When he woke, he was active and then became increasingly distressed. He thrashed violently in his bed followed by becoming completely unresponsive. I checked for a pulse and found none. I immediately called a code and began chest compressions.
That is the situation Ashley Van Der Zee found herself in as she finished one of her very first shifts as a new nurse. She had only recently graduated from Washington State University College of Nursing.
Ashley’s efforts continued for 30 minutes and ultimately saved the patient. Her story exemplifies how simulation-based training can prepare someone to turn the seemingly impossible into an “I’m possible.”
Ashley’s was working at a level 1 trauma center in Seattle. Her first job as a new nurse. One of her patients that evening was an elderly male. He had been brought there for a wound VAC (vacuum-assisted closure) following injuries that had left him with severe orthopedic trauma, a collapsed lung, and a crushed pelvis. He had just emerged from surgery and had begun regaining consciousness from anesthesia when he started showing signs of a pulmonary embolism (PE).
Ashley was the first to recognize that the patient was suffering from a PE. When she found that he had no pulse, she immediately took the lead. She quickly assembled a team of available staff, assigned roles, and began directing Cardiopulmonary Resuscitation (CPR). “I had an identical simulation at WSU where the patient had a PE. I was very surprised by my ability to remain calm and level-headed, but I could…because I had done it before,” Ashley said.
For nearly 30 minutes, Ashley and her team performed CPR. The attending physicians and anesthesiologist, who had left after the surgery, returned and began managing the code. After repeated rounds of compressions and team members rotating through using high performance CPR protocols, the patient finally returned to spontaneous circulation. He was going to live.
In the hours that followed, Ashley’s fellow nurses recognized her for seizing the initiative. “They were blown away; I went from new nurse to nurse running the code. When they asked me how I knew what was happening, I shared my experience with the similar simulation. I thought during my first code I would be so uncomfortable. But, in that instant, I have never been more calm and collected,” Ashley said.
Ashley’s story illustrates how simulation is being used in healthcare today. Historically, providers were confined to learning by treating real patients. The National Council of State Boards of Nursing (NCSBN) now recommends that simulation can be used to replace up to 50% of required clinical hours. Across healthcare, simulation is now being used, not only to teach clinical skills, but to teach critical thinking, leadership, and teamwork skills. “See one, do one” is making room for “Simulate twice, act once.”
We would like to thank Ashley and the simulation staff at WSU for their mutual contribution to the goal of zero preventable harm. It was because of their combined dedication and efforts--students and educators alike--that Ashley’s first code was not her first. If it were not for Ashley’s simulation experience, she may not have been able to act as decisively and boldly as she did. You are examples to all of us in the simulation and patient safety community of what it means to say “I’m possible.”
Earlier this year, our CEO, Tore Laerdal, declared Laerdal's commitment to achieving zero preventable harm. Hear what he had to say.