Many U.S.nursing programs are using  simulation to provide  nursing students practice while not in a direct care setting. With  virtual reality and software they can  assess the plastic model patient provided with non direct patient access.The simulation broadens nursing observation and assessment skills. This is invaluable in health care settings when the nurse enters the field.Teachers can program now the medical issues patients may present in the simulation.The ability to simulate patient fact patterns is helpful  also for the nurse to observe, assess and readily learn how to communicate findings  with their healthcare team.