FNU’s Innovative Faculty Adjust to Students’ Needs during the Crisis

Dean of Nursing
Joan Slager, CNM, DNP, FACNM, FAAN

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.

Are you interested in learning more about what programs FNU has to offer? Fill out this form to start the conversation today!

The Frontier community is proud to have students and alumni serving on the front lines of the COVID-19 pandemic. Throughout the next few weeks, we are committed to sharing their stories in order to provide insight, hope and encouragement. Thank you to all the health care workers who are risking their own well-being daily to serve our nation. Click here to read more stories of courage and dedication.

There have been many stories and statements suggesting that the COVID-19 pandemic has changed life as we know it forever. Regardless of what the future holds, Amanda Dunham, DNP, FNP-C, Class 29, said that the call to serve remains the same.

“I think FNU students and alumni are called to serve and COVID-19 is no exception,” said Amanda, owner of Dr. Dunham Integrative Family Health NP, PLLC, a women’s-centered primary care practice in Clifton Park, N.Y.

“We serve our communities. We take care of patients in need. We advocate for people without a voice. Hopefully, that never changes.”

During the pandemic, Amanda’s small practice in upstate New York has taken steps to broaden its reach and help any in the community in need of care.

“Though we typically reserve Telehealth for established patients, I have opened Telehealth services to anyone in need,” Amanda said.

“Children, women, men and older adults needing prescription refills, evaluation for medical issues and even mental health are encouraged to use our services. I have already seen the negative impact social distancing is having on mental health for many people and I encourage patients to use Telehealth if these services are needed.”

A native of the area, Amanda knows the Clifton Park community well. Her practice is located across the street from the local high school. She maintains employment at a local urgent care center in addition to administering her own practice. She is deeply connected to the community and the needs of her patients.

The only nurse practitioner provider at her primary care practice, Amanda also employs a dual-licensed massage therapist/esthetician and a registered nurse. The resulting collaboration results in what Amanda describes as a “whole-person approach to care.”

“My experience at FNU empowered me to be an entrepreneurial-minded health care provider who is dedicated to serving the local community,” Amanda said. “Our goal was to create a patient-centered practice where people could come feel cared for and at home.”

Amanda had to make quick adjustments to that model by expanding the Telehealth options for patients, hoping to reduce exposure while remaining open for those in need of in-person care.

“We hope these measures can avoid unnecessary trips to emergency departments and urgent care centers where patients may be exposed to COVID-19,” Amanda said. “Telehealth is excellent for discussing lab tests, medication management and even to discuss mental health concerns.”

Mental health is a rising concern as the pandemic persists. Amanda said that many patients are worried about being a “well carrier” and passing the virus on to their families without even knowing they have it. Others are dealing with the stress of home-schooling their children while working from home or feeling trapped by not being able to go out for dinner or exercise.

“I’ve seen a surge of depression from isolation and I think many patients are struggling with anxiety,” Amanda said.

“For many patients, they may have no history of anxiety, so this may be their first time navigating those concerns. Additionally, typical coping mechanisms, such as yoga studios and gyms, may not be available. With our patients, we discuss the importance of social distancing, infection control precautions, and of course, self-care for their physical and emotional well being.”

One potential positive outcome of the pandemic is the exposure in flaws and gaps in the healthcare system in the United States and the identification of solutions. In this the International Year of the Nurse and the Midwife, COVID-19 is making many more people aware of the quality and value of care nurses provide.

“Full practice authority for nurse practitioners across the nation is a must,” Amanda said. “Patients need access to healthcare and nurse practitioners and nurse-midwives are uniquely qualified to minimize the gap in care, increase access and provide quality healthcare that is affordable. I’ve been so proud of my colleagues who are opening their arms and practices to patients in need.”

Though the circumstances may change, for so many like Amanda, the call to serve never does.

2020: Year of the Nurse and the Midwife

Frontier Nursing University (FNU) is proud to support and join the World Health Organization’s international campaign designating 2020 as the “Year of the Nurse and the Midwife.” In recognizing the International Year of the Nurse and the Midwife, FNU joins the efforts to raise awareness of healthcare shortages in the U.S. and abroad; demonstrate the need for more nurses and nurse-midwives; educate the public of the value of nurses and nurse-midwives in their communities and advocate for access to quality healthcare for every individual.