This article was written by Frontier Nursing University (FNU) Dean of Nursing, Dr. Joan Slager, DNP, CNM, FACNM, FAAN and was originally published by ACEN.
Just as Frontier Nursing University (FNU) teaches its students to understand and address the needs of the communities they serve across the country, the FNU faculty and staff are keenly aware of the needs of our student community. Those needs are ever-changing, never more so than during the COVID-19 pandemic. I am incredibly proud of how our faculty and staff acted with tremendous efficiency, professionalism, and care to ensure the best possible outcomes for our students.
As the first wave of COVID-19 grew and spread, FNU began receiving notices from many of our clinical partners that they were either limiting or eliminating clinical rotations for students. By April 24, 2020, 140 clinical organizations had suspended all student rotations and 13 clinical organizations had implemented restrictions but had not suspended all student rotations. Thus, 289 students had rotations impacted by COVID-19 restrictions or cancellations between March and July. Some of our students were about to travel to campus for a skills-intensive session to prepare for clinical rotations.
Some students were abruptly without clinical sites in the middle of their clinical experience, and some could see the finish line, but no longer had the opportunity to complete their final clinical hours. In the DNP program, carefully planned quality improvement projects imploded as patient visits decreased or priorities shifted in the sites.
Faced with these urgent issues, the FNU team rapidly went into problem-solving mode. As President Stone reminded us, with our expanding use of technology to develop and refine a quality education program for students all over the country, while maintaining a sense of community, we have prepared for this for years.
Within a few short weeks, the following programming and policies had been developed:
- Regional clinical faculty and didactic faculty developed simulated and web-based activities that could be counted as clinical hours, thus allowing progress in clinical courses. Students who had met a minimum of 500 face-to-face clinical hours used these experiences to complete their clinical hours and graduate.
- Policies allowing telehealth visits in the family nurse practitioner, women’s health nurse practitioner, and midwifery programs were approved.
- The number of telehealth hours permissible in the psychiatric mental health nurse practitioner program was increased.
- Virtual clinical preparation courses were developed for all programs. Students joined faculty via telecommunication sessions and practiced skills in preparation for clinical.
- The DNP faculty developed four virtual quality improvement projects, allowing students to continue progress toward their Doctor of Nursing Practice degrees.
The efficient and well-planned development and implementation of these measures were vital to our students, many of whom would have had to go on hiatus or even withdraw from the university if these options were not available to them.
As the year continued to be challenged by the pandemic, the adjustments that were developed to enable students to continue to progress in their clinical education provided some valuable insight and lessons for the faculty and students. The faculty discovered that some of the skills taught during on-campus clinical sessions could be improved using the technology employed during the virtual clinical bounds. For example, demonstrating suturing techniques on a large display screen was more beneficial than when a single instructor circulated around a room of students practicing this skill. The simulated clinical scenarios that were taught in a virtual environment demonstrated the value of incorporating simulations into the clinical courses to enhance students’ exposure to infrequent clinical presentations or to facilitate evaluation or remediation.
In all tracks, the initial clinical courses were converted to a virtual format taught by a combination of didactic and clinical faculty. Students practiced foundational clinical skills such as taking a patient’s history, critical thinking, and clinical reasoning guided by expert faculty. The feedback from students and their preceptors revealed that students demonstrated more confidence and were better prepared for clinical experiences after completion of the virtual courses. As clinical sites began reopening to students, the tangible evidence that some clinical preparation beyond the one-week intensive clinical-bound week was beneficial led to the development of a hybrid approach to the clinical courses. Currently, all students receive an initial 30‒60 hours of virtual clinical instruction led by faculty in a simulated environment, and the remainder of the hours are fulfilled in the clinical sites.
Prior to the pandemic, the psychiatric-mental health nurse practitioner (PMHNP) students spent about 10% of their clinical time providing care via telehealth. Although discussions about including telehealth in the other program tracks had occurred, no provisions for this had been developed. Many clinical practices rapidly converted to providing some visits via telehealth, which accelerated the development of policies and procedures that allowed students in all tracks to participate in telehealth visits with their preceptors. In the PMHNP program, the utilization of telehealth increased to 70%.
While telehealth as a care delivery modality preceded the pandemic, its utilization has expanded exponentially, especially in rural communities. Recognizing the need to prepare our graduates to deliver care via telehealth, software was purchased that will facilitate the incorporation of simulations into our programs across the curriculum as well as enable us to teach students how to provide healthcare via telehealth.
While many universities struggled with the challenges associated with the COVID-19 pandemic, FNU seized the opportunity to adapt, learn, and improve our programs. These examples of flexibility, creativity, and resilience are part of our heritage.
In-person Frontier Bound orientation sessions and Clinical Bound sessions are returning at FNU, and the innovative teaching methods that were seen throughout the pandemic will continue to be used in our distance education programs. The pandemic has taught our faculty and staff ways to enhance the in-person experience at Clinical Bound and to improve the didactic portion of our programs.
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