Nursing students were literally on the edge of their seats in the Wilkinson Center on February 3rd and 4th. The shrill sound of a whistle echoed through the large room, and they bolted to their feet. Chaos erupted as people dashed every which way, forming long lines at surrounding tables in a frenzy that would put the Wall Street trading floor to shame. Why all the pandemonium? Simple – each student must fight to stay afloat in the annual Poverty Simulation.
While an outside observer might have only seen people running frantically, these nursing students were actually engaging in an educational simulation to teach them about the realities of poverty. This simulation teaches the nurses greater compassion for their future patients.
BYU College of Nursing originally began this program about 15 years ago. they purchased it from the Missouri Community Action Network, a nonprofit focused on helping people out of poverty. According to College of Nursing’s Assistant Controller Nancy Salanoa, the format consists of about 25 “families,” each of which includes three or four students. In an hour, these families simulate a month of poverty, with each week lasting 15 minutes.
AN IMPORTANT PERSPECTIVE
Why go through all the trouble of setting up this simulation? Global & Population Health Nursing Coordinator Ryan Rasmussen explained the grand purpose behind it. “Many students don’t have experience understanding all of the barriers placed in front of someone who lives in poverty,” he said. “Many times you see someone in poverty on the street, and it’s easy to think they're in poverty because they are not motivated to get out.”
The Book of Mormon prophet King Benjamin said it best: “Perhaps thou shalt say: The man has brought upon himself his misery; therefore I will stay my hand…But I say unto you, O man, whosoever doeth this the same hath great cause to repent…” (Mosiah 4:17-18).
Because of this simulation, these nursing students will better empathize with patients in tight circumstances. As they become the healthcare leaders of tomorrow, they will remember to put themselves in their patients’ shoes because they never know what pressure they could be under. Even just this tiny glimpse into life in poverty has impacted their viewpoints forever.
FIRSTHAND EXPERIENCES
Each student is given one of several roles, including parents working several jobs, older people who may have health problems, children, and many more. Some are fortunate enough to begin the simulation with a home and a small supply of money, but others begin in a homeless shelter. Regardless of the circumstances, each is given many challenges to overcome, some of which seem insurmountable.
Each student experienced the simulation a little bit differently, but they all came away with one impression: Grappling with poverty is no simple feat!
Fourth-semester nursing student Tanner Wright played the role of a 57 year-old stroke victim named Ned. Unable to work due to mild paralysis, “Ned” would sit at home all day waiting for his son and daughter-in-law to return from work, unable to support them financially. “It’s difficult to try and manage a budget that you don’t really have,” Tanner reflected.
Rylie Rasmussen, a fifth-semester student, was assigned to be a preteen child. With one parent in jail and the other at work all day, she had no way of getting to school or participating in productive activities. When asked about what that experience taught her, she said that “There are a lot of aspects [of poverty] I never would’ve considered.”
Another fifth-semester student, Micah Paulsen, sat at the “clinic” table with a staff member to negotiate pricing for a recent surgery. He’d been handed a “Bad News Card,” which were randomly given out to participants over the course of the simulation. Between surprise medical operations, unexpected inconveniences, and more unfortunate situations, students were given additional problems to work through on top of their busy schedules.
JR Benson found that he could better relate to people who come into the ICU where he works because of the simulation. “It changed the way that I can care for [my patients], treat [my patients], and provide them with resources,” said JR. “I learned about a lot of resources here and I'm sure that I can even find more after this experience.”
In each simulation, Nancy has found that the “clinic” table is often empty. People who are truly in poverty typically can’t prioritize their health as there are so many things on their plate (like paying rent, work, school, etc.). Fifth-semester student Jenna Mundell found that this fact changed her view as a future nurse:
Health really is your last priority. If you're struggling with other things, being in the hospital might seem like the biggest stressor because you've got 70 other things that you're working on. Really taking the time to know what [a patient] is struggling with can give them the resources that can hopefully alleviate that.
A REALISTIC APPROACH
To fully immerse students, the simulation is designed to make the experience as realistic as possible.
For example, professors and volunteers who spoke foreign languages were encouraged to speak solely in the other tongue to imitate the immigrant experience. Places like the pawn shop spoke only in Spanish which left many students struggling to make cash through that avenue.
Students also had to manage resources, such as buying food periodically and conserving a limited number of bus passes to move around the room. After the first “week,” students who hadn’t purchased food were reminded that they were “all starving” by the program director.
There was even a volunteer who went around performing "illegal activities" like stealing people's goods, selling drugs, and generally causing chaos to simulate the real world where these issues are commonplace in low-income communities.
LASTING IMPRESSIONS
Post-simulation, students met in discussion groups to debrief and share what they learned in their experiences. Many were shocked at how difficult it was to “succeed” and obtain enough food or find shelter. They found that as they moved down Maslov’s Hierarchy of Needs, the more desperate they became.
Another concept that was emphasized in the simulation is that these issues are closer to home than some think. There’s a tendency to picture poverty in faraway cities, but one doesn’t have to leave Provo, Utah to find those who struggle.
The program director, Cody Martensen of Provo’s Community Action Services & Food Bank’s Circles Initiative Coordinator grew up in a low-income household and experienced these challenges firsthand. Seeing people fight for economic security, he’s gained valuable insights about the challenge it presents.
For years to come, BYU College of Nursing students will have their eyes and hearts opened to the reality of poverty. As they become more empathetic nurses, they will go forth to serve with greater compassion, patience, and Christlike charity.