Trailblazing Innovation: Honoring 150 Episodes of Innovation in Nursing Education

In this milestone 150th episode of Nursing EDge Unscripted, hosts Dr. Kellie Bryant and Dr. Raquel Bertiz welcome internationally recognized simulation pioneer Dr. Suzie Kardong-Edgren. Dr. Kardong-Edgren reflects on the early days of nursing simulation, from unpacking the first manikins to shaping standards and research that transformed nursing education. She shares lessons learned from early challenges and emphasizes the importance of mentorship, innovation, and perseverance in advancing simulation practice. The conversation explores her vision for competency-based, learner-centered education and the need to retain nursing’s humanistic focus on caring and spirituality. Listeners gain insight into Dr. Kardong-Edgren’s enduring impact as a trailblazer who continues to inspire educators to challenge convention and lead with purpose.

Dedicated to excellence in nursing, the National League for Nursing is the leading organization for nurse faculty and leaders in nursing education. Find past episodes of the NLN Nursing EDge podcast online. Get instant updates by following the NLN on LinkedIn, Facebook, Instagram, Bluesky, and YouTube. For more information, visit NLN.org.

Transcript

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Welcome to this episode of NLN's Nursing Edge Unscripted. I'm Dr. Kellie Bryant and I'm joined here by my co-host, Dr. Raquel Bertiz from the National League for Nursing. Today marks a monumental milestone. This is our 150th podcast episode and we could not think of a more fitting guest to celebrate this moment than Dr. Suzie Kardong-Edgren, an award-winning, internationally recognized simulation scholar and educator. Not only has she done so many amazing things when it comes to simulation nursing education, but she's also opened the doors for many of us as a wonderful mentor and really has created the foundation of nursing simulation education. So, just to give you a little bit of her bio because it could be extensive, but this is the short version. Dr. Kardong-Edgren has authored more than 140 publications and served as a consultant on the landmark NCSBN national simulation study, which provided the evidence that up to 50% of traditional clinical hours can be replaced with high quality simulation. She's also served as the editor-in-chief of Clinical Simulation in Nursing for 10 years and has held numerous leadership roles such as past president of INACSL and chair of the research committee for Society for Simulation and Healthcare. Currently she serves as an associate professor at the MGH Institute of Health Professions in Boston mentoring the next generation of MS and PhD simulation researchers. So welcome Dr. Suzie, thank you very much. And like your 150th episode, I'm so delighted. I'm about the same age. So I like it. I like it. So I had the privilege of starting with the first question and mine's gonna be very broad. How did, what first drew you into simulation? How did you get started in simulation? Tell us that story. We had, we had a graduate program that got one of the gigantic CAE Laerdal manikins when it looked like Arnold Schwarzenegger. They did not have time to learn how to use it and it sat in the giant coffin-like box for several several months and Mindy Anderson dug it out and said, "I'm going to learn how to work this thing." And we used it in our assessment class and we wrote our first assess our first scenarios but we didn't know what we were doing and it turned out to work really well and we realized there's more we can do with this and then more scenarios started coming out. I think the first people were CAE with their giant 90 different scenarios that they had written and they were about an hour and a half long a piece if you think back that far. And they sold them, They came with the manikins. They were beautiful. But that was when we first started learning, oh, there's a whole story that goes with this and a way to teach with it. But we had no idea what we were doing, right? I think we all started that way. It all started probably with a manikin in a box and nobody wanted to take it out of the box because they were scared and didn't know what to do with it. Absolutely. Yeah. So, it's almost like accidental discovery of how well simulation works. And I think you've witnessed simulations evolution right so yeah looking back what were the most compelling milestones that you have seen in the growth of simulation education. Thank you so much for asking that question because as I think about it, I think some of the big things were, smart thing that happened is Laerdal realized they're making manikins and they asked came to Pam Jeffries and said, well, why don't you talk about using this and help us learn how to use this in nursing. And she wisely she looked around she said, there's nothing written about this. She did her Jeffrey's Framework, which was the road map for the rest of us to figure out, okay, how do you do this? And then the next step really were the standards and Kim Leighton was the president of INACSL when she said we've got to have some standards. So that, I think, those were critical pieces and I will note that it took until the second or third issuance of the standards that we realized pre-briefing was kind of important. But if you look back at the DASH handbook and the DASH tool put out by CMS they had pre-briefing in the very first iteration of the DASH. So they were way ahead of the game. They had already figured that out, but it took us all a while to catch up, a while to catch up with them. So, I think that was critical. And then I think when we started attending, when nurses started attending IMSH in force and that that was really the first place where IPE got to be a big thing. And when you attend IMSH, we've gone through the different parts of having RN after your name or doctor after your name, physician after your name, and now we've gone to there's nothing after your name. And I was there when the poor lady doctors when there weren't that many of them around and I sat down next to them and I'm just babbling away and they thought I was a physician. The minute they figured out I was a nurse, it was like I had cooties. Oh no. No. So, it was really funny because they had so much trouble establishing them their own professional identity as women physicians. I completely get it. But I started laughing when what happened because I thought, "Oh, I know what you're going through. I'm sorry. I tainted you." So, but we're not... It's not that way now. At least I don't feel it anymore. I think that's it's pretty cool. So, I think all of those things really contributed to how we got to where we are today. When we began, you know, using simulation, it wasn't widely accepted. I know when I started, what 17 years ago, it was a little bit taboo. And I'm sure you probably faced the same when you were starting your journey in simulation. What challenges did you face convincing others of the value of simulation? And how did you overcome those challenges? I will say I had one of the biggest screw-ups of my entire career at a place which shall remain nameless. I could I could maybe feel myself blushing because I'm going to tell tell a bad one on me. I did not understand diffusion of innovation. Or you read it but you don't realize this is when it this is when you do it. I screwed it up so badly and I also can say I somewhat fault my mentors because they did not prepare me for this. I was almost like the sacrificial lamb. I got sacrificed really badly. Having experienced that, I had to get a whole group of people on board to use simulation because we' taken whole classrooms out of the building. We gotten a huge grant. We had 20 Laerdal manikins stacked up like cordwood and we had to use them. So the powers that be said, "Okay, Suzie, your job is to go out and tell the faculty." I did everything wrong there is to do wrong. And what I should have done is read the diffusion of innovation and believe it and go out and talk to people individually before it was ever going to come to be and get them on, get them ready for what was coming, whether they were going to get on board or not, because we were going. That's not what I did. I screwed up so badly that when I had an opportunity move, I did and said, "I will never be forgotten for this. I will always be remembered that I was the one who screwed this up so badly." When I got to a new place, the story had completely changed and they were brilliant because they hired me because I was into sim. They didn't know what it was and they weren't doing it and that was fine. But the first person to come and talk to me said, "I don't know why you're here and you're trying to take my job with this plastic dummy." And I was I was shocked and taken aback and I said, "Actually, I'm trying to help you improve your job. Let me show you what it can do." So, I started with one person showing her what we could do. And I said, why don't we do a research study and see if using this is actually better than what we're normally doing now? And so I had learned a good lesson. And I will say that there is a game out there free online called the diffusion simulation game. Anybody can play it. And I found it again by accident literally 3 weeks ago as I'm writing a course that will use it in the course. And it's got all those things you really should do when you have to persuade people of whatever the next big change is going to be. If it's VR, if it's I don't know what I don't know, the holiday, I don't know what the next thing we will all be trying to get people to do is. But it is a great game and they give you all kinds of hints and help. But, anybody's going to have to make a big change, I suggest you look at that game and play it and remember what you learn because it will help you. We're going to make sure we add that link. And and Suzie, trust me, we've all been through those trials and tribulations, but I think we needed to go through them in order to get to where we are today. It was brutal. And I learned I learned I'm trainable. Yep. which is of course something that we can relate to. I can definitely relate to almost like pushing so hard that it's really difficult but I am kind of like interested in what you said about mentoring and that how do we prepare our next generation of of innovators if you will so that they would have a better experience than than us. I will tell you that I'm wallowing around in the AACN Essentials right now because I'm writing these courses for a program that uses AACN and the assumption seems to be that everybody's going to be a leader and I'm here to tell you no, they're not. We have a lot more managers because it's easier to be a manager and go along with with everybody and say the emperor is fully clothed. This is beautiful. It is a lot harder to look at things and say, "No, this isn't working." Or, "The emperor has no clothes." And I come from a family, it's just a genetic trait, if the emperor has no clothes on, we're going to say it. And that is a gift and it is a curse. Learning how to say the emperor has no clothes on in a way that people can hear it is the key. And so innovators, we probably we all find each other. We have a lot of people that are in master's programs. We have some programs that have simulation in the master's program now. But somehow those of us who are going to do well in sim find each other. And I will say that one of my gifts is identifying talent. And I can walk into a room and just observe people and I can a lot of times pick out who the talent's going to be. Walk up and start talking to them. I've got a good beat on that. But there are plenty of people who want to be, but for some reason are just not going to be or they and when people tell me I'm a mover and a shaker I'm thinking no because that's been my experience and when you tell me that you're not. You show by your action not by what you say. So, I think when we find people who are going to be innovative, we need to help nurture them. And if they're in a place that they're getting squashed, I tend to tell them, you need to leave and go someplace where what you have to offer will be appreciated. Some people can pack up and move easily and other people can't. So, what do we tell those people that are stuck? And I'm going to say, do not bend. Stick with your, stick the course, keep saying your truth, keep innovating, and eventually somebody's going to recognize it. It may be a turnover in leadership. It may be a publication that gets you so much notoriety that people can't say you're wrong. But stick with your guns. And I think that that's why I've been successful and that I've only done what I want to do and what I like to do. People told me when I first started at a school that shall remain nameless, you said you do sim, but you're not going to. You're going to do these things that you get funding, R1 funding for, and it was all kinds of stuff in nursing that I just, it just does not float my boat. I'm not interested. I care about education and producing good educators. And I said, "No, I'm not doing that." And they've never been told no before. You could tell by the look on their face. What? She said, "No." And I said, "No, I don't like that. I'm going to do this. This is my passion and this is what I will do." And I'll tell you what, it hasn't turned out badly for me. If people know you know yourself, they're going to know what they've got and they're going to either value that or they're going to force you out one way or the other. But I've been very lucky and been able to do what I want to do and it's turned out okay. and I think it will for you too. Wow, that is some pearls of wisdom there. Thank you so much for that, Suzie. I want to switch gears a little bit and talk some about your research and one of my favorite articles which I think is pivotal. People still talk about your article is the article on evidence versus eminence clinical hours of nursing education where you kind of just challenge the way that we're conducting traditional clinical and trying to get people to not focus so much on the hours but the the quality which I think is the same in simulation. So if you could redesign clinical education from the ground up what core principles would guide it? Well, we just have to academic system as we know it. Everybody's struggling with this because brick and mortar in this semester is what drives everything. If we were really if we were a forward-thinking business, we would get rid of that structure as some of the for-profit schools have that are competency based and say if I've got somebody that I can get through all clinicals, all of the the clinical skills that I want them to have in simulation in 3 weeks and then them put into clinical with preceptors where they can demonstrate in 3 weeks everything I need for them to do. We got their money for the course. They've completed the competencies. They could now move on. If I was queen, that is what I would do with the academic system today. This the we keep talking about competency based. We're not there yet. And it just breaks my heart when I look online at both the NLN and the AACN websites and they're still talking about grading, grading, grading, grading. And I'm thinking, let it go, girl. You're either competent or you're not. And grades, I think we hang on to grades because it's easy to control. competency and seeing somebody do something that demonstrates I can critically think and I can apply what I've seen is much harder to do. That is a lot to unpack. So I was just listening to what you're saying in terms of what we need to do in nursing education to really move us forward to maybe if we say concept-based education. So be it, right? But we're not there yet. So, and I know that many of us are looking at simulations and how simulations can truly move us there. So, what are your thoughts on that? I'm so glad that simulation came about. I'm so glad we're getting so much better at it. I am shocked that there are education masters out there that still do not have freestanding simulation classes. It's been about 20 years and we used to say the diffusion cycle was really about 17 years and I heard somebody say no it was actually dropped to 15 years and 3 months or something like that. Lovely, but not for simulation. So I am still devastated, appalled, can't believe that there are education master's programs that don't have freestanding simulation courses in them and that we still teach the same old stuff we've always taught in those courses. And I think it's because we've got still a lot of people and I will say it, they need to die or retire before things are going to change. And either way, let's go team because we have a lot to offer the health care industry, which is on its last legs as far as I'm concerned. It's falling apart and we're trying to give resilience to nurses to work in a system that's broken. No, we need to stop worrying about that. We need to fix the system and nursing needs his final seat at the table, not the keep wishing, keep wishing. I would really I also would love to get in there that, as I'm looking at, I don't know, I don't, I'm not that familiar with the NLN competencies but the AACN has really gone social determinants of health as has the government and nursing embraced that and I want to say that I worked with somebody years years ago who talked about where did the nursing go? Where did the nursing go as I was talking about simulation. And I thought, what is she talking old woman? What are you saying? Now I know what she was talking about. And what we're talking about is the human caring. I don't know if you know the human caring theory by Watson. But I think that what nursing used to be and was and we had those things of cultural cultural awareness, spiritual awareness for our patients, a couple others. It doesn't matter. Those are the two that really stand out in my mind. those words that nursing embraced have been co I think they've been co-opted by social determinants of health and I really don't like that and now it's become politicized, which does not help us and I think I would ask us to move back to our cultural caring our spiritual caring for our patients. And spiritual, if you really look at social determinants of health is basically kind of wiped out. I'm not a fan and I would I would say nursing please think this. Okay. As we move forward as now that old woman who said, "where's the nursing care." I'm going to say, "Where's the nursing care?" The care. Care. So we need to bring it back. I see that we only have a couple minutes left and there's so many more questions but I'm going to end on this one. When you look at your journey, your legacy in nursing. What has been the most rewarding part of that journey? I think probably the first time I was in sim and I saw the student who finally got it and had that aha moment. It doesn't get old. I think I remember the first time it happened and I was on the other side of the glass. Because I'd seen them do a lot of things that I was on the other side of the glass up against the window going, "What are you doing?" And then I saw them kind of figure it out and go, "Ah, I'm going to do this." And I thought, "Oh, this is wonderful. This is wonderful." I learned what was probably happening when I wasn't in the room at clinical with people. God knows what they were doing. So when I could see them do it in sim first and kind of can steer them in the right direction, I think we're all a lot better off. Patients, educators, and the learners. Yeah, I think we all have those stories too where, you know, students don't always appreciate simulation when they're in the moment, when they're in school. But I love when, you know, for example, you're on LinkedIn and you get this random message from somebody who graduated years ago. And I remember like I really hated sim when I was in school. But I have to tell you this story about how sim has helped me in my role as a nursing educator. If it wasn't for that diabetic DKA scenario, I would have not been able to take care of x -patient I just had last week. So yeah, I agree with you. Those aha moments or when they the students finally realize this really is making an impact. I am really learning and this is an effective way of education for our students. So thank you for that. And that is longitudinal evidence, qualitative evidence that we have not necessarily collected. And it is something that maybe is waiting there for a research study to be done. And it's going to be a really weird looking IRB, but it if you think you've got something to say that you simulation helped you in something that happened to you, an actual clinical, you know, tell us about it. That might be a really great study. Sounds like a next study for you, Dr. Suzie maybe. Oh no, no. Not for me. Yes we can definitely relate to those internal and external rewards of the outcomes our student outcomes and we will always be grateful to you Dr. Suzie, as one of our trailblazers, like I've said earlier, you had a remarkable career. It really exemplifies the power of innovation. I would say you're an innovator. I think I saw that in your profile just like, oh, she's an innovator. And yeah and of course the evidence and the mentorship that you had given us in nursing education. I for one can personally attest to that mentorship. I am Dr. Suzie's student. I'm a proud graduate now finally. She was my student. She was my student IHP. And yeah and we did talk a lot about how are we educating our future educators in simulation and yes, that's really a great learning experience for me and yeah. So you're an inspiration. So thank you for obliging us to be here and thank you. It was an honor to be asked and this will be a memorable 150th episode for us. Absolutely. And I also want to thank you, Suzie. Not only you're a trailblazer, but you are a mentor and cheerleader for a lot of us starting out in our simulation careers. And you've opened doors. You've connected people. And I just want to say I appreciate you so much. And thank you for everything that you've done when it comes to not only simulation, but nursing education. Thank you. Thank you so much. You're so kind.