UTC Doctor of Nursing Practice students Alexis Murray (blue scrub cap) and Sabina Dukic (right) work with Erlanger nursing residents during a clinical simulation collaboration. Photo by Angela Foster.
A patient arrives with abdominal pain but doesn’t think it’s anything serious. A nurse begins an assessment. A provider is called in. What follows depends not just on clinical knowledge but also on how clearly information is shared and how confidently roles are carried out under pressure.
That dynamic drove a full-day collaborative simulation focused on communication and patient care across clinical settings, held Jan. 21 at Erlanger’s Holli Counts and Joseph Grendys Simulation Center.
The simulation paired University of Tennessee at Chattanooga Doctor of Nursing Practice students and Erlanger nursing residents at the start of bedside practice, giving both groups space to step into unfamiliar roles and work through clinical decisions in a controlled environment.
Six UTC DNP students—two from the Family Nurse Practitioner program and four from the Acute Care Nurse Practitioner program—rotated roles throughout the day as Erlanger nursing residents worked alongside them through a scenario that moved from the emergency department to the operating room and then the intensive care unit.
UTC Doctor of Nursing Practice student Alexis Murray points to a monitor while two Erlanger nursing residents observe during the simulation collaboration.
The collaboration marked the first time UTC advanced practice nursing students and Erlanger nursing residents had participated together in a simulation of this scope. The simulation was developed and led by UTC College of Nursing Assistant Professor Chris Doneski.
“There’s a lot of research and evidence on the transition from nursing graduates to early-career nurses, and there’s a lot of research on the transition from a bedside nurse to an advanced practice registered nurse—or APRN—but there’s not really anything that looks at how we come together to build teamwork, confidence and communication between those roles,” Doneski explained. “We’re trying to see if this is an area where we can really hone in on some of these skills that we might not necessarily get until we are actually out in practice.”
From Erlanger’s perspective, the collaboration addressed a common challenge for nurses early in their careers.
“I think it’s really important for the nursing residents to do this because it’s going to expose them to communicating with providers,” said Samantha Calhoun, nurse residency coordinator at Erlanger. “Communication is key when we’re in health care, and it’s something they’re really nervous about when they first come out of school.
“This is giving them a safe environment to test that out, to learn, to be able to have discussions with providers in real time.”
Calhoun said the partnership with UTC added an important layer to the experience.
“These nurse practitioner students are in their senior year; they remember being here and they’re able to really sympathize and help them through that process,” she said. “I think it’s great that our nursing residents get to see some possible new career opportunities in the future if they decide to go into graduate school.”
UTC Doctor of Nursing Practice student Brooke Williams, playing the role of a provider, speaks with two Erlanger nursing residents.
Throughout the day, the participating UTC students—Family Nurse Practitioner students Brooke Williams and Amanda Rice and Acute Care Nurse Practitioner students Alexis Murray, Travis Wright, Sabina Dukic and Allison Kiemeyer—rotated roles, sometimes serving as providers, sometimes as patients and sometimes as observers.
During the first several emergency department simulations, Williams played the role of the provider while Rice was the patient.
Williams, on track to graduate in May as part of the first cohort to complete UTC’s Family Nurse Practitioner DNP program, said experiences like this have been central to her development.
“I think they’re invaluable,” said Williams, a native of Nashville. “I think it helps us go in and do better assessment skills. I think it helps us engage with patients and communicate more effectively—and know what questions to ask.”
She said repetition and realism are what make simulation effective.
“I can tell you that simulations such as this really helped me to be in a real-life situation,” Williams said. “That way I can calm down and remember the things that I know that I know because we’ve practiced it so many times.”
Williams brings a wide range of clinical experience to the Family Nurse Practitioner program. Her nursing background includes pediatric emergency medicine, mental health care at Moccasin Bend Mental Health Institute and pediatric home health. She also works as a sexual assault nurse examiner with the nonprofit Partnership for Families, Children, and Adults, and serves as a part-time clinical adjunct instructor at Chattanooga State Community College.
She said the simulation’s structure allows students to take risks without lasting consequences.
“It’s a safe space,” Williams said. “It’s OK to mess up here, but when you get in the real world, you want to try your absolute best for everything to be clinically sound.”
Rice has been a nurse for nearly 16 years, beginning her career in medical-surgical nursing before transitioning into public health. Her professional background includes extensive work in women’s health and sexual health, and she is trained as a sexual assault nurse examiner.
The Ringgold, Georgia, native said the experience brought back the early days of her own career.
“Just remembering what it’s like to be a new nurse is so important,” Rice said. “Everybody starts somewhere.”
She pointed to the shift that occurs when nurses move into advanced practice roles.
“Learning how to communicate between teams is especially important,” Rice said. “For someone like me transitioning from a nurse to an NP … I’m so used to doing things myself because that’s what I do as a nurse. Now, I’m learning how to delegate.”
Assistant Professor Chris Doneski leads a debriefing session.
For Doneski, the debriefing that followed each scenario was as critical as the simulation itself.
“That’s where a lot of the learning happens,” he said. “We talk about what went well, what didn’t go well, how it made them feel and how that translates to real practice.”
He said those conversations also provided something that can be hard to capture in a busy clinical environment: perspective.
“You’re getting multiple viewpoints from different roles,” Doneski said. “That’s something you don’t always get when things are chaotic and busy in the hospital.”
That perspective was echoed by the UTC students.
“I think just remembering how we felt when we were new nurses,” Dukic said during one of the debriefings. “For me, it’s remembering that if you have a new nurse, this may be their first time doing this. They’re not going to know all the things. Give them some grace.”
She also reminded the nursing residents sitting across the table from her that confidence matters in patient care.
“Just remember your patient doesn’t know that you don’t know things,” Dukic said.
UTC Doctor of Nursing Practice student Allison Kiemeyer role-plays a surgeon while DNP student Travis Wright manages airway support in the simulated operating room.
Calhoun, who observed the simulations throughout the day, said she saw value from an educator’s standpoint.
“Watching the nurse residents interact with their providers will help me guide them on education in the future as far as where they might be lacking in communication,” she said.
Both UTC and Erlanger see the collaboration as a foundation for future partnerships.
“Definitely,” Calhoun said when asked if she would want to do more simulations like this. “I would love to.”
Doneski said early feedback from the pilot suggests the approach is worth continuing. He said the experience also helps inform what future interprofessional simulations could look like as UTC prepares to open the new Dorothy and Jim Kennedy Health Sciences Building, located a short drive down 3rd Street from Erlanger.
“As this grows, we’ll be more impactful,” he said. “We’ll be able to pull in more roles, get different viewpoints and continue to build on what we’ve seen really works.”
The simulation experience at Erlanger, he said, reinforced a simple but essential idea: patient care improves when communication is intentional, practiced and shared.
“It’s all just planting a seed and watching it grow,” Doneski said.
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Dorothy and Jim Kennedy Health Sciences Building
Photos by Angela Foster
UTC Doctor of Nursing Practice student Amanda Rice, center, plays the role of a patient.
