Changes to Nursing Programs’ Clinical Requirements in Response to COVID-19

The COVID-19 pandemic has fundamentally changed the way people live, forcing everyone to adjust to a "new normal" of social distancing and staying at home as much as possible. The virus has also disrupted numerous industries, including education and healthcare.

As a result, many colleges and universities have transitioned to online learning. Although students and faculty in various disciplines have struggled to adjust to the new conditions, these changes present an especially large challenge for nursing and medical students. Aspiring nurses must complete their clinicals by working directly with patients at healthcare facilities. However, students can no longer complete this crucial part of their education as they have traditionally done.

"This is a real issue right now," says Jennifer Olszewski, EdD, MSN, CRNP-BC, and clinical assistant professor and chair of the Accelerated Nursing program at Drexel University. "The possibility of delayed graduation if our clinical affiliates cannot accommodate student nurses is an issue we are planning for at this time."

Potential Impact on the Nursing Workforce

In some ways, COVID-19 only exacerbated existing problems in the nursing industry. By the time the virus reached the U.S., the profession was already grappling with a nursing shortage. According to the American Association of Colleges of Nursing, an increasing number of baby boomers reached the age of 65 and began requiring more healthcare, just as many nurses were nearing retirement. Meanwhile, nursing school enrollment rates did not grow fast enough to replace the nurses leaving the industry.

The spreading pandemic further increased the demand on America's healthcare system. Up to 14,000 nursing students preparing to graduate from entry-level nursing programs may need to delay their graduations this year. This is largely because social distancing rules have made it difficult -- if not impossible -- for learners to complete their clinicals. However, many graduate programs are coming up with inventive ways to keep students on track for graduation.

What Schools Are Doing in Response

Schools and government entities alike are developing strategies to help nursing students finish their degrees and enter the workforce.

For example, California's state government announced an emergency waiver reducing the number of required onsite clinical hours in healthcare facilities for nursing students. This would reportedly help 9,000 nursing majors to graduate on time and begin working to help hospitals overwhelmed with coronavirus patients. Wisconsin established a similar emergency measure in March, permitting nursing students to graduate with only 75% of their normally required clinical hours.

Schools and government entities alike are developing strategies to help nursing students finish their degrees and enter the workforce.

Universities are experimenting with different ways for aspiring nurses to obtain their clinicals. At Drexel, students no longer work directly with patients under supervision. Still, according to Olszewski, Drexel has "pulled in many platforms for virtual learning this term in lieu of direct patient contact," including running simulations with live actors.

"We are developing creative ways to enhance future clinical experiences with longer 'shifts' —perhaps night shifts— to increase site availability and 'frontloading' didactic to allow for more days per week for clinical experience," Olszewski adds.

Other schools are also getting creative. The University of Washington allows senior nursing students to work at COVID-19 call centers. Doctoral students may serve in telehealth and telemedicine call centers, and licensed graduate students can work with COVID-19 patients at care centers.

However, these policies can only go so far. Although California's efforts should help students close to graduating begin working, hospitals may not be able to schedule enough shifts for nursing students in the middle of the pandemic.

What Can Nursing Students Do?

In this uncertain and stressful time, it's no surprise that nursing majors and graduate students might find themselves unsure of how to continue with their education -- especially when schools have switched to virtual learning.

"It is important for students to value the content and its delivery," Olszewski says. "It is important that they recognize what type of learner they are and communicate that with faculty. Students should also connect with classmates and create virtual study groups."

Although aspiring nurses may fear health and safety concerns that come with working on the COVID-19 frontlines, for many, the pandemic has only reassured nursing students about their career choice.

But the most important thing for nursing students, Olszewski emphasizes, is "transparent and honest communication."

Although aspiring nurses may fear health and safety concerns that come with working on the COVID-19 frontlines, for many, the pandemic has only reassured nursing students about their career choice.

"Nursing is a selfless career path… the public is now seeing this," Olszewski says. "We chose this profession to provide care to the individuals, populations and public."

Resources for Nursing Students

• Outbreak Preparedness and Response Guide The Association for Professionals in Infection Control and Epidemiology has made this important text about emergency management and infectious disease disasters free to read for all healthcare professionals and students.
• American Nurses Credentialing Center COVID-19 FAQs The ANCC website answers questions about testing, live remote proctoring, and how the pandemic may affect your path to licensure.
• American Association of Critical-Care Nurses e-Course AACN offers all nurses a free online course covering COVID-19 pulmonary, ARDS, and ventilator resources.
• Nurse Educator Podcast Although this podcast's target audience is typically nursing instructors, students can learn a lot from recent episodes on COVID-19. Get started with the episodes on disaster preparedness for nursing students and coping with COVID-19.