Virtual Clinicals: What Counts and Where VR Fits

“Virtual clinicals” gets used to mean several different things: screen-based patient cases, recorded video cases, headset VR, and sometimes telehealth placements. If you are planning a program, it helps to separate them, because they teach different things and regulators may treat them differently.

Three kinds of virtual simulation in nursing

• Screen-based virtual simulation. Students work through a patient case on a laptop or tablet, choosing assessments and interventions. Easy to scale, good for clinical reasoning.
• Video and 360 video. Students watch a scenario unfold and answer questions. Cheap to produce, but the patient cannot respond to the student.
• Headset VR simulation. Students stand in a ward, move around the bed and act with their hands. The best platforms run a patient model that responds to what they do.

Can simulation replace clinical hours?

The most cited evidence is the NCSBN National Simulation Study. Students were randomised to a control group (clinical as usual, with up to 10% simulation), a group with 25% of clinical hours replaced by simulation, and a group with 50% replaced. NCSBN reports that the study provides substantial evidence that up to 50% simulation can be effectively substituted for traditional clinical experience in all prelicensure core nursing courses, under conditions comparable to those described in the study.

Two cautions. First, “conditions comparable to the study” matters: NCSBN reports that an expert panel later used the study data and the INACSL standards to develop national simulation guidelines for prelicensure programs, including preparation and planning information for faculty and program directors. Second, what counts towards clinical hours is set by your regulator or accreditor. Rules vary by jurisdiction, so check yours before you plan.

Where VR fits in a virtual clinicals plan

VR does not need to replace anything to be worth it. The most practical plans use it in three places:

1. Before the sim lab. A 2022 crossover study of nursing students found that doing virtual simulation first and high-fidelity manikin simulation second gave higher reflective thinking and self-confidence scores than the reverse order. It was a small study using screen-based simulation, but the logic carries: rehearse the thinking first, then the hands.
2. For rare, high-stakes events. Cardiac arrest, newborn resuscitation and the deteriorating patient are rare on placement and expensive to stage with manikins.
3. For repetition. A student can run the same scenario five times in an afternoon, with a scored debrief after each run.

Make the debrief count

The INACSL debriefing standard says all simulation-based education must include a planned debriefing process, facilitated by a competent person or a technology-enhanced system. A good VR platform gives you both: an automatic summary of timed actions for the student, and data the facilitator can use to guide the conversation. Read more in Debriefing in simulation: what good looks like.

Virtual simulation nursing, done properly

Firsthand XR runs room-scale scenarios on standalone headsets, with a live patient engine, practice and assessed modes, and team sessions. See how it maps to nursing programs on the nursing simulation page.