A nurse learner is in a VR headset, caring for a virtual patient with abdominal distention who requires decompression. Down the hall, a classmate is inserting a nasogastric (NG) tube into a manikin simulator.

Two different modalities, one shared goal for the educator and simulationist: building more prepared nurses through immersive, hands-on simulation experiences.

Today’s nurse learners can do both, all before setting foot in a real hospital.

But with so many simulation tools, it’s easy to feel like you have to pick one. Manikins or immersive VR? Tactile feedback and psychomotor skill practice or clinical judgement development with a high level of immersion?

Budget willing, you don’t have to settle for just one.

While the term symbiosis typically refers to the mutually beneficial relationship between two organisms, we’re thinking of SIMbiosis: a hybrid approach where manikin-based simulation and immersive virtual reality simulation work together to create a comprehensive learning experience.

Let’s explore how SIMbiosis actually comes to life in a clinical simulation experience.

Better Together: The Power of Hybrid Simulation

Starting with a manikin, Students learn initiation and insertion of an NG tube. They can measure proper tube length, insert the NG tube, check for correct placement, and initiate suction per order. They receive immediate feedback, which informs muscle memory and reinforces technical precision. They are honing their fine motor skills using real equipment to prepare for patient care at the bedside.

Next, they step into a lifelike virtual hospital room; the patient is talking to them, blinking, and making eye contact. Learners must assess the patient, recognize the need for an NG tube, verify the provider's orders, and insert the tube. Throughout this process, nurse learners must quickly decide on an action—developing their clinical judgment 'muscle' in real time. This fully immersive practice enhances their confidence in recognizing and responding to critical cues and in communicating effectively with both providers and patients.

The result? A hybrid simulation model that blends clinical judgment with hands-on tactile skills so learners know both what to do and how to do it.

Modality Deep Dives

Manikin-Based Simulation in Nursing Education

Your learners enter the sim lab and are greeted by life-sized manikins—some with basic anatomy, others with advanced features like pulse, breath sounds, and pupil response. These physical simulators help students develop hands-on skills in a safe, structured environment.

Whether practicing chest compressions, inserting an IV, or assembling a nebulizer for medication administration, manikin-based sims help learners develop the calm reflexes needed to act under pressure.

While they don’t replicate the full clinical picture, manikins remain essential for skill-building that starts in the hands and settles into instinctive confidence.

Manikin Sims are best for:

• Practicing psychomotor skills
• Completing hands-on procedures in a sequential manner 
• Building tactile precision through repetition

Immersive Virtual Reality in Nursing Education

Your learners put on a headset and they’re instantly inside a hospital room, face-to-face with a virtual patient. The moment the invisible supply cart drawer receives a subtle hip-nudge from your student isn't a glitch—it's proof your simulation has transcended technology to feel real. 

UbiSim’s immersive VR simulation platform is designed by nurses to help learners think, act, and feel as if their virtual patients are genuinely under their care, until they remove their headset.

When your learners enter a VR scenario, they focus entirely on patient care. They interact naturally, reaching for instruments, verifying medications, and communicating with patients exactly as they would in real clinical settings.

This intuitive experience creates a psychological state where learners become so immersed that they respond as if the situation were real.

Immersive VR Sim is best for:

• Sharpening clinical judgment with realistic scenarios
• Practicing protocols and prioritization under pressure
• Strengthening natural communication, empathy, and confidence

Preparing Confident Nurses with SIMbiosis

Picture this: A nurse learner walks into their clinical rotation after practicing in your sim center. Their preceptor watches as they assess the patient, verify orders, and calmly and confidently insert an NG tube. Afterward, the preceptor shares with you that your students’ level of skill and preparation exceeded their expectations.

That competence was built from the use of both modalities. In the sim lab, they felt the flexibility of the NG tube and slight resistance upon insertion, then they applied the step-by-step approach of attaching the tube to suction. In immersive VR, they practiced clinical judgment, navigated complications, and communicated under pressure. 

That’s SIMbiosis in action!

Gregg Schroeder, MSN, APRN-CNS, the Director of Nursing Education at Hesston College, shared about simulation, preparing his learners for clinicals: 

“Every hospital where we do clinicals tells us ‘Your students come to us so much better prepared than other students.’ What they notice the most is our students' level of self-confidence, their assertiveness, and their ability to deal with psychological stress. They’re not afraid to just get in there. And so, they've had to realize, UbiSim really does do something.”

Hybrid simulation is about giving nurse learners the best of both worlds. When immersive VR and manikin-based simulation work together, students don’t just satisfy a checklist—they enter clinical practice prepared, practiced, and ready to care for real people on day one.