Editor's note: This is part of a regular series about the courses being taught at Nebraska's colleges and universities, as well as the instructors and students involved in them.
It happened in an instant.
Warning sounds alerted the team of student nurses at Bryan College of Health Sciences of plummeting oxygen levels.
Their patient was crashing, yet the aspiring health professionals froze.
"We just kind of stood there: 'What do we do?'" said Trinidie Christensen, a third-year nursing student from Denver.
About 30 seconds -- the blink of an eye for most, but an eternity with a life on the line -- went by before the shock subsided, added Brielle Weverka of Arapahoe, who is also a third-year student at Bryan's nursing college.
Then, the classroom lectures and studies and training kicked in.
The care team propped the patient up to better open up her airway and replaced the nasal tube with a mask to create a steadier flow of oxygen, before calling the rapid response team that would stand by in case the situation worsened, Weverka explained.
The experience was harrowing, but also entirely made up.
Instead of a real person, the patient was a manikin capable of breathing, blinking and crying. And instead of a hospital room, the whole scene took place in a state-of-the-art learning lab in Bryan's new simulation center.
Weverka, who is part of the Nursing Care II class, said the simulation reminded the students to be nimble and assertive, as well as to rely on their training when the unexpected happens.
"I think our teacher was just waiting for us to get to that 'aha!' moment," Weverka said, "which was super nice."
Bryan College of Health Sciences, which is enrolling a record 775 students this year, has been using simulation as a teaching technique for nurses and other health care professionals since 2003.
The simulation center, and its high-tech teaching labs and classroom spaces, reopened at Bryan East Campus earlier this year in a renovated dormitory.
Barbara Sittner, director of the center, said the days of learning to give an insulin shot by injecting an orange or administering an IV with a teacher helping guide the needle into a vein are gone.
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Now, students perfect skills like assessing patients after admission to labor and delivery to hooking up a ventilator in an intensive care unit in a controlled environment long before they step foot on a hospital floor.
"We don't really have it quantified yet how many times it takes for someone to feel proficient," Sittner said, "but we've seen the difference in doing simulation."
This week's simulation, run by instructor Jenna Dubas, centers on caring for a cancer patient who has vomited -- a recipe Sittner concocted of "vomit powder, oatmeal and a little tea" -- and is complaining of nausea.
Each of the six students in the class are in the room working together as a team. There's a primary care nurse, a nurse responsible for medicine safety and an evidence-based practice expert, to name a few.
Dubas monitors the students from a control room, recording their progress on camera while also playing the role of the patient. When the student nurses ask the patient a question as part of their assessment, Dubas responds into a microphone that transmits her voice from the manikin's mouth.
If something goes wrong, and it inevitably does as the students put their classroom knowledge to practical use for the first time, Dubas can adjust the manikin's breathing and heart rate, or give voice to pain or discomfort.
"They do a good job of making it real," said Christensen, who wants to return to work in Denver after graduating.
The goal of the simulation in the Nursing Care II class is to give the students an idea of the scope of a working RN through simulation, teaching them to troubleshoot situations and rely on their instincts, Dubas said.
"I always tell them, there's a box we've made that we'll let you ping pong around in, but we won't let you get too far off course," Dubas said. "If they do, we try to stay in character and queue them to do something different."
Weverka and Christensen said their experiences in the simulation center have given them room to practice the skills they'll need to be successful in the nursing field, where a 34% shortage is projected in Nebraska by 2025.
Sittner said working nurses, physicians and other health care professionals -- 400 in all -- have refined their skills using simulation since the center opened in August.
"The more that people use it, the more they want to use it as a teaching modality," Sittner said. "It's all focused on quality and safety, and it's the best thing for our nursing students to practice different skills."