Tennessee Nurse - May 2021

Page 18 Tennessee Nurse May, June, July 2021
Caring During COVID-19: Nursing Education
Mary Eve Rice, DNP, MSN, CPNP,
Bettina Shank, DNP, MSN, RN, CNE,
Terri Clark, MSN, RN,
Michele Robertson, DNP, MSN, APRN, FNP-BC,
Amy S. Hamlin, PhD, MSN, APRN, FNP-BC,
Tasha Ruffin, DNP, RN,
& Debra Rose Wilson, PhD, MSN, RN, IBCLC,
AHN-BC, CHT
The COVID-19 pandemic has challenged individuals
and systems across the planet, and in the world of
nursing, innovative approaches were required, and
valuable lessons are still being learned. The world has
seen nurses step up to the plate to manage the care
of the ill and then to vaccinate the masses. Nursing
education had to also step up to the plate to ensure that
there are graduates stepping into practice. This article
reviews some of the challenges that nursing education
in Tennessee has overcome and gives honor to nursing
schools across the state who found creative, safe, and
thorough ways of preparing students for practice. This
is written through the eyes of nursing professors from
Austin Peay State University, TN.
Nursing faculty were faced with the difficult act of
balancing a quality nursing education with navigating
the challenges of living through a pandemic. COVID-19
impacted teaching methods, clinical experiences,
existing policies, styles of leadership, personal and
academic lives of nursing students, and nursing
faculty’s professional and personal lives. During these
unprecedented times, leaders worldwide faced the
obstacles head-on, with creative ideas, collaboration,
and flexible hearts to care for those we serve.
Taking Care of Students
Nursing school is known for intense rigor and
demanding requirements. Nursing students were
already tackling the stressors of obtaining a nursing
degree when the COVID-19 pandemic compounded
this into what seemed to be an impossible challenge.
Nursing instruction changed drastically and abruptly.
Students struggled to adjust while facing numerous
hurdles with their children at home full-time and
unstable income sources for their family. Many nursing
students (RN to BSN and graduate students) were not
only students but also essential workers. Going to
school and working in healthcare during a pandemic is
incredibly strenuous and overwhelming. Faculty made
efforts to alleviate stress by offering stress management
webinars via zoom, with prizes. A pedagogy of care
includes an added focus on flexibility, connection,
empowerment, prediction, and preparation. Faculty
allowed more flexible deadlines and opportunities for
revision submissions without lessening quality work
expectations. Faculty consistently made extra efforts
to reach out to students, assessing stress levels and
evaluating students’ overall mental health. Followup
emails and telephone calls reminded students
that the faculty cared. Faculty played a crucial role in
empowering students to persevere.
Taking Care of Teaching and Learning
Before the pandemic, the use of technology in
nursing education was not uncommon. Nursing faculty
and students were familiar with learning management
systems, video conferencing, virtual quizzing, simulation,
and other online technologies. With the sudden impact of
the pandemic, transitioning to an online platform became
necessary. Student learning outcomes could not be
compromised. Zoom sessions focused on academic issues
but were also adapted to include logistical, technical, and
emotional support. Zoom meetings allowed opportunities
for review or further instruction. Assignments were
adapted to support online learning and included
developing a virtual “telehealth” visit experience for
nurse practitioner students, online teaching opportunities
for nurse educator students, and online simulation for
traditional pre-licensure students.
Test proctoring services were shut down when the
outsourced proctors went on lockdown. Some students
needed reliable computer equipment and reliable
internet to stream online lectures, and the university
assisted. Concerns with the Family Educational Rights
and Privacy Act (FERPA) and student privacy arose from
video conferencing’s exponential use. Solutions included
proctoring students via online video conferencing, bringing
small groups to campus lab activities while maintaining
social distancing and personal protective equipment (PPE),
and avatar-based online simulation.
Taking Care of Clinical
Clinical learning is a staple for nurses and healthcare
professionals. Public safety and the need to develop
new colleagues in the healthcare sector collided.
Fortunately, multiple large community hospitals
collaborated and continued to allow modified clinical
experiences for nursing students. Long term care
facilities, some hospitals, and other community partners
could not allow students. But, as clinical agencies
closed their doors to students, the Tennessee State
Board of Nursing began offering educational programs
guidance. The guidance allowed undergraduate nursing
programs to increase virtual simulation and on-ground
labs to account for up to 50% of clinical hours. For
graduate students, the National Organization of Nurse
Practitioner Faculties (NONPF) sent a statement to all
programs reaffirming the minimum requirement of 500
direct patient clinical hours for NP programs. NONPF
stated that programs requiring greater than the 500
minimum direct hours could waive the additional hours
if a student had demonstrated educational outcomes
and competencies or use virtual simulation. Later, as
the vaccine became available, APSU student nurses and
their faculty (like many other Schools of Nursing across
TN) provided immunization sites for the State of TN.
Taking Care of Policy
With COVID-19 also came many policy addendums,
from classroom spaces to clinical placements, and
most importantly, considerations to faculty, staff, and
student safety. A campus COVID-19 Task Force was
formed and kept everyone abreast of the viral threat
and thresholds. Community partners from within the
community, university, and state banded together to
make uniform informed changes with safety, healthy
work environments, and education at the heart of each
decision in an unprecedented way. Clinical sites, external
partners, and the state board of nursing helped guide
decisions. Networking and collaboration were a staple
of quality leadership in education during COVID-19 and
policy changes helped to clarify concerns and fears
amongst the faculty, staff, and students. At all levels,
policymakers worked creatively and with innovation
to ensure educational and workforce needs were met
while maintaining public safety and sufficient access to
healthcare.
Taking Care Through Leadership
In March 2020, leaders in nursing education
programs had to adapt quickly and lead with conviction.
Leadership skills had to evolve to accommodate the
continually changing virus challenges for the faculty
and the students. To establish a culture of connection
during a socially distanced period was fostered
through weekly zoom meetings among the faculty and
weekly student communication to keep all informed.
The Nursing Director created and posted YouTube
videos for the students and faculty to view, providing
uplifting messages to ease anxiety and improve morale.
Leadership focused on providing transparent, positive
communication by attempting to deliver the right
message, at the right time, in the right way during the
ever-changing havoc experienced day-to-day. Positive
feedback from faculty, thank you emails, and reassuring
calls solidified leadership efforts and helped rejuvenate
leadership for the continued challenges.
Taking Care of Faculty
Holistic nurses are taught to put their own “oxygen
mask on first” to care for another, as is wisely advised
in every pre-flight safety lecture. Peer-reviewed
research reminds nurses to care for themselves, draw
on resilience, seek out online resources, and extend
compassion to others. Activities that helped regulate the
community and boost faculty morale included weekly
email messages from leadership, regular Zoom meetings
to check-in, and a surprise Zoom wedding shower for
a nursing faculty member. Additionally, celebrating
birthdays, successes, and milestones via Zoom helped
normalize the need to celebrate life events and remain
a supportive community. The School of Nursing held a
civility challenge during an established “Civility Week.”
This week encouraged different cohorts of faculty
to try to “out-civil” each other. The week ended with
planned team-building activities, prizes, laughter,
and encouragement. In difficult times, nurses must
remember to step back, breathe, rest, and intentionally
choose self-care as an internal resource. Working
during a world crisis impacts personal lives, as well as
professional practice. Nurturing healthy relationships,
choosing one’s battles carefully, seeking mindfulness
and compassion training, taking breaks, getting
outside, and sharing gratitude, are examples of ways to
incorporate deliberate self-care.
Conclusion
During COVID-19, nurse educators across Tennessee
are finding successful new teaching methods and lessons
far beyond coping. Lessons learned help direct continued
restructuring and program improvement. Despite a
worldwide pandemic, positive reflections and outcomes
have arisen. Unity was a crucial element of success. Faculty
and students kept the focus on as much of a positive
experience as possible. Transparency and inclusion for all
aided in the fluid teaching environment.
Nursing students and faculty have been tremendously
affected financially, academically, and psychologically.
COVID-19 turned the world upside down in a matter of
days and weeks, and those impacts still exist. The silver
lining to the pandemic is that successful innovative teaching
and learning modalities were developed and will continue.
Schools of Nursing across Tennessee remain committed
to empowering students to become critical thinkers,
healthcare leaders, excellent communicators, and life-long
learners. These lessons were only enhanced through the
challenges of COVID-19.
This research/manuscript did not receive any specific
grant from funding agencies in the public, commercial, or
not-for-profit sectors.
References available upon request.