The quote arrives for a high-fidelity manikin, with a monitor, software and a first-year warranty. The capital committee approves it. A room is cleared. Eighteen months later the manikin is under a sheet in that room, used a handful of times by the one educator who knows how to run it, and the facility has concluded that simulation is expensive and not very useful.
The purchase was not the mistake. The budget was. It priced the equipment and almost nothing else, and simulation is not equipment. The National Council of State Boards of Nursing makes the same point in its simulation guidelines, which adopt a definition from the simulation pioneer David Gaba: simulation is a technique, not a technology.
This article sets out what an in-house simulation program for a hospital, long-term care facility or nursing program really requires, line by line. It includes a worked example built entirely on stated assumptions, so you can swap in your own numbers, and it does not quote prices, because equipment and labor costs vary too widely between vendors, regions and years for any single figure to be honest.
Two public sources give a facility leader most of what a budget needs to cover. The first is the NCSBN Simulation Guidelines for Prelicensure Nursing Programs, published in the Journal of Nursing Regulation in 2015 after the NCSBN National Simulation Study. They were written for nursing schools, but the program checklist reads like a budget template. It asks for a budgetary plan for sustainability and ongoing faculty training; a framework providing adequate fiscal, human and material resources; an adequate number of dedicated, trained simulation faculty; job descriptions and an orientation plan for them; designated space for education, storage and debriefing; adequate equipment and supplies; and a long-range plan for simulation use in the years ahead.
The second is the INACSL Healthcare Simulation Standards of Best Practice, whose Operations standard addresses the infrastructure behind simulation: strategic planning, policies, financial resources, personnel and role responsibilities, competency-based training for the people who operate equipment, and program metrics. Read together, the message is consistent. A simulation program is people, space, equipment, time and a plan, and a budget that funds only one of them will fail.
Every in-house program, however small, has the same six lines. Some will be zero in your first year; none should be forgotten.
Space is a seventh consideration rather than a line: a converted room may have no new cost, but it has an opportunity cost, and it still needs storage and somewhere to debrief.
The example below is built in hours, not dollars, so it holds whatever your local rates are. Every number is an assumption chosen to make the arithmetic clear, not a benchmark. Replace each one with your own.
Assumptions. A facility wants every one of 120 nurses to attend one four-hour simulation session a year. Sessions take six learners. Each session is staffed by two people, an educator and an operations specialist, and each works six hours per session: one hour of preparation, four hours of delivery and one hour of reset and documentation. The program writes four new scenarios a year at twelve hours each, and puts two facilitators through debriefing training of twenty-four hours each.
The arithmetic. 120 nurses in groups of six is 20 sessions. Twenty sessions at twelve staff hours each is 240 hours of facilitation and operations time. Learner time is 120 nurses at four hours, or 480 paid hours. Scenario development is four times twelve, or 48 hours, and facilitator training is two times twenty-four, another 48 hours. The total is 816 hours of people time, to deliver 480 learner hours.
Two things stand out. Under these assumptions, learner time is twice the facilitation time, which is why a budget that leaves it out understates the true cost of the program badly. And the capability-building lines are small next to delivery, which is why they are the first to be cut and the most damaging to cut.
Turning hours into dollars. Multiply each line by the relevant loaded hourly rate from your finance team, including benefits, and add any premium for shift cover. Then add the non-people costs: the equipment purchase price divided by its expected years of service, plus annual service contracts and software licenses, plus consumables per session multiplied by the number of sessions. The total, divided by the 480 learner hours delivered, gives a cost per learner hour. That single figure is what you compare against contracted training, and it is what our guide to measuring training ROI uses as its cost input.
Most of a simulation program's cost is fixed or semi-fixed. The equipment costs the same whether it runs twice a month or twice a day, and so do the service contract and much of the staffing. Cost per learner hour therefore falls as use rises. An under-used lab is not a cheap lab with spare capacity; it is an expensive one.
Group size is the clearest lever, and also the one with a learning trade-off. Holding everything else in the example constant, here is what changes when only the number of learners per session changes.
Bigger groups are cheaper per learner, but every extra learner is usually an observer rather than an active participant. Observation has real value when it is structured, yet a program that pushes group size up purely to cut cost will eventually cut learning too. The INACSL standards emphasize design driven by objectives, so let the objectives set the group size and let the budget follow. Our article on what fidelity actually buys makes the same argument about equipment: the right specification is the one that fits the objective, not the most impressive one.
The NCSBN guidelines advise nursing programs to begin slowly and steadily increase the amount of simulation as they acquire expertise. That is sound budgeting advice for any facility. A phased plan might look like this:
Phasing protects you from the sheeted-manikin outcome, because each purchase follows proven use rather than preceding it.
An in-house program is not the only route. Contracted and mobile providers turn fixed costs into variable ones, which suits facilities with uneven demand or no spare educator capacity. Our honest comparison of contract and in-house training sets out how to decide, and our article on on-site mobile clinical training covers the trade-offs of bringing simulation to the unit. Many facilities end up with a blend: an in-house core for frequent, predictable needs such as orientation and annual competency, and contracted capacity for surges, specialist scenarios and facilitator training.
Before you present a simulation budget, check that it answers each of these questions:
What is the biggest cost in a simulation program? It depends on the program, but equipment is rarely the whole story. People are the recurring cost: trained facilitators, an operations specialist, and the paid time of the staff who attend. In many facility programs, learner time is a large line that never appears on an equipment quote. Build your own model with your own rates to see where your money goes.
How much does a high-fidelity manikin cost? Prices vary widely by model, configuration, software and service package, and change over time, so we do not quote figures. Ask vendors for a total cost of ownership over the expected service life, including software licenses, warranties, service contracts, consumables and training, not only the purchase price.
Do we need a dedicated simulation lab to start? No. Many facilities start with in situ simulation on their own units, task trainers and low-fidelity equipment, and borrowed meeting space for debriefing. The NCSBN simulation guidelines advise programs to begin slowly and increase simulation as expertise grows, which is sensible advice for facilities too.
How do we calculate cost per learner hour? Add the annual costs of people, annualized equipment, service contracts, consumables, space and faculty development, then divide by the total learner hours actually delivered in the year. The number falls as utilization rises, which is why scheduling and demand matter as much as purchasing.
Is it cheaper to contract simulation training than to build in-house? It depends on volume, staffing and how steady demand is. In-house programs carry fixed costs that pay off at high, steady use; contracted training converts those to variable costs. Many facilities land on a hybrid. Model both with your own numbers before deciding.
Wahero Health Institute helps hospitals, long-term care facilities and nursing programs across Texas plan, staff and run simulation, from facilitator development and scenario libraries to on-site delivery while you build in-house capacity. See our services for facilities, visit the simulation lab page, or contact us to work through the numbers for your own organization.
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This material is published by Wahero Health Institute for professional education and is not individual medical advice, a care protocol, or a substitute for clinical judgment. Always follow your facility's policies, your state's nurse practice act, and your own scope of practice, and confirm medication doses against a current authoritative reference before administration. See our Terms of Use.
