Standardizing the unexpected

Master of Nursing student Lois Campbell and teaching assistant David Buckner discuss neonatal care.

Traditionally, when nursing students step onto a hospital unit for their maternal-newborn clinical rotations, the learning outcome is often left to chance.

Clinical experiences in direct patient care environments depend on which patients are admitted that day and which nurses are available to mentor. In a fast-paced environment like maternal-newborn care, complex emergencies—such as postpartum hemorrhage, preeclampsia, or shoulder dystocia—are rare for a student to encounter. When they do occur, students are often pushed to the perimeter of the room, observing rather than acting.

To solve this unpredictability, the University of Minnesota School of Nursing is reimagining its practicum model in the prelicensure Bachelor of Science in Nursing (BSN) and Master of Nursing (MN) programs. By pairing traditional direct patient care with hands-on simulation and immersive virtual reality (IVR), the school is ensuring that every student actively manages high-stakes maternal-newborn emergencies before graduation.

Multimodal practicum approach elevates curriculum

This multimodal practicum approach was designed to elevate the curriculum. “Direct patient care is so random. You have no idea what experiences you’re going to get,” says Cynthia Bradley, PhD, RN, CNE, CHSE, ANEF, the school’s director of simulation. “In simulation, we can standardize clinical education. Moving forward, we’re going to do what we’ve done with maternal-newborn care across our clinical curricula—what are the clinical skills students need to know? Then we will do all of those in simulation and in immersive VR.”

Carol Flaten, DNP, RN, PHN, assistant dean for Prelicensure Programs, emphasized how crucial this approach is for prelicensure students navigating complex health needs.

“Simulation and virtual reality allow us to guarantee that every student encounters critical, low-frequency scenarios that they might never see in a hospital experience,” Flaten says. “In a traditional clinical experience, if a patient experiences a severe postpartum hemorrhage, the primary focus is rightfully on rapid clinical intervention by the nurses and healthcare team. A student naturally takes a less involved role. In our simulated and VR environments, the student is the primary nurse. They have to assess, make decisions, communicate, and intervene directly.”

The newly structured maternal-newborn practicum combines three distinct learning environments: traditional in-person clinicals, high-fidelity hands-on simulation, and fully immersive VR.

On simulation days, students practice hands-on physical assessments using manikins that simulate normal labor, delivery, and sudden complications. Standardized human patients (SPs) give students real-time practice in communication and empathetic care.

In the IVR platform, students wear a headset for full immersion in a virtual patient room. There, they operate with autonomy as the lead nurse—assessing vital signs, identifying deteriorating patient conditions, and administering care.

David Buckner, BSN, RN, C-EFM, a teaching assistant and a nurse-midwifery Doctor of Nursing Practice student, noted that this layered approach helps bridge classroom learning and direct patient interaction.\

“It is a great opportunity for students to immerse themselves in a situation where patients may be actively in labor or in critical condition and experience the emotional toll that can affect both patients and staff. It puts students in a position to offer the nursing skills and the human support of labor, where you must be able to support people through one of the most vulnerable experiences,” says Buckner. “The beauty of simulation is that it is a safe place for mistakes to happen. It provides a safety net for students where they can try new things, take the lead, and grow into confident practitioners.”

Scenarios in IVR and simulation cover critical pre-labor and triage situations, severe preeclampsia, membrane assessments, delivery complications, hemorrhage, and rapid handoffs to providers.

The power of mistakes without shame

One unexpected benefit of VR technology is how it changes student reflection during debriefing sessions. Unlike traditional simulations where instructors observe a student’s every move, IVR scenarios are completed independently.

“In IVR, nobody’s watching them, and nobody’s really guiding them. They make all of the decisions on their own,” Bradley says. “What we found in debriefing is that students in VR are so willing to tell you their mistakes, whereas when you see them making mistakes in person, they have a hard time talking about it. It’s about psychological ownership. I was responsible for this patient, and I made this mistake, but nobody watched me. There’s no shame, no humiliation, and they can repeat the experience to learn from it.”

For students in the prelicensure programs, the technology serves as a vital bridge to building clinical judgment. Lois Campbell, an MN student who completed her hospital clinical hours on a postpartum unit at M Health Fairview Masonic Children’s Hospital, highlighted the value of encountering high-acuity scenarios in VR.

“VR gives you a lot of good skills,” Campbell says. “You get to be in a situation that’s very uncomfortable—like managing an acute complication or an emergency—where you’re not ready to be the primary nurse yet in real life. But in VR, no one is actually going to get hurt, and mistakes can happen in a safe space. It helps concrete what we learn in class and retain it because you’ve actually been through it.”

Campbell noted that while direct patient care in postpartum care focuses heavily on routine monitoring and parental education, VR pushes students to navigate high-stress triage environments, such as identifying preeclampsia or evaluating maternal vitals under pressure. “If I were to walk into a room now and see a patient with a postpartum hemorrhage, I would know where to start,” she says.

Data-driven future for nursing education

Looking ahead, the school plans to leverage data analytics generated by AI-driven IVR software to analyze how students develop clinical judgment over time. By looking at student action logs through AI analysis, faculty can pinpoint exactly where gaps occur—whether a student fails to recognize a subtle vital sign change or delays an urgent intervention.

With plans to expand this practicum model to psychiatric-mental health and pediatric courses, the program positions immersive simulation not as a replacement for real-world care, but as an essential partner.

“This is a solid pedagogical approach that supports what they learn in clinicals,” says Bradley. “We are ensuring our students are ready to care for patients safely.”