By Paul Mazurek, RN, BSN, M.Ed., CCRN, CFRN, CHSE-A, NRP, IC
Across nearly three decades in healthcare—as a nurse, paramedic, educator, and simulation specialist—I’ve witnessed the evolution of nursing education firsthand. What concerns me most today is a question that profoundly impacts many nurse educators: When a student earns their RN license, are they truly prepared to care for patients?
Too often, the answer is no.
This is not a critique of nursing students. To the contrary, they are some of the most dedicated, intelligent, and resilient individuals I’ve worked with. But the system that trains them is struggling to meet the complexity of modern healthcare. Our educational structures have not kept pace with the real-world demands that nurses face starting with their first day on the floor.
The Decline in Readiness
Historically, about 1 in 3 new nurses was considered ready for independent practice upon graduation. Today, that number has dropped dramatically. A 2021 report in the Journal of Nursing Education placed it below 10%. Even more telling is the disconnect between perception and performance: while 72% of nursing educators believe their students are ready, fewer than 20% of hospital administrators and clinical supervisors agree, according to a 2020 report from Wolters Kluwer Health.
These are not abstract figures. They reflect a growing gap between the classroom and the clinical environment—a gap with direct consequences for patient safety and team confidence.
The primary issue is not knowledge. It’s the application of that knowledge in high-pressure, unpredictable scenarios. It’s clinical judgment, prioritization, decision-making, and perhaps most critically, patient advocacy.
When It Became Deeply Personal
My awareness of this crisis deepened when it affected someone close to me—my mother-in-law, Marsha. She was vibrant, active, and beloved by many. During a hospitalization near the end of her life, she did not receive the advocacy she deserved. Her care team missed critical signs of dehydration and renal failure. When I raised concerns, I was dismissed—not on the basis of clinical evidence, but because I asked questions outside the usual hierarchy.
The most troubling response I received was, “That’s what the doctor ordered.” I was reminded of something a mentor once told me: if those words ever come out of your mouth as a nurse, you’ve stopped thinking and started following. As a result, in my professional opinion, Marsha passed away prematurely.
Advocacy is not optional. It’s foundational to nursing. It must be cultivated deliberately in training—not assumed as an instinct that will emerge on its own.
Systemic Shifts—and Missed Opportunities
The roots of this issue are structural. Over the past 20 years, we’ve moved from an apprenticeship model—where bedside mentoring was central—to a fragmented academic model. Diploma programs have been phased out, clinical site availability has diminished, and the demand for higher degrees has resulted in more classroom time and less hands-on experience.
Simulation has been positioned as part of the solution. Studies support replacing up to 50% of clinical time with simulation. But how simulation is deployed matters. Measuring success solely by National Council Licensure Examination (NCLEX) scores or confidence levels misses the bigger picture. Confidence without competence is dangerous.
What today’s learners need are high-fidelity, emotionally engaging, decision-rich environments that mirror the realities they will face in practice.
Technology Matters
Nursing students today are digital natives. They engage deeply with interactive technology and expect it as part of their education. Yet many programs still rely on passive learning methods such as PowerPoint presentations, recordings, and static mannequins.
At VRpatients, we’ve taken a different approach.
Through the development of AI-driven, asynchronous virtual reality learning, we’re delivering the most realistic non-live patient encounters available. These scenarios replicate the dynamic, often chaotic conditions of real-world care, requiring learners to identify clinical cues, prioritize interventions, and act under pressure.
Unlike traditional simulation, VR allows us to guarantee exposure to critical cases—severe hypotension, respiratory failure, sepsis—regardless of clinical site availability. It enables consistent, measurable development of clinical judgment, advocacy, and pattern recognition.
This isn’t just a technological innovation; it’s a pedagogical one. It bridges the gap between theoretical knowledge and practical readiness in a way that today’s clinical environments demand.
Moving Forward—With Purpose
The tools to address nursing’s most urgent educational gaps exist right now. We have the ability to develop clinical judgment and advocacy—not in theory, but in practice. And the stakes could not be higher.
Ultimately, nursing education must answer a simple, sobering question: are our graduates ready?
If we cannot confidently say yes, then it is our responsibility—as educators, institutions, and innovators—to build an education model that ensures they are.
It is not enough to graduate nurses. We must prepare them.
If we’re serious about preparing the next generation of nurses, then we can’t keep relying on outdated methods and hoping for better outcomes. We need tools that meet students where they are—and push them where they need to go.
VRpatients is already delivering that.
If you’re an educator, decision-maker, or someone who believes nurses deserve better training—and patients deserve better care—let’s talk about what it means to be VR trained. Click here to begin learning more about how we are changing clinical education—one immersive scenario at a time.