Mary Lou Sole pauses for a moment before allowing herself to go there. Back to the day in 1991 when she was flipping through a magazine and saw these words: 亚洲成人视频. The old days, you might say.

Over the past 40 years, UCF鈥檚 nursing program has graduated more than 11,000 alumni who have gone on to work in the White House, risen to the ranks of Chief Nursing Officers, and launched their own groundbreaking healthcare businesses.

鈥淗onestly, I鈥檇 never heard of it,鈥 she admits. Intrigued, Sole visited the little-known campus when she and her husband moved to Florida from San Antonio, Texas, where she taught in the University of Texas at Austin鈥檚 School of Nursing. On the eastern edge of Orlando, she saw an 鈥渋ntimate鈥 department of nursing with 500 students and 17 faculty members. But during that tour, she sensed something much bigger than sheer numbers.

鈥淭here was this willingness to try new things,鈥 says Sole, who would eventually go from curious visiting instructor to the Dean of UCF鈥檚 College of Nursing. 鈥淚 knew right away it could be a very different kind of nursing program.鈥

One of those new things was nursing simulation, for which UCF this month received accreditation from the Society of Simulation in Healthcare and the Council for Accreditation of Healthcare Simulation Programs.

Over the past 40 years, UCF鈥檚 nursing program has graduated more than 11,000 alumni. They鈥檝e moved on to work in the White House, risen to the ranks of Chief Nursing Officers, and launched their own groundbreaking healthcare businesses. But the r茅sum茅s, just like the numbers, are not the core of what makes UCF鈥檚 College of Nursing stand out. To understand 鈥渄ifferent,鈥 you have to see their education in action, in real time.

Healthcare by Total Immersion

Step off the elevator and onto the 6th floor of University Tower in Central Florida Research Park. You鈥檙e no longer in a typical classroom setting. This is a hospital wing. There鈥檚 a nurse鈥檚 station, gurneys, IV stands, ultrasound machines and 鈥 during times when we鈥檙e not physical distancing as a result of a global pandemic 鈥 a healthcare team discussing rounds as well as patients in need of various types of care.

UCF鈥檚 Simulation, Technology, Innovation and Modeling (STIM) Center is as real as you can get without real consequences.

Earlier this spring before the campus closed, I visited that hospital wing just as medical chaos was about to ensue.

A young woman named Lauren is going into labor in an obstetrics (OB) suite. It鈥檚 a risky birth because Lauren鈥檚 medical history makes her a candidate for postpartum bleeding. The baby, Hunter, has a wide frame and seems to be experiencing shoulder dystocia (when the shoulders are too large for the birth canal). Hunter might have breathing problems, too.

Two nursing students enter the room, which is also filling with intensity. They introduce themselves and wash their hands. They鈥檝e got this 鈥 hopefully.

We are witnessing healthcare by baptism 鈥 total immersion. The students are preparing for worst-case possibilities at UCF鈥檚 Simulation, Technology, Innovation and Modeling (STIM) Center. It鈥檚 a creative type of nursing education. It鈥檚 unpredictable. It鈥檚 as real as you can get without real consequences.

Both mother and baby are highly-sophisticated manikins, which can look similar to mannequins you see in a clothing store but are much more advanced and used in healthcare simulation training. For example, Lauren has a pulse. Her lungs and bowels make sounds. She actually goes through labor and gives birth to Hunter in this room. You鈥檇 never know from the serious mood on the 6th floor that all of the patients have been tailored by the engineering and computer science labs across the street in Central Florida Research Park. Each nursing student signs a contract before entering STIM training. The contract says, 鈥淎lthough this is not a human, I will treat it as if it were my own mother.鈥

The simulation is so well orchestrated, so professional, in many ways it鈥檚 more impactful than a literal hospital experience.

鈥淲e set it up so students provide the type of hands-on care that they might not have a chance to experience in hospital training,鈥 says Laura Gonzalez, UCF鈥檚 director of simulation in the College of Nursing. 鈥淚n labor and delivery, for example, a mom-to-be probably doesn鈥檛 want nursing students observing at the bedside. But here, the students have to work through it. They don鈥檛 know what鈥檚 going to happen until it happens.鈥

Just like real life.

Nursing students check that Mr. Harrison, one of six manikins used to teach best nursing practices, is able to breathe comfortably through a ventilator. (Photo by Steven Diaz ’19)

A Hub of Healthcare Simulation Expertise

There鈥檚 a commotion around the corner in another patient room. It鈥檚 Greg Harrison. Mr. Harrison鈥檚 chart says he鈥檚 51 years old, has no known allergies, and he came in for complications related to acid reflux. But something is starting to go wrong.

鈥淲e decided [simulation] is where healthcare education needed to go, and we wanted to be the leaders. So we hired internationally-recognized experts to create critical mass and momentum.鈥
鈥 Dean Mary Lou Sole

鈥淚 feel queasy and can鈥檛 get comfortable,鈥 Mr. Harrison says.

Two certified facilitators are in a control room down the hall, observing the nursing students on a TV monitor. One instructor has a headset and mouthpiece so she can be the eyes, ears and voice of Mr. Harrison.

鈥淭ell me what else you鈥檙e feeling, Mr. Harrison,鈥 says one student.

鈥淚t feels like butterflies in my chest, and I鈥檓 sweaty.鈥

As the students look at his chart and check his vital signs, Mr. Harrison suddenly goes into cardiac arrest.

A virtual Greg Harrison or a human Greg Harrison would be in good hands on this floor. The expertise is staggering. Doctors and nurses from UCF鈥檚 world-class healthcare partners provide feedback and sometimes participate in the simulations. And the faculty and staff are literally a who鈥檚 who in the field of simulation. Gonzalez, Desiree D铆az and Mindi Anderson were three of the first certified advanced healthcare simulation Educators (CHSE-A) in the world. Syretta Spears, the assistant director of UCF鈥檚 STIM Center, is one of the premier certified healthcare simulation operations specialists. Their presence has attracted the most sought-after simulation educators to the nursing program, and made it possible for UCF to be one of the only universities in the nation to offer a master鈥檚 degree and a graduate certificate in healthcare simulation.

鈥淭here was some debate a few years ago about whether we should go all-in with simulation,鈥 says Sole. 鈥淲e decided this is where healthcare education needed to go, and we wanted to be the leaders. So we hired internationally-recognized experts to create critical mass and momentum. The STIM Center on the 6th floor exemplifies our investment in people and resources.鈥

The student-to-facilitator ratio is typically never higher than four-to-one, better than many hospital internships. Patient rooms have ventilators, defibrillators, cabinets stocked with supplies, and six manikins that cost $45,000 to $65,000 apiece. The technology and the knowledge to apply it to healthcare education is so impressive that leaders from other major nursing schools come to the 6th floor to observe it in motion for themselves.

But UCF鈥檚 College of Nursing still has something that cannot be bought or touched. It鈥檚 what shaped the program when it opened in 1979 and attracted Sole, who was recently reappointed as dean, here in 1991.

鈥淲e鈥檙e nimble. What worked in the past for a certain type of care might not be the best approach now or in the future,鈥 says Gonzalez. 鈥淲e have the freedom to mix things up and expose our students to anything.鈥

And 鈥渁nything鈥 is underway at this moment.

A Better Way to Prepare Nurses

Uh-oh. A little boy has gone into respiratory failure in the room next to Mr. Harrison. His name is Paulie G. The facilitators in the observation center watch to see if the students notice Paulie G鈥檚 heart rate dropping to 60 beats per minute and how quickly they administer treatment.

鈥淚t is like getting on an airplane with a pilot who has only read a manual on how to fly. You want to know they have at least been in a simulator a few times. Isn鈥檛 healthcare just as consequential?鈥
鈥 Assistant Professor Desiree D铆az

鈥淚t鈥檚 just like you find in the workforce,鈥 says Gonzalez. 鈥淎lways changing.鈥

In Mr. Harrison鈥檚 room, two other students have started CPR. They鈥檙e up against another obstacle you鈥檒l never deal with in a classroom: It鈥檚 Mr. Orion, a close friend of Mr. Harrison.

Mr. Orion is a live volunteer, one of the 鈥渆mbedded participants鈥 from the UCF community who comes in and adds another layer of realism to simulation. He鈥檚 basically an actor. Sometimes the participants are subtle. Sometimes they aren鈥檛. One might play the role of a mother who goes hysterical over a child鈥檚 worsening condition. Or there could be a temperamental husband in the room with his sick wife.

Mr. Orion? He鈥檚 just a good friend of Mr. Harrison coming to chat. But he shouldn鈥檛 be in the room during cardiac arrest. A nurse needs to have the presence of mind to politely ask him to leave.

Over the course of these 60 minutes, you observe that UCF鈥檚 College of Nursing isn鈥檛 specifically a healthcare model and it isn鈥檛 a social-work model. It鈥檚 both 鈥 the blend of art and science and the wherewithal to sometimes show people the door.

When each simulation is over, the students and instructors will go into a debriefing room and replay on a monitor what just happened. They critique. They compliment. They cringe. They correct. It鈥檚 much better to learn from mistakes here on the 6th floor than out there.

鈥淚n a hospital, a first-year nurse might be asked, 鈥楬ave you ever done this? No? Well we need you to try it now, on a live patient,鈥 鈥 says D铆az. 鈥淚t is like getting on an airplane with a pilot who has only read a manual on how to fly. You want to know they have at least been in a simulator a few times. Isn鈥檛 healthcare just as consequential?鈥

Quite often the staff receives emails and calls from nurses in the field. They鈥檙e UCF graduates giving thanks. As in, 鈥淲e had a risky medical situation yesterday and I knew what to do because of what we learned in simulation.鈥

But there鈥檚 another angle to it all. Simulation isn鈥檛 just vital signs and prescriptions and Mr. O鈥橰ion leaving his walker in the doorway. Some of the most valuable lessons foreshadow encounters you might not think of in nursing until they happen.

Amanda Leyva ’18 checks the status of Raj Patel, a manikin simulating a patient from a long-term care facility who has experienced complicates from a feeding tube. (Photo by Steven Diaz ’19)

Learning Empathy Through Simulation

No one knows this patient鈥檚 name. He doesn鈥檛 speak English and none of the nurses speak his language. He鈥檚 lost control of his temper and his bowels. The very best nurses might be able to put themselves in the shoes of the patient needing standard care or, more importantly, in the patient鈥檚 gown and bed. But this?

鈥淎bsolutely, you can learn empathy. To be a good nurse, you have to learn it, no matter the circumstances.鈥
鈥 Assistant Professor Desiree D铆az

鈥淎bsolutely, you can learn empathy,鈥 says D铆az. 鈥淭o be a good nurse, you have to learn it, no matter the circumstances.鈥

D铆az became a simulation specialist with a research focus on healthcare disparities because it鈥檚 personal for her. In 1999, she was with her 5-year-old son on the French side of the island of Saint Martin when he was electrocuted. D铆az had trouble communicating with medical personnel because of the language barriers, even as her son鈥檚 hand melted to itself.

鈥淚 had all kinds of questions in that frantic moment, but there was no one to translate and interpret,鈥 she remembers. 鈥淚t happens more often than we might realize. So we need to make sure our students see nursing as much as a calling as it is a career. They cannot bring personal biases about people into care.鈥

The patient could be a teenage refugee or a traveler from another country. He wants his mom. It鈥檚 dark. His asthma starts to escalate. Do you wonder why the parents aren鈥檛 here, or do you comfort this boy as if you are his family?

A patient could be a transgender person who was in a car accident. Will you privately judge this person or treat them with the same love with which you鈥檇 treat your own brother or sister?

A patient could be an inmate from the county prison, making threats and yelling profanity at you. How do you protect yourself while also treating his internal bleeding as best as you can?

鈥淵our preconceived ideas and thoughts about a patient will affect your actions as a caregiver,鈥 says D铆az, 鈥渟o we better figure out now how you鈥檒l deal with your bias and fears in simulation. It is a safe place to be vulnerable.鈥

And what about that patient whose name you still don鈥檛 know? The one who has lost control of everything? Some lessons on empathy have to be learned more literally, without technology or Mr. Orion. In other words, there鈥檚 nothing like wearing a 鈥減oop bag鈥 for two days to fully understand what it鈥檚 like for a patient who can鈥檛 help themselves.

鈥淭he perspective changes dramatically when a student feels almost exactly what a patient feels,鈥 D铆az says.

As she speaks, Mr. Harrison is undergoing an operation of sorts.

Where Nursing Meets Engineering and Computer Science

Down the elevator and across the street from the STIM Center, Mr. Harrison is being recreated. The manikin is just like the current Mr. Harrison, but with facial expressions that can change in real time 鈥 a droop for a stroke, a grimace for pain, or a smile to say, 鈥淭hank you, that feels better.鈥

This is another differentiator for UCF鈥檚 College of Nursing: being in the same neighborhood with UCF鈥檚 world-renowned Institute for Simulation and Training.

This is another differentiator for UCF鈥檚 College of Nursing: being in the same neighborhood with UCF鈥檚 world-renowned Institute for Simulation and Training (IST). While the elite nursing simulation experts dream up a better Mr. Harrison, the engineering and computer science teams bring it to almost-life as a patented physical-virtual patient simulation.

鈥淭here aren鈥檛 a lot of layers between here and there,鈥 says Gonzalez, referring to the interdisciplinary collaboration and to the distance between real and unreal.

Mary Lou Sole sensed the same nearly 30 years ago, a direct route from 鈥渘ever heard of it鈥 to preeminence. But even prestige and leading-edge technology have never been the goal. For her, and for everyone within proximity of the 6th floor, all of the expertise and simulation and manikins with pulses point to one ultimate goal: Let鈥檚 make healthcare better, for real.