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The American Association of Colleges of Nursing reports that more than 80,000 qualified nursing school applicants were turned away in 2019 because of low numbers in faculty, clinical sites, and preceptors. And the COVID-19 pandemic has only worsened the struggle for nursing students to secure clinical placements.
"Nurses and facilities are swamped with numerous COVID-19 patients," says Karen Ouzts, Ph.D., RN, PHNA-BC. "They are simply unable to add precepting on top of this."
But Ouzts and other nurse educators offer ideas for alternative nursing clinicals experience.
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Why Have Clinical Opportunities Been Limited?
Robin Squellati, Ph.D., APRN, cites a nationwide nursing shortage, higher levels of student requirements, and nursing students not being a priority as reasons for reduced clinical opportunities.
"The nursing shortage crosses over to education," explains Squellati. "There are fewer nurse educators, which compounds the problem."
According to Deb Kelly, a nurse administrator, "COVID-19 has presented additional challenges and limited access to clinical placements."
"When the pandemic initially began," Kelly explains, "healthcare providers halted clinical placements in an effort to mitigate the spread of the virus and to preserve resources, namely personal protective equipment for their essential workers."
But there is hope. Keep reading for options to combat the shortage of traditional clinical opportunities.
The Importance of Clinical Experience
Clinical experience provides nursing students at all levels with hands-on training and interaction with real patients. This can prepare them for their future roles. The number of required clinical hours varies from state to state depending on the state board of registered nursing, but all state licensure boards mandate clinical training.
Aspiring registered nurses (RNs) learn basic nursing skills like administering medication, assisting patients with daily living, and updating patient charts. Advanced practice nurses gain experience with specific patient populations and nursing specialties.
Additionally, though mentorship in nursing cannot replace clinical hours, it can help supplement and support clinical experiences.
Ouzts, program director for Walden University's RN to bachelor of science in nursing (BSN) bridge program, explains that the school "implemented a mentoring approach for practicums even before COVID-19."
As a result, she says, "We were able to easily transition to mentoring by phone and over the internet to still meet learning outcomes."
Alternative Clinical Experience Placements
Our nurse educators offer several suggestions for alternative clinical experiences for students having trouble finding more standard openings.
Crystal Slaughter, DNP, APRN, and faculty member for Walden University's RN-to-BSN program, recommends virtual clinical simulations, such as Shadow Health.
"Shadow Health provides a robust digital clinical simulation environment that provides students with learning opportunities through engaging in assessment of a variety of culturally diverse patients," Slaughter says.
Some schools have provided nursing students with simulated clinical experiences using mannequins. These mannequins have life-like functions such as breathing, a pulse, and heart and lung sounds. Some nursing programs use student actors to help create unfolding healthcare scenarios for nursing students.
Alternative Clinical Sites
Squellati offers ideas for clinical placements that may not be as overwhelmed with COVID-19 patients.
"Some alternative locations for live interaction with various types of patients include nursing homes or long-term care, urgent care centers, dialysis centers, psychiatric facilities, behavioral health facilities, acute care drug rehab facilities, community care centers, home care, hospice centers, and military or VA facilities," Squellati suggests.
Kelly, chair of the nursing department at Clarion University, found a silver lining in the COVID-19 pandemic that provided students with a unique clinical option.
"With the approval of our State Board of Nursing, our students were able to apply what they learned in community health by rotating through the massive vaccination clinic in the spring of 2021," Kelly explains. "They were able to see first hand the significant role nurses play in health promotion and wellness."
Nursing students should verify that alternative clinical opportunities comply with program and state rules for clinical experience. They should also receive approval from their school or department, along with their state board of nursing.
Clinical Experience Frequently Asked Questions
What counts as clinical experience for nurses?
The Commission on Collegiate Nursing Education (CCNE) defines clinical practice experience as a planned learning activity that offers students opportunities to understand, perform, and refine professional competencies at the appropriate program level.
How do you get clinical nursing experience?
Students typically learn about clinical opportunities through their nursing education programs; however, they can also find their own clinical sites that meet CCNE criteria for clinical experiences and are approved by their school or program. Distance learners, for example, typically secure clinical rotations in their home communities.
Do you need clinical experience for nursing school?
The CCNE requires that nursing programs at all degree and certificate levels include clinical experiences. These clinicals must prepare students for their professional role. These can include simulation labs and virtual experiences as long as they provide in-depth learning.
How are nursing clinical hours calculated?
Nursing schools and programs vary in terms of how many clinical hours they require. They also differ in how they calculate clinical hours so they meet state requirements. A typical formula consists of a 3:1 ratio of clinical hours to classroom credit hours.
Meet Our Contributors
Deborah (Deb) Kelly
Deb Kelly is a nurse administrator and chair of the nursing department at Clarion University. She has been a faculty member at Clarion since 2003 and received her terminal degree from the University of Pittsburgh. Prior to becoming department chair and nurse administrator, Kelly taught in the ASN, RN-to-BSN, MSN, and DNP programs.
Karen Ouzts, Ph.D., RN, PHNA-BC, program director for Walden University's RN-to-BSN program, has more than 25 years of experience in nursing education. Her primary area of expertise is in public health nursing (PHN), enhanced by her master's degree in maternal child health. She also served as a Wyoming PHN state supervisor. Ouzts is certified as an advanced PHN through the ANCC.
Robin Squellati, Ph.D., is an advanced practice registered nurse and faculty member for Walden University's master of science in nursing program. Squellati is a certified nurse practitioner and a veteran of the U.S. Air Force, where she served as a nurse for 28 years.
Crystal Slaughter, DNP, APRN, is a core faculty member for Walden University's RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized intensive care unit patients. Slaughter's clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.
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