Changes in nursing education

January 27, 2021

Lindsay Caplan

In this unparalleled period in time, healthcare workers have risen to the front lines and have performed as no less than heroes. There is, now more than ever, an increasing demand for these workers, especially nurses.  

While the call-to-action rings loud and clear throughout the world, one piece of the equation that is often overlooked is the training necessary before a nurse can practice. And at a time where education is shifting to the virtual sphere, an education in the field of nursing looks very different to how it appeared before. 

Nursing moves into the virtual world 

A traditional education consists of lecture courses in a crowded classroom, shoulder to shoulder with other students, and all eager to learn what they need to further pursue their dreams. Now, these desks sit vacant and the projectors collect dust as they are traded in for webcams.  

Nursing lectures are conducted via Zoom. They can last anywhere from 2-4 hours, generally with a break or 2 inserted in the time frame. A Zoom code is listed in the syllabus for each course and used by students to log into the lecture about 10-15 minutes before it begins. The professor will also login, muting the students so that there is no background distraction.  

The first part of each lecture will be for questions on the last lecture, or on any assignments from the last class session. Students will unmute themselves to ask questions, one at a time. Cameras can be left on or off during these Zoom sessions, depending on the preference of the student and their comfort level with the platform.  

The professor then dives into the lecture of the day, with supplemental power-points used to guide the discussion and to take notes after the lecture is completed. One strategy that students often use is to pull up the power-points during the lecture. While following the lecture, they add their own notes to the bottom note section on the content that the professor is covering but that is missing in the slides.  

Enforcing participation and teamwork in online nursing programs 

Opportunities for participation exist when the professor asks questions about the material, or if the student has questions of their own. In some courses, the class is split into “breakout rooms,” or smaller Zoom meetings where students can discuss or work on assignments in a collaborative setting. This allows for study groups and virtual friendships to form. The benefit being not only for the purpose of learning, but also for fostering a close-knit environment between nursing students, even when they have not met in person. At the conclusion of these lectures, students leave the meeting and get started on their assignments.  

Professors also often offer their own version of office hours, which consists of optional Zoom meetings where students ask questions in a smaller environment and the professor reviews exam material and formats. These can be especially helpful to attend with virtual classes as it creates a more personal relationship with the instructor, and it’s easy to zone out during a lecture and miss something.  

Just like normal school: homework, assignments, quizzes and projects 

Even though school is completely from home, there’s still homework! These assignments vary greatly based on the school that you attend, but one constant is textbook readings. These supplement the lectures and provide more information that the professor may not have touched on but can further understanding.  

All textbooks are available for online purchase and reading, but they can also be mailed to your home address in a physical format, based on your preference. For my school (Phillips School of Nursing at Mount Sinai), it was necessary to purchase the online version. With this format came online assignments based on the textbook and a course code that allowed you to access them upon purchase. These assignments consisted of quizzes based on the textbook readings that were graded and had to be completed by the end of the semester. While they were time consuming, they increased learning and took the place of in-class quizzes, to make virtual lectures more efficient. Other, larger assignments and projects were more difficult to complete virtually.  

This is where virtual proctoring services are utilized. These services offer a system of identity verification, face recognition, and video monitoring -with live proctors virtually on hand. 

Group projects are done via Google Docs and Zoom meetings. Video submissions take the place of in person assessments. Some examples of these are as follows. At Columbia University, one group paper is assigned per semester, where the topics of a paper are divided among group members and each writes a portion. These are divided via Google Docs, so the other members of the group can edit or add information to other pieces and make the writing as congruent as possible. They meet remotely to discuss the project and provide help to one another. This keeps the collaborative aspect of nursing school alive, but in a different, safer format as required due to the current pandemic.  

More assessments including practical experience on family and friends 

At Mount Sinai, an important portion of the curriculum is learning how to complete a head-to-toe assessment on patients. A practical assessment is necessary to demonstrate competency. As this cannot be done in person, it is performed via a video submission with the assessment performed on roommates, friends, or family. This not only eliminates risk but allows the opportunity for multiple attempts and the time to practice on your own schedule to ensure that all skills are learned to the best of your ability. While slightly different from performing an assessment in a hospital or a laboratory setting, it provides the essential experience.  

Exams are one of the biggest challenges that instructors have had to face. How can an effective testing environment be created from home in the presence of external distractions? How can students be held accountable without an examiner sitting in the room? This is where virtual proctoring services are utilized. These services offer a system of identity verification, face recognition, and video monitoring -with live proctors virtually on hand. Students complete their exams online on a webcam server. Technical difficulties do, of course, present from time to time, but they are quickly resolved by an IT team standing by to answer questions or troubleshoot. Some standardized tests, including the ACT and the MCAT, have also been available in this online format for some years.  

Online lab components in nurse education 

All of these are important components of a virtual education in any field. One of the most important parts of a nursing education is the hands-on experience. Specifically, this component is where student nurses learn the skills required in the field. This is when they begin to work with patients in a supporting role to facilitate the transition into practice. These skills are taught in labs and clinical settings.  

When education was taking place in the traditional manner, labs were in 3-hour sessions took place once or twice a week. Students were taught skills such as assessments, vaccine and medication administration, and general hospital protocol. These would be in large groups of 50 or more students. Now, labs take place once a month, so about 3 or 4 times per semester. They are broken up into different sessions, staggering the number of students in the building, and then broken up further into classrooms so that each group has no more than 6 people who have all been tested.  

The rest of the labs are conducted virtually through a program called vSim, where lab and clinical scenarios are simulated through virtual nurse/patient case studies. In these, patients present for a variety of different reasons and it is the job of the student to choose the correct actions of the nurse to care for them in the way that they would in a hospital setting. While sometimes it can be a bit frustrating to restart if you click the wrong button, repetition and the action itself is a great way of learning the steps and committing them to memory before even stepping foot in a hospital.  

Limited or no hospital experience available to nursing students 

In the past few paragraphs, the changes in traditional education, exams, and labs have been discussed. But the question on everyone’s mind – how are clinicals handled in the middle of a pandemic? This is a bit more up in the air and is one of the more difficult issues to handle. It is the best way to learn but sends students from the frying pan into the fire, putting them in the middle of a battleground where stress levels of stress and infection risks detract from the experience.  

Nursing students are generally introduced into a larger hospital that is affiliated with the school they attend, rather than a smaller, more specialized practice. The mixing of floors, the stretched capacity of hospital beds, and the overall risk of introducing more people into a high-risk setting begs the question of whether it is advisable to let students in at all.  

For the time being, students are allowed on non-COVID floors in the hospitals, where there will be less risk of transmission to both student and patient. However, with the recent spike in cases, some hospitals no longer allow students if the number of cases or determined risk is too high. In some states, where the numbers are lower or the restrictions are less, students are practicing in hospitals as normal, with the addition of PPE.  

There is no direct answer as to what will happen with clinicals. Decisions are made on a week by week, case by case basis. Administrators are trying to get answers to their students as quickly as possible and are doing everything in their power to facilitate the clinical hours that students need to sit for the NCLEX exam. 

Nursing meets the challenges of the changing face of education and healthcare  

In these unprecedented times in our ever-changing world, it comes as no surprise that nursing education is also affected. One might ask whether they really want to rise to the call of action and pursue a career in nursing. If yes, how would they pick a school that would provide them with the best education in these changing times? There is no correct or incorrect answer to this question. The courses offered and the NCLEX passage ratings are no longer of highest importance.  

Things to consider, instead, include communication between the school and the students, disruptions in education and clinicals, and how prepared the schools are for virtual education. 

Preparation for virtual education is demonstrated by schools offering hybrid courses before the pandemic, showing that they have the technology and are prepared to utilize it. There will be less of a learning curve for everyone involved if this is the case.  

Reading student reviews of the way the schools are run and overall interscholastic communication can be helpful in making these decisions. While no one knows what the next day will hold, keeping students up to date as new information and new developments present themselves is crucial for the mental health of all involved.  

Do your research by speaking to past students and present professionals 

However, if there are no open houses or opportunities to meet in person, can this research be done? One method is to join the Facebook group for the school and contact either current students or alumni to hear firsthand about their experiences. Reading articles and websites only provides a piece of the story. Primary sources are the way to get a true glimpse into what life is like at a school.  

LinkedIn can also be an excellent resource for finding students to speak with. An even better solution is to locate an alumni directory. Don’t be afraid to reach out to anyone you can find. Alumni, especially in the field of nursing, are always happy to speak about their experiences, good or bad, and assist in any way they can. In my personal experience, I received messages asking about my experience after my first semester. I had a productive conversation with an interested student that I enjoyed and that helped her to make her decision.  

Overall, while nursing education looks a bit different now than it might have a year ago, it still stands by the same principles of preparing new, motivated nurses for a lifetime of caring for others and making the world a better place. Every obstacle in education can be overcome with this in mind. In the end, nurses pursuing education now will be more prepared for anything that their careers can throw at them and will build an adaptable determination that is incomparable. 

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