One of the challenges in nursing education is infusing the student nurse with the knowledge, the experience, and the confidence to successfully leverage clinical reasoning, clinical decision-making, and prioritization of care.

Employers Know Exactly Where Novice Nurses Need More Support

As an educator with over twenty years in academia, I have seen firsthand how nursing students struggle with the nuances and cues that inform clinical decision-making. Simply put, current nursing education is often deficient in translating theory into everyday practice, carrying through to daily essential skills that include tending to basic patient needs, staying organized on the floor, and even anticipating potential risks and their consequences.

In 2017, I completed a study with a colleague where we sought to characterize nursing education deficiencies in the workplace, attempting to pinpoint precisely where further educational support could be most beneficial. We found employers knew exactly where their novice nurses were deficient, and that it was consistently the same areas: attending to risk consequences, and prioritization skills (Gonzalez and Allred, 2017).

Novice Nurses Use Rules Where Experience Falls Short

Student nurses and young career nurses prefer rules over intuition and insight. Rules are reliable in ways that their experience is not (yet).

For that reason, the nursing process remains as relevant today as it did 50 years ago. It provides a guiding framework to aid the nurse in the decision-making process, and help them both develop and adapt even in times of crisis and heightened patient risk.

When in doubt we can always assess.”

Having facilitated hundreds of hours of nursing simulation, I can attest that when students are not sure what their next steps should be, rechecking vital signs is an easy fallback. Their job becomes exponentially more challenging when a decision needs to be made in light of patients’ deteriorating conditions.

How Do We Prepare Nurses for Real World High-Risk Patient Situations?

A critical component of the decision-making process is the rationale behind the decision, choosing the correct intervention for the right reason.

Within nursing education, insights into student rationale affords the educator a glimpse into the nursing student’s thought process and provides an opportunity to help the learner reframe their decisions.

The unfortunate reality, however, is that due to factors like clinical shortages, clinical decision-making and prioritization of care are often learned passively and without intentionality.  There is research to suggest that novice nurses do not have the sound clinical judgment to practice safely (Hensel & Billings, 2019). Hensel and Billings (2019) recommend the use of simulation and clinical scenarios to foster clinical judgment—and they are not alone.

Jessee (2019) points out that learning to successfully manage one patient is unrealistic when applied to the clinical setting with multiple complex patients. Modifications are needed to existing curriculum and courses in favor of intentional activities to develop critical decision-making and prioritization of care.

The use of simulation and unfolding case studies are effective in prioritization skills (Hensel and Billings). These intentional activities allow the learner to reflect on their decisions without fear of harming a patient. The delivery of real-time feedback allows for maximum situation learning and improvement, while also providing the safest space for students to practice (and for patients, who run no risk in these simulation environments).

Serious Gaming: The Latest Enhancement for Nursing Education

In a recent study, Harder et al. (2019) created simulations to use in a non-manikin learning activity suggesting there is more than one way we can foster the development of prioritization skills.  One such way is through the use of serious gaming.

Serious gaming in healthcare education is a relatively new concept. Serious games are developed with a purpose other than entertainment such as teaching specific knowledge or skills. Wang et al. (2016) define a serious game as one that includes challenging goals, scoring, and an engaging design.

Serious games have been shown to increase learner satisfaction, they are self-paced, allow for repetition and provide immediate feedback (Olszewski and Wolbrink, 2017). Gaming naturally drives students to compete—even if “just” with themselves—and better themselves.

Games are natural avenues for self-motivation, which means that they can be used as educational tools that serve many types of learners, not just the most independent self-starters. Games exist in other parts of life, and so there is even less onboarding time to explain how they work to students and faculty; success is easier to define and speak of when it comes to games, and so learning teams can hit the ground running with them.

Gamification has been characterized as an effective pedagogic methods across a broad range of disciplines; nursing education is no different.


Here at Sentinel U, we have developed the Prioritization of Care specialty series which is built with serious gaming concepts in mind.  The learner is presented with multiple patients with robust backgrounds and details that the learner will need to prioritize care and nursing interventions for?. The interventions are evidence-based and feedback is provided with scores.

The Sentinel U Prioritization of Care product is scalable, providing the most convenient method for nursing students to intentionally learn priority skills and decision-making.

Learn more today about how you can quickly build the best solution for your team to hit the ground running with on-demand mastery of clinical nursing skills.



Hensel, D., & Billings, DM. (2020). Strategies to teach the Nationl Council State Borad of Nursing Clinical Judgement Model. Nurse Educator, 45(3) 128-132 doi:10.1097/NNE0000000000000773

Gonzalez, L. &  Allred, K. (2017). A collaborative approach to simulation development. BMJ Simulation and Technology Enhanced Learning;3:159-162

Olszewski, A. & Wolbrink, T. (2017)  Serious gaming in medical education. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 12(4) 240-253 doi: 10.1097/SIH.0000000000000212

Harder, N.,  Stevenson, M.  &  Turner, S. (2019).  Using simulation design characteristics in a non-manikin learning activity to teach prioritization skills to undergraduate nursing students. Clinical Simulation in Nursing, 36, Pages 18-21,

Wang, Ryan BA; DeMaria, Samuel Jr MD; Goldberg, Andrew MD; Katz, Daniel MD A Systematic Review of Serious Games in Training Health Care Professionals, Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: February 2016 – Volume 11 – Issue 1 – p 41-51 doi: 10.1097/SIH.0000000000000118