The VA Roseburg Healthcare System's (VARHS) Nurse Mandi Day (NMD) event has traditionally been the educational model for assuring nursing personnel's technical competency.

In its design, NMD is an opportunity for nursing personnel to participate annually in activities involving sustainment of healthcare skills and development of critical thinking. NMD previously utilized poster board presentations, written tests of the nursing staff's knowledge of critical skills and informational videos — but little in the way of interactive learning.

In 2014, simulation task trainers were introduced into NMD for individual skill competencies such as: management of enteral feeding tubes, care of Foley catheters, vital signs and a Geri-Manikin was utilized for applying physical restraints. There was overwhelming approval by the nursing staff for the progressive simulation modalities. This feedback supported leadership decisions to advance NMD into a more complex and comprehensive simulation environment.

Prior to the education department's implementation of the revised 2015 NMD, several hands-on safe patient handling (SPH) simulations occurred using an employee wearing a bariatric suit. Accompanied by the facility's SPH coordinator, the employee serving as a "standardized patient" for the scenario received assistance from the Community Living Center's nursing personnel when found on the floor.

SPH tools utilized during the session included a hover mat, ceiling mounted lift assembly and hover jack. Role play of real-life scenarios reinforced SPH strategies associated with managing a bariatric veteran. Throughout the simulation, special emphasis was placed on team communication and coordination, along with patient and staff safety.

Data from the SPH simulations supported the continued integration of simulation into NMD. Participants' feedback indicated that the SPH bariatric simulation event was informational and applicable to everyday situations.

Many of the staff also stated that the hands-on training was more effective as an educational method than traditional training involving PowerPoint lessons, posters and classroom discussions. Sample comments from the nursing staff included:

• "Excellent demonstration, and I learned a lot."
• "Hands-on training is always best for me to remember."
• "I like this because it's easy and more safe for patients."

Low- and high-fidelity manikins were utilized in the patient care settings. Lifelike wall murals were hung to create a realistic backdrop.

Successful efforts within nursing healthcare teams often begin with the integration of theory, practice, expert knowledge and simulation-based education.

Dr. James Hay, associate chief nurse executive for education and informatics, applied his research in healthcare simulation as a model for designing the new NMD system at VARHS. Under Hay's direction, the education department reassessed the NMD training format, identified ways to meld core competencies as objectives within simulation scenarios, and developed a progressive vision of simulation for the nursing staff.

The VARHS education department, quality management department, and inpatient clinical nurse leaders collaborated to create a new, lighter and faster model of NMD. Even though the traditional format served many purposes, integrating a simulated, immersive-learning environment into NMD created an exciting change for VARHS nursing staff.

To aid in a smooth transition of the new design, education staff and inpatient clinical nurse leaders worked with nurse managers to solicit feedback and coordinate teams of nursing staff to both facilitate and participate in scenarios. A total of 58 VARHS nursing staff from a variety of care areas including emergency department, community living center, dementia protective care unit, acute medicine unit, patient-flow coordination team, inpatient mental health, operative care department, ambulatory care, and nursing administration attended the first two-day period.

Simulation scenarios engaged staff in realistic experiences from one of three different perspectives of veteran care (ambulatory care, mental health, inpatient care). The foundation for each scenario was built upon five standardized objectives to include infection-control strategies, skin-care procedures, standardized team communication to maintain situational awareness, and utilization of safe patient handling equipment.

Each simulation opportunity lasted approximately 30 minutes. Teams of nursing staff engaged in one scenario that included a presimulation briefing guided by a checklist, a 10-15 minute scenario and a debriefing in which the participants discussed the lessons learned.

Low- and high-fidelity manikins were utilized in the patient care settings. Lifelike wall murals were hung to create a realistic backdrop. Mobile walls subdivided a large auditorium that housed the three different patient care settings. A live actor alternated with a simulation manikin between the mental health and inpatient scenarios, providing a heightened sense of realism to each simulation.

From 58 participants, 39 provided written feedback that indicated an overall approval rating of 80 percent for the revised NMD format. Sample of the narratives written by the nursing staff:

• "I just completed Nurse Mandi Day. This year it made learning fun. Great presentation. Please thank your department for an outstanding job well done. Thank you!"
• "VARHS nursing staff recognizes and acknowledge that simulation scenario approach provides critical thinking practice and a dynamic educational training experience."

The success demonstrated by NMD has caught the attention of other healthcare organizations. VARHS has been invited to share this simulation format, covering nursing critical skills and tasks in other communities. Moving forward, the VARHS Education Department is already adapting new scenarios to enhance simulation training into future NMD, nonclinical staff trainings, student experiences and clinical staff orientation.