment, it was very difficult. And I think anything that makes it easier for educators to communicate that to nurses and students is.

[28:25] It's just really profound.

[28:27] So how does simulation support the development of clinical judgment? And what can it offer that,

[28:35] like, traditional clinical experiences sometimes can't?

[28:40] Christy: Well, that is probably one of my greatest passions, Michelle, is how we can use simulation to help with clinical judgment, but also to help prepare us for the unexpected or the, you know, those events that occur,

[28:55] you know, rarely, but can have significant consequences for nurses and for patients. Right.

[29:03] One of the things that I think in simulation that we can do incredibly well is to create a safe space for that learning.

[29:11] So we often think about it as a place to make mistakes and learn from them without any risk of harm to the patient.

[29:20] And I think that that risk of harm extends to the nurse because we go into this for a variety of reasons, but many of us are looking at a way to help, to make a difference, to,

[29:32] you know, improve care in some way.

[29:36] So simulation, for me is a place where I can introduce situations or scenarios that have meaning to our practice, to the settings that we're going to be working within,

[29:51] the interactions that we might have with other team members.

[29:56] You know, that can be a challenge for new nurses as well.

[30:00] And I also find it as a great opportunity for us to hone those communication skills that,

[30:06] in all honesty, are kind of suffering nowadays.

[30:10] You know, being able to communicate clearly what it is that

[30:14] you're trying to communicate, but also to listen even more carefully to what that person may be saying to you. And so that's where I see simulation creating an opportunity to

[30:27] really support those goals of communication. And clinical judgment and developing empathy,

[30:36] you know, those soft skills that we've learned through our practice and through our experience and really creating a safe place for that to happen.

[30:45] And one that can be evaluated, you know, the one that can be measured,

[30:49] one that we can learn from and improve,

[30:51] engage in deliberate practice, as I always like to say.

[30:55] Michelle: Yeah, that's amazing that the world of simulation can facilitate all those things, like the soft skills. And do you think some of that has to do with,

[31:05] like, performance anxiety maybe?

[31:09] Christy: Absolutely.

[31:09] Michelle: You know, yeah, because,

[31:11] you know, students are always so nervous about everything.

[31:15] And having to do a procedure with a real life person,

[31:20] you know, can create so much anxiety.

[31:24] And to be able to do that in a simulation setting, I think that would notch that down a little bit.

[31:33] I want to tell just a very brief but interesting story of back in the day. I like to say back in the day.

[31:43] So I went to nursing school from my ADN from 1983 to 1985.

[31:51] So it was a long time ago,

[31:52] but we didn't have any simulation back then. You know, I guess the closest you could say we had was the ResusiAnnie dolls, you know, the mom and the dad and the kid that we did, you know, our CPR simulations on.

[32:11] So in nursing school,

[32:14] we had to actually practice on each other.

[32:18] And it was really something to do that. And you gained a lot about what the patient experience was. We had to give each other injections.

[32:32] We even had to put NG tubes in each other.

[32:36] And that was a real experience.

[32:41] Christy: Uncomfortable, I'm sure. Very uncomfortable.

[32:45] Michelle: And I brought that through all the way into my pediatric days. You know,

[32:50] we would frequently have to put NG tubes in pediatric patients. And I just was like, oh, God,

[32:58] I know how, and to some of the kids, the older kids, I would say, 

[33:03] I know that this is uncomfortable because I've had one. And so that helped kind of bridge that gap.

[33:09] But simulation has changed so much. It's evolved so much.

[33:15] What do you see as the biggest challenges that simulation programs are facing right now?

[33:23] Christy: Oh, what a great question, Michelle. And I love that story because I recall, you know, we would

[33:31] I think intradermals were the only thing that we actually were allowed to do on each other.

[33:36] But we used simulation pads, we used mannequins. And I remember when I was finishing my nursing program, we had gotten our first high fidelity mannequin,

[33:48] and we were still focused on just doing a code.

[33:52] And it's a great environment. It's a great resource to do a code blue, you know, resuscitation scenario. But there's a lot more we can do with simulation today.

[34:04] And I think that's what's important

[34:06] When we think about this. Many of the challenges that we're finding in SIM centers today is a lack of space and aging equipment.

[34:16] So we have mannequins that now are maybe outside of 

[34:21] their warranty.

[34:23] They require a lot of maintenance. You know, they might be, you know,

[34:28] becoming less effective in their role because of how rapidly technology has developed.

[34:36] And we're finding that often learners, and I'm thinking of learners not just as nurses, but every member of the healthcare team has these learning needs.

[34:48] And we think about the needs of our learners as evolving and they might come at that moment.

[34:54] It might just be an emergent need for support in medication administration, for example.

[35:01] And in my experience,

[35:04] when we bring that into the simulation lab, it takes a lot of planning.

[35:09] It takes a lot of physical assets and a lot of equipment that may be disposable and therefore causing an additional cost.

[35:18] So one of the things that we're finding is that it's about timing, it's about budgeting, it's about resources,

[35:26] and it's also about the human resources to be able to administer, run simulations for these purposes. And so that's really what was the impetus for me to join UBIsim.

[35:39] And our virtual reality simulations really address a lot of,

[35:43] really all of those issues so well.

[35:46] And that's kind of what's exciting.

[35:49] Not only in clinical,

[35:51] where we have those clinical shortages, faculty shortages,

[35:55] there's a huge need for experiential learning. And that is across the board that, that follows us throughout our careers. Right. Because as you said, when you're doing those,

[36:05] code scenarios, we need something to work on. Right. But we also need to understand the process of doing that.

[36:12] So the way that I see simulation today,

[36:16] and virtual simulation is not really replacing the educator, it's not replacing everything that we've always done. It's amplifying the impact of our simulation centers. It's amplifying the impact of the individual educator, the individual nurse.

[36:34] I suppose full circle for me, because that's where I started. I wanted to amplify the impact of,

[36:40] of what a supportive nurse colleague could be.

[36:45] So I think that's one of the greatest benefits that we see is not only creating a safe space,

[36:51] but also a space that adapts and personalizes the experience for the learner while being able to truly measure that competency attainment, that clinical judgment that we so desperately need 

[37:07] to support in our nurses.

[37:10] Michelle: Christy, is technology like AI, is that affecting simulation?

[37:16] Christy: Absolutely. I'm so glad you asked. So AI, as we know, has been a huge talking point over the last several years.

[37:25] And what we're finding is that nurses need to be prepared to utilize AI in practice, and that's becoming an expectation.

[37:34] So in our study, we interviewed nursing leaders, hiring managers and those folks,

[37:40] and we wanted to find out, you know,

[37:43] why is it becoming hard to find practice-ready nurses?

[37:47] Because we found that 65% of them said it's harder today than it was three years ago to find those practice-ready nurses.

[37:56] And part of that is readiness for using tools like AI.

[38:02] So a lot of the things that we're finding have to do with a lack of experience,

[38:07] using those previously,

[38:10] working in interdisciplinary teams,

[38:12] being able to perform clinical judgments in a fast paced environment,

[38:18] and also having enough of that simulation practice in order to feel confident going into those experiences.

[38:26] They're telling us that AI is becoming a part of everyday nursing and so it can be intimidating to new graduates and experienced nurses, right?

[38:37] We aren't at a place where we have an overabundance of nurses,

[38:42] right?

[38:43] And so finding a way to support nurses and keep them in practice, and not only keep them there, but help them feel competent and confident in what they're doing.

[38:54] We can incorporate things like AI into our teaching and into our simulations to provide even that individualized feedback, that unique experience,

[39:05] but to also be able to look at what are the performance metrics, for example, that we're looking for in simulation. Because let's be honest, we don't just go play in the lab, right?

[39:17] There's gotta be an outcome, there's gotta be a return on investment.

[39:21] And one of the things that we're finding is that by using simulation and embracing the power of AI in a intentional way, in a way that, you know, we're creating some of those guardrails because at the end of the day, we still need nurses and we need educators and we need people behind that technology so that we have a good outcome with it.

[39:47] We can really use AI as a tool,

[39:51] as a way to enhance the experience and allow for more practice reflection, growth and improve safety, really, because we can repeat it over and over and over again until we've got it down.

[40:07] And that's one of the things that our learners are looking for, right? Our nurses want to be able to do this,

[40:14] you know, jump in, you know, take on a break in a conference room or something,

[40:20] you know, jump into a scenario and practice that new skill or that process that maybe you haven't hung blood for a little bit. Maybe you want to practice that before you go hang some blood, you know, whatever it may be, you know, allowing the learner to kind of help with that.

[40:36] And AI can help provide those reports as well,

[40:39] you know, letting us know where are our gaps, if you will, or where are opportunities for improvement.

[40:45] So I know that was a long answer, Michelle.

[40:48] Michelle: No, it's, it was,

[40:50] was everything needed to be said there. And I think exactly as you said, AI is here to stay and it's here in nursing, in medicine, in health care.

[41:02] And it is a tool and we have to learn how to use it,

[41:07] you know, to its best ability and to,

[41:11] to its greater good, if you want to say that.

[41:15] So yeah,

[41:16] let's talk about balance. Christy,

[41:19] you've been both a nurse and an educator.

[41:22] How do you keep the human side of nursing alive when so much of our focus is on efficiency,

[41:30] metrics and outcome?

[41:33] Christy: So my background is in oncology and palliative care, so I always feel that I was infused from very early on that it's about body, mind and soul.

[41:43] So we have to care for ourselves right, before we can care for anyone else.

[41:47] And one of the interesting things that I'm seeing in practice is the use of technology as a way to help us find that well being and find that ability to center, even if it's a meditation.

[41:59] You know, I know many folks, you know, have apps on their phones and, and different tools that they use to kind of help create that centering, that mindfulness in our practice.

[42:11] And I think that it's an important thing to incorporate in our everyday,

[42:16] not just when we're at work. Right.

[42:18] But it's important to do it while we're at work and not just on vacation. 

[42:26] So I find that for me the best way to,

[42:32] to really show up, I guess in the best, in the best way that I can and,

[42:38] and that will result in better outcomes, better metrics because we're focused, we're intentional and we're cared for.

[42:48] And I think there's more and more of this emphasis in our,

[42:53] our society, but also in our health care systems to take care of that nursing workforce. And I know many of our organizations, our nursing organizations are including this in full day conferences,

[43:04] right. All about well being.

[43:07] So I, I think the metrics are necessary because at the end of the day it is a business. Right?

[43:13] If we don't have a

[43:18] funded organization, if we can't support 

[43:22] the ability to deliver that care, the care is no longer going to be there.

[43:27] So how we can be most efficient with that, I always think,

[43:30] how can I be, do the best work I can with the resources given to me?

[43:35] And I've done a lot of fundraising for community organizations and healthcare.

[43:40] And a lot of that I think about is when I choose a charity, I think about where are those funds going and how are they really helping the people that need them the most.

[43:51] And I think that's true in our, our health system.

[43:55] How are we using those resources, nurses included,

[43:59] to the best of their abilities, but in the most appropriate, I don't know if that's the word, but to achieve the outcomes that we want to.

[44:09] And those are not just monetary. Right. They are in the health of our communities. You know, I think the sign of a good health system, a healthy community,

[44:19] is kind of that result.

[44:23] So give me a little philosophical here on kind of how it all comes together, but I think that there's more to it than numbers,

[44:31] certainly.

[44:32] Michelle: Yes, you're absolutely true. And the numbers, you know, as you said, they have to be there. We have to have outcomes, we have to have metrics, all of that. But also to your point,

[44:45] it has to start with recognizing the individual.

[44:51] And the individual has a responsibility to themselves to be the best individual that they can be.

[45:00] And however they do that, whether that's through mindfulness meditation,

[45:05] however they care for themselves,

[45:08] you know, that's gonna be up to them.

[45:11] And really how we care for each other too, because we're a community and,

[45:16] you know, 

[45:18] we have to be there for each other. We primarily need to take care of ourselves, but we also have to make sure that our colleagues are cared for.

[45:28] and that makes those metrics and those outcomes so much better. Right?

[45:34] Christy: Absolutely.

[45:35] You made me think of something as we've talked so much about simulation and technology,

[45:41] and I think one of the things that we often forget is when we use those technologies,

[45:46] we're using that to support us in building empathy,

[45:51] in reflecting on that care. And that also is internal. You know, the first question I ask my learners when we leave a simulation is how do you feel?

[46:01] Because it matters how you feel after that situation. The same is true when I've been in a code blue situation.

[46:08] You know, the first thing you want to think about is, okay, let's just pause for a moment. How am I feeling now? We can analyze the situation and so we use, you know, structured debriefing methods.

[46:18] We, I personally have used both debriefing for meaningful learning and the Pearls method of debriefing.

[46:25] Both of these target that first, you know, how did I feel?

[46:28] And then I can analyze. Now let's look at what happened.

[46:32] And then what could we do better next time?

[46:35] How could we improve this process so that we have the same outcome if it was positive or an even better outcome?

[46:43] And that's really, I think, where the learning happens for us as we go through our careers. Right. The more we've gone through this, the more we're able to separate.

[46:53] Okay, first I feel. And then I can learn, you know, what am I learning from this?

[46:59] Michelle: I think that's a brilliant approach because, you know, in the debriefs of old, you know, going back years and years ago,

[47:08] nobody ever asked that question, how do you feel?

[47:11] I was talking about this the other day. They were sort of punitive in nature. You know, what did you do wrong? Why didn't you do that fast enough?

[47:19] Why didn't you do that at the prescribed time?

[47:23] But nobody ever approached the question of, how did that make you feel?

[47:30] And I think I'm hopeful that those things are changing.

[47:36] And you just talked about it, and so,

[47:38] you know, bravo.

[47:40] That's fantastic.

[47:43] Okay, so looking forward, Christy, what's next for you?

[47:47] I think I read something somewhere that said you might be in a psychiatric mental health nurse practitioner program.

[47:58] Christy: Yes. 

[48:00] That's interesting.

[48:01] So, yes, I was interested in psychiatric mental health,

[48:06] and I'll tell you,

[48:09] really kind of a personal journey.

[48:12] My father passed away just under a year ago.

[48:17] And when I was, I took a step back and I took some time off to care for him.

[48:23] And in that time, I was like, well, where do I want to spend some of this effort? And I've really found that through support groups and through those conversations with skilled counselors and professionals, that you can really have meaningful growth during times of struggle and challenge.

[48:47] And you can also say it's okay to not be okay.

[48:51] And opening up some of those conversations was something that's important to me.

[48:58] Right now, I am kind of excited about where we're going with some of the.

[49:05] The work that I'm doing, you know, in virtual reality.

[49:08] How can we use virtual reality to support mental health?

[49:12] You know, how can we create opportunities for better understanding those who may be experiencing mental illness or having challenges that,

[49:23] you know, a complicated grief process or managing loss, those sorts of things?

[49:29] So I'm really excited that I've had an opportunity to kind of see all sides of the situation, right? I've had the opportunity to be the nurse. I've had the opportunity to be the patient,

[49:42] and then I've also had the opportunity to be the caregiver.

[49:46] And so that has given me a really unique perspective, I think,

[49:51] not only in my own personal growth,

[49:54] but also professionally being able to bring that perspective into those situations that are meaningful to others and helping develop those skills. And I say this as something to keep in mind.

[50:07] You know,

[50:08] We've talked about all these technologies and stuff that, that can help support this,

[50:14] but truly we can enhance that clinical judgment process using some of those AI technologies to really target, okay, here's the patterns that I noticed in your responses.

[50:27] Here are some of the things that 

[50:29] really showed up frequently in the conversation and that can

[50:36] support that deliberate practice, that intentional improvement process,

[50:41] but also metacognitive growth, which has been something of interest to me over the years. You know, how do I see,

[50:48] how I look at and think about things?

[50:51] You know, 

[50:52] What do I think about my thinking, what do I think about that process? And to me, that has been part of my healing.

[50:59] But, but introducing that into these resources, that it's not just about the task, right? It's not just about starting the IV. It's understanding why that person needs the IV and the experience that getting that IV has on them and what that feels like for you as the person,

[51:17] you know, placing that IV.

[51:19] So to me, I wanted to make it as painless as process as possible,

[51:23] as quick as possible.

[51:25] And so that's why I want to make sure that I'm using the right tools, the right resources,

[51:31] and doing it for the person who needs it. Not just, you know, to say, hey, I got another one.

[51:37] You know,

[51:38] not that we don't like to celebrate those victories, but there's more to it, I think,

[51:44] and I think that gives us an opportunity to step back and say, okay, so what am I saying here? What am I doing and how is that affecting me and the people I work with?

[51:55] Michelle: Well, first I will say I'm sorry that you lost your father.

[51:59] And,

[52:00] you know, I think it just. You're so well rounded. I will say that because you've had so many experiences and what you've done is you've brought all of those human experiences with you into everything that you do for 

[52:17] Yourself,

[52:18] for your colleagues, for your students.

[52:22] And I just, I think that's amazing.

[52:24] And I think that that, again,

[52:28] is a superpower that nurses have.

[52:33] And I love that everything you do, you're bringing the human component into it.

[52:38] And that's how it should be because nursing is a human endeavor.

[52:45] And I just, I love what you're doing and I think you have such a bright future. I have interviewed now, I think, three psychiatric mental health nurse practitioners, and I've said to every one of them that if I had known this specialty was out there,

[53:02] I would have been so there. I think it's, I just, I think it's fantastic.

[53:08] So I'm excited for you.

[53:10] I know that there are going to be people that are going to have questions, Christy. So where can they find you?

[53:18] Christy: Well, thank you so much. I would love to continue the conversation with anyone who's interested. I think the easiest place to find me is on LinkedIn at. I'm under Dr. Christy Heid.

[53:29] C H R I S T Y H E I D and I'm also available at Cheid@bster.com. I'm always happy to connect and I'm happy to share some of that.

[53:41] The contact information with you and the reference, I believe would be exciting to hear what folks think about this latest research that we're finding about practice readiness. So I'd love to share that with your listeners as well.

[53:55] Michelle: That's great. Yes, we will put all those in the show notes. Rebecca can send those to me.

[54:00] And we definitely want to make sure the conversation continues because this has been so much fun. And I want to thank you again for reaching out.

[54:09] I think your message about innovation grounded in empathy is going to just resonate with so many of us.

[54:19] So thank you, Christy, again for being my guest today.

[54:24] Christy: Thank you, Michelle. It's my pleasure.

[54:27] Michelle: Well, reached the end and so we're at the last five minutes. And so if you know anything about the Conversing Nurse podcast, at the end, we have this fun little five minute segment called the Five-Minute Snippet.

[54:42] So are you ready to play?

[54:44] Christy: I am ready, Michelle. I've been looking forward to it. Yay.

[55:29] Michelle: All right. If nursing simulations came with a soundtrack, what song would play every time a student nails their scenario?

[55:41] Christy: Oh, my goodness. What song would they play?

[55:44] Would they hear?

[55:46] I feel like it would be the theme song from Rocky or something.

[55:50] You know, where they're at the top of those stairs and they're just like.

[55:55] Michelle: Oh, yeah, that's exactly right now.

[55:57] Christy: Yes.

[55:58] Michelle: That's awesome. Okay.

[55:59] Christy: Because I always said if you make a mistake, you learn from it, you're still successful.

[56:04] Michelle: Yes, absolutely. Okay. If you could create a simulation for any real life situation outside of nursing, what would it be?

[56:16] Christy: Well, that's really interesting. A simulation outside of nursing?

[56:20] Michelle: Yeah.

[56:20] Christy: Like.

[56:21] Michelle: Like grocery shopping etiquette or

[56:24] Christy: That's exactly where I was thinking, Michelle. I was thinking the grocery store.

[56:28] I was literally thinking of the grocery store. I'm thinking, you know, how do you go in there and get out of there with only what you intended to buy?

[56:36] Like, I think that's the challenge. It's not going in and just, you know, finding what you need. It's only what you need, not the rest.

[56:43] Michelle: Exactly.

[56:44] Christy: Right. Yeah.

[56:45] Michelle: Okay. Which would you rather have as a co-instructor, a very dramatic mannequin, or an overly confident AI Assistant?

[56:57] Christy: I think I would have a lot of fun with the overly confident AI assistant because I would like to challenge the assistant and what they actually know about the human response.

[57:09] So I have a lot of fun with AI. I've had the great pleasure of working with our sim committee at ODIN, and we do a lot with AI and so we try to break it a lot of the time.

[57:19] So I think that would be my answer.

[57:21] Michelle: Love it. Love it.

[57:22] I can't wait till my brother Chris hears this episode.

[57:26] My brother has been a guest on this podcast for three or four times now, and he's a researcher,

[57:33] and he likes to say that he's,

[57:37] What does he say? Shoot.

[57:39] He loves AI,

[57:41] man.

[57:42] It's escaping me right now, but anybody talking about AI, he's going to be all over it.

[57:48] Okay, if your coffee mug could talk during simulation debriefings,

[57:54] what would it say?

[57:56] Christy: It's time for a refill.

[58:00] I think I go through quite a bit of coffee, and, you know, debriefing is one of those things that I think I could do all day, but my learners have other things to do.

[58:10] So I think, yeah, we, you know, if I'm caffeinated enough, it'll go a little bit, you know, I want to stick to that schedule. It's real important.

[58:19] Exactly.

[58:20] Michelle: Okay, last question. Let's say your mannequins could talk during a scenario. What do you think they'd say to the students halfway through a code blue?

[58:31] Christy: Oh, my goodness. What would they say? I wanted to say, am I going to live?

[58:36] Michelle: My chest hurts.

[58:38] Christy: Exactly.

[58:40] So, yeah, I think it'd be pretty interesting to hear the feedback, you know, because, you know, the patient's unconscious. Right. The mannequin's unconscious during that experience.

[58:49] So I think it would be a lot of the simulators that we use now to say, you know,

[58:55] you know, push harder, deeper, faster, you know,

[58:59] staying alive.

[59:00] The songs that we sing to keep on pace. So, yeah, it would be a coach.

[59:06] Let's say that it would be coach.

[59:09] Michelle: Christy, you did so good during the five minute snippet. Thank you 

[59:13] For indulging me.

[59:15] It's always fun. It's always fun to let our hair down a little bit after we talk about so much serious stuff. So I appreciate it.

[59:23] Christy: Great question. I appreciate it, too.

[59:25] Michelle: Yes. Well, thank you so much again for joining me today, and I hope you have a wonderful rest of your day there in Ohio.

[59:33] Christy: Thank you so much, Michelle. It's been wonderful.