Nursing professional development (NPD) practitioners are continuously exploring new, innovative, and active learning strategies to increase nurses’ engagement and enrich their own professional development. Every year the Kaleida Health Nursing Education and Professional Practice (KHNEPP) team is tasked with developing annual web-based learning for registered nurses (RNs) and unlicensed assistive personnel (UAP). Previous strategies to fulfill mandatory annual regulatory requirements for nursing staff have been mundane and predictive, often leaving NPD practitioners uninterested with the chore of reproducing redundant content. With minimal changes made over the past three years, this led nursing staff to skip content and move quickly through the post-quizzes. It was time for a change. Our goal was to provide a new learning experience for nursing staff.

Gamification in healthcare education has become a valuable learning method. More recently, escape rooms have been implemented across many healthcare professions. Having had experience with escape rooms in our RN orientation, nurse residency program, as well as socially, we decided to adapt that idea to a digital platform. An initial search of the nursing literature was robust with escape rooms or boxes for in-person education for residency programs, orientation, or unit-based learning. However, there was little to be found for use of a solely digital escape room format as a means for meeting annual regulatory requirements. We also found that during the shift to virtual classrooms for primary and secondary students, because of COVID restrictions, educators in those settings were using many versions of virtual escape rooms. The teachers in those settings often used Google Forms or similar software for developing their content.

Multiple federal and state agencies require annual and ongoing education for acute care nursing staff. In order to provide a record of completion and system-wide accessibility, we were required to create the digital escape room within the organization’s existing learning management system. At Kaleida Health, the Department of Learning and Engagement is responsible for eLearning management oversight. As project leads, we met with Darlene Smith and Jooel Albuez, Learning Technologies Specialists, to determine feasibility. It was determined that the concept could be used to meet the established learning objectives. 

As project leads, we created the first module about restraints and then held a workshop to demonstrate the concept and provide ideas around escape room puzzles that would translate well digitally. The remaining content leads worked with KHNEPP adult and pediatric NPD practitioners across the system to create the phlebotomy, blood transfusion, and fall prevention portions of the digital escape room.

Articulate Storyline software was used to develop the escape room. Storyline is limited to 11 ‘Graded Question Options’ (Figure 1). As a result, ideas for traditional escape room puzzles would need to be reverse engineered to fit the answering structure of the software. An avatar facilitator was created using Synthesia Studio-AI Video Generator (Figure 2). This avatar was able to provide a pre-brief as well as give voice guidance within the experience. In addition to the avatar’s instructions, digital Workstations on Wheels were imbedded on each slide to access pertinent polices or quick-reference cards.

Figure 1: Storyline Graded Question Options

Figure 2: Synthesia Avatar

A common theme was threaded throughout the experience. The staff member was trapped in a patient’s room until all four challenges were achieved. With the success of each challenge, the participant was granted an electronic key to open a lock. Once all four challenges were completed the staff member was be able to ‘escape’ and finish the encounter (Figure 3).

Figure 3: Main Screen

Considering this learning strategy was new for many nurses, a pilot was conducted with a cross section of staff who provided immediate feedback. Baby Boomers and late Generation X nurses felt some puzzles were too difficult, grew impatient, and considered abandoning the program. Alternatively, Millennial and younger users enjoyed the modality and navigated through the challenges with ease. After extensive revisions and testing, the digital escape room was published and assigned to 2,700 RNs and 692 UAPs.

The initial goal of this project was to implement a methodology to promote problem-solving and an opportunity to develop critical thinking. The KHNEPP team was excited to promote a fun but challenging exercise to engage the staff. Feedback from staff is still ongoing as the initial due date for completion was extended due to the latest COVID surge. While the goal was achieved, there were some limitations. Development of the escape room was very time consuming. It took six months from initial concept to final publication. Software limitations confined some creativity with puzzle development. There were also growing challenges for many NPD practitioners, as there were generational differences within our own team when it came to comfort with technology.

While it lacked the teamwork and collaboration aspects of a traditional escape room, anecdotally, we did find staff working on it together and encouraging each other through it. Now that the staff understands the concept well, we’ll look to build a more challenging escape room next year.