Fifteen Fall 2020 Nursing and Allied Health Clinical Education Scenarios
inspired by "15 Fall Scenarios" from Inside HigherEd, April 22, 2020
By Jennifer Eccles, PhD, RN
System Director for Nursing Initiatives
The Minnesota State HealthForce Center for Excellence
Minnesota State Colleges and Universities
June 18, 2020
As pointed out by Edward J. Maloney and Joshua Kim (April 2020), higher education has faced many challenges in the era of the COVID-19 pandemic. Maloney and Kim (April 2020) offered insightful advice in outlining 15 Fall Scenarios for higher education institutions to consider when planning for fall 2020 education during the continuing pandemic.
However, nursing and allied health science education programs have faced unique challenges, which differ from other higher education programs. Students in nursing and allied health are generally required to have significant patient contact during their programs in the form of clinical learning experiences. Faculty accompany and/or supervise students in hospital units, long term care facilities, home care settings, public health settings, clinics, tele-health, and more. When the COVID-19 pandemic became more pronounced, and supplies such as N95 masks were short, most nursing and allied health students could not attend clinical learning experiences out of a concern for safety and to protect the supply of personal protective equipment (PPE). In fact, many schools donated to make sure that our frontline healthcare workers had all the PPE, equipment, and even medical furniture, we could find.
In fall 2020, we are preparing for several different scenarios. Students have had truncated or eliminated clinical learning experiences in the spring, yet are hoping to graduate in December or May. To maintain the rigor of our programs, these students must have contact with patients and clients in real world clinical environments. As our PPE stocks return to an adequate level, we must make plans for students to return safely to clinical agencies, so that they may graduate from rigorous programs and be ready to join the healthcare workforce.
In keeping with the 15 Fall Scenarios proposed by Maloney and Kim (April 2020), here are how those same 15 scenarios may relate to clinical learning experiences:
- Back to Normal: Nursing and allied health Students are in clinical learning experiences with no changes from prior to the pandemic.
- A Late Start: Students start clinical experiences as usual, but later in the semester. Hours lost are made up by increasing clinical experiences later in the semester, or adding high fidelity or virtual simulation experiences.
- Moving Fall to Spring: Nursing and allied health clinical experiences which would normally happen in fall, would move to spring semester. Theoretical and virtual learning from spring would move to fall. Student experiences displaced in spring would move to summer. This would delay graduation for students scheduled to complete their programs at the end of fall semester, and would decrease the supply of new nurses and allied health professionals entering the workforce.
- First Year Intensive: New students in programs would have more theoretical and virtual learning, including material from later years moved into the first year. Clinical experiences would be concentrated in later years of the program.
- Graduate Students Only: In the case of clinical experiences, this scenario includes only students who need clinical experiences for graduate nursing and allied health programs, such as nurse practitioner or nurse anesthetist programs. Also included in this scenario is the ability to classify students by major or by class. This may, then, also incorporate senior pre-licensure nursing and allied health students in clinical experiences and have the junior and below pre-licensure nursing and allied health students catch up with more intensive experiences later in their programs.
- Structured Gap Year: Healthcare agencies need employees now more than ever. This is an opportunity for future nursing and allied health students to gain real-world healthcare experience. By developing a pathway for how these experiences might potentially be counted as credit for prior learning, nursing and allied health programs could take advantage of structured gap year opportunities by offering accelerated programs to those students.
- Targeted Curriculum: This option includes prioritizing clinical experiences to those learning objectives that are core to the program and require an in person experience. Programs may increase virtual and on campus simulation experiences, and decrease time in clinical to only those times needed for students to meet the core course objectives. This could be flexible and individualized to the student, with some students meeting course objectives in less time than others do.
- Split Curriculum: Experiences are split into online virtual experiences, in-person high fidelity simulations, or in-person clinical experiences. Students are required to take a certain number of each type. This increases in person clinical experience opportunities for more students through preservation of those experiences for the prioritized in person learning needs.
- A Block Plan: Courses are offered one course at a time in shorter blocks of two to four weeks. Clinical learning experiences are intensive, with time off from the clinical area for online theoretical learning no shorter than two weeks between clinical learning experiences. This gives students a chance to quarantine at home for two weeks to ensure they are not developing a COVID-19 infection prior to going to a different clinical learning experience. This also allows some students to complete online theoretical learning while others are in a clinical learning experience, and then switch places, thus ensuring full use of potentially limited clinical learning opportunities.
- Modularity: This option is a combination of the block plan and a non-block plan. Students may attend intensive clinical experiences in short blocks, combined with other courses that may occur during, before, and after the block. Modules for existing courses are taught in shorter timeframes consistent with how clinical learning experiences are scheduled.
- Students in Residence, Learning Virtually: This model gives students the ability to attend local clinical learning experiences while maintaining safe distances as they learn virtually. This option also gives students the opportunity to have appropriately socially distanced in person skills education in the on campus skills and simulation labs. Faculty could take turns locating themselves in the skills and simulation labs, with students having appointments to complete some 1:1 or appropriately distanced, low density, in person experiences.
- A Low-Residency Model: In this iteration, clinical experiences could be paired with intensive in-person learning needs over a short timeframe, with students having online learning before and after. The on campus and clinical experiences would be accomplished in waves, to maintain low density on campus. An example may be a one-week intensive skills lab, paired with high fidelity simulations, followed by two weeks of intensive group clinical experiences, and then a move back to online learning. Students would benefit from the relationships built during the intensive experiences.
- A HyFlex Model: Applying this model to clinical experiences may allow for greater access to clinical experiences. In this option, students would have a faculty teaching much of the course virtually, but also supervising in person clinical experiences. The faculty might teach clinical virtually, but the student has in person experiences with an employee, partnered virtually with the faculty, at the clinical site to precept the student. This allows the faculty to maintain physical distance, the student to have in person experiences working side-by-side with only one staff member rather than with a group of co-students, and the faculty to supervise several students in clinical experiences.
- A Modified Tutorial Model: In this approach, the teaching and learning is primarily an online experience, with small group in person clinical learning experiences, which allow for adequate safety precautions and decreased numbers of contacts for the students and faculty. Due to the smaller group sizes, this takes more faculty time to accomplish.
- Fully Remote: As occurred in spring 2020, no nursing or allied health students would be allowed into clinical learning experiences. However, rather than stop all exposure to the clinical learning environments, this model fits into an academic-practice partnership model. The academic-practice partnership model has been endorsed in a Policy Brief by major nursing leadership organizations in the United States, namely the American Nurses Association, National League for Nursing, National Council of State Boards of Nursing, American Organization of Nurse Leaders, American Association of Critical Care Nurses, Organization for Associate Degree Nursing, Accreditation Commission for Education in Nursing, and the Commission on Collegiate Nursing Education (Policy Brief: U.S. Nursing Leadership Supports Practice/Academic Partnerships to Assist the Nursing Workforce during the COVID-19 Crisis, March, 2020). Such an agreement has students employed at the clinical agency and earning college credit for completing specific learning outcomes during their employment. All contact with faculty would be distance or virtual, accompanied by virtual skills labs, and virtual simulations. During the pandemic this may be one of the safest models, providing social distance for students who are in situations where they may be caring for people with active COVID-19.
As with Maloney and Kim’s (April 2020) original 15 Fall Scenarios, the way that each of these clinical learning experience options is implemented depends on local situations. Some programs will need combinations of these scenarios, and some will need unique variations. Nevertheless, the commonality lies in keeping our nursing and allied health students caring for our patients and communities and learning in real world environments. I am doubtful that anyone currently wants a nurse or allied health professional who had no experiential learning opportunities in hospitals, long-term care, home care, public health and other healthcare settings. Our students need to be considered essential in clinical settings, especially during this pandemic, for higher education to continue supporting the healthcare workforce.
Prior to her statewide role in Minnesota State, Dr. Eccles was Dean of Health Sciences at Minnesota State College Southeast, in Winona, Minnesota, and Director of Nursing at Century College, in White Bear Lake, Minnesota.