Date of Doctor of Nursing Practice Project Completion

Spring 4-30-2026

Faculty Advisor

Rashmi P. Momin DNP, MSN, APRN, FNP-BC

Abstract

Purpose

The goal of this quality improvement (QI) project was to enhance new graduate nurse (NGN) clinical readiness through an interprofessional high-fidelity simulation focused on recognizing and responding to patient deterioration during nurse residency onboarding.

Background

New graduate nurses often feel uncertain about recognizing clinical deterioration and communicating. Research shows that simulation-based and interprofessional training improve judgment, teamwork, and communication. This project aims to achieve at least a 10% increase in NGN clinical readiness following the implementation of a high-fidelity simulation program.

Methodology

A pre–post QI study based on Kolb’s Theory and PDSA principles was conducted in a nurse residency program in Round Rock, Texas. Twenty-two NGNs participated: 22 before and 20 after the intervention. They underwent a single high-fidelity pulmonary embolism simulation on a computerized mannequin, randomly assigned to six groups of four. Each session included a 5-minute pre-brief, 20-minute simulation, and 10-minute debrief. Performance was assessed with the RAPIDS checklist, focusing on recognition of deterioration, teamwork, and escalation. The Casey-Fink Readiness Survey measured clinical preparedness before and after. Outcomes were compared using descriptive statistics.

Results

Post-intervention findings demonstrated improvements in NGN’s confidence, communication, and recognition of patient deterioration. Performance during simulation scenarios also improved following the implementation of a structured pre-brief, with stronger teamwork and escalation behaviors observed across learner groups.

Implications for Practice

Incorporating high-fidelity simulation into nurse residency programs can enhance NGN clinical preparedness, communication, and early recognition of deterioration. Continuing simulation-based training within onboarding programs may support clinical readiness and improve interprofessional collaboration.

Keywords

new graduate nurses, high-fidelity simulation, clinical readiness, interprofessional collaboration, patient deterioration recognition

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