“Negotiating, Navigating, and Networking”: Three Strategies Used by Nursing Leaders to Shape the Adoption and Incorporation of Simulation into Nursing Curricula—A Grounded Theory Study

Background. Implementing simulation requires a substantial commitment of human and financial resources. Despite this, little is known about the strategies used by academic nursing leaders to facilitate the implementation of a simulation program in nursing curricula. Methods. A constructivist grounded theory study was conducted within 13 nursing programs in Ontario, Canada. Perspectives of key stakeholders including nursing administrators , simulation leaders , and nursing faculty were analyzed using the constant comparison method. Results. Nursing leaders, specifically nursing administrators and simulation leaders who successfully led the adoption and incorporation of simulation into nursing curricula, worked together and utilized negotiating, navigating, and networking strategies that impacted the adoption and incorporation of simulation into nursing curricula. Conclusions. Strategies that were found to be useful when planning and executing the adoption and incorporation of an innovation, specifically simulation, into nursing curricula provide practical approaches that may be helpful to nurse leaders when embarking upon an organizational change. 1. Introduction The use of simulation as a teaching strategy in nursing education has developed significantly within the past decade [1–3]. Despite the increased use of simulation and the attention received [3], the integration of simulation into nursing curricula has been inconsistent. In 2004/05, the Ontario Government provided each nursing program in the province with approximately $500,000 in funding to purchase simulation equipment [4]. Prior to this time, the use of mid- to high-fidelity simulation equipment as a teaching strategy was uncommon in most programs of nursing. Mid- to high-fidelity equipment is defined as life-like equipment that can imitate real-life responses to medical conditions [5, 6]. What followed was a time of dynamic change in nursing curricula as nursing programs started the process of incorporating simulation which provided an opportune time to examine how organizational culture shapes the adoption and incorporation of simulation. Taplay and colleagues [7] discovered key organizational elements that shape a common process of adoption and incorporation of simulation into nursing curricula. Institutions that were able to navigate this process and integrate simulation into all levels of curricula in which nursing content was taught were classified as high uptake. The key organizational factor that was identified in high uptake sites was the shared leadership among nursing leaders. This