University of Buffalo Prepares Nursing Students to Serve Rural and Underserved Communities

Key takeaways:

• REACHvr uses VR simulation to prepare nursing students for the challenges of caring for rural and underserved populations.
• The program provides hands-on experience in a simulated environment, helping students adapt to resource-limited healthcare settings.
• REACHvr helps build a pipeline of nurses who are motivated and prepared to work in rural and underserved communities.

Why REACHvr? Why now?

The United States faces a severe nursing shortage, particularly in rural and underserved areas. Patients in these regions have limited access to healthcare providers, leading to higher mortality rates and increased rates of chronic illnesses..

Dr. Foltz-Ramos created REACHvr to directly address these disparities:

“We received a HRSA grant to develop this program because rural and underserved populations experience significantly higher healthcare disparities. There’s a 23% higher mortality rate in these areas, along with increased cases of chronic diseases like heart disease, diabetes, and mental health disorders—but they lack access to resources, including nurses.”

By immersing students in realistic virtual scenarios, the program helps them understand the challenges of providing care in resource-limited environments.

“We hope with REACHvr, to create a pipeline of nurses who are not only aware of the challenges in rural and underserved communities but are also motivated and prepared to work in those settings. By giving them an immersive, hands-on experience, we hope to make a real impact on the healthcare workforce and, ultimately, patient outcomes in these areas.”

Preparing Nursing Students for the Realities of Rural Healthcare

The lack of clinical placement opportunities in rural settings has historically made it difficult for nursing students to gain exposure to these unique challenges. REACHvr bridges that gap by allowing students to treat patients in a simulated rural clinic without ever leaving campus.

“In VR, our students get experience treating patients in the rural clinics, which is important if they do decide to work in that area. But even if they work in a hospital in Buffalo, they're going to encounter patients who are from those settings—so they have to know how to care for them.”

Caring for rural patients requires a different approach, particularly when it comes to care continuity and discharge planning.

“When they go to discharge those patients, they have to understand the differences—that they can’t just say, 'All right, follow up with OT, PT, nutrition,' because the access to that is not there. It might be a completely different way of providing that continuity of care, which is so important for preventing hospital readmission.”

How REACHvr Engages Students

Each semester, students complete two VR scenarios along with an online learning module and a screen-based telehealth virtual simulation.

“We bring in eight students at a time, split them into groups of four. Two of them are active participants, and two act as observers (ghosts). Then they swap for the second scenario. Everyone pre-briefs and debriefs together.”

The interactive, immersive nature of VR simulation is one of the key reasons students find the experience engaging and valuable.

“We love that we can have two active nurses together in the simulation. To me, that’s one of the biggest things that makes UbiSim stand out—the ability to have multi-users in the same scenario.”

Faculty/Student Feedback

Since implementing REACHvr, the University of Buffalo has seen overwhelmingly positive feedback from both students and faculty. 

“A recurring theme in student feedback is the realization that nursing care involves more than simply completing a checklist of tasks. Students are gaining a deeper appreciation for the importance of building rapport and engaging in meaningful communication with patients. They also recognize how approaches to care must be adapted based on the individual patient.”

Here’s what a student had to say:

“REACHvr really opened my eyes to the differences in caring for patients in rural and underserved communities. The online modules helped me understand the background, including limited access to care, transportation barriers, and the importance of community resources; however, it was the virtual reality simulations that made it real. Being immersed in the rural clinic helped me recognize how much I take certain resources for granted. I had to think critically and adapt my communication and plan based on the available resources. It made me more aware, more flexible, and more compassionate. I know this experience will influence how I approach patient care no matter where I practice."

Bringing Rural Healthcare to Life with Custom-Built Scenarios

To ensure the highest level of realism, the REACHvr team collaborated with experts to develop scenarios based on real-world cases.

“We wanted to make these scenarios as realistic as possible, so we worked directly with nurse practitioners, clinics, and public health departments in rural and underserved areas to develop the content. The NPs from these communities helped us design cases that truly reflect what students would encounter in the real world.”

The program currently features four VR scenarios, each designed to expose students to common rural healthcare challenges:

• Postpartum depression: A single mother with three young children experiencing postpartum depression.
• Pediatric well-child visit: A five-year-old child living in transitional housing who needs a kindergarten check-up.
• Acute care case: A patient with liver failure and a history of alcohol abuse requiring urgent care.
• Chronic disease management: A patient with heart disease, diabetes, and hypertension facing long-term health challenges.

Expanding Enrollment and the Future of VR in Nursing Education

A recent policy change in New York State is opening new opportunities for VR-based clinical education.

“In 2023, New York State passed a law allowing us to replace one-third of clinical hours with simulation. Before that, we weren’t allowed to count it as clinical experience. The purpose of this change is to expand enrollment, because without being able to use simulation, we couldn’t train more nurses due to a lack of clinical sites.”

This shift to using VR as a simulation tool is helping address the nursing shortage while ensuring that students still receive high-quality training.

“We don’t traditionally recruit from high schools because our nursing program begins in the junior year, and we have more applications than available spots. But as we plan to expand enrollment, one of the things we plan to do is actually have VR scenarios for younger students to attract them to the field.”

As REACHvr continues to grow, it is setting a new standard for how nursing programs can prepare students for the realities of healthcare, especially in underserved communities.