Policy Brief: Clinical Experiences for Unvaccinated Nursing Students


In collaboration with the National Council of State Boards of Nursing (NCSBN) and other national nursing organizations, OADN is endorsing this very important policy brief regarding alternative clinical requests for unvaccinated nursing students.  OADN supports this policy brief as a guide for our member schools as each of you address this very important issue during these challenging times.

Download a PDF of the policy brief.

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To provide guidance to boards of nursing and nursing education programs that are receiving requests from students for alternate clinical experiences when the program’s clinical sites require the COVID-19 vaccine.



Currently, nursing programs are receiving requests from unvaccinated students to provide alternate experiences when the designated clinical facility mandates the COVID-19 vaccine. These requests range from using 100% simulation as a substitute for the clinical experience to the program finding other types of activities and case studies/scenarios.

Much of the fear and concern over receiving the vaccine is based on misinformation and lack of knowledge about the vaccine and its development (U.S. Department of Health and Human Services, 2021). According to one study, as of August 2021, 92% of nursing faculty were vaccinated or planned to be vaccinated and 86% of currently enrolled students have been vaccinated (National Student Nurses Association, 2021). Thus, it is a small number of students who are vaccine-hesitant and affected by vaccine mandates. This policy addresses these students.

Clinical experiences are integral to nursing education. NCSBN’s National Simulation Study (Hayden et al., 2014) demonstrated that up to 50% of clinical experience can be substituted with simulation. According to the American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education (2021), “Simulation experiences represent an important component of clinical education… However, care experiences with actual individuals or groups continue to be the most important component of clinical education…Simulation cannot substitute for all direct care practice experiences in any one sphere or for any one age group.” (page 21)

As of Aug. 23, 2021, the Pfizer vaccine has received full Food and Drug Administration approval. The vaccine protects health care professionals and students as well as patients. In fact, millions of people in the U.S. have received COVID-19 vaccines. All three of the vaccines available in the U.S. have undergone the most rigorous safety monitoring in U.S. history (Centers for Disease Control and Prevention, 2021).

The COVID-19 vaccine’s authorization is based on scientific evidence (Food and Drug Administration, 2021). Identifying, assessing, and integrating reliable evidence into one’s practice has been and continues to be an expectation for the preparation of professional nurses (AACN, 2021, 2008).

Unvaccinated individuals are at risk for contracting COVID-19, thereby increasing the chances for more variants to emerge and, more importantly, putting vulnerable individuals at risk; especially hospitalized patients, nursing home residents, health care professionals and peers who may be immunocompromised. (Plater, 2021).



  • Students should be vaccinated when clinical facilities require it so that they can participate in the clinical experience and progress in their programs.
  • Nursing education programs should reach out to students who are vaccine-hesitant and counsel the students about the benefit of the vaccine and the need for it as a student enrolled in a nursing program, and address myths and misleading information about the vaccine.
  • Course descriptions should include that a clinical component is required.
  • Nursing education programs are mandated by boards of nursing as well as accreditors to provide students with clinical experiences. They are not obligated to provide substitute or alternate clinical experiences based on a student’s request or vaccine preference.
  • Just as the nursing education program and/or clinical facilities require other vaccines, the facilities have the option to mandate the COVID-19 vaccine.
  • Boards of nursing have no obligation to waive their current rules/regulations about clinical experiences for
    unvaccinated students.
  • Transparency is essential. Even if mandated by the academic institution, students can refuse the vaccine. Therefore, if the student refuses to be vaccinated and is not entitled to a reasonable accommodation under the disability laws* or is not entitled to a reasonable accommodation for a sincerely held religious belief* then, the student (a) may be disenrolled from the institution/nursing program or (b) may not be able to fulfill the clinical requirements of the program, resulting in them not graduating.
  • Accommodations made for students under the disability laws or for a sincerely held religious belief should be decided on a case by case basis.



* In providing an academic adjustment to students with disabilities, post-secondary schools are not required to lower or substantially modify essential requirements. (U.S. Department of Education, 2011)



American Association of Colleges of Nursing (AACN). (2021). The Essentials: core competencies for professional nursing education. Retrieved from https://www.aacnnursing.org/Portals/42/ AcademicNursing/pdf/Essentials-2021.pdf

American Association of Colleges of Nursing. (2008). The Essentials of Baccalaureate Education for Professional Nursing Practice. https://www.aacnnursing.org/Portals/42/Publications/ BaccEssentials08.pdf.

Centers for Disease Control and Prevention. (2021, August 19). Key things to know about COVID-19 vaccines. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/keythingstoknow. html?s_cid=10493:covid%2019%20vaccine:sem.ga:p:RG:GM:gen:PTN:FY21

Food and Drug Administration. (2021, August 23). FDA approves first COVID-19 vaccine. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine

Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), S3-S40.

National Student Nurses Association. (2021, August 16). Survey of vaccination status July 1 – August 15th for nursing students, faculty and new graduates reveals unexpected results. Retrieved from https://www.nsna.org/uploads/2/2/4/5/22459246/national_student_nurses_press_release_-_report_ of_july_2021_survey_of_vaccination_rates_-_final.pdf

Plater, R. (2021, August 10). Unvaccinated people are increasing the chances for more coronavirus variants — here’s how. Healthline. Retrieved from https://www.healthline.com/health-news/unvaccinated- people-are-increasing-the-chances-for-more-coronavirus-variants-heres-how

United States Department of Education. (2011). Students with Disabilities Preparing for Postsecondary Education: Know Your Rights and Responsibilities. Retrieved from https://www2.ed.gov/about/ offices/list/ocr/transition.html

United States Department of Health and Human Services. (2021). Addressing COVID-19 vaccine misconceptions. Retrieved from https://wecandothis.hhs.gov/outreach-tools/addressing-covid-19- vaccine-misconceptions



National Council of State Boards of Nursing (NCSBN)

Accreditation Commission for Education in Nursing (ACEN)

American Association of Colleges of Nursing (AACN)

American Nurses Association (ANA)

American Organization for Nursing Leadership (AONL)

National League for Nursing (NLN)

NLN Commission for Nursing Education Accreditation (CNEA)

National Student Nurses’ Association (NSNA)

Organization for Associate Degree Nursing (OADN)