After more than four decades as a nurse, Michael Ackerman is passionate about critical care nursing, innovation and speaking at the National Teaching Institute & Critical Care Exposition (NTI). He currently serves as director of the Center for Healthcare Innovation and Leadership Program, as well as professor of clinical nursing, at The Ohio State University, where he recently introduced extended reality (XR) into the undergraduate nursing curriculum.
In this interview, Ackerman shares his experience and the lessons he’s learned about using virtual reality (VR) and the metaverse to educate nurses. In addition, the longtime NTI presenter discusses his popular preconference session, Experiential Learning: The Use of Extended Reality and the Metaverse in Nursing Education, which he and his colleagues are bringing back for NTI 2025.
What’s the elevator pitch for your half-day preconference session?
Our objective is to challenge the conventional way of education. If you want a fun, interactive, engaging experience using cutting-edge educational technology, this is the session for you. It gets people immersed in both the content and the technology, but it’s also pedagogically structured for effective learning.
We start with 15 minutes of didactic microlearning instruction, where we cover topics such as VR and the metaverse, how to pick the best hardware and software, and best practices for setting up an XR program. Then we move on to the hands-on stations where they get to put on a headset and actually experience VR simulations.
People want to be engaged; they want to be part of it. It’s an exciting way to learn.
Tell us about the equipment and lessons you use. What are attendees’ reactions to the experience?
We have four different hands-on stations. There are several different types of headsets available, but we’ve found the Oculus Quest 3 works best for our needs. So every station uses the Quest 3 headset and a different type of software program, depending on the topic. There’s soft skills training, metaverse training and two patient simulations.
One reason people like it is that we’ve distilled it down to the information they need to know to start using this technology immediately. That’s why people come to NTI - they want information they can take home and start using on Monday, and that’s how we’ve structured this course.
When and how did you become interested in using the metaverse to educate nurses?
I’ve always been a tech junkie. Many critical care nurses go into the ICU because they like technology. After two years at Ohio State, I started to explore the ideas of XR and the metaverse, and how we can effectively utilize them in our teaching.
Then three years ago, the American Nurses Foundation put out a call for proposals aimed at disrupting nursing education. We had already started down the path of developing an XR program, but it was moving slowly. So I put a team together and we applied for a grant. That infusion of money really allowed us to accelerate what we were doing.
We believe it’s a very effective way to teach. It’s engaging, and there are things you can do with VR and the metaverse that you just can’t do in a classroom with two-dimensional PowerPoint, or even in a simulation lab. We’ll never fully eliminate didactic instruction or manikin-based simulation – that's not the goal. But the idea is to augment that education with experiential learning.
Nurses from varied backgrounds and of many ages learn differently. How is experiential learning with virtual and augmented reality helpful for educators and learners?
We learned a lot about this in the first year after receiving the grant when we integrated VR across our entire undergraduate curriculum, which includes 700 students plus faculty. We assumed it would be a no-brainer for the students in their early 20s and they would just catch on, but we were really wrong about that.
When it comes to how quickly people adapt to technology, it’s less of a generational thing and more about exposure. In our sessions, we’ve found that by the time the groups get to the fourth hands-on station, it’s already easier for them to operate the technology.
We learned the importance of how a new technology is implemented. We decided to dedicate more time to making sure people understood how to do things such as putting the headset on and using the hand controllers. That really made a difference in how effective it was and how easily people could use it.
What are some of the best topics for experiential learning?
Right now, the best-use case is for clinical training — critical thinking, decision-making and exposure to different situations. The beauty of it is the student puts the headset on and they’re all by themselves; there’s no prompting. It gets them to think independently and practice taking care of a patient.
It’s also very effective for soft skills training. Some of the more common programs focus on managing conflict, giving feedback, providing bad news and dealing with microaggressions. But there are also topics such as how to interview effectively. This software actually puts the student in the situation, so they’re experiencing what it’s like as the person who is engaged in that discussion.
Virtual reality is a great way to develop empathy. We use a program that allows people to understand what life is like as a homeless person. When they enter the scenario, they’re in a tent and they experience the police coming by to take the tent down. It’s amazing to be in the lab and listen to the students go through that – they’re truly empathizing with people in that situation. VR lets them practice skills they wouldn’t otherwise have the opportunity to develop.
How can a nurse educator get started with an experiential learning program in their hospital?
The market for VR software and hardware is evolving rapidly, so there are a lot of players in the space.
It all starts with the use case – how they’re going to use it and what they want the learner to get out of it. That’s the first question I ask when someone tells me they want to get started with VR. Depending on the situation, the best solution isn’t always going to be VR; it might be a 180-degree video or maybe screen-based simulation. We just went through this with our hospital system. One of the chief nurses wanted to use VR to train for low-volume, high-risk procedures, but it turned out that doing it with a 180-degree video was faster and less expensive than building an entire VR platform.
Once they establish their use case, the next step is to shop for software. Every company’s going to tell you their solution is the most effective, but you have to test-drive it. When we consider a piece of software, we try to break it. If we can’t, then it will probably work for us.
After they find the right software, they need to figure out the hardware that will support it. There’s a wide range of headsets available now that go from $300 all the way up to $10,000. But most nursing simulations don’t need a $10,000 headset. My advice is to find a headset that is almost off the shelf, out of the box, ready to go.
My biggest advice is to start small. Pick some early adopters and just start with a pilot to see if it works for you.
What other applications do you envision for VR and augmented reality in nursing?
I think this technology is going to evolve to become more of a therapeutic agent in addition to an educational tool. We’re starting a study with nurse managers where one group will get more of a traditional resilience training, and the other group will use this relaxation software three times a week. We’re going to see if it affects burnout and resilience.
A nurse shared how they’ve been using VR in their burn unit. Every day, they have to change the dressings on the wounds of these patients, which is painful. The patients get a lot of medications and a lot of sedation. But what they’ve started to do is use VR headsets and play some type of relaxation software for the patients. They don’t have all the data yet, but they believe they’re seeing less medication usage and less sedation. So I think we’re going to start to see more of that.
Let’s say you’re at NTI 2030. Where do you envision experiential learning will be at that time?
I’d like to see more experiential learning. Perhaps instead of just a preconference session, we start to intersperse the experiential learning throughout the meeting itself.
I just think people learn best when they’re engaged. So I’d also like to challenge presenters to think differently about how they teach and to use different methods. In our sepsis session, we give people T-shirts and they act out the sepsis cascade. Afterward, people tell us they never understood it until they saw a neutrophil chasing a bacteria and it was two of their friends acting it out.
It’s all about getting people more involved in the content and to really make it fun. That’s been our goal for a long time, and people really seem to love it.
Is there anything else you’d like to share?
I’ve presented at every NTI since 1992, and I’ve been an attendee for even longer. It’s an amazing meeting – it’s uplifting, it’s high-energy and just a great place to network and meet new people. It’s been such a privilege to be a presenter, and I still get so pumped to present every year. I’ll see you in New Orleans!
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