Nursing Students Losing Experience

While planning her summer wedding, Carlotta Jackson was looking forward to spending the last semester of her college career shadowing a nurse in a hospital.

From the day she set foot on campus as an ambitious freshman, and even before then since many of her close family members have jobs in health care, she’d been told over and over again of the importance of this clinical experience.

It’s not only important from a learning standpoint; it’s a big deal for nursing students because once they’ve reached this point, it’s all that stands between them and graduation.

University of South Carolina at Upstate nursing students are required to spend 124 hours accompanying a nurse over the course of their final semester. Through this, they learn first-hand of the stresses, the unpredictability, and the long hours that accompany the medical profession.

Jackson missed out on that experience this year. Normally, she wouldn’t get a degree. This isn’t a normal year.

Relaxed nursing standards

The South Carolina Board of Nursing relaxed education standards for nursing students due to COVID-19, a global pandemic that has been fought on the front line by nurses, often without adequate supply of masks and other personal protective equipment.

USC Upstate was among the schools that reached out to the state board with concerns about students not being able to meet the clinical components amid the public health crisis.

“I didn’t want to expose students to the virus,” Shirleatha Lee, the dean of USC Upstate’s Mary Black School of Nursing, said in a phone interview. “Hospitals also have to protect their personal protective equipment. We knew this was out of our control, and we had to find a way to make it work.”

After hearing from colleges, the Board of Nursing tweaked its long-established requirements.

Before, schools were able to use simulators to account for 50 percent of a student’s clinical experiences. This semester, all of the clinicals at USC Upstate — which would normally happen in a hospital setting with face-to-face interaction with patients — have been handled by students at home over the computer.

It’s certainly not the same, Lee said.

Having missed out on that experience in the hospital, many students are disappointed, she said. Some worry that replacing the real thing with a simulator means they won’t be as prepared going into the profession.

Lee doesn’t believe students have anything to worry about.

“It’s going to be OK,” she said. “I feel confident these students will be successful and leave this program just as good if not better than they always do.”

Julie Denesha, the chair of the nursing program at Spartanburg Community College, which offers associates degrees in nursing, also had to replace clinicals with online materials this year. She also voiced optimism in student success going forward.

“We are more than confident that they are able to enter the workforce when they graduate,” said Denesha.

If the state board hadn’t changed the requirements, senior nursing students across the state would be unable to get a diploma in May.

Some USC Upstate students said they are grateful the nursing board relaxed its guidelines during these already stressful times.

But should the public be concerned about the next wave of South Carolina nurses entering the profession without the same education requirements as their predecessors?

No, according to the state’s Department of Labor, Licensing and Regulation.

“The Board and LLR recognized that due to this unprecedented situation, nursing programs and its students would need to have the flexibility to continue the clinical education of these students as classrooms and clinical sites were closed to these students,” Lesia Shannon Kudelka, communications director with the LLR, said in response to questions about the state’s nursing board.

“The Board simply provided (students) greater latitude to achieve these goals during this public health emergency,” she said. “The nursing programs are still educating and training nursing students that meet or exceed the accreditation standards of their accrediting bodies and nurses must pass their national exam to establish competency to practice.”

‘A Dagger’

Carlotta Jackson knew her last semester as a nursing student would be difficult and stressful. And that was before the coronavirus arrived.

The 23-year-old from Chesnee got engaged on Thanksgiving Day. When school started back after Christmas, Jackson found herself juggling classwork and planning a June 13 wedding.

And then, around mid-March, just as Jackson was poised to begin her hospital clinicals, something she’d anticipated for years, the virus began its spread across the U.S. and schools closed.

For about a two-week period, there was a lot of uncertainty about how senior nursing students would be able to fulfill their requirements for graduation.

“There was not a whole lot during those two weeks that we did,” Jackson recalled.

Finally, professors informed students of the new gameplan. It involved computers and a software program called ATI that helps prepare nursing students for the NCLEX exam — the test that must be passed for nurses to obtain their license.

Seated at a picnic table outside the Mary Black School of Nursing Tuesday with a laptop open in front of her, Jackson demonstrated one of the program’s simulation exercises.

On the screen, a patient lay in a bed with a nurse by his side. Jackson had to correctly identify the order of tasks that should be completed. She also had to get the nurse on the screen to ask the right questions of the patient.

As preparation for the NCLEX, Jackson said it’s a helpful program.

“I believe the NCLEX will be a bit more head knowledge and application that I’m already prepared to answer,” she said.

But as she prepares to enter into the profession following her May graduation, she believes she could have learned a lot more from following a nurse through a series of 10, 12-hour shifts.

“During those 12-hour shifts, that’s where we would get to do a lot more application than we’ve ever done in nursing school,” Jackson said. “It feels a little bit like I was robbed of the biggest learning experience.”
But, “I’m grateful I’m able to graduate,” she added, “even if this year wasn’t what we preferred.”

Other nursing students gave similar sentiments.

Having to miss out on the hospital clinical “hit pretty hard,” said Aaron Reiter, a 24-year-old student from Rock Hill.

“When I was a first-semester nursing student, I’d hear the seniors talk about their practicum. You always hear how great the practicum is and how you learn so much. We were all expecting so much out of that. For us to not be able to work in the hospital was a huge dagger; it was really sad.”

Kaylee Anderson, a student who lives in Greenville, called it “disappointing.”

“I think that direct patient care experience and working 12-hour shifts with a nurse would have gotten us more ready,” the 22-year-old said.

“It’s definitely disappointing, but I’m still glad that we are able to graduate on time.”