October 20, 2020

What are Nursing Clinicals Like During COVID-19?

Leona Werezak
By: Leona Werezak BSN, MN, RN

By: Leona Werezak BSN, MN, RN 

While most people have been wanting to avoid hospitals, nursing students this fall were looking forward to returning to them to continue their education. Clinical placements have become a hallmark of nursing education that students have come to expect and faculty have relied on to help prepare new graduate nurses.

To find out how clinicals are changing for nursing students this fall, we spoke with some nursing faculty to learn what clinical nursing education looks like during the pandemic.

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How Have Nursing Clinicals Changed Due to COVID-19?

Gretchen Williams is an adjunct clinical instructor at Northern New Mexico College. She says that “clinical education looks a bit different this year given the current pandemic.”

Mandatory Masks and Screenings

She explains, “the biggest change is that all...students are required to wear a mask in the hospitals and in simulation labs. The students also have screening questions to answer before being allowed into clinicals or simulation labs and have to have their temperature checked as well.” 

Virtual Clinicals

Wendy Arena, an adjunct clinical instructor at Fitchburg State University in Massachusetts, teaches mental health clinicals in a newer privately-owned psychiatric hospital. She says, “I feel very fortunate that the hospital is still allowing nursing students from my university to come to the hospital for clinicals.” 

However, she says the university where she teaches has chosen to make part of the clinical experience virtual. She explains, “this means that students rotate between clinicals in the hospital...a community home care setting, and completion of online simulations. The trend toward using simulation for clinical learning was happening even before the pandemic.…The hybrid model seems to be working well.”

Hybrid Online and In-Person Nursing Programs

Rachel Nall is a clinical assistant professor at the University of Tennessee at Chattanooga teaching in the Nurse Anesthesia program. She says, “our clinical training is very dependent upon hands-on experiences and learning in the hospital.“ 

She shares that a new student cohort attended classes online this summer and attended simulation labs in smaller groups than usual with students being required to wear masks. Following this, students began their clinical experience after Labor Day which she says is standard practice for the program.

What Led to the Changes to Clinical Education This Fall?

As Arena from Fitchburg State shares above, although the hospital where she teaches was allowing students to continue with their clinical experience at the hospital, the nursing program chose to reduce the amount of time students and faculty are in the hospital by moving to a hybrid model of clinical education. She says this includes a mix of clinical time in the hospital, a community home care setting, and online simulations.

A Desire to Put Student Safety First

While clinicals are continuing as usual for students in the Nurse Anesthesia program at the University of Tennessee at Chattanooga, Nall points out this decision was made “in cooperation with the university’s policies, the clinical facilities where we place students, and governmental direction. Our students are our commitment, first and foremost. We want them to have clinical experiences, but we want them to do so safely.”

Concern for student and faculty safety is also a top priority at Northern New Mexico College according to Williams. Although clinical education in hospitals is still occurring, she says it “is being conducted more carefully” with the nursing program following guidelines set out by the state nursing board and direction provided by local hospitals. This has meant fewer students are allowed on hospital units at a time requiring faculty to find more observational experiences and provide more virtual simulation opportunities for students, Williams says.

What Concerns Do Faculty Have About Clinical Nursing Education and COVID-19?

Arena shares, “Since I already work as a staff nurse in the hospital where I teach, I’m not that concerned about potential exposure to COVID-19. I’m there for work several days a week anyway. I don’t believe being there an extra day increases my likelihood of exposure. Patients are tested in the ED (emergency department) before transferring to the psychiatric hospital and are strongly encouraged to wear masks when out of their rooms.”

Communication Challenges Due to Masks

However, Arena explains, “The pandemic has created a different set of challenges in this setting. Having to wear a face mask all the time, for example, creates a barrier when it comes to therapeutic communication. The muffled words and inability to see patients’ facial expressions makes it difficult to establish rapport.” 

Increased Rates of Anxiety and Depression

Arena says she has also seen an increase in first-time psychiatric admissions for people who are being treated for anxiety and/or depression on an outpatient basis. She says, “The stresses created by the pandemic overwhelm their coping abilities and they end up in crisis and require an inpatient psychiatric admission.”

Nall sums up faculty concerns well stating, “We want to educate the next generation of nurse anesthetists and provide them with the clinical experiences they need to graduate on time and feel prepared to take on their clinical practice. We also want our students and patients to be safe. Currently, we feel we are able to balance these priorities. I think if at any time there were concerns that this would not be the case, we would consider alternative learning forms.”

What Concerns Do Students Have About Clinical Nursing Education and COVID-19?

Unlike the faculty we interviewed, Arena says, “None of her students at Fitchburg State have expressed concern about contracting the virus. And the feedback from students about having simulations as part of their hybrid clinical model this term have been mostly positive,” she says.

Williams shares “Students have expressed that they don’t feel as prepared and quite ready to be nurses yet since their time was cut short in the hospitals and they only had virtual simulations… they constantly question if what they are doing will be good enough.”

Unlike Arena’s students, Williams says, her students have expressed fears about contracting COVID, but have mostly become fearless leaders in showcasing the new normal for nursing school right now. “The students are more brave, and show such an understanding the constant change, that we as faculty are constantly in awe of how they have dealt with ever-changing times.” 

How Do Hospital Staff Feel About Clinicals?

A potential concern about students returning to clinical experiences in hospitals is their need for personal protective equipment (PPE) that has been in high demand and short supply for hospital staff since the pandemic began. 

However, Nall states they’ve been fortunate since there has been enough PPE in the community and hospitals where they practice to keep both healthcare personnel and their students practicing safely.

Williams explains, “Now that the students are back in the hospital (for now), the nurses and other staff have taken very well to having them back. I have spoken to nurse managers and nurses about this….across the board, the nurses, and healthcare staff are just so happy to have them and teach them. The staff recognize that these nursing students are the future in nursing.”

What Alternatives are There to Clinicals?

In terms of substituting other options in lieu of traditional clinical placements, Williams says they have a plan in place at Northern New Mexico College in the event that a student is required to quarantine. 

She explains, “We utilize i-Human and although it isn’t foolproof, and doesn’t give the student true hands-on experience, it is a great alternative to not doing anything at all. It also challenges the students in their critical thinking which is important in nursing school.” 

She concludes “I am excited to see how the semester turns out, and I’m ready to see how the students grow. Whether that be fully in the hospital setting for clinicals, or mixing it up using the virtual SIMS if needed.”

Want to Learn More About Nursing School Clinicals During COVID-19? Check out Nurse Alice and Nurse Haskins' Beyond the Bedside video!

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