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Gamification Brings Effective Learning, Along with a Bit of Fun, to Nurse Education

Analysis  |  By Carol Davis  
   April 19, 2021

Denver Health's online scavenger hunt and escape room helps train new nurses by 'hitting different modalities of learning and being able to capture all learners,' Denver Health nursing educator says.

Denver Health is putting finishing touches on a new teaching game—a virtual escape room that will roll out during National Nurses Week, May 6-12.

An escape room—whether a physical room or an online, virtual room—requires participants to crack codes, uncover hidden clues, and solve challenging puzzles, all designed to help them escape the room or an impending disaster in a limited amount of time.

The new game's virtual setting is the hospital's night shift on December 31, 1999, and the impending disaster is an information technology (IT) catastrophe caused by a Y2K bug threatening to shut down all hospital computer systems. The objective is to find the clues and solve the puzzles in time to escape the IT disaster.

Education components of the new virtual escape room game are based on nurse-sensitive outcomes, says Jama Goers, PhD. RN, Denver Health's director of Nursing Education and Research.

"We want more awareness about NDNQI® [National Database of Nursing Quality Indicators]—how it's defined and how we're doing at Denver Health, as well as really highlighting some of the successes that we've had over the past year," she says.

For example, part of the game shows several NDNQI benchmark charts, asks the question, "Which indicators has NICU outperformed benchmark for 8 out of 8 quarters?" and offers several possible answers.

Teams can physically gather together to play the game or they can play individually on demand, says Jennifer Bonn, RN, a Denver Health professional development specialist.

"Our intention is that they can do both," she says. "I envision a night shift crew on a slow shift playing together or a single nurse playing alone during some downtime. That’s why the leaderboard will include participation by unit and by team. If it's collaborative, it would be highly effective and more fun."

Gamification is a growing trend in healthcare education, as evidenced by the increasing number of peer-reviewed scholarly articles on the subject.

Making learning fun

Denver Health started using gamification in 2014 with an orientation game called Saving Denver, a two-hour, in-person scavenger hunt around the health system's campus, as part of a larger orientation program.

Saving Denver calls for teams of participants to follow a map and work together to save Denver from an infectious disease by finding and unlocking dozens of clues to lead them to the location on campus of their next challenge.

For example, when a team finds a locked box containing the next clue, their task is to log into the health system's computer system, access a particular policy, and find its number, Goers says. That policy number is the code to unlock the box.

"Every activity was associated with an organization policy, she says.

Besides familiarizing new nurses with Denver Health policies and culture, the game also helps them get acclimated to their new surroundings, Goers says.

When the pandemic required social distancing last year, Denver Health created an online version of the scavenger hunt, allowing the health system to continue its fun orientation even with the constraints of COVID.

"They still have the same clues and hints and need to do things [as the in-person game], but they're able to navigate now through a virtual campus," Goers says

'Gamification [is] an effective way to teach'

Learning with games is effective, according to research exploring nurse education and gamification.

"The use of serious games as part of the teaching-learning experience in nursing education fits into the philosophy and strategies of active learning," according to the 2015 study, Gamification: An Innovative Teaching-Learning Strategy for the Digital Nursing Students in a Community Health Nursing Course. "The 'digital' nursing student needs engagement, stimulation, realism, and entertainment—not more readings and PowerPoint supplements in the classroom to support learning."

A 2017 study, Using Gamification to Improve Productivity and Increase Knowledge Retention During Orientation, explored the effectiveness of three different teaching methods—academic, online modules, and gamification—for teaching orientation.

A sample of 115 nurses was divided into three groups, each learning from a different teaching method, to evaluate their clinical knowledge before and after orientation. 

Related:  Productivity Skyrockets in Sharp Healthcare's Gamified Revenue Cycle

The gamification group posted the highest mean scores post-orientation, compared to the academic and online module groups. The study concluded that, "gamification [is] an effective way to teach when compared with more traditional methods. Staff enjoy this type of learning and retained more knowledge when using gaming elements."

Measuring gamification's success for Denver Health's nurse education consists primarily of gathering feedback and self-reporting, Goers says. 

Providing the best tools for learning

Some people can learn from traditional instructional methods, but others require more tactile approaches to learn and retain information, which is what gamification offers, Goers says.

"It's about hitting different modalities of learning and being able to capture all learners," she says. "That way, we're able to fully capture our learners' needs in providing the content that they're going to need to be successful."

Gaming is one solution for capturing and holding attention people's attention spans, which some experts estimate can be as little as just seven minutes.

"It's about finding that balance and being able to maintain attention and deliver content that's meaningful to our end users," she says.

Advantages of gamification

Besides offering a bit of fun to nurses as they learn, gaming provides team building and socialization, and learning a particular policy becomes more appealing and less of a checked box, Goers says.

"Instead of it being, 'Here we are going through another policy,' people are a little bit more engaged in trying to get through the game quicker because there is that competitive component or that reward at the end," she says. "That makes it fun and it's a little bit different."

Learners also appreciate the flexibility of navigating the system at their own convenience, she says.

"They don't feel pressure that they have to do it within a certain timeframe, so they're able to absorb a little bit more," Goers says. "And they just really appreciate a different approach to policy and procedure and onboarding."

“We're able to fully capture our learners' needs in providing the content that they're going to need to be successful.”

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.


Denver Health will roll out its new teaching game, a virtual escape room, during National Nurses Week, May 6-12.

Gamification is a growing trend in healthcare education.

Educating with gaming methods is as effective as more traditional methods, studies indicate.

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