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.”
Nurse of the Week Kirsten Flanary has an abundance of the compassionate nature that is a defining characteristic among nurses. This week, she serves as an example of the many nurses around the country who are venturing out of their comfort zones to join the fight against COVID-19. Flanary, a 25-year-old ED and travel nurse who has worked at Holston Valley Medical Center in Kingsport, Tennessee, and Vanderbilt University Medical Center, was stricken by the news about the devastating impact of COVID-19 on New York City. Kirsten couldn’t seem to stop thinking about the overwhelmed city and soon found herself ready to join the fight.
As she listened to the reports that came flooding in, Kirsten thought, “All these big cities are just drowning in this virus. Nurses are exhausted, they’re working long hours, they’re not having days off. Everybody is getting sick…” When the pandemic spread and legislators removed restrictions preventing nurses from using their licenses to practice out of state, Kirsten was ready to do what she could to help ease New York’s plight. She had never even been on an airplane, but that now seemed like a small consideration in the overall scheme of things.
Kirsten’s mother—who is a nurse as well—was initially flabbergasted. “Her response was, are you insane? But she has been my biggest support in all of this.” An undaunted Kirsten packed her bags, flew into the Big Apple on Sunday, April 5, and joined the thousands of nurses working on the front lines of New York’s COVID-19 pandemic. Kirsten arrived in a desolated city, but since her arrival, she has been inspired and gratified by the appreciation of those who remain:
Now, Kirsten, too,
is braving the virus while caring for a seemingly endless flow of
patients, but she feels committed: “When you start nursing you take
an oath. We put our patients first and typically put ourselves last.
I felt like I needed to do something.”
Our Nurse of the Week is Sara
Croley, a University of Tennessee (UT) College of Nursing alumna who
recently gave a $7.5 million donation to the university, making it the largest
donation in the college’s history. Croley hopes her donation will go toward ‘investing
in the future of nursing,’ ultimately helping to decrease the burden of current
nationwide nursing shortages. The donation was made in partnership with Croley’s
husband, Ross Croley.
to UT officials, $5.5 million of the donation will support the College of
Nursing’s building renovations, and $2 million will establish the Sara
Rosenbalm Croley Endowed Dean’s Chair. The $60 million renovation project will
allow the college to increase enrollment. The college has had to turn away
qualified applicants in the past due to a lack of space and resources.
Croley tells WBIR.com, “Having worked as a nurse for many years, I have cared for people during some of their most difficult moments. Nurses play such an important role in people’s lives. Ross and I are investing in the future of nursing in Tennessee. We hope this gift opens a door of opportunity for many more amazing nurses to enter the workforce.”
US Bureau of Labor predicts a nationwide shortage of 1.2 million registered
nurses between 2014 and 2022. According to UT, the majority of Bachelor of
Science in Nursing students work in Tennessee after graduation, with an
estimated 45 to 60 percent remaining in the Knoxville area specifically. Pending approval from the UT Board of Trustees, the
renovated nursing building will be named the Croley Nursing Building. It’s
projected to be about 100,000 square feet, more than twice the size of the
To learn more about Sara Croley, a University of Tennessee College
of Nursing alumna who recently gave a $7.5 million donation to the university to ‘invest in the future of nursing,’ visit here.
Our Nurses of the Week are the nursing students from West Carolina University’s School of Nursing who volunteered to provide services at a free rural health care clinic in eastern Tennessee. More than 10 students provided patients with medical, dental, and vision care. Over a thousand people attended the free clinic over a period of three days during which the clinic provided an estimated $883,456 in free medical care.
Elizabeth Sexton, WCU assistant professor of nursing and an excursion leader, tells WCU.edu, “These students from community mental health nursing practicum class were up at 4 a.m. to take part in the clinical services. They got exposure to it all, from triaging patients, giving flu shots to helping in the dental and vision areas. They also got to see the big picture. For whatever reason, whether lack of health insurance, lack of resources, inadequate healthy nutrition, poor dental hygiene or substance abuse, the needy individuals were there and seeking help for dental, vision and medical problems, and so appreciative to receive it.”
Remote Area Medical is a nonprofit organization based in Rockford, Tennessee, since 1985 and has held mobile clinics for uninsured and underserved families and individuals, assisted by health care professionals and students. Its mission is to prevent pain and alleviate suffering and to enhance quality of life through the delivery of competent and compassionate health care to those who are impoverished, isolated, and underserved in the US.
To learn more about the West Carolina University nursing students who volunteered to provide healthcare services at Remote Area Medical’s mobile clinic, visit here.
Our Nurse of the Week is Saman Perera, a Tennessee-native nurse fighting healthcare inequality through Doctors Without Borders. Born in Sri Lanka and raised in Hendersonville, TN, Perera decided to join Doctors Without Borders after graduating from nursing school and is now setting an example for his community on how to get involved in global humanitarian efforts.
After attending the University of Illinois for his bachelor’s degree in nursing and Vanderbilt University for his master’s degree, Perera embarked on his first mission to Haiti following the 2010 earthquake to help with the cholera outbreak there. His missions have also taken him to work in primary care in the Democratic Republic of Congo and to the frontlines of Chad treating war-wounded victims.
However, Perera was most recently stationed on a two-month medical mission in Bentiu, South Sudan, working in a refugee camp hospital made up of 130,000 residents. The camp was created as a result of a civil war breakout in the area. Although his missions often take him to volatile, war-torn environments lacking housing and running water, Perera says the toughest aspect of his job is managing the emotions involved. Perera has found that the best way to cope with the emotions of treating victims of war is to focus on task-oriented jobs like training local nurses.
For Perera, his work with Doctors Without Borders goes beyond just nursing and medicine. He tells UTDailyBeacon.com, “I realized that medicine, for me, is a Band-Aid to something a lot bigger; we’re talking wars, huge injustices, malnutrition in countries like Congo. For me, my presence there and the presence of Doctors Without Borders is more than medicine, it’s a way of saying injustice is not okay.”
Perera recently moved to Knoxville, TN after returning from his two-month mission in South Sudan. He plans to work as a hospital nurse practitioner while he prepares for another Doctors Without Borders mission trip. In his spare time, Perera encourages other current and future healthcare workers to get involved in global aid and serve those in need.
To learn more about Perera’s time as a medical mission nurse for Doctors Without Borders, visit here.
Our Nurses of the Week are Kyle Cook, 53, and Carla Saunders, 51, neonatal nurse practitioners at a children’s hospital in Knoxville, TN. After decades spent caring for infants, these two nurses recognized a major problem when they had six babies in the nursery at once suffering from substance withdrawal. After looking to experts for answers on how to treat these delicate patients, they discovered that no one yet had the answers, and became the experts themselves.
It was 2010 when Cook and Saunders began to see the effects of the opioid crisis themselves. The first time they realized that they had a problem was when they had six babies suffering at once, but that number quickly began to grow. Cook, 53, tells NPR.org:
“We couldn’t fix it; we couldn’t make these babies better. Little did we know that was the tip of the iceberg. We had 10, and then 15, and then, at one point, 37 babies in the NICU that were withdrawing. We were bursting at the seams.”
Unprepared and short-staffed, they knew they needed to find a new solution because their current practice wasn’t helping the inconsolable infants they were attempting to treat. They worked at a small children’s hospital, but knew that the problem they were facing was a representation of a greater substance abuse problem happening all over the US.
When they called across the country looking for experts to advise them on how to treat these special patients, they discovered that nobody had the answers. They were left to find the answers themselves, and wound up helping to establish one of the first treatment protocols for babies exposed to opioids and a program connecting mothers with treatment and therapy options.
To learn more about Cook and Saunders’ experience treating babies suffering from opioid withdrawal, listen to the full podcast below: