The Future; AR/VR Learning with Flight Nurse Expertise featuring Jannie White Sponsored by Innovative SimSolutions

Have you ever wondered what it's like to trade the steady ground of a pediatric ICU for the adrenaline-pumped skies of flight nursing? Our esteemed guest Jannie White, a seasoned nurse and innovative educator, joins us to weave her captivating tale where critical care meets the cloud. Her journey is one of transformation, embracing the power of simulation in flight nursing education, while also navigating the cultural nuances of tight-knit medical teams.

Fasten your seatbelts as we climb to new heights with Jannie's insights into helicopter EMS. She maps out the evolution from the days of emergency medicine residents to the dynamic two-nurse teams, shining a spotlight on the crucial teamwork between flight paramedics and pilots. As we venture into the realm of virtual reality, Janney illustrates how this groundbreaking tool is changing the educational landscape, offering unprecedented realism that could only be matched by the emergencies themselves.

But that's not all—Jannie also shares the pioneering steps UCAN is taking in the hiring and training of nurses, using simulation as their compass. Through her anecdotes, we grasp how simulations are increasingly becoming the key to unlocking the potential of nursing candidates, testing everything from their clinical proficiency to their ability to stay cool under the most intense pressure. Discover how the shift to virtual reality is democratizing access to top-tier training, and stay tuned for the riveting discussion on multi-patient simulations that are preparing nurses for the unpredictability of clinical practice. Join us at the Sim Cafe, where every sip of conversation is a step toward the future of nursing education and patient care.

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Transcript

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The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of anyone at Innovative Sim Solutions or our sponsors. This week's podcast is sponsored by Innovative Sim Solutions. Are you interested in the journey of simulation accreditation? Do you plan to design a new simulation center or expand your existing center? What about taking your program to the next level? Learn from Deb Tauber from Innovative Sim Solutions. A call to support you in all your simulation needs. With years of experience, Deb can coach your team to make your simulation dreams become reality. Learn more at www. innovativesimsolutions. com or just reach out to Deb Contact today. Welcome to The Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser. Join our host, Deb Tauber, and co-host Jerrod Jeffries as they sit down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in and learn something new from The Sim Cafe.

Deb Tauber: 1:31

Welcome to another episode of The Sim Cafe. Welcome Jerrod, welcome Jannie. Today we are featuring Jannie White from My Neck of the Wood, Chicago. We are featuring Jannie White from my Neck of the Wood, Chicago. Do you want to say hello to our guest, Jerrod? you want to say hello to our guests Jerrod ?

Jerrod Jeffries: 1:44

Yeah, and happy new year to everyone as well, and we're kicking off with a great guest here, one that's a great experience as well as an innovative and visionary outlook, so we appreciate you being here with us.

Jannie White: 1:55

Thanks so much for having me. Happy New Year everyone.

Deb Tauber: 1:58

Thank you and Jannie. Why don't you tell our listeners a little bit about yourself and about your very interesting background and career?

Jannie White: 2:05

Sure, I've been a nurse for about 100 years. I like to joke. I started my career actually pre-nursing. I started working with a pediatric population on a trach event unit at the Children's Hospital locally here and that really spurred my excitement for taking not only taking care of the patient as a whole but also taking care of really critical and high-risk patients. So when I graduated I went into the pediatric critical care realm and spent a good amount of time there, transitioned to an education role as the clinical educator in the PEDS ICU. From there I did the flip that most people don't do. I not only went from ICU to ED, but I went from pediatrics to adult. So I went to a level one adult trauma center.

Jannie White: 2:58

I transitioned over there as a pediatric educator but honestly, they taught me much more about taking care of adult patients probably than I taught them about the care of the pediatric patient. And then I was able to transition to really my dream job and my goal of being a flight nurse. So when I was very young I wanted to be an astronaut and then I transitioned into healthcare. So this was kind of the meld of all of those things. Within the first few years of being a flight nurse, I became an educator and then I developed and ran the simulation program for the flight team. Since then, I learned a lot, had a lot of fun and amazing opportunities in the flight world. Some of the challenges that I had in that physical simulation realm led me to learn about virtual reality and augmented reality other technologies, and in my pursuit of that I learned about VR and now I currently work as a VP of client solutions and a virtual reality company.

Jerrod Jeffries: 3:59

Incredible, and I want to double click on the flight nurse stuff because this really is, I feel, like a perfect bridge on so many different levels. So first is does the flight nurse, is that a school that you do Well, one you did simulation with it, I assume, or when I first started simulation did not exist with the flight team.

Jannie White: 4:22

So it was really about five years into my career there that in that development of the educational program I brought simulation into that realm.

Jerrod Jeffries: 4:31

OK, wow, and then so, through this transition, what actually? That even begs the first question is what was the culture of the attitude like when flight nurses were actually changing their practice from pre-simulation to kind of say, hey, there's this new education and this new. What was that like?

Jannie White: 4:48

That's a great question. I think that it was, and there were a number of iterations within the program in terms of evolving of the team. So in that initial time frame we have this tiny group of eight flight nurses. The joke used to be someone would retire before there was a role that opened in flight nursing and so very tight knit group that was very, very focused on providing the best care possible.

Jannie White: 5:16

Certainly there were some frictions of. This is a new way of delivering education in nothing that anyone had experienced. Most of the flight nurses had been in the role for a long time outside of something like a megacode and ACLS had no experience with simulation. I had an amazing mentor and great team. I was at the University of Chicago and the simulation team there really was just phenomenal in training me as an educator to be able to have the skill set to be able to not only create but also provide simulation scenarios, deliver them and the debriefing afterwards and really with that such that we all know the importance of the debriefing that focus on having all of that prior to launching our first scenario. I think we've had a lot of bumps and hurdles along the way, learned, growing pains, both from my perspective as well as as the team, as the team grew, and I think all of those has just made for a better experience each time we made an evolution in the process.

Jerrod Jeffries: 6:25

Okay, so now our simulation has come into flight nursing school and maybe even some background on flight nurses. Is there a nurse? Or, sorry, is there a flight attendant or stewardess, or whatever the appropriate term is? Is someone a trained nurse? That's on, you know, personnel for the airline.

Jannie White: 6:42

It's such a great question, I actually should clarify I am a helicopter EMS flight nurse so a HIEMS flight. Okay, all right. I was a helicopter EMS flight nurse, so what we did was worked on either helicopter or ambulance transport.

Jannie White: 6:56

It was whether related or unable to access or too close to fly to. But primarily we worked on a helicopter and when I first started we were a nurse emergency medicine resident team. Over the course of time that team transitioned to be a two nurse team but nationwide I would say, actually the most common configuration is nurse and flight paramedic, in terms of the team that's out on the helicopter and, of course, our pilot.

Jerrod Jeffries: 7:25

Okay, so then it goes back to the simulation question. Were you ever training with the flight paramedic or the pilot in some of these simulation scenarios?

Jannie White: 7:34

Yeah, absolutely Part of you. In a small team environment in that way, being able to all cohesively work together was so critical to the mission. In both the flight, nurse and emergency medicine resident configuration, as well as in the nurse and nurse configuration, we always used to the same team that was taking care of the patient to train together. So we might have had some objectives where it was individual, for onboarding or something, but for most of our tip to tail simulations we had the team that was involved in the care of the patient doing the simulation. In addition, we used the helicopter, so we actually took our mannequins into the helicopter. We flew the helicopter around so we could have that practice in situ. So our pilots were involved in the training.

Jerrod Jeffries: 8:21

That's incredible.

Deb Tauber: 8:22

What year did you guys start? That Was Scott DeBore there at that time.

Jannie White: 8:26

Scott DeBore was there at that time. Yeah, Scott's great. Deb, you're testing my COVID loss of sense of time, but it's been at least 10 years that the simulation program has been up and running.

Jerrod Jeffries: 8:42

Yeah, and we can move forward. I just was captivating. This is the first time I've ever heard of this.

Jannie White: 8:45

I can talk about helicopters all day.

Jerrod Jeffries: 8:48

Yeah, I think that's another podcast because I want to get into aviation one side too, but so okay. So you started there and then you said 10 years ago. So then you started going into more education virtual. What year was that? And tell us from that starting point on of kind of the transition into there?

Jannie White: 9:08

Yeah, I would say about four to five years ago I was starting to hit some limitations in the type of training that I could effectively provide to the team. So what? I had such an amazing and high functioning team. We did quarterly airway education as a requirement for flight nurses and then also really to be able to train to be agile and unique and austere environments With that. We use the same mannequin or suite of mannequins each time and most of my nurses had learned the trick to be able to intubate the mannequin when they weren't supposed to be able to. So turned everything on trismas airway obstruction and you would get to the point where I would be anticipating that they would be completing a surgical craig and they're like I got the tube and like wait no, and sure enough every time they got the tube, but it really was.

Jannie White: 10:03

They had learned, they had worked with this piece of equipment so frequently that they knew how to work around it and get the ET tube in, even when they weren't supposed to be able to.

Jannie White: 10:14

So that's really what led me on that journey to think about are there different ways that we can do this right? I know that in real time, every patient that I see, every airway that I see, is it looks different. And while I'm training, once my team has gotten the mechanics and the physical completion of the procedure down the steps of it, now we're training for the. We meet people on their very, very worst day and usually in some really unique situations, so thinking about ways that we could really simulate that type of environment and that type of training in a realistic way. So it was a really long story for me to say that's how I started to learn about different types of technologies and different and I think in that moment I was thinking about something that was a little bit more in that augmented reality world, could we use our mannequin but have a different visual in order to be able to provide that training?

Jerrod Jeffries: 11:17

Just summarizing that for myself. It's like you saw, you know maybe harsh terminology, but you saw that students were cheating. They're like, okay, we can game this, we know how to do it. And then you're like, well, that's not exactly fair. There's probably new technologies out there. Let's see what we can do, experiment with new technology, and then now I'm probably getting ready to go where it are now.

Jannie White: 11:38

Yeah, yeah. So it was a really synergistic time frame. At the same time that I was exploring different technologies, I learned about virtual reality, what virtual reality was.

Deb Tauber: 11:49

I'll be honest.

Jannie White: 11:50

The very first time I put on a virtual reality headset, it was because my youngest child convinced me that he needed to have it because there's a game called Job Simulator, so that would help him develop a career. So I think I was cooking on my very first VR experience. But really being able to take that and think about oh, this would be really cool if I could apply this into a training modality, and it's like Siri, or whomever is listening on the back end to send me the ads for my social media feeds was paying attention, because that's right around the same time that I learned about Oxford Medical Simulation, which is who I work for now.

Jerrod Jeffries: 12:33

So actually that's interesting too, because you were interested in the technology and what it could do. And then you found Oxford Medical, the company you work for now. Yes, OK, wow. And so what got you into simulation then was actually flight nursing school or being a flight nurse in that experience. And then now you transform this into more of a, something I don't say larger, but different.

Jannie White: 12:58

What's really amazing is I feel like when I was a flight nurse and a flight nurse educator, I had huge impact in the training we did some really amazing tip to tail simulations.

Jannie White: 13:11

We saw demonstrable change in practice, looking at quality outcomes and how our nurses were taking care of patients. But I had ability to participate in a very small slice, so really great impact and stretch out to the number eight now 20 flight nurses and everyone that they take care of. What's really meaningful now is that I have that ability to create that same type of impact but at scale. The ability for me now to partner with other educators who are bringing a new and innovative modality to their training environment, and then that reach that they have in terms of all of the patients that they're going to affect. I mean, that's really why we all get into it. Right Is to ensure that we're providing that best care.

Jannie White: 14:01

And create a difference.

Deb Tauber: 14:02

Yeah, yeah.

Jerrod Jeffries: 14:04

And so a little bit about Oxford Medical. How I don't say how big, but you guys, is it out of the UK, is it US? So what's, what's some of the background there?

Jannie White: 14:14

Yeah, it was originally a UK founded company. We've been in the US for six plus years now. Ok, Initially with working with academia, nursing schools, medical schools, but within the last several years we've now made that transition to partner with hospitals and health care systems. So really changing that way that we're delivering clinical education to our team members.

Jerrod Jeffries: 14:37

Great.

Deb Tauber: 14:38

Now, Jannie, when did you guys start to use simulation for hiring practices at UKAN?

Jannie White: 14:45

Yeah, we went through a phase when we were making that transition from a nurse resident team to a nurse nurse team.

Jannie White: 14:54

We knew that we were going to have to scale the team, but also because we were hiring so many people in rapid succession, we really needed to ensure that we were hiring the absolute right candidate, ensuring that there really wasn't time to hire someone, spend three months training and then realize that fit wasn't quite right or that knowledge that they brought to the team.

Jannie White: 15:20

And our team was incredibly unique in that we had we take care of everyone, from trauma patients to pediatric critical care, neonatal transports with our neonatal team or neonatal nurse practitioners. So you really had to have this wide array of knowledge and also be able to do it under a high stakes, high stress environment. So in that transition period, we brought simulation to the table as a way to not only have an opportunity to evaluate the candidates that we're coming through, but really also to give people an idea of what is this environment going to be like. You really can't know what it's like to be a flight nurse or a transport nurse until you've stepped in those shoes, and this gave them a moment to step into the shoes of a flight nurse role and kind of have understanding of what that looked like.

Deb Tauber: 16:15

Did you ever have people that after they did it, they were just like no, this is just not for me.

Jannie White: 16:20

We had not very many, but a few here and there.

Jerrod Jeffries: 16:25

Yeah, All the better. I mean, if it's not a right fit, it's not a right fit and you just save both people time energy mental chair Right.

Jannie White: 16:33

Absolutely, and what we thought we learned some really interesting things. So we really focused initially on that clinical piece Are they able to manage a complex pediatric patient? Are they able to take care of a acutely-decommon seeding adult patient? But along the way we learned a number of pieces that we were able to incorporate into those simulations of thinking about how did they react in a high-stakes environment when there's a other team member that you need to communicate with in that same time. So it came to communication engaging with family members. Are you solely focused or are you able to multitask when you're in that high stress environment? Because when you're a flight nurse, you're always playing in someone else's house and taking care of patients and other people's environments. So that education bit, pr component and the calming presence was always something that you had to bring to the table as well. So we really found that we got a snippet of being able to evaluate that piece of the role.

Jerrod Jeffries: 17:39

So, going through all these different pieces and I know you mentioned also neonatal, some nurse practitioners, peds, et cetera Do you have a favorite simulation story among all these?

Jannie White: 17:47

Like that's so hard to pick. There's many in my experience that I think are my favorite. So I think in my physical simulation world one of my favorites was a multidisciplinary simulation that we did with our neonatal ICU team. So we called these tip-to-tail and it's a pet-to-toe tip-to-tail of the helicopter tail rotor and we started with an initial call. So this involved our communication specialist.

Jannie White: 18:15

We had one of our attendings in the neonatal ICU play the role of a referring physician. They called or connected with our neonatal ICU fellow who's able to provide a little bit of guidance on that care of the patient. And then they dispatched the flight team. So now the team needs to assemble prep pre-brief. There was always a pre and a debrief in this flight world as well. So they pre-briefed the transport. They went in our simulation lab. Our simulation lab served as many, many referring hospitals. They stabilized the patient and then we packaged the patient up into the transport isolate, put them in the helicopter and we completed a large orbit.

Jannie White: 18:59

So we had two helipads at the university. We flew from one to the other with a little bit of time in between so that they could practice that a decompensation of the patient in the helicopter as well. And then when we landed, we handed off to the neonatal ICU team, so to the neonatal ICU nurses that would be taking care of the patient. So really this full beginning to end process. And then at the end we did these debriefing components that involve pulling the groups together to debrief what did that handoff look like? What information did you feel like you had and you didn't have and you needed? How was that transition? But then also pulling the teams individually in terms of how did that go, in terms of that transport piece or the communication piece, so really being able to dive into the intricacies of everything that goes into taking care of that transfer of a critically ill neonate.

Deb Tauber: 19:55

Yeah, now you haven't been out too long. I mean you just essentially retired from the flight, nursing what a couple months ago?

Jannie White: 20:06

It was a year ago. It was January of last year, okay.

Jannie White: 20:11

And as nurses do. Right, I had two roles for a bit of time, but really my passion right now is to be able to build that VR simulation community and partner with different institutions to change that way that we're delivering education Primarily. I work primarily with our hospital and healthcare system partners in that ability to transform how we're training our clinicians, not only taking things from I think we've all done this as a clinician rate those online click, click click where I might not have actually watched my whole scenario to something that's meaningful in a scalable way. Not all of our partners have access to simulation labs and they might be a little bit more remote or not have the resources to be able to engage in some of the physical simulation that some of our larger institutions have the ability to. So really democratizing that simulation experience.

Deb Tauber: 21:13

So do you have a favorite virtual reality simulation story you want to share?

Jannie White: 21:19

I do, and it's going to be a little bit of a repeat story, because you chatted with the Big 10 team about the simulation, the multi-patient simulation.

Jerrod Jeffries: 21:32

Just to give our listeners a little background. We did another podcast to what Jane is getting ready to get into of some Big 10 schools using their technology and such, but it's another podcast that she's referring to. Just want to let those others know.

Jannie White: 21:46

And you should definitely listen to that other podcast. That team's doing some really fantastic work. So that multi-patient scenario is really just one of my favorites. It works in that transition to practice sphere where we're seeing that gap in nurses graduating and coming to practice because they really don't have that opportunity to take care of multiple patients in that academic setting. Right, when you go off to a nursing clinical you take care of maybe one or two patients three if you're really lucky and now you come into that clinical setting and you're taking care of, you know, five patients.

Jannie White: 22:26

And what I love about it is that it has the ability to pull in the physical components of thinking about the patient's diagnosis. You're able to see their evolution. So, patient with anaphylaxis, for instance, you're seeing that rash evolve. You're hearing that change in their shortness of breath. You're able to listen to their lung sounds. You're really seeing that physical evolution. But also the scenario functions in a way that is non-branching and not standardized. It takes that engine, that physiology engine, as well as the inputs on what people do, and that patient evolves in ways that are different, even if I play the scenario twice in a row, because I've made some different decisions and done things in different orders, so really almost like a matrix in the way the scenario evolves, and then you have that ability to add a new patient each time. You come in to the point where you're taking care of five patients and really managing that load to patients that are decompensating near the same time. What do we need?

Jannie White: 23:28

W D I delegate to and also follow the patient through that journey of their hospitalization right. That patient that I met in that first scenario. Once I get to the fourth, I discharge them home. There's so many different pieces around DEI social determinants of health, the physical management of the patient, as well as that ability to have that emotional connection. I think that's my favorite. There are a few of the patients that I've met in the virtual environment where I'm like oh, I've met you in real life and this feels real. The seizing patient. It creates a little bit of internal stress in a good way of that. This is oh gosh, this patient is decompensating in front of me. I need to do something about it.

Jerrod Jeffries: 24:13

My question to you is is there an ideal time? Because I feel like there's a lot of complications but complexities around the multi-patient, which again I love but is there a way to kind of pause the scenario, or is there a way to pick it up or hand it over, or how does that work? Can you just give me a little more insight there?

Jannie White: 24:32

Yeah, and just to clarify, when you ask about time, you're asking about time in the headset or time in the scenario.

Jerrod Jeffries: 24:38

Yes, that's correct.

Jannie White: 24:39

Yeah, most of our scenarios are, quite frankly, 30 minutes, 20 to 30 minutes in length, and literature shows that is about the ideal time that you want to spend for these multi-patient scenarios. Obviously, as you're taking care of more and more patients, that might not.

Jerrod Jeffries: 24:54

It's the same as a cooking class you used before you got into 20 or 30 minutes. Right.

Jannie White: 25:01

Sorry, go ahead With those. You are able to answer your question directly. You are able to pause the scenarios. So if you get to the point where you're like, oh, I've been in my headset for 20 minutes, I can pause and then pick it right back up where I've left off.

Jerrod Jeffries: 25:14

Fantastic.

Jannie White: 25:15

We find that most people are so immersed, though, that they keep going, and because you're not doing something like riding a roller coaster or base jumping or swimming with sharks, then people do pretty well in that scenario, even in that full length of time. They have that emotional connection right, so they don't want to leave them.

Jerrod Jeffries: 25:35

And it's funny you mentioned the roller coaster, because everything that goes viral with VR is always some insane high adrenaline death or do or die thing and it's like, well, there's other use cases for VR as well. And then just walking a plank and then getting pushed over by, you know, under the sea, by pirates or something. That's a good clarification too.

Deb Tauber: 25:55

Yeah, now, Jannie, do you miss the flight? Nursing at all?

Jannie White: 25:59

I get this question a lot.

Deb Tauber: 26:01

I figure.

Jannie White: 26:02

I miss flying in the helicopter, no doubt. Well, just put that out there. Maybe one day we'll have a VR scenario in a helicopter.

Jannie White: 26:09

So I can virtually fly in the helicopter again. I do fly enough now commercially that I'm flying quite a bit and have had my fair share of practice taking care of patients on a commercial airplane. But from the flight nursing perspective, the timing was right. We've grown a new team. It was time to hand over the ratings to the next generation and they're an amazing team doing amazing work. I don't miss getting up at 3am when it is negative 20 degrees outside and I've had back to back calls and five minutes of sleep and trying to get my legs properly into the flight soon. But there is nothing like flying in a helicopter and the impact that you can make on a patient in that moment. There's a lot of tragedy in flight nursing but when you really were able to make the impact, those saves were monumental and I do keep those close and, to your own words, right, you having such an impact on one individual or maybe a small group with flight nursing.

Jerrod Jeffries: 27:13

But that scale, you know you're having an impact, Although you don't see it firsthand all the time. You have such a larger number because of what you're doing here. So thank you.

Deb Tauber: 27:23

And what you're doing here is very forward thinking. What do you think is on the horizon next?

Jannie White: 27:30

I guess I'll ask a clarifying question around that for me personally or in the industry.

Deb Tauber: 27:36

In the industry? Yeah, in the industry. I don't want to push you too much into what are you doing next?

Jannie White: 27:43

Well, here the team stuck with me. I am really doing the work that I'm passionate about now. So, from the industry perspective, I think we're in such early stages for the technology there is just a wide range of things that we can scale into. I think we'll see the technology, so the hardware, continue to evolve in advance. I think that things like haptic gloves so the ability to do more hands-on components Now it's you know not, it's good for some things, but you're still holding a gross motor sized hand controller to be able to engage at least in a affordable and scalable manner for most people. So I think things like haptic gloves will advance and we'll see some more of those hands-on tactile things that are done well. I think that's the key right. There's so much out there that can be done. Really being a part of things that are done, and done well, not just done to be put out there, is key.

Deb Tauber: 28:52

Well said, yes, agree. Now, Jannie, is there anything that you want to leave our listeners with, any words of wisdom or anything that you want to impart?

Jannie White: 29:04

I would say and this comes back to your question initially about was there any friction when teams first started using simulation I would say my takeaway would be embrace the change on the journey and don't be afraid to try new things. I think when I first started in my educator role, I was bringing problem-based learning as this brand, brand new thing. I'm now showing my age and you know now. Look at that evolution to where we are now and we're able to hold on to the roots of some of the pieces that were critical at that point, but also drive that change forward in the way that we innovate and shift our thinking.

Deb Tauber: 29:57

Excellent, excellent. Anything else that you want to share? Do you have any closing thoughts?

Jerrod Jeffries: 30:02

No, I love this. This was great. I think we've pivoted from the physical world to the flight nerves, over to the virtual one of what you're doing with Oxford and really appreciate the time here. This was incredible.

Deb Tauber: 30:16

Yep, thank you very much.

Jannie White: 30:19

Thank you both. I so appreciate your time.

Deb Tauber: 30:21

Oh, we appreciate you and everything that you've done and everything you continue to do. We look forward to seeing you in a couple weeks at IMSH.

Jerrod Jeffries: 30:30

Certainly.

Deb Tauber: 30:31

Yeah, all right. Thank you very much and happy simulating.

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