Enhancing wilderness post-MSN DNP nursing competencies through simulation and telehealth innovation

Wilderness and remote healthcare requires clinicians to deliver high-stakes care amid resource limitations, environmental hazards, and prolonged evacuation timelines.

This exploratory concept review proposes a conceptual framework for post-MSN DNP nursing preparation in austere settings, focusing on role adaptability, clinical decision-making, and training innovations including simulation, telehealth, and mobile diagnostics.

A targeted literature review (2010-2025) informed the identification of key competency themes across team-based care, education, and safety, though findings are descriptive and intended to guide framework development rather than establish empirical outcomes.

Role fluidity, rather than discipline-specific hierarchy, consistently defines care delivery, with nurses contributing expertise in patient monitoring, prolonged field care, care coordination, and risk mitigation. Three practice-shaping trends emerge: expanded telehealth for specialist support, simulation-based training for low-frequency high-acuity events, and mobile diagnostics for field decision-making. Key gaps include limited outcome data, inconsistent competency standards, and policy frameworks misaligned with austere practice.

Standardized competencies, team-based training, and cross-disciplinary outcomes research are recommended as priorities, with anticipated benefits including improved APRN workforce readiness, enhanced interprofessional coordination, and stronger systems-level capacity for remote care delivery.