Puzzles Make it an Escape Room

The second in our informational series on Nursing Escape Rooms. This post covers the "fun" part of an escape room...the puzzles.

Simulations are wonderfully effective but when you add a puzzle, riddle, or clue, you have a motivational, fun, and unique “game” that increases knowledge, skills, and teamwork in a “safe” environment presented in the form of a game.
The following is a creative list of puzzle ideas and tips to make your next nursing education escape room a great success.
  • Use puzzles that tie in with the theme” of the escape room. For example, in one of our pediatric escape rooms, the young patient has a balloon with them that contains a clue on a piece of paper inside. It is suggested to the learners (in the form of a clue) that they are to break the balloon to obtain the next clue. (click here for the hoonii Pediatric Child Abuse Escape Room)
  • Another good idea is to have a box labeled “SHREDDER to indicate the place where personal health information is shredded for patient security. Have a clue or riddle on a piece of paper, cut it into several pieces, and place it in the shredder for them to put together. You can add another “puzzle” element to this idea by requiring learners to “find” the pieces of the riddle as they solve puzzles throughout the room. They can escape the room when they find all the pieces and solve the riddle. You can also cut a piece of paper with a note in the shape of puzzle pieces that fit together. Again, when they find all the pieces of the puzzle, they can escape the room.
  • Use an inexpensive “recorder” to record information or a clue. These “recorders” can be purchased at places such as Amazon for a few dollars and can be re-recorded over and over. A nurse educator at com used this technique in a pediatric nursing escape room and it was very successful and fun for learners. (Click here for a link to Amazon recorder.)
  • Some nurse educators use envelopes with ‘choices’ where the learner must choose the correct response. This element is perfect for assessment, signs and symptoms, answers to dosage calculation questions, and more. The facilitator supplies the learners with the envelopes when the learners are directed to request them.
  • Locked boxes with “changeable” combination locks are very useful. The combinations correspond to answers to puzzles such as dosage calculation questions. Locks are available on websites such as
  • Use a multi-linear model for your escape room to encourage learners to work as a team. (Click here to see our previous blog post for ideas and a helpful map for this model)
  • Mazes with acronyms/mnemonics that trigger a sequence or list of occurrences or events. An example is REEDA for assessing an OB patient’s episiotomy: R = redness; E = edema; E = ecchymosis; D = discharge; A = approximation. When the learners solve the MAZE, they obtain the answer to a clue or the numbers to a combination that opens a locked box.
  • Have clues ready and available if learners become stuck. These could be in the form of questions to “lead” them to the answers or actual answers to the clues.
  • Generate QR codes that the learners can scan that give clues to advance in the escape room.
  • Use invisible ink pens to provide hidden clues to the solution of puzzles. Pens with “invisible” ink and a blacklight built-in can be purchased online at sites such as Amazon for less than a dollar a pen. This can be perfect for a “secret” substitute for a nursing penlight.
  • Display pictures or skills that are to be placed in a specific order such as wound care in order of priority.
  • Interactive games and puzzles can also be created on a laptop. One of our nurse educators designed a “twinkling” image of stars for a pediatric escape room that is available on Download the escape room and “customize” it to your own original escape room. (Click here for the Pediatric Child Abuse Escape Room). also has a template to instruct nurse educators in animation and interactive activities to use for their own interactive tools and games. (Click here for the Hoonii template) In this example, learners must “notice” the numbers in the stars to unlock a box that contains a “reward” and the next clue. The “stars” image is integral to the scenario and is the code to unlock a locked box.
  • Set up a code for your laptop after a challenge is solved such as a dosage calculation or normal potassium level lab results. Once the learner earns the code and gains access to the laptop they are led to another puzzle or clue.
  • Use fun riddles to identify items such as the number of bones in the body or a clue that directs the learner to look at something else in the escape room to help them complete the game.
  • Make the boxes or containers from old items such as cereal boxes, bags, cardboard boxes, etc. for the boxes that must have a lock on them. They can also be purchased online.
  • Laminate anything that is made of paper (especially items that will be handled by learners) to extend the useful life of the items.
  • If you are going to facilitate other escape rooms, purchase combination locks from online stores as their combinations can be changed. These are inexpensive and add to the “realism” of a true escape room.
Escape rooms can be as “high” or “low fidelity” as needed. Visit Hoonii escape rooms for our complete list of escape rooms that require little to no monetary investment to facilitate.
Escape rooms take a great deal of time to develop. For complete and original escape rooms for nurse educators who are short on time, visit Nurse educators write and test escape room scenarios and follow INACSL standards.
Also, if you want to write your original teaching tools, escape rooms, simulations, or worksheets, consider sharing them with other nurse educators and earning money by opening your own “shop” on Go to Hoonii Shop Owner for more information. It’s free and easy to open and you can even choose a fun name for your shop while giving you access to all the customers who visit
 A nursing education escape room creates an engaging learning opportunity to enhance skills and boost understanding of concepts learned in theory. Learners are motivated and gain self-confidence in working collaboratively in a “safe” environment.

For the most effective tips on planning your own nursing escape room visit for upcoming NEd Talks including escape room information on:

·        Developing a needs assessment
·        Meeting INACSL Standards (The International Nursing Association for Clinical Simulation and Learning)
·        Prebriefing and debriefing also has pre-written and complete nursing escape rooms to use in your classroom. They have been developed by nurse educators to meet the standards of nursing simulation design.