Perspectives on Creative Clinical Placement in the Time of COVID-19

Reimagining, Transforming, and Disrupting the Way Nursing Students Train During COVID-19

Lynda M. Peoples, DNP, CRNP
Thomas Jefferson University College of Nursing
Philadelphia, PA

Concerns regarding preceptor availability and engaging high-quality preceptors are not unique to Thomas Jefferson University College of Nursing (JCN). Preceptors consistently face obstacles to precepting, including but not limited to: time restraints, lack of space, lack of employer support, inadequate provider staffing and productivity demands. Add a national pandemic and the majority of clinical site opportunities came to a screeching halt. 

Commencing March 13, 2020 all clinical rotations for JCN students were suspended. For students set to graduate in May 2020, we utilized best practices to implement virtual simulations and case-based approaches to meet clinical hour requirements and student learning outcomes in a timely manner. For students graduating in August 2020 and beyond, we developed a combination of approaches; virtual simulations and making up clinical hours in the summer and fall semesters. 

Hospitals and other clinical sites with whom we typically partner canceled clinical placements to protect students and patients from infection and preserve scarce supplies of personal protective equipment (PPE) for essential workers. We had to consider requirements from accrediting agencies and state licensing bodies, as well as the needs of our clinical partners and student and patient safety, in opening clinical education opportunities. We also were mandated by local, state and federal regulations in regards to the pandemic. 

On June 15, JCN ushered almost 700 students back and prepared for an additional 500 starting in the fall semester. A majority of our faculty and staff became certified as PPE fit testers and assisted our occupational health department in fit testing all JCN students. JCN provided PPE to all our students to take to clinical sites, removing PPE shortage as a barrier to return. We trained graduate nursing students to be fit testers and deployed them to occupational health sites to assist that department in the overwhelming need for assistance as they were fit testing and responding to exposures across the enterprise (14 hospitals, 7 urgent care centers, 19 outpatient centers and 2 academic campuses). We called on our clinical partners across our enterprise to take our students. We reached out to alumni and even asked faculty to take students. We used telehealth sites to augment their learning. We asked students to front-load hours and, once a student finished required hours, we replaced with another student. 

The second most challenging aspect aside from procuring sufficient clinical sites for graduate and undergraduate students is communication. The ever-changing logistics/policies/numbers, even things far out of our control (e.g., travel restrictions, mandatory quarantining for some returning students depending on the state or country they are returning from, and classroom restrictions) necessitates constant and consistent communication.  We are balancing the need for the students to continue their education and prioritizing their safety. 

Moving Beyond the Obvious: Engaging New Clinical Partners During COVID-19

Beth Ann Swan, PhD, RN, FAAN
Emory University, Nell Hodgson Woodruff School of Nursing
Atlanta, GA
 
To effectively equip the next generation of registered nurses (RNs) with the knowledge, skills, and attitudes needed for their expanded role in the community, schools of nursing must re-evaluate their curricula, as well as assess the need for nursing faculty development in this area.  Pre-licensure programs have traditionally focused their clinical experiences in the acute care setting.  However, hospital clinical sites have become increasingly difficult to secure and during COVID-19 many hospitals and health systems stopped all acute care clinical learning opportunities. During these challenging times, nurse faculty had to move beyond the obvious and create new opportunities to offer greater exposure to new settings of care and emerging RN roles. 

The immediate action was to move to clinical simulation activities. Subsequently, questions arose about state educational program requirements (e.g., in-person clinical vs. simulation, state licensing requirements, accreditation requirements, regulatory issues). While simulation may be a short-term temporary solution, it is not a long-term solution. To move beyond simulation, we created action steps to connect with a variety of community partners.  Foundational to setting-up conversations was: 1) identifying “what’s in it for the organization?”; 2) developing talking points specific to the partner organization that addresses the question why does our school want to collaborate with you? how can our school partner with you to support your mission? what are your needs in serving individuals, families, and/or communities? how can we support those needs?; 3) establishing the relationship with the support of a “connector” to provide introduction, establish credibility, and facilitate dialogue; 4) establishing loyalty; 5) sustaining communication; and 6) nurturing the relationship. Equally important is building an evaluation component, both formative and summative evaluation, as you move forward with relationships with external stakeholders and confirm everyone understands what evaluation is.

One new partner we connected with was the American Red Cross. In response to the challenge of clinical placements, we met with Dr. Linda MacIntyre, Chief Nurse for the American Red Cross (ARC) and her colleague, Chris Cole, ARC Senior Recruiter for Volunteer Services (Atlanta, GA).  Several new clinical opportunities for baccalaureate nursing students during COVID-19 were identified.  Students can gain training and experience as Blood Donor Ambassadors with a focus on health equity and knowledge about the roles for diverse blood donors.  Students can complete didactic training and gain clinical experience with community preparedness and disaster health services performing health screenings and assessments. In Fall 2020, students will participate in clinical learning with the ARC’s Service to the Armed Forces Program. Students will support veterans and their families as they navigate the healthcare system learning about case management roles focused on both physical and mental health, as well as working in pairs to complete 30-day follow-up telehealth visits.