The Patient Safety Institute (PSI) is the simulation center for the North Shore-LIJ Health System and Hofstra North Shore-LIJ School of Medicine. In 2012, PSI was granted accreditation from the Society of Simulation in Healthcare (SSH) for excellence in the areas of core standards, teaching/education, assessment and systems integration. This accreditation recognizes that PSI adheres to the rigorous educational standards set by the society, a prestigious international organization. Several PSI team members serve as SSH accreditation site reviewers and have received SSH certification as Certified Healthcare Simulation Educators.

In September 2014, Springer Publishing published a groundbreaking book about PSI. Edited by Kathleen Gallo, PhD, MBA, RN, FAAN and Lawrence G. Smith, MD, MACP, Building a Culture of Patient Safety through Simulation: An Interprofessional Model. The book describes in detail the success of the organization in using simulation in an interprofessional clinical learning environment to achieve patient safety. 

The book also provides detailed case studies using concrete methods and examples to illustrate the application of theory into practice, introduces simulations adaptable to any size organization and for use by healthcare professionals in all specialties as well as includes theoretical foundations and practical application for educating learners.

Nursing fellowships

Nursing fellowship programs offer an environment wherein new graduates and experienced nurses receive the educational support and clinical coaching necessary to become successful in a new specialty field. These programs build the foundations needed to attain specialty certification in critical care, emergency and pediatric nursing. The programs have also helped the health system address issues related to recruitment and retention. Since creating critical care, emergency and pediatric nursing fellowship programs, the health system has recruited more than 1,100 nurses in  many specialties. Besides improving the quality of patient care and resolving a major recruitment challenge, the fellowship programs have decreased overtime costs and the use of more expensive per diem nurses hired through nursing agencies. Participants in the fellowships are required to make an employment commitment of 24 months to the unit to which they are hired.

In 2005, the William Randolph Hearst and Rhoda N. Gilbert Critical Care Nursing Fellowship Program (CCNF) was the first fellowship developed by the NSLIJ Health System. CCNF is used as the foundation for subsequent nurse fellowships. CCNF is a specialized orientation process which provides a critical care foundation to recent graduate registered nurses or experienced registered nurses who are considering critical care specialties. This specialized program affords a full complement of didactic and clinical experiences needed to develop competency in the critical care arena.

The fellowship program is a year in length because of an identified need to prolong the learning experiences of new graduate RNs. It uses a blended learning program to educate its nurses.  The fellowship model consists of (1) the use of behavioral interviewing, (2) nurse leaders as mentors, (3) Essentials of Critical Care Orientation (ECCO), AACN’s web based critical care curriculum, (4) professional seminars, (5) Associate Fellows - experienced critical care nurses educated in the art of preceptorship of new graduate Nurse Fellows, (6) Master Fellows - masters prepared educators providing education and guidance to the Nurse Fellows during the length of the Fellowship Program, and (7) simulation as a learning strategy. The elements of the fellowship program are educational interventions that can impact nurse retention, quality of care, and patient safety.  The program provides opportunities for essential patient management and the clinical experiences needed to develop competence in the critical care specialty. Instruction addresses the following areas:

  • Didactic experiences and professional seminars in vital areas such as comprehensive assessment skills, patient care management, interprofessional collaboration and nursing models of care delivery. Leadership development workshops focus on communication, delegation and transcultural care.
  • Clinical simulation in an interprofessional discipline learning environment that builds competence by replicating the intensity and need for teamwork found in fast-paced critical care settings.
  • Direct care assignments via hands-on work experience in selected critical care specialties including cardiothoracic surgery, coronary care, medical ICU, neuroscience ICU, Cardiac Cath Lab and surgical ICU.

Since their inception in 2005, the critical care nurse fellowship program has educated over 700 critical care nurses. Noting the success of the programs, CLI has created similar programs to strengthen staff in the organization’s emergency and pediatric units.

The Emergency Department Nurse Fellowship Program (EDNF) is a specialized orientation process which provides an emergency care foundation to recent graduate registered nurses or experienced registered nurses who are considering emergency department specialties. This specialized program affords a full complement of didactic and clinical experiences needed to develop competency in the emergency department arena. Following the foundation of the CCNF, the EDNF uses an ED specific core curriculum, as well as emergency department specialty education for both adults and children.   Since this program’s inception in 2006, more than 200 nurses have graduated from the program.

The Pediatric Nurse Fellowship Program is designed for nurses interested in working in pediatric intensive care units and pediatric emergency departments. The program provides a platform for RNs, based on a Pediatric core curriculum to develop the skills, techniques and critical thinking necessary to work with infants and children with complex medical needs. Didactic and hands-on courses bridge the gap between what was learned in school and what is needed on the job. The Pediatric Nurse Fellowship Program has seen over 100 nurses complete the program since it began in 2007. 


SimWARS is a competition that challenges interprofessional clinical healthcare teams to compete against each other in simulated patient scenarios. Teams apply to participate and are chosen through a robust application process. An expert panel examining the areas of teamwork, communication and clinical decision-making constructively critiques each team’s performance. The judges’ panel is comprised of content experts. Members of the audience, who also view the scenarios in real time, vote for the winner of each case using an audience response system based on their direct observation and the panel’s input. Each medical case is a mystery for the team until they enter the patient’s room, and they must rely on their professional knowledge and experience to treat the patient appropriately.

The inaugural SimWARS competition was held in September 2010; it is held annually at the PSI. In 2012, the competition expanded to include a regional competitor in the finals, allowing the organization’s interprofessional teams to demonstrate their abilities amongst a winner from a different SimWARS competition.

Clinical Skills Center

The Clinical Skills Center is dedicated to improving the quality of healthcare education using a standardized patient program. A standardized patient is an individual who has been carefully trained to portray a patient, family member or other character during encounter with a learner. Standardized patient roles range from the simple (routine physical exam) to the more complex (disease diagnosis), offering the learner a wide variety of experiences. Learners may interact with the standardized patient in smallgroup settings or in one-on-one encounters.
Working closely with faculty from the Hofstra North Shore-LIJ School of Medicine, the Clinical Skills Center provides methods of assessing clinical skills in a controlled environment. The Observed Structured Clinical Exam (OSCE) is a unique assessment tool, giving learners an opportunity to interview and examine standardized patients in a mock clinical setting. The standardized patient is trained to observe the learner during an encounter and give appropriate post-encounter feedback both on a checklist and face to face. The encounters are recorded and pre- and post-encounter data is collected and reviewed by faculty.
Standardized patients are also an increasingly popular and integral addition to both clinical and non-clinical learner-encounters for programs throughout the health system. Their detailed and realistic portrayal of patients, family members, staff members and administrators provides a unique and practical experience for learners from a variety of disciplines. The Clinical Skills Center provides a safe environment in which learners are able to practice physical examination skills, history-taking skills and communication skills and receive immediate feedback from faculty, peers and the standardized patient.