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Background: Mid-level nursing leaders are responsible for creating work environments that support the healthcare team and promote optimal patient outcomes. Nursing faculty must create a learning experience in which students can best develop advanced leadership skills. There is need for scholarly inquiry into the use of simulation-based learning (SBL) for development of advanced leadership skills. Purpose: The purpose of this study was to examine the relationship between SBL and participant perceived confidence in standardized leadership competencies and clinical judgment wherein participants were graduate nursing students enrolled in a Master of Science in Nursing Leadership program. Research questions for this study were: (1) Is there a difference in perceived confidence in performance in standardized competencies pre- versus post-SBL activity? (2) How are clinical judgment scores related to perceived confidence for standardized performance competencies? (3) What are the experiences of graduate nursing leadership students participating in a SBL activity for nursing leadership skill development? Methods: Using a cross-sectional approach, graduate nursing students (N=14) were invited to participate in the study. Descriptive statistics were used to capture demographic information, a paired t-test was used to determine the difference between pre-and -post levels of perceived confidence, and Pearson’s r was used to determine the relationship of perceived confidence and clinical judgment. Perceived confidence was measured with a scale designed for participant perceptions of confidence related to the standardized performance competencies. Clinical judgment was measured with Lasater’s Clinical Judgment Rubric. Qualitative items were designed to elicit participants’ reflections of the SBL experience. Results: Findings included a significant and positive correlation for perceived confidence related to standardized competencies when comparing pre- and post-SBL activity (p<.001). There was not a significant relationship observed between perceived confidence and clinical judgment. Qualitative findings for five open-ended questions were largely supportive and positive, however, ways to improve the SBL experience were also noted. Conclusion: While an abundance of evidence exists to support the use of SBL to teach clinical skills in healthcare education, there is a clear gap in the literature in the use of SBL for teaching leadership skills. The significant finding of improved participant perceived confidence post-SBL activity provides preliminary evidence to support additional research and how SBL may be used to effectively teach advanced leadership skills. Development of an instrument to objectively measure leadership skills is an area for future research, along with exploring innovative ways to deliver SBL to technology-savvy adult learners.