Whether you like retro games such as Pac Man, Centipede, or Asteroids or more modern ones like World of Warcraft, Call of Duty, or Madden NFL, you’ve got to admit that there’s something fun about making your way to the next level or finally getting a really high-scoring game. Mercy Medical Center in Baltimore, Maryland has taken the concept of video games one step further—and is using them to teach skills and information to its nurses.

Susan Finlayson, DNP, RN-NE-BC, Sr. Vice President, Operations and Stacey Brull, DNP, RN, NE-BC, Sr. Director Research, Education and Nursing Informatics, at Mercy Medical Center, took time to answer our questions.

How are video games used to help in training nurses?

We use video games as a teaching tool to help explain complex information, onboard new nurses, and provide an alternative to classroom training. Using both plug-and-play games as well as customized games provides our nurses with information they need when they need it, and in a fun, interactive format.

The World of Salus™ is an excellent example of a video game that we use in orientation to cover key topics pertinent to nurses starting at Mercy. Instead of sitting through 3 days of classroom lectures, our new employees venture into a World where they create an avatar, earn badges, explore knowledge objects, compete on a leaderboard, and complete challenges to make it to Finales and receive their certificate of completion.

The World of Salus is a complex adventure game; however, we also simpler games that we can quickly customize for more specific types of training. Doesn’t playing a slot machine game to learn about infection control practices sound like fun?

Video games also help identify areas needing further training and education. As with most technologies, we are able to develop specific reports telling us areas where a nurse(s) may have struggled with a specific topic as well as areas needing less time and attention. Video games, with reporting functions, create individualized learning plans for the learner versus a one-size-fits-all.

Are these regular nurses or nursing students?

The current games we use are primarily for current and new nurses entering Mercy Medical Center.

Please explain in detail how you use them.

We started small using free online games in staff meetings and other learning environments where we could plug and play our material. For example, one of our educators was teaching specific regulatory information and used a quizzing game during her presentation as an interactive tool to supplement her lecture. Another educator used a QR code to have employees perform a scavenger hunt through an online app during their unit orientation.

We now create a lot of our games. For example, we have a game called The Quest for Magnet Status where nurses had to go to different pyramids and learn about the components of the Magnet Model. Each pyramid has a hieroglyphic that the nurse needs to decode to find the secret of the ancient legend. Other types of games we have created include puzzles, trivia, and races. We have even begun to venture into virtual reality games.

Regardless of the type of game we use, our goal is to utilize the best game mechanics in developing a positive avenue for engagement. Since we know people are playing online games all over, why not use games in training?

What video games are used?

We create a lot of our own video games, but we also use Kahoot, Classcraft, C3Softworks, and other online games in our gaming toolbox.

How did you come up with the idea to use them?

We were seeing a lot of our employees texting under the table or continuously checking their phones during classroom presentations. We had the ability to pull reports indicating that staff members were just clicking the “next” button all the way through our online modules on our learning management system in order to answer the obligatory questions at the end. More importantly, we found that despite teaching—and many times reteaching—behaviors and outcomes weren’t changing. Therefore, we knew we had to find a more effective and efficient way to reach our staff and came across a new term at the time called “gamification.”

We looked extensively into what gamification was and how it was being used in other sectors to see if we could adapt it in health care. We even took a course on gamification. Through this discovery phase, we knew we had to give gaming and gamification a try, and now that we have, we would never go back.

What benefits have you seen as a result of using video games? 

Our staff is more excited to learn because learning doesn’t seem like a chore anymore. The games are clearly more pleasing to the senses, using a wide variety of aesthetics and music which connects the player’s emotions with the content. We have even conducted research demonstrating gaming as better in terms of user satisfaction and retention of information when compared to didactic classroom learning and e-learning modules in a learning management system.

In addition, games are a wonderful tool for teaching material that isn’t used a lot or reinforcing aspects of a course to the students. Since the end-user can quickly go in and learn what they need to know, they are more intrinsically motivated to play. There is so much diversity in games, too. Games can easily be changed using different colors, different interactions, or different game mechanics. And, games are adaptable so they can be used for quick need-to-knows as well as competency management. Having an employee play a timed code cart video game to find the necessary equipment in a code situation is much more powerful than having a cart open in a classroom for the employee to “explore.” Video games have improved the way our staff critically thinks and approaches problems.

How do the nurses respond to it?

The nurses love using games in learning. They enjoy the fact that it is self-paced, providing them with as little or as much time as they need to learn the content. The environment provides them with opportunities to make mistakes and learn from them without feeling incompetent. In fact, our orientees have enjoyed The World of Salus so much that our current staff is asking if they can go back through orientation and play the game. That statement is a true testament to the impact video games have had on our organization.

How long do they use them? What do they do? 

Video games provide the end user the ability to play when they want and where they want. The World of Salus game takes about 4 hours to complete in its entirety. Other games, such as Code Card Blitz, take about 15 minutes.

Do you use video games all the time for training nurses?   

We use games as much as we can in training. If we aren’t using games, we are committed to using some type of interactive teaching tool in our training including a variety of multimedia and online media platforms.

How do video games help nurses learn with real patients? 

The world of possibilities using video games is mind-blowing. Whether the game is single player, multiplayer, 2D, 3D, or virtual, a video game could be made for just about any situation and any type of patient. The good news is that having these situations in a video game provides nurses with the ability to make mistakes without harming a patient. To us, providing a safe, fun environment where nurses can essentially create their own learning pathway will help them make better choices when working with real patients in any health care setting.

What are the challenges to using video games in this way?

One of the biggest challenges to using video games in training is having the time and resources to develop them. Making video games isn’t easy and needs a variety of skilled professionals. The World of Salus took a little over two years to develop.

What are the rewards? 

Engaged staff! When you have nurses asking for additional training or wondering when the next contest or game is coming, you have their attention. When you have their attention, you have better outcomes and more satisfied staff.

Is there anything else that you think is important for people to know?

Since gaming is relatively new and innovative in health care, we wanted to be at the forefront. But there is still a lot of research that needs to be conducted to better understand the uses of gaming in nursing education. Having said that, using games to help train nurses has been one of the most exciting and energizing journeys we have been on at Mercy.

However, don’t reinvent the wheel.  Reach out to other fellow gaming educators, like us, and learn from each other. The sky is the limit, and it’s a great time to take training to a new level in health care.

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