“Now It’s Just Part of the Culture”: How VR Became Standard Practice at UT Austin

‍Key takeaways:

• Nicole Manley’s diverse background bridges technology and nursing, driving innovation in simulation education.
• UbiSim is now a fully integrated part of UT Austin’s nursing culture, supporting student learning in labs and classrooms.
• VR helps students build confidence and clinical judgment by understanding the “why” behind protocols before hands-on practice.

The Value of Simulation and the Need for VR

Nicole reflects on her early clinical experiences: "It was challenging for me as a new nurse trying to figure everything out in front of a patient, especially in the ER. If I had been able to practice in a virtual environment like students do now, I would have had more confidence in some of the emergent patient scenarios."

Today, she channels that experience into creating safe and supportive learning environments: "I enjoy being able to give students opportunities to practice skills and scenarios, making mistakes with no judgment, and learn from them before performing on a patient. Nursing is already stressful. Half the battle is just developing that confidence that you do know what you're doing and projecting that. Once you’re able to do that, your practice is just seamless."

Integrating UbiSim into the Culture

UT Austin School of Nursing began using UbiSim in 2022. After three years of integration, Nicole says: "Now that the VR program is in place… this is probably the first year where it just feels like a part of the culture. Everyone is on board with VR."

Students now sign up for open lab sessions and are required to complete VR orientation before participating in clinical course simulations. "They can practice in open lab, do the orientations at their own pace and learn how to use the VR devices. They can repeat scenarios from class, or just explore the application if they want."

Nicole emphasizes that VR is not replacing clinical experiences but enhancing them.

"We had some students express concern that VR might replace their clinicals, and I think it's important to clarify that’s not the case. VR helps them prepare and feel more confident going into clinicals—it’s a supplement, not a substitute," she says.

Scenarios and Sustainability

UT Austin uses VR for a variety of simulations, including:

• Neonatal fever (protocol and clinical judgment)
• Blood administration (previously “clunky,” now protocols are clarified through VR)
• Pediatric asthma (protocol-based decision making)
• Preeclampsia in the perinatal program (replacing limited clinical placements)

With 650 students across all cohorts (60 undergrads per cohort, and graduate students), UbiSim has helped UT Austin scale simulation to meet growing demand.

Nicole sees UbiSim as sustainable: "We have our set scenarios, our set orientations. I think what we’ve implemented is going to stay and be sustainable for a very long time. We’re even interested in growing our use of the platform."

VR for Clinical Judgment and Protocol Mastery

Nicole explains that VR helps shift student focus from task completion to understanding protocols: "Oftentimes in simulation, they get very focused on tasking—doing the IV start, giving a medication—and they really don’t understand the why or their priorities. The VR scenario gives them a chance to work through that piece and understand the why of what they're doing, the order of the process they’re completing on the patient, and work through all that before they get to the manikin-based simulation."

She shares an example: "There’s a reason why you’re doing things in a particular order. For example, the neonatal fever scenario could be a sepsis situation with this infant. You have to draw all the blood samples and cultures first before giving any medications, because you need to know what’s growing in the bloodstream. VR helps them get practice following protocols, which is so important."

Student & Faculty Response

Student preparedness has notably improved: "Even for simulations, they're much more prepared." Nicole has observed significant benefits of VR on student performance: "I've observed students that I thought were in the middle, but when they completed a VR simulation, it turns out they were stellar… I would have never known that in a team-based simulation."

Faculty, initially hesitant, have grown into VR through intentional support: "Initially, we kept it low stakes. We do one-on-one orientations, let them check out headsets to take home so they can practice without feeling judged. This really helped them get comfortable and confident to teach with VR."

UT Austin’s VR infrastructure is robust, with a dedicated VR coordinator and 20 trained staff (TAs and student workers in addition to nurse educators): "We’ve created a lot of resources like guides centered around how our students and faculty process information. We’ve trained every single one of our 20 teaching graduates and undergraduate student assistants on VR."

Final Thoughts

Through intentional integration, student-centered support, and collaboration with faculty, UbiSim has become part of the simulation culture—enhancing confidence, improving clinical judgment, and helping students prepare for real-world nursing challenges.

"I’m trying to get my money’s worth," Nicole laughs. And clearly, she is.

Special shoutout to UT Austin's VR Coordinator, Jonathan Spear, and Simulation Coordinator, Amanda Marshall, who keep the program robust.