Nursing School, Nursing Students & COVID-19

Amanda Ghosh

Amanda Ghosh

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Nursing students, and those about to enter nursing school, face an unprecedented healthcare crisis. On top of demanding schedules, we will be asking students to master unfamiliar fears and manage uncertainties. To assist them, I interviewed nursing career coach Keith Carlson and got his advice.

An Interview with Nurse Keith: Addressing Student Concerns During COVID-19

Anyone entering nursing school or finishing nursing school only to find themselves on the “front lines” of an epidemic has a right to be concerned. 

I interviewed nursing career coach Keith Carlson to see how nursing students could address such fears.

Keith has been a nurse since 1996. He is the author of Digital Doorway, an award-winning blog, and the creator of the Nurse Keith Show, a highly respected podcast. In his tenure as a nurse, Keith has served as a Chief Nursing Officer and a Director of Nursing. He is also a popular holistic career coach for nurses. If you haven’t already subscribed to Keith’s podcast, you may want to subscribe now. He is sharing regular Coronavirus updates.

The following is an abbreviated transcript of our conversation.

Me: Do you think nursing schools will change how they’re educating students due to COVID-19?

I’m hearing through the grapevine that nursing schools and their certifying bodies are looking towards more robust simulation labs, as well as digital online simulation; this is, of course, nothing like the real thing, but we have to protect students from harm. 

Also, some schools are considering students doing more forms of hands-on training with one another, which can have benefits in terms of less exposure to infected patients. Plus, when you train this way with your student colleagues, your fellow students can give you very specific kinds of feedback as they’re on the receiving end of an exam, and then they’re providing the exam as well.

Me: So, you’d be practicing on each other more often?

Yes.

Me: Keith, what would you tell nursing students who are about to start a nursing program and who are concerned about what we may ask them to do during COVID-19?

That’s an understandable fear in the days of COVID-19.

If nursing students begin to be used as CNAs for clinical experience or are asked to see patients directly, they need to weigh their own relative risk (some nursing students may be older, immunocompromised, chronically ill, post-chemotherapy, or have vulnerable family members at home.) 

Talk with your school and discuss your concerns.

Me: If students speak to their school about their concerns and don’t get adequate answers, how would you advise them to proceed?

In my opinion, your education is not worth risking your life or the lives of your loved ones. If answers are inadequate, you can band together with other student allies and demand a meeting with senior faculty and administration. 

If you get negative pushback, go to the Chancellor, College President, or other executives. 

If you still don’t feel satisfied, contact the organizations which provide certification for your school and request a meeting. 

If you need to blow the whistle on the school, do so; and if you need to move on and find a more responsive school, that is always an option, however unfortunate and inconvenient that may be. 

Me: What do you think nursing schools should be doing to protect and prepare students during COVID?

The previous responses are a partial answer to that question—more robust simulation labs, digital online simulation, and hands-on training with fellow students. 

That said, it’s also important for students to feel heard and seen, and they must feel that their concerns are being taken seriously. They’re paying good money to attend, and students are actually the reason their professors and instructors have jobs in the first place, so schools are beholden to them, not the other way around.

Me: How should nursing schools cope with COVID? In other words, what should students expect of their schools during this crisis?

Schools should have a strategic plan for mitigating the circumstances of lost hands-on clinical experience. They should provide live and online simulation education for learning clinical skills, and they should allow students to discuss their concerns about the pandemic and how it impacts their education.

It’s reasonable to expect your school to keep the lines of communication open and not leave students in the dark; this means involving student committees or the Student Nurse Association in planning and decision-making. 

And, of course, your school should be certain to make sure that all CDC and WHO guidelines at actual clinical sites are being adhered to. 

It is also crucial that schools follow the lead of their accrediting bodies regarding nursing education during COVID-19. 

Me: I would like to add that students can get a sense of some of what their schools are encouraged to do by visiting the American Association of Colleges of Nursing’s website where they address COVID preparedness.

Me: What options do students have if they run into situations where they don’t have the PPE that they need to protect themselves?

They could meet with school officials and program directors to discuss contingency plans. 

Nursing student bodies are diverse; there are bound to be those who are older, immunocompromised, chronically ill, or living with vulnerable family members, so students need to self-advocate and stand up for proper protection. 

Me: Do you have any additional suggestions for those studying to become a nurse amid this pandemic?

Nursing students should consider becoming more independently knowledgeable about public health. Public health gets little attention in nursing education since it’s ‘not on the NCLEX,’ which is often schools’ excuse for dropping the ball on important subjects since they are so focused on the big exam; this is, a mostly understandable, yet unfortunate, aspect of nursing education. 

Nursing students should also know and realize that COVID-19 is sadly not an anomaly; epidemiologists and public health experts have been predicting this type of pandemic for years. SARS, MERS, Ebola, H1N1 (swine flu), and others have been dress-rehearsals for this time, and COVID-19 may not even be “the big one” that many have forecasted for so long. 

Me: What advice would you offer someone who may be reconsidering a career in, say, the ER or ICU, at this time?

Nursing students should realize that, while the ER and ICU may be sexy and exciting and featured on TV shows, and in the movies, a great deal of healthcare happens in school-based clinics, rural health centers, and public health departments around the country. Not everyone can or should work in acute care (only about 50-60% of nurses work in hospitals, anyway), and we need savvy, thoughtful nurses everywhere. 

Me: How could student nurses who are angry about the positions their colleagues face (e.g., treating COVID positive patients without PPE, their hospitals not allowing them to talk to the media, retaliation against nurses who express safety concerns, etc.) channel their anger?

If nursing students want to understand how healthcare works in the bigger picture, they can become politically and socially active. 

They can also take part in the legislative process by joining their state nursing association and other nursing and healthcare organizations, and they can learn to advocate for the health of the public, as well as for their education and well-being in the workplace. 

Many state nursing organizations — like the New Mexico Nurses Association – hold conferences and seminars during their states’ legislative sessions, and nursing students can avail themselves of these opportunities and get involved by learning how to understand bills, advocate and lobby, and influence the political and legislative processes. It can be very empowering. 

Meeting with local, state, and national legislators doesn’t have to be scary, and knowing who represents you at all levels of government is crucial. Nurses are the most trusted professionals year after year in the Gallup Poll for a reason, and we need to advocate for our fellow citizens. 

When you have that “RN” after your name, you’re representing the profession as a whole, and your legislator should take note of your professional status as a nurse. 

Even a letter to the editor in your local paper can have an impact when you have that “RN” after your name.

Me: If there’s one (or a few) point(s) you’d like to leave us with, what would it (they) be?

Anyone entering the healthcare sphere at this time — or any time in the future — needs to be realistic and clear-eyed. 

Our pandemic and epidemic response, public health infrastructure, and healthcare workers’ understanding of such mechanisms and situations must become more nuanced and sophisticated. 

The time for burying our heads in the sand and simply memorizing the side effects of ACE inhibitors and the cranial nerves is over.

Nurses must now (by dint of their position in society as the most trusted professionals in the United States) serve as clinicians, social workers, grief counselors, healthcare economists, public health and legislative/political advocates, and givers of compassion, love, kindness, and understanding to all they encounter.

If Florence Nightingale were alive today, I believe she would stand up for such an outlook and education for nurses, and she would push nurses to fulfill this larger societal responsibility and instruct schools to step up to the plate. 

Students should know that nursing school is simply a means to an end, and the ongoing learning and the larger social responsibility of the nurse evolves far beyond the basics of nursing education. 

Me: Wow, that’s excellent advice to leave us with, thank you, Keith!

Next Steps for Concerned Students

Hopefully, this interview provided some direction if you’re a concerned nursing student. As far as the next steps go, consider using Keith’s advice, speaking to your school, and having conversations with family members about how they feel living with you if you’re seeing patients, and remember, you can connect with Nurse Keith for more information. 

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