Why do undergraduate nursing and nurse practitioner students rarely train together before they share a hospital unit? In 2026, a four-faculty Quinnipiac team published a study in the Journal of Clinical Simulation, funded by the Eva Stearns Faulkner Simulation Education Research Funds, on building partnerships through simulation.1
RN and NP graduates routinely hand off patients and manage rapid responses together, but most curricula keep them in separate simulation centers. That gap surfaces as communication errors and role confusion in the months after graduation. Structured RN-to-NP simulation gives programs a concrete way to close the gap before licensure and clinical placement demands intensify.
What Is Interprofessional Simulation, and Why Pair RN and NP Students?
Nursing-only simulation versus cross-profession team training: these two models prepare students for fundamentally different collaborative challenges, and understanding the distinction matters for curriculum design and student outcomes.
Defining the Terms
Interprofessional simulation typically brings together students from different healthcare disciplines, such as nursing, medicine, pharmacy, and physical therapy, to practice team-based care in controlled scenarios. This broad approach addresses how multiple professions coordinate around a shared patient. However, a more specific model pairs students within the same profession at different practice levels, and some researchers use the term "intraprofessional" to describe this approach. When an undergraduate nursing student works alongside a nurse practitioner student in a simulated clinical encounter, both are operating within nursing's scope, but their roles, decision-making authority, and clinical responsibilities differ substantially.
Why the RN-NP Pairing Fills a Gap
Most interprofessional education programs focus on the classic triad of medicine, pharmacy, and nursing students collaborating on complex cases. While valuable, this model often misses the day-to-day reality that many RNs will navigate after graduation: working directly with NPs in primary care clinics, urgent care settings, specialty practices, and hospital units where NPs manage patient panels. The communication patterns between a bedside nurse and an NP differ from those between a nurse and a physician. RNs relay assessments, raise concerns, and advocate for patients in ways shaped by their shared nursing foundation with the NP, yet the power differential and clinical authority remain distinct.
Mirroring Real Post-Graduation Relationships
Pairing students at different nursing degree levels, one still learning fundamental assessment skills and one learning diagnostic reasoning and prescribing, creates a realistic hierarchy. The bedside-track student practices upward communication, structured handoffs, and recognizing when to escalate. The advanced-practice student practices leading a clinical conversation, synthesizing information under time pressure, and providing feedback that supports rather than intimidates a less experienced colleague. This dynamic mirrors the evolving nursing roles both will encounter in practice, making the simulation experience immediately transferable to clinical rotations and first jobs.
Inside a New Study: Building Partnerships Between Nursing and NP Students
A faculty research team at Quinnipiac University recently published a study in the Journal of Clinical Simulation that examines how simulation can serve as a structured vehicle for building intraprofessional partnerships between undergraduate nursing students and nurse practitioner students.1 The study, titled "Building Intraprofessional Partnerships Between Undergraduate Nursing and Nurse Practitioner Students Through Simulation," was supported by the Eva Stearns Faulkner Simulation Education Research Funds and represents a funded, peer-reviewed effort to move beyond anecdotal claims about teamwork training.
The Research Team and Their Roles
Four faculty members co-authored the study, each bringing distinct expertise to the project:
- Gina Robertiello: Clinical assistant professor of nursing
- Rich Feinn: Professor of medical sciences
- Tyler Traister: Associate professor and director of the undergraduate nursing program
- Ingrid Bell: Clinical associate professor and director of the adult-gerontology acute care nurse practitioner program
This combination of undergraduate program leadership, graduate NP program direction, clinical teaching experience, and medical sciences methodology created a research team capable of designing scenarios that speak to both educational levels.
What the Study Set Out to Accomplish
The study's stated aim was to examine whether simulation could improve communication, teamwork, and mutual role understanding between students at different points in their nursing education. Rather than placing students in separate training silos, the researchers brought undergraduate nursing students and NP students into shared nursing simulation scenarios where they had to collaborate, hand off information, and negotiate clinical decisions together.
This approach addresses a gap that many programs recognize but struggle to close: bedside nurses and nurse practitioners often train in isolation, then meet for the first time in high-stakes clinical environments where miscommunication carries real consequences.
Why This Model Is Replicable
What makes this study useful for other programs is its grounding in a citable, funded framework. Programs seeking to justify cross-level simulation to accreditors or curriculum committees can point to this Journal of Clinical Simulation publication as evidence that the model has been formally examined. The study's focus on communication, teamwork, and role understanding aligns with widely recognized interprofessional competencies, making it adaptable to curriculum mapping and accreditation self-studies at institutions with similar simulation infrastructure.
The Evidence: Communication, Teamwork, and Confidence Outcomes
A growing body of research ties interprofessional and intraprofessional simulation directly to the IPEC Core Competency domains of Communication, Teams and Teamwork, Roles and Responsibilities, and Values and Ethics. The numbers below show why nursing programs continue to invest in cross-level simulation experiences.
Core Skills Practiced: SBAR, Handoffs, and Role Clarity
SBAR as the Common Language
Among the core nursing acronyms, SBAR (Situation, Background, Assessment, Recommendation) gives RN and NP students a shared framework for passing clinical information under pressure. It works because it forces the reporting nurse to organize a patient story into a predictable sequence rather than a stream of loosely connected observations. In simulation, that structure becomes something students rehearse out loud, in real time, with a partner who is trained to expect it and to push back when it's incomplete.
The Handoff Scenario
A typical scenario places the RN student at the bedside, gathering vitals, reviewing the chart, and noticing a change in condition. The RN student then delivers an SBAR handoff to the NP student, who is cast in the receiving clinician role. The NP student has to do more than listen: they ask clarifying questions, request missing data, and think out loud about differential possibilities before deciding on next steps. This back-and-forth is where the real teaching happens, since a flat, one-way report doesn't test either student's reasoning or nursing school communication skills the way a probing exchange does.
Practicing Role Clarity
Role clarity gets built alongside communication skill. RN students practice staying within their scope, observing, documenting, escalating, while NP students practice owning the diagnostic and treatment-planning pieces that fall to them. Scenarios are often designed with a moment where the RN student is tempted to speculate on a diagnosis or the NP student is tempted to perform a task better suited to nursing staff. Catching that boundary in a low-stakes simulation is far preferable to sorting it out for the first time on a unit.
Where the Correction Happens
The debrief that follows is where communication gaps and role confusion actually surface. Faculty walk both students back through the handoff, asking what information was missing, where the SBAR structure broke down, and where scope boundaries blurred. Students often recognize their own gaps once a faculty facilitator names them aloud, which is why the debrief, not the scenario itself, is frequently described as the most valuable part of the exercise.
Designing RN Vs. NP Simulation Scenarios: What Should Differ
RN students enter simulation with two to four years of nursing education behind them, while NP students bring a minimum of a BSN plus graduate coursework spanning six to eight total years. That gap in preparation should drive every design decision, from the complexity of the patient case to the cognitive demands placed on each learner.
Scope Alignment Is the Starting Point
The single most important principle is matching scenario objectives to each role's scope of practice. RN-level scenarios should focus on skills the bedside nurse owns: assessment within existing orders, medication administration and adverse-effect recognition, documentation, monitoring for changes in condition, and knowing when and how to escalate. NP-level scenarios should layer on the clinical reasoning that advanced practice requires: obtaining a comprehensive history and physical, generating a differential diagnosis, ordering and interpreting diagnostic tests, prescribing or titrating medications, and managing polypharmacy or multiple comorbidities.
When both groups work the same simulated patient encounter together, the scenario design must make those boundaries visible. The RN student identifies a change in status and communicates it; the NP student receives that communication, synthesizes it with the broader clinical picture, and adjusts the plan.
Complexity and Ambiguity Should Scale Differently
RN scenarios typically benefit from structured decision trees: vital signs trigger a protocol, and the learner follows or escalates. NP scenarios should introduce deliberate ambiguity, competing diagnoses, incomplete data, and the need for shared decision-making with the patient. Including unstable or emergency presentations in NP cases pushes learners to act under time pressure, mirroring the projected 35 percent growth in NP roles through 2034 and the expanding full practice authority NPs hold in 27 states plus Washington, D.C.
What to Build Into Joint Scenarios
When RN and NP students share a simulation, faculty should design for interaction, not parallel play. Effective joint scenarios include:
- An SBAR handoff moment where the RN student formally communicates findings to the NP student.
- A prescribing or order-change decision the NP must make based on the RN's bedside data.
- A debrief question asking each learner to articulate the other role's contribution.
This deliberate separation of objectives within a shared case is what transforms a standard sim into a meaningful cross-level learning experience.
Faculty and Scheduling Logistics for Cross-Level Simulation
The single biggest barrier to pairing RN and NP students in simulation is not pedagogy, it is the calendar. Undergraduate nursing courses and graduate NP programs run on different academic rhythms, use different clinical block structures, and answer to different program directors. Making them meet in a simulation lab on the same afternoon takes deliberate coordination well before the semester starts.
Aligning two academic calendars
Undergraduate cohorts typically follow a fixed 15-week semester with clinical days locked in months ahead. NP students, especially those in part-time or hybrid tracks who are working while in nursing school, often carry rolling clinical hours, evening seminars, and intensive on-campus weekends. Program leaders who run successful joint simulations usually pick two or three fixed dates per semester and build both syllabi backward from those anchor points. Publishing those dates in the course catalog before registration opens prevents the last-minute conflicts that sink most cross-level plans.
Simulation-center and staffing demands
Shared lab time competes with skills check-offs, OSCEs, and standardized patient encounters already on the books. A single interprofessional case can tie up two rooms, a high-fidelity manikin, an SP, and audiovisual staff for a full afternoon. Sim center directors typically require requests one to two semesters in advance and often batch cohorts into a dedicated joint simulation day to concentrate resources.
Co-facilitation is non-negotiable. A nurse faculty member frames scope-of-practice expectations for the bedside role, while an NP faculty member coaches diagnostic reasoning and orders. Debriefing without both voices in the room tends to flatten the learning back into a single-discipline exercise.
Practical workarounds when schedules will not bend
- Block scheduling: Reserve a shared intensive week where both cohorts pause regular clinicals for paired scenarios.
- Joint simulation days: Run three or four scenarios back to back so students rotate through RN and NP roles in a single session.
- Recorded and asynchronous scenarios: Capture a live encounter, then have the opposite cohort review and debrief on their own time, useful for online MSN-FNP students who cannot travel to campus.
None of these fully replace live pairing, but they keep the collaboration alive when the master calendar will not cooperate.
Can Interprofessional Simulation Count Toward Clinical Hours in an MSN-FNP Program?
Whether simulation can formally replace direct patient care hours in an MSN-FNP program remains one of the most commonly misunderstood questions in advanced-practice nursing education. The short answer: simulation is widely recognized as a valuable learning tool, but no national accreditor currently offers a blanket percentage cap that lets MSN-FNP programs swap out a fixed share of nursing school clinical hours for simulation.
What CCNE, ACEN, and AACN Actually Say
The CCNE accreditation guidance states that the standards, the AACN Essentials, and NP-specific criteria "do not specify or limit the number of hours of simulation that are acceptable." At the same time, CCNE frames simulation as something that "augments clinical learning" and is "complementary to direct care opportunities," not equivalent to them.
AACN's Essentials FAQ acknowledges that simulation can satisfy some clinical learning requirements but stipulates it "cannot substitute for all direct care practice experiences in any one sphere of care for any one age group." That functional limit matters: even where simulation is counted, it cannot eliminate the need for hands-on practice with a given patient population.
ACEN treats simulation as part of meeting overall program outcomes but, in its published position materials, does not set a national percentage substitution cap for APRN clinical or practicum hours.
The 50% Figure Belongs to Prelicensure, Not MSN-FNP
The widely cited "up to 50% simulation" threshold comes from evidence supporting prelicensure (BSN and ADN) nursing education. It does not apply to Family NP (FNP) or other APRN tracks. Some individual programs or state boards permit 10 to 25 percent of clinical hours to be met through simulation, but those allowances are program-specific or jurisdiction-specific, not universal national rules.
How Intraprofessional Simulation Fits
Experiences like the Quinnipiac-style RN-to-NP partnership simulations are typically designed as supplements that strengthen communication, role clarity, and teamwork. They enrich clinical education without claiming to replace the supervised direct-care hours that certification bodies and accreditors still expect.
Advice for Programs
If your program uses interprofessional or intraprofessional simulation in any capacity, document how those hours align with accreditor guidance in your self-study narrative. Spell out which competencies the simulation targets, how outcomes are assessed, and how the experience complements (rather than replaces) direct patient care practica. This documentation protects programs during accreditation review and demonstrates intentional curricular design.
Validated Tools for Assessing Interprofessional Competencies in Simulation
Choosing the right assessment instrument is essential when measuring whether RN and NP students are actually building teamwork competencies during shared simulation exercises. The tools below range from observer-rated behavioral checklists to self-report attitude surveys, so faculty can triangulate objective performance data with students' own perceptions of collaboration. Programs planning cross-level simulation can pair an observational tool (such as the TPOT) with a self-report measure (such as the T-TPQ or ICCAS) to capture both what evaluators see and what learners experience.
| Tool or Rubric | What It Measures | Best Used For |
|---|---|---|
| TeamSTEPPS 2.0 TPOT (Team Performance Observation Tool) | Objective, observer-rated behavioral assessment across 25 items covering team structure, leadership, communication, situational awareness, and mutual support | Faculty or trained raters scoring team performance in real time during simulated clinical scenarios |
| TeamSTEPPS T-TAQ (Teamwork Attitudes Questionnaire) | Self-reported attitudes aligned with core TeamSTEPPS objectives, including openness to structured communication and shared leadership | Pre- and post-simulation surveys to track shifts in students' attitudes toward evidence-based teamwork principles |
| TeamSTEPPS T-TPQ (Teamwork Perceptions Questionnaire) | Self-reported perceptions of teamwork quality in communication, mutual support, and situational awareness, scored on a 1 to 5 Likert scale | Measuring nursing students' subjective perceptions of teamwork effectiveness after simulation or other interprofessional education activities |
| ICCAS (Interprofessional Collaborative Competencies Attainment Survey) | Attainment of interprofessional collaborative competencies, including role clarity, shared decision-making, and communication across disciplines | Evaluating whether students from different program levels (for example, prelicensure RN and NP tracks) are meeting interprofessional collaboration benchmarks after training |
| KidSIM Team Performance Scale | Team process behaviors such as communication effectiveness, identification of roles and responsibilities, and coordination during acute scenarios | Simulation-based acute illness management training, particularly useful for assessing undergraduate-level team dynamics in high-acuity exercises |
FNP-Specific Competencies You Can Build Through Interprofessional Simulation
Simulation that pairs Family Nurse Practitioner students with undergraduate RN students does more than teach teamwork in the abstract. It builds the specific clinical competencies that FNP graduates need on day one of practice, and it does so in ways that traditional NP-only simulation cannot replicate.
Diagnostic Reasoning in Real Time
When an RN student delivers a structured handoff, the FNP student must immediately begin sorting through differentials. This is diagnostic reasoning under pressure, the same cognitive load an FNP faces when a floor nurse calls about a deteriorating patient. The simulation forces NP students to verbalize their clinical thinking aloud: asking clarifying questions, weighing competing hypotheses, and committing to a working diagnosis before moving to management. That kind of practice maps directly to the IPEC competency domain of Roles and Responsibilities, where advanced practice students must demonstrate their scope while respecting what bedside nurses bring to the clinical picture.
Prescribing and Closed-Loop Communication
Ordering medications and treatments is only half the prescribing competency. The other half is confirming that orders are received, understood, and executed correctly. Interprofessional simulation creates space for FNP students to practice closed-loop communication by verbalizing orders back to RN students, who then repeat the order and confirm their understanding. This back-and-forth mirrors what happens in acute care and outpatient settings when verbal orders are given. It reinforces the Interprofessional Communication domain and builds habits that reduce medication errors in practice.
Care Coordination and Delegation
Population health management requires FNPs to practice care coordination in nursing across multiple touchpoints, and that often means delegating follow-up tasks to nursing staff. Simulation scenarios can build this competency by placing the NP student in a position where they must assign specific tasks to the RN student: scheduling referrals, arranging patient education, or coordinating discharge instructions. These delegation decisions require the NP student to apply assignment, delegation, and supervision principles to understand what falls within an RN's scope and how to communicate expectations clearly. The activity aligns with the Teams and Teamwork domain, where learners practice collaborative decision-making and mutual accountability.
By structuring simulation around these activities, programs give FNP students repeated practice in the competencies that distinguish advanced practice from bedside nursing, all while reinforcing the IPEC framework that accreditors expect to see in curriculum documentation.
Bringing Interprofessional Simulation to Online and Hybrid MSN-FNP Programs
Geographic distance between RN and NP students enrolled in online or hybrid Master of Science in Nursing (MSN)-FNP programs creates a real obstacle for interprofessional simulation: you cannot easily gather a bedside-track nursing student from one state and an advanced practice student from another in the same physical sim lab. Programs have responded by building synchronous virtual alternatives, including virtual reality nursing education tools, that preserve the collaborative, real-time elements that make interprofessional simulation effective.
Telesimulation and Live Video Platforms
Telesimulation models use video conferencing platforms to connect learners in different locations during the same clinical scenario. One student may manage a virtual patient while another joins via live video to consult, accept a handoff, or co-manage a deteriorating case. The 2026 IMSH program features dedicated sessions on telesimulation design, reflecting growing adoption. Programs report using standard video tools for synchronous interprofessional scenarios, pairing the technology with structured debriefs immediately afterward.
Virtual Patient Platforms as Substitutes
Case-based virtual patient platforms can stand in for manikin work when in-person access is limited. Shadow Health offers 24/7 access for nursing and other health professions students, supporting standardized digital encounters. Simucase allows learners to observe, assess, diagnose, and intervene with virtual patients and explicitly supports interprofessional collaboration scenarios. Oxford Medical Simulation delivers interprofessional VR experiences that can run on-screen for students without headsets. SimX enables multiuser VR scenarios where entire care teams, including nursing and advanced practice trainees, train together from different locations.
These platforms work best when paired with live video debriefs. A student completing a case asynchronously gains more from the experience when faculty and peers from another discipline review decision points together in real time afterward.
The Ongoing Need for In-Person Immersion
Virtual platforms handle communication, clinical reasoning, and role clarity well, but hands-on procedural skills still require periodic face-to-face sessions. Hybrid MSN-FNP programs typically schedule intensive on-campus immersion days where students practice physical assessment, procedures, and high-fidelity manikin scenarios that cannot translate fully to a screen. Programs should be transparent with applicants about how many in-person days are required and where they take place.
How Students Can Seek Out These Experiences
Interprofessional simulation opportunities are not yet standard across all nursing programs. Whether you are applying to an entry-level BSN track, an RN-to-BSN bridge, or an MSN-FNP program, a few targeted questions can help you identify schools that invest in this kind of cross-level training.
- Ask admissions and faculty advisors directlyDuring program information sessions or one-on-one advising calls, ask whether the curriculum includes intraprofessional simulation sessions that pair undergraduate nursing students with nurse practitioner cohorts. Programs that have formalized these experiences will be able to describe the specific scenarios, timing in the curriculum, and learning objectives.
- Compare simulation center partnerships across programsWhen evaluating schools, look for evidence that the simulation center serves both the undergraduate nursing and MSN-FNP tracks, not just one or the other. A shared facility with cross-level scheduling signals that the program is structured for collaborative learning between bedside-track and advanced-practice students.
- Look for funded simulation researchPrograms that secure dedicated research funding for simulation innovation, much like the Eva Stearns Faulkner Simulation Education Research Funds that supported the Quinnipiac University study published in the Journal of Clinical Simulation, tend to iterate on scenario design and assessment. Ask whether faculty are conducting or publishing simulation research, which is a strong indicator of ongoing program investment.
- Request to observe a joint simulation sessionIf possible, ask whether you can sit in on or shadow an existing intraprofessional simulation before enrolling. Observing how RN and NP students interact during a scenario, practicing SBAR handoffs, negotiating role boundaries, debriefing together, gives you a realistic preview that no brochure can replicate.
- Clarify virtual simulation logistics for online and hybrid programsIf you are considering an online or hybrid MSN-FNP program, ask specifically how interprofessional simulation scenarios are scheduled, what platform is used for virtual delivery, and how performance is assessed. Understanding whether synchronous sessions pair you with RN-track peers or rely on standardized participants will help you gauge the depth of the interprofessional experience.
Intraprofessional simulation builds the collaborative reflexes that RN and NP graduates need from their very first clinical shift, not months into orientation. Programs structure these experiences differently, so asking targeted questions during admissions about simulation pairing, SBAR training, and assessment tools is essential. The Quinnipiac study published in the Journal of Clinical Simulation confirms that this model is moving from informal experiment to funded, peer-reviewed instructional design. Students who seek out these opportunities during their nursing school planning will enter practice better prepared for the team-based care environment that already defines modern nursing.