In the COVID-19 hotspot of New Jersey, nursing students can experience an unexpected supplement to their education. As a junior at Seton Hall, Cara Underwood has been a nursing assistant since December. When she started work on the cardiac unit at St. Peter’s University Hospital, life and work took place in a different world to the one she is in today.
At the end of February, though, Underwood’s floor was converted to a COVID-19 step-down unit for patients who had emerged from the ICU or whose symptoms were not acute enough to require intensive care. Since then, she has seen enormous changes. As the pandemic progressed, her workweek expanded from 24 hours to 40 hours, and her responsibilities have grown at an accelerated rate. With the progression of the virus, everything seems to be changing. As Cara explains, “No one on my floor has ever died during my shift and I worked a lot before this. Normally… they end up in the ICU and the ICU is where you see the deaths. But we’re just seeing it happen so quickly and also the ICU is so full that we’re starting to get those more severe cases on my floor.”
The rapid spread of the virus is providing the nursing junior with a crash course: “We’re really seeing the rapid deterioration in these older folks, you know, 60 and older where we’re just unable to keep their oxygen saturation up.” And working outside the ICU is no longer insulating her from encounters with code blues. Underwood remarks, “Over the weekend we had two deaths, which, like I said, I’d never seen one before as a nursing student. I mean, you have two back to back. It was unreal.”
She is also facing at firsthand the shortage of PPE, and a fellow nurse and her family tested positive for the virus and required hospitalization. Of the lack of PPE, Cara says, “It just seems unreal how that’s supposed to be protective for us. It’s scary. But we’re working with it. I mean, they say this is what we signed up for. I’m not sure if we signed up to be unprotected while we’re in the workplace, but we try to do our best.”
However, this trial
by fire has not succeeded in dampening her passion for nursing: “I’ve
always known I wanted to help people. And the truth is when, when I’m
in those rooms and I’m helping these people I know that it’s what
I’m supposed to do…. Before I worked in the hospital, [nursing]
was this thing that I was working towards, you know? Getting to be a
nurse and caring for people. And now that I’m on the battlefield,
so to speak, it’s more of a reality. It’s not the perfect nurse
life that I may have envisioned but I know I’m still supposed to be
For more on Cara
Underwood’s experience at St. Peter’s Hospital during the
pandemic, see her interview
with the Seatonian.
What do you do with 154 nursing students who are suddenly unable to participate in the hands-on nursing (clinical) care that makes up 60% of their education each week?
That was the challenge facing Mary Ann Jessee, PhD, director of PreSpecialty education at Vanderbilt University School of Nursing, and the 30-plus faculty who instruct those first-year (prelicensure) nursing students in patient care.
With the spread of COVID-19, the students’ clinical education in hospitals, clinics and other facilities was suspended in mid-March. VUSN was unwilling to postpone clinical learning and possibly delay the students’ path to becoming advanced practice registered nurses. So faculty got creative.
“For a couple of weeks, we had been determining what we would do if students weren’t able to be in the clinical setting,” Jessee said. “The course coordinators, Erin Rodgers, DNP, and Heather Robbins, DNP, and I brainstormed what would it look like to do a virtual experience for students that would enable them to experience the same clinical learning. Could we use the Simulation Lab and have the students participate by telling someone in the lab what to do?” The faculty consulted VUSN Simulation Lab Director Jo Ellen Holt, DNP, who responded enthusiastically with suggestions.
The result was a virtual live-streamed learning experience with students using their instructors and Simulation Lab staff as avatars to interact with the school’s high-fidelity nursing mannequins and provide patient care.
“One instructor acted as the student’s eyes, ears and hands while another observed and coached, just as they would do with actual patients in the clinical setting,” Rodgers said. “Students instructed their avatar on what to do, step-by-step. The avatar reported the results, and then the students as a group evaluated whether that skill was implemented correctly and discussed the outcome.”
The students joined the simulations via video conferencing, working in the same six-student cohorts as for their in-person clinical learning. Each student experienced directing the avatar and discussed the scenario with their group.
“What we’re trying to mirror is the typical direct patient care experience and clinical conference, but in a virtual format,” Jessee said. “We had to determine how to recreate those patient interactions, and in those, ensure that students had the ability to conduct assessments, prioritize patient needs, make decisions about care, implement that care and evaluate the results.”
Throughout the simulation, the instructor is observing and coaching, as they would with actual patients. “In the virtual clinical experience, the faculty member can’t see the student doing the assessment or preparing for safe medication administration. The student needs to explain it before the avatar acts so the faculty can see that the student knows how to do it. This allows faculty to assess the same competencies in the virtual simulation as in the clinical setting.”
The School of Nursing’s PreSpecialty program is for students with bachelor degrees in a field other than nursing. They spend 12 months in intense generalist nursing learning, then spend 12-18 months gaining specialty education. In addition to directing the PreSpecialty level, Jessee serves as assistant dean for academics, generalist nursing practice.
The virtual clinical simulation is only one strategy that the PreSpecialty faculty are using for clinical skills. The school also uses the Virtual Healthcare Experience portal, developed by Canadian schools of nursing to engage students in highly complex scenarios using actors, as well as materials from the Institute for Healthcare Improvement, ReelDX videos and faculty-created case studies.
VUSN PreSpecialty clinical faculty created multiple virtual clinical simulations to support pediatric, adult, obstetric and psychiatric-mental health care. Students whose clinical experiences did not require the simulation lab participated in similar virtual situations within a simulated home or office setting.
Before starting the virtual curriculum, the School of Nursing consulted the Tennessee Board of Nursing and the Commission on Collegiate Nursing Education (CCNE) to determine how the simulations would relate to the students’ future licensing. “They sent us confirmation that simulation can be used one-to-one in place of direct patient care,” Jessee said. “Every hour that students are logging in these virtual activities counts toward their preparation for the national council licensure examination, NCLEX.”
Student reaction has been positive. “Students are amazed that we created these things. They’ve had great experiences—it’s been intense and challenging—and they’ve had good team work,” Jessee said. “One student told her instructor that she felt the virtual clinicals were valuable and that they’d helped her with exams in other courses.”
One student gave feedback not on the clinical experiences but on her reaction to how VUSN has handled the COVID-19 crisis. “I have felt supported and seen by you, and all of my instructors in the past weeks…Earlier this week, our clinical group was discussing how, despite all the craziness going on in the world, we feel least concerned about our education and trajectory because of the incredibly talented faculty and resources at VUSN. Thank you!”
The faculty also judged the simulations successful. “We were able to develop meaningful, realistic virtual experiences that would provide students with opportunities to learn and demonstrate competency in essential clinical thinking skills,” Jessee said.
Although she doesn’t know of other schools that have created similar virtual clinical simulations, Jessee said that nursing schools across the country are developing various creative learning experiences. “We’re all working to enable on-time graduation of nurses to fill vacancies in the nursing workforce,” she said. “Our students won’t miss a beat.”
“It’s been stressful for students and added an extra workload on faculty but it has been so worth it to see the learning realized by the students,” she said. “It’s really rewarding.”
As a nursing student looking ahead at my career, Covid-19 may be my best professor I have yet had. Professor Covid-19 is teaching me how to be a leader, and the difference from a good nurse from an exceptional nurse in assessing and responding to a situation. It has taught that everything will not be okay if I continue with my assumptions that someone else will protect me. I think of myself, sitting in lecture weeks ago wondering how I ever assumed that as a nurse, it would be okay to rely upon others to assess a situation. I ask myself, what societal and academic influences gave way to the habit I see in myself and many others of counting on someone else to critically think and perform a thorough assessment.
I vaguely remember hearing something about MERS and getting it confused with SARS—I figured they were the same disease, but really, what did it matter? I would be protected, along with everyone else in the developed world. Epidemics and outbreaks don’t happen here.
I glanced at the H1N1 signs posted at my community college in search of the poster advertising a house-warming party. Someone else is assessing that situation. The college and health care leaders will protect us students.
The siren alarms
went off with Ebola and as a good student of life, I already knew that I didn’t
need to critically think about it. I’d be just fine, and I was. Sorry
Africa. It’s just that we have special people protecting us.
As a CNA, I see many nurses who have a similar attitude as I did. They were the ones that do a minimal assessment and apply little or no critical thinking to their work. It appeared to me that this someone else wasn’t these nurses.
I graduate with my
Entry-BSN in a matter of months. The idea that assessing and responding to outbreaks,
epidemics, and pandemics, are activities that others perform was months away
from becoming part of my practice as a nurse. God forbid it became my
management philosophy. I had a few brave professors at school that told me that
the likelihood of an emergency was great, but it didn’t matter to me, nor my
classmates. The professors didn’t understand that each of my life experiences
differed from their alarmist, paranoid, unnecessarily stressed, pessimistic way
of looking at life. Those wise professors stood out as the few and far between
and some students made fun of them behind their back. We might as well have
said, “Pandemics and stuff like that doesn’t happen to us, professor, and if it
did, someone else would protect us. Can we go back to reviewing the indications
of Zyprexa. That will be on the test, right?”
I now see that my real Professor goes by the name of Covid-19 and he has given me my Zyprexa. I am on lockdown along with billions of people. I now know that this stuff happens, and it has happened many times. I didn’t assess the situation, nor did I critically think things through. It isn’t that that events like this don’t happen to us in the developed world, rather, these events happen quite often and until recently, we are fortunate that intelligent others protected us from the several outbreaks over the years. Now, Professor Covid-19 has taught me, and hopefully several of us, that this someone else is me, my classmates, and all other nurses that relied upon someone else to perform assessments and critically think.
The Level-1 Trauma center that I work at has played a key role in leading our region in flattening-the-curve, at least so far. We have leadership that began preparing before most hospital systems and governments did. As a CNA and nursing student, I witnessed the hard and unpopular work (some would call virtuous work). I also witness the nurses and other health care workers who were to join me in this class taught by Professor Covid-19. They are those that copy previous shifts’ assessments, rely on others to critically think about their patients’ treatments and outcomes and those that assumed that due to our status as health care professionals, we didn’t need to prepare when Professor Covid-19’s class was called-to-order.
As nurses and future nurses, let’s learn from this. Many health care professionals and nurses didn’t do well on this test. As for me, I plan on getting an A on the ensuing tests by Covid-19 and his fellow instructors by properly assessing and critically thinking like nurse are taught to do in each situation whether small or large and preparing for such.
With the closures of universities and colleges due to the spread of COVID-19, life is unlike it’s ever been for students and nurse educators. While some classes are held online anyway, there are many that take place in person.
Julie K. Stegman, Vice President, Nursing Segment at Wolters Kluwer, Health Learning, Research & Practice, took time to answer our questions about what you can do to continue learning or teaching during this time.
of colleges and universities have closed or are closing. Nursing students may
be looking for ways to study while at home. Until their professors/instructors
begin offering online classes, what should they do?
This is an incredibly challenging time. Nursing students face mitigating circumstances for completing their clinical hours, and nurse educators are pivoting to a fully online teaching format that many are not accustomed to. From discussions with nurse educators, we know they are facing challenges with the typical steadfastness and resilience we see from nurses daily.
Nurse educators are keeping their students engaged virtually
by suggesting independent learning activities, such as reading their textbooks
and taking advantage of online videos and interactive exercises. They’re also
making students aware of educational webinars offered by organizations like ours
on key topics such as clinical judgement.
We are also reminding nurse instructors of the tools
and resources they have at their disposal and can make available to their
students virtually. Our Lippincott CoursePoint+ solution for example is an
online program that offers students a lot of opportunity for self-learning,
including applied learning and assessment as well as virtual simulation activities
that mirror real-world practice.
can they determine which websites are providing accurate information or not?
Nursing education has a variety of legitimate sources
for accurate information. In fact, one of the hallmarks of nursing education is
using the latest evidence in making decisions about a patient’s care.
Because of that nursing students typically don’t run into trouble identifying
reputable and authoritative sources of data and information.
Nurse educators are also represented by premiere associations like the National League for Nursing, the American Association of Colleges of Nursing, and the National Council of State Boards of Nursing that are proactively helping instructors guide students toward the latest information. The nursing profession is also represented by premiere associations (including Wolters Kluwer) and publications like AJN: The American Journal of Nursing.
there ways that they can study together online? Should they set up private
Facebook groups with other students they may already be in study groups with?
Are there better ways of doing this? Please explain.
Many nursing schools use learning management systems which provide an opportunity for them to create a forum for discussion topics as well as opportunities to connect students with one another. Because this is all done virtually, it’s one of the best ways students can stay connected and engaged at home.
instructors/professors: what kind of tools can they access online or through
other technology that will allow them to keep teaching? Until they can, what
should they do?
learning has been embraced in nursing education for some time and has had a
positive impact on preparing students for real-world practice. In fact, Lippincott
CoursePoint was the first-to-market integrated, digital nursing education
solution back in 2013 and continues to deliver the industry’s most trusted
content and resources, including case studies and real-time data. Fortunately,
many nursing instructors and professors are familiar with these digital education
tools and it’s been a shorter learning curve.
powerful digital tools and insights allow nursing instructors to adapt their
approach on the fly to meet students’ needs, even if those students are at home.
is so unlike anything any of us have experienced before. Is there anything regarding
what nursing students and nurse educators can do while schools are closed that
is important for our readers to know?
At Wolters Kluwer, we are committed to our nurse educators and supporting them in these challenging times. We have and are continuing to provide resources for our educators for transitioning to online learning including free webinar training, as well as recorded webinars, blog posts and white papers on our Lippincott Nursing Education website. We are also maintaining an information resource about the latest guidance for nurses in practice at Lippincott NursingCenter.com.
Nobody looks forward to applying for financial aid, but for
post-secondary school students it’s almost as unavoidable as death and taxes. Did
you fill out your FAFSA (Free Application for Federal Student Aid) form back in
undergrad school? If you’re planning to apply for aid in obtaining your
graduate degree, get ready to revisit the financial aid grind!
It can get complicated. Certified College Planning Specialists Carl Buck and Rick Darvis, authors of Pay for Your Graduate Nursing Education Without Going Broke, advise that “no graduate nursing school will necessarily replicate the same financial aid application, nor will funding or financial aid award letters be the same.” So, keep track of the requirements at the institutions where you’re applying.
Recent Changes to FAFSA Requirements
Over the past few years, some changes have been made in the FAFSA financial aid process. For instance, tax information used to be required for the previous full tax year—but now, you must provide information from your prior, prior tax year (for instance, on the current 2020-21 FAFSA form, you should enter your tax information from 2018). Also, keep in mind that the FAFSA submission start date is now October 1 (the 2020-21 form opened on October 1, 2019; the deadline is June 30, 2021). The sooner you file, the more grant money you are likely to receive, so file sooner rather than later!
Confirm whether you are considered dependent or independent. As a grad student you are probably now no longer a dependent of your parents or guardians. In this case, you will only be reporting your own tax information, not your family’s. However, there can be exceptions to this rule. In some grad programs, for financial aid purposes, students who are under 30 are still classified as dependents (whether or not you are in fact independent). Be sure you know whether a program you’re applying to has such a requirement; if it does, you still need to supply your parents’ tax information.
How Does the FAFSA Compute Your Financial Needs?
The Federal financial aid process calculates your expected annual
family contribution. This is based on the assets held by you (and if married,
your spouse) and/or your family—such as money in savings, checking, stocks, CDs
real estate (excluding your own home)—and annual earnings. From your total in
assets and adjusted gross income, the FAFSA calculates how much you (or your
family) can contribute toward your schooling costs. This Expected Family Contribution
(EFC) is subtracted from the cost of your attendance.
Important note: as Peterson’s points out, if you or your parents filed or were eligible to file tax form 1040EZ or 1040A, however, the FAFSA will only calculate financial need based on adjusted income.
Free Webinar on Financing for Nursing Grad School
You can attend an upcoming webinar on how to manage financing for nursing graduate school. Hosted by Certified College Planning Specialist Carl Buck, author of Pay for Your Graduate Nursing Education Without Going Broke, the topics covered will include: case studies based on real nurses’ successful creative financing strategies, how to negotiate your own financial aid package, new nursing scholarships, and how to benefit from tax incentives.
To register, click on one of the below dates and times:
at 2PM EST
March 3, at 1PM EST
Nursing student retention is a major question at nursing school programs across the US. What factors help a student stay in or drop out of a program, and how can you stay on the winning side of the retention statistics?
The Surge in Nontraditional Nursing Students
If you’re not coming to nursing school straight out of high
school, join the club! The nursing student body is attracting a growing number
of what are referred to as “nontraditional students.” According to Marianne R.
Jeffreys, author of Nursing Student Retention: Understanding the Process and
Making a Difference, nontraditional students tend to fall into one or more
of the following categories:
- Age 25 years of age or older
- First-generation college students
- Attend school on a part-time basis
- Members of ethnic or racial minority group
- Speak English as a second language
- Have dependent children
- Have a GED
- Commutes to campus
- Changing to nursing from a former career
- Taking remedial, refresher, or update courses
- Male students
Despite the need for nurses from varied backgrounds to treat an increasingly diverse patient population, nontraditional students face a number of challenges. Quite often, a nontraditional student is driven to drop out owing to time and/or financial constraints, family/childcare responsibilities, work commitments, and other conflicts that interfere with their ability to fulfill course work requirements and achieve academic success.
However, there are a variety of options available to students in such situations. Many programs seek to reactivate lapsed students by offering tuition waivers and make use of special grants to increase student retention and head off the drop-out process. Look for a school that is making use of such grants to create peer-mentoring networks, test prep workshops, and other special activities—measures that have been proven to enhance your experience and increase your chances of success in the program. Taking advantage of these opportunities can help you to meet the challenges of your course-load, reduce stress, give you greater confidence, and increase your chances of passing the NCLEX.
Get the Support You Need—and Deserve
If you are a nontraditional student, keep in mind that your background and situation make you very attractive to the nursing profession! Nontraditional students are in great demand at all levels of nursing education; with your background and abilities you can make a unique and vital contribution.
According to a recent CUNY study, “support by faculty, friends, and family was the key determinant of first semester nursing students’ ability to remain in the nursing course.” Keeping this in mind, take confidence in your value to the profession, don’t be shy, and put yourself out there:
- Make an effort to ask questions in classes and go to faculty for help: it is always better to ask a question than to leave it unasked! If there is something you don’t understand, speak up in class—and if you have more questions than can be managed during a lesson, schedule time to meet with your instructors for help after class.
- Worried about financing your degree? Talk to your financial aid advisor to apply and negotiate for student loans—they’re not just for recent high-school grads. And, if you’re in a BSN program, don’t forget that a nurse externship enables you to collect a salary while gaining hands-on experience with patients—and will also hone your competitive edge in the job market.
- If your school offers a peer mentoring program, take advantage of it. According to the journal Nursing 2020, “students who are peer mentored have better rates of retention and are more successful.” Connecting with a peer mentor can help you to master a challenging course, develop better study habits, bring you closer to your classmates, and increase your self-confidence—all of which can lead to a higher GPA and NCLEX score!
- Make the most of your school’s academic support services. Keep in mind: regular meetings with your faculty advisor can make an enormous difference—for instance, did you know that counseled students have higher retention rates than non-counseled students?
Pursue Success in Your Classes
Nursing is a demanding, rigorous
discipline, but those demands can be met. Here are some basic steps you
can take toward success in obtaining your degree and license:
- Practice self-efficacy: Self-efficacy
reflects confidence in the ability to exert control over one’s own motivation,
behavior, and social environment. Stanford University’s Albert Bandura says of self-efficacy,
“After people become convinced they have what it takes to succeed, they
persevere in the face of adversity and quickly rebound from setbacks. By
sticking it out through tough times, they emerge stronger from adversity.” Push
negative thoughts out of your head and motivate yourself to succeed; form
targets and commit to meeting them; be persistent—approach hardships and
setbacks as challenges to be overcome with increased energy and efforts.
- Double down on your studying skills (check out
the University of North Carolina’s helpful guide, Study
Smarter Not Harder). Did you know that time management, organizing, and
planning are better indicators of academic success than your total number of
study hours? Using your time effectively is the key.
- Attendance is vital.
Did you know that your nursing program’s attendance policies may be stricter
than the policy of your parent institution? You also need to take into
consideration that in a nursing program, in addition to your classroom hours, attendance
requirements also include specific nursing course components such as skills
laboratory and/or clinical hours.
while you attend class and read your textbooks and notes is also essential: how
involved are you during class and when reading? Speaking of notes, have you
developed good note-taking skills? Did you know that most studies indicate
it is more effective to take notes by hand instead
of using a laptop?
- If you have outside obligations that are making
it hard for you to focus, talk to a peer mentor or a faculty advisor—sooner
rather than later—about adjustments you can make that will help you to
concentrate and remain alert.
How Family, Children, and Work Affect Student Retention
remarks, “People have lives that constitute more than nursing school. The
reality is that environmental factors can influence student retention,
persistence, and success more than academic factors.” When it comes to academic
success, personal “environment” plays a key role in student retention. For
example, are you living with family or raising children? Working a full- or
part-time job? Do you have a long commute to and from school? For the
traditional student, college adjustment and social integration into the college
residential life-environment play a substantial role in academic success. For
the nontraditional student, “environment” is largely composed of off-campus
life: where you live (and with whom), the financial constraints you live under,
family/work obligations, transportation issues, and other factors that affect
your life both on- and off-campus.
One hurdle to look out for is the late-semester crunch. Studies have found that the challenges a nontraditional student faces on a day-to-day basis can be lighter or heavier depending on the time of year. Earlier in the semester, for instance, family, relationship, and work responsibilities can exert a moderate, but manageable pressure on the demands of school. Later in a semester, though—for example, when exams are pending—those same responsibilities can feel a lot more burdensome. This is a good time to seek out faculty and peer mentor guidance for help managing time and juggling the various “hats” you wear while fulfilling responsibilities at home, work, and school.
And what about children?
An increasing number of students have dependent children; how do they manage?
Research has shown that even single parents are more resilient than might be
expected. In one study, almost 60% of students with children reported that they
found child care to be supportive of their goals and aspirations in nursing,
while others stated that their child-care arrangements did not influence course
retention at all. As Jeffreys adds, “notably, all of these students remained in
nursing courses throughout the semester and successfully passed the course.”
Working while attending school is becoming a fact of life for both traditional and nontraditional students. Even traditional students now often work 30 hours a week or more. And, once again, the perceived impact of employment responsibilities on schooling can be subject to that late-semester crunch. What may seem manageable earlier in the semester can start to feel increasingly restrictive later on. When setting your hours of employment, also keep in mind that the number of hours you work can have a significant impact on academic achievement and student retention: a 40-hour work week can make school substantially harder than a 30-hour work week. Plan out your budget, and don’t take on more hours than you absolutely need.
The Role of Encouragement and Emotional Support
Families can offer forms
of support that can compensate for lack of financial wherewithal. Emotional
support and expressions of pride and encouragement regarding your educational
and career goals can make all of the hardships worthwhile. In her book,
Marianne Jeffreys cites a study of over 1100 culturally and generationally
diverse undergraduate commuter nursing students that showed family emotional
support was one of the most powerful influences on their ability to remain in a
nursing course. If you feel that your family or significant other could be more
supportive of your efforts, supplement your own inner resources by talking to
your advisor or peer mentor. And remember your friends: the support of good friends
can give you a boost during crucial moments.
As nursing schools are becoming increasingly reliant on nontraditional students, the issues such students face are attracting ever more attention from administrators and faculty. In addition to the student retention measures already in place, programs will continue to seek out ways to attract—and retain—nontraditional students and support them in their progress toward their degrees. And, whether you are a nontraditional or a traditional student, make your voice heard! Talk to faculty, administrators, and peer mentors to contribute your own suggestions about ways to pave the path to success to graduation.