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Playing a simulation game sharpens emergency department skills

A game that simulates the challenges of an emergency department is helping nurses and other healthcare professionals to develop clinical leadership skills
Picture of healthcare professionals taking part in The Floor game, which simulates the challenges of an emergency department and is helping nurses to develop clinical leadership skills.

A game that simulates the challenges of an emergency department is helping nurses and other healthcare professionals to develop clinical leadership skills

The Floor is a simulation game that recreates the day-to-day workings of an emergency department (ED), helping nurses and other healthcare professionals to develop clinical leadership skills.

With increasing pressure and constantly shifting patient acuity and flow, managing the shop floor is a difficult but essential skill.

Table-top simulation is a familiar feature in major incident and natural disaster training as a cost-effective way of equipping staff to respond to serious incidents.

The game includes a range of ED scenarios, events and patient profiles

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A game that simulates the challenges of an emergency department is helping nurses and other healthcare professionals to develop clinical leadership skills

Picture of healthcare professionals taking part in The Floor game, which simulates the challenges of an emergency department and is helping nurses to develop clinical leadership skills.
A session of The Floor game at Brighton and Sussex University Hospitals NHS Trust

The Floor is a simulation game that recreates the day-to-day workings of an emergency department (ED), helping nurses and other healthcare professionals to develop clinical leadership skills.

With increasing pressure and constantly shifting patient acuity and flow, managing ‘the shop floor’ is a difficult but essential skill.

Table-top simulation is a familiar feature in major incident and natural disaster training as a cost-effective way of equipping staff to respond to serious incidents.

The game includes a range of ED scenarios, events and patient profiles

This method of teaching has been adapted for the ED by staff at Brighton and Sussex University Hospitals NHS Trust.

The Floor game was invented by Salwa Malik, an emergency medicine consultant at the trust, to help with a mock major incident day in 2015 when she was a registrar, and includes a range of scenarios, events and patient profiles.

It takes 90 minutes to play and each session involves 12-14 healthcare professionals.

The table-top simulation kit has added to the styles of teaching the trust delivers

Brighton and Sussex University Hospitals NHS Trust has been using The Floor to train nurses and healthcare assistants at the trust for the past two and a half years, and it is routinely used for major incident and CBRN (chemical, biological, radiological and nuclear) study days.

As practice educators involved in developing and designing study days, introducing a fun table-top simulation kit has added to the styles of teaching we deliver, and we love to see staff including nurses getting into the spirit of the game.

Picture of The Floor game, which simulates the challenges of an emergency department and is helping nurses to develop clinical leadership skills.

We use it as a teaching and training tool by pairing a senior band 6-7 nurse with a band 5 member of staff to play The Floor together. This allows junior staff to learn from the leadership style of the more senior nurse and appreciate the difficult role of leading a shift in the ED. It also gives more junior staff the chance to deal with difficult situations and problems in their own way, by assuming the role of the senior nurse.

Nurses' understanding of clinical conditions and management of the ED

We use The Floor to see how nurses are developing their understanding of clinical conditions and management of the department, and they find it a useful aid if they are planning to apply for a higher band or have just stepped up.

If we decide to declare a major incident in a game we take time to decide on roles and responsibilities using our own major incident role cards, familiarise the team with triage protocol, and sort and divide up the zones.

Before the game we give a major incident lecture, enabling participants to implement what they have learnt and ask questions about what is happening during the game.

Nurses feel more confident and knowledgeable

This has made staff feel more at ease about trust processes and pathways during a major incident and it generates brilliant discussions in the debrief – how we could do things better, what resources we lack and clarification of procedures.

The feedback from our staff has been phenomenal and is the reason we have embedded the game into our teaching programme.

Nurses feel more confident and knowledgeable and this can be seen in the way they work in the emergency department.


Sarah Fry and Justin Walford are senior nurse practice educators at Brighton and Sussex University Hospitals NHS Trust. Andy Yeoman is director of Focus Games


Find out more

The Floor – Emergency Department Simulation

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