By Parmitha Chanduri
Photography by Rayni Shiring/University of Pittsburgh
“We are struggling greatly with four people living on one income. To combat this, we moved another family into our house.”
This was just one of the many eye-opening reflections by students in their senior year at the University of Pittsburgh School of Nursing, who participated in a poverty simulation on Oct. 2 as part of their Community Health Nursing Clinical Practice course. What began as a classroom assignment quickly transformed into an eye-opening experience that many students described as intense, emotional and ultimately valuable in shaping their perspective on patient care.
“My intention behind this simulation is for our future nurses to understand their impact beyond the care they provide in the hospital,” said Na-Jin Park, assistant professor of health and community systems, School of Nursing, who teaches the course and organized the simulation.
The simulation grouped students into “families” with varying structures, from elderly individuals living alone to families with multiple children. Each group received a packet outlining their roles and responsibilities, and students huddled together in their family units to understand their family’s specific financial and social constraints. Those assigned to play the roles of children were expected to remain dependent and avoid making financial decisions, while adults had to navigate the challenges of work, transportation, childcare and basic survival, mimicking the circumstances of a real family.
Over four simulated “weeks,” each compressed into 15 minutes, students engaged with various community resources, including employment centers, schools, social services and quick cash outlets. Each round began with a whistle, and students raced to complete essential tasks. Rules were strict and mirrored real-world constraints: transportation passes were required for jobs, services were overwhelmed with long lines and families risked eviction if payments weren’t made on time.
At first, stations buzzed with activity. But by the second week, many students could no longer access employment due to missed shifts or a lack of bus passes.
“We ran out of money and couldn’t even afford transportation to get to work,” said Campbell Speakman, a participating nursing student. “It was frustrating knowing what we needed to do but not having the means to do it.”
Paige Behm, another participating nursing student, shared a similar struggle.
When she needed to get an Electronic Benefits Transfer of government assistance, “I was sent to the wrong line,” she said. “And I didn’t have enough time to fix it. It was incredibly stressful—just waiting in line, knowing the clock was ticking and you might not get the help you needed.”
Some students experienced additional complications, like having personal items such as cameras or refrigerators “stolen” during the simulations, adding to the stress. Despite these challenges, many students described the experience as incredibly valuable.
“It wasn’t fun, but it was real,” said Speakman. “Even though we knew it was temporary, it gave us a deeper understanding of how overwhelming poverty can be.”
Behm agreed, adding, “I went into it thinking it was just an activity for our class, but it ended up being so much more than that. It really changed how I think about the families we work with.”
By the third week, eviction notices were being handed out. Some families banded together, combining households to survive. Overall, the simulation created a controlled environment where future nurses could experience the stress, limitations and emotional toll of poverty, without real-world consequences.
That sense of shared struggle and community resonated with many participants—and served the goal of Park’s intention behind putting together the simulation as a part of the course curriculum.
“Health care providers must understand how social determinants of health influence individual health outcomes in order to deliver effective care,” Park said.
“It really opened my eyes to how many things outside the hospital affect someone’s health,” said Speakman.
Behm added, “It made me think more about meeting patients where they are. We might only see them for a short time, but their struggles don’t end when they leave our care.”
Students also emphasized the importance of the roles of nurses in patient advocacy in the discussion after the simulation.
“As nurses, we need to understand the struggles of our patients so we can advocate for them,” said Behm. “This simulation helped build that empathy.”
