Nursing Virtual Simulation Oxford Medical Simulation
Nursing Virtual Simulation Oxford Medical Simulation

The NHS has a nursing crisis

Across the UK there is a shortage of more than 100,000 staff, with a massive 36,655 vacancies for nursing staff in the NHS in 2020.

According to the Kings Fund, this shortage represents “a greater threat to health services than the funding challenges” with the RCN adding:

“We don’t have enough nurses to keep all our patients safe” Dame Donnar Kinnair

In response to shortage, two related events have occurred.

Firstly, the government releases a £15m fund for simulation. Secondly, simulation has been accepted as a replacement for clinical hours.

This piece covers both of these developments.

£15m Fund for Simulation 

In March 2021 the government announced that £15m would be awarded to English universities to invest in new simulated training facilities and technologies for nursing and other health students.

“Examples given by the government for what the funding could be spent on included virtual reality technology, manikins, role play activities, and smartphones, tablets or computers”, according to the Nursing Times.

Simulation for Clinical Placement Hours

In January 2021, revised NMC Recovery Standards were introduced. These state that “the amount of practice learning time spent in simulated practice learning experience can be up to a maximum of 300 hours across a programme’s duration.”

These standards were designed to help manage the backlog of nursing students who require placement activity. With an increasing need for new nurses in the face of clinical placement capacity issues, it it likely the standards will be in place for several years, if not indefinitely.

“We know that simulation can be an effective alternative way of learning and can be a more flexible practical learning tool to support students in progressing their studies” Mike Adams, RCN Director

As such, there is now a clear mandate to use simulation in place of clinical hour replacement, so the next question is, ‘can I use virtual simulation for clinical placements?’

Can I Use Virtual Simulation for Clinical Hour Replacement?

The answer to this question comes from a number of sources, and is resoundingly: ‘Yes!’

To emphasise this virtual reality was noted in the release comments…

“Examples given by the government for what the funding could be spent on included virtual reality technology” Nursing Times

…and this has been backed up from various sources.

From the NMC: “Simulation is defined as an artificial representation of a real world practice scenario that supports student development and assessment through experiential learning with the opportunity for repetition, feedback, evaluation and reflection.” This definition firmly encompasses VR simulation.

This is acknowledged in the HEE Simulation Strategy 2020: “Evolving technologies, such as virtual reality, allow learning to be self-guided and personalised, deliverable on a larger scale and hence more efficient in terms of time and cost”

From HEE East of England: “The various types of simulated experiences include: 1. Simulated patients; 2. Manikins; 3. Virtual reality simulators. 4. Wet labs; 5. Bench-top skills trainers

As such, VR is considered a valid tool for delivering simulation, and the NMC clearly give universities the freedom to use as they see fit: “Approved education institutions (AEIs) can chose how best to apply this recovery standard…”

Clinical hours replacement with VR simulation
Clinical hours replacement with VR simulation

How Much Time in Virtual Simulation Equals Clinical Experience?

Now that we’ve established virtual reality simulation can be used to replace clinical hours, the question comes to how many clinical hours can be replaced with virtual simulation. 

The answer to this depends on the source of virtual simulation, the resources provided before and after and the structure in which the scenarios are implemented into the curriculum.

Nurse Educator Molly Schleicher notes that, using one OMS Nursing scenario:

“The 2 hour virtual simulation experience (based on a 20 minute scenario run twice with structured prebriefing before and debriefing after) would equal 4 hours of clinical time.”

This involves the scenario, virtual debriefing and use of deliberate practice and is based on the INACSL Standards of Best Practice. A full breakdown of how to structure learning to meet these requirements can be found here: Using Virtual Simulation to Replace Clinical Hours


Therefore, despite the huge pressures put on nursing schools recently, it has spurred positive action: the government is encouraging significant investment in simulation; virtual simulation is considered a valid approach; and there’s an acknowledgement nationally that VR “allows learning to be self-guided and personalised, deliverable on a larger scale and hence more efficient in terms of time and cost”

If you are interested in how best to implement VR simulation – please get in touch with one of our educational specialists, we’re happy to help!



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