Teaching nursing students in the COVID-unknown

Grappling with “educator guilt,” a nursing professor learns vital lessons far from the front lines

Jenn Brunworth teaches via zoom
Prof. Jennifer Brunworth, EdD, MSN, RN, teaches her nursing students via Zoom. Even illness doesn’t keep students away.

Ask any nurse, and they’ll likely tell you they chose nursing because they had a desire to care for people. Nursing faculty would likely answer the same but add that they now teach in order to develop students into compassionate and knowledgeable emerging nurses who can provide excellent care.

Even with that clear sense of purpose, however, many educators, including myself, have struggled with a feeling that we should be on the frontlines using our clinical skills, not sitting safely in our homes teaching. One colleague echoed these feelings saying, “It feels incredibly selfish that I am not working in the hospital, especially while I am preparing students to go work there.”

This sentiment was repeated time and again in the early days of teaching during COVID-19. But as is often true, time offered clarity and mindsets began to evolve. Let me share my own experience.

As an Assistant Professor of Nursing I can attest that teaching nursing students is the most rewarding calling. To stand in a classroom interacting with students, watching their faces as they imagine their future, master a new skill or concept, and begin to show signs of the nurses they will become is thrilling and humbling.

Of course, in the early months of 2020, that familiar face-to-face model of teaching ground to halt. Teachers and students were driven from their classrooms into the virtual realm of online education by the global COVID-19 pandemic.

Navigating the new normal

As teachers, flexibility is a desirable characteristic – and as a nurse, it is downright indispensable. Being both allowed nursing faculty to tackle the conversion from on-ground to online education with relative ease.

Make no mistake, it was not easy, but it was viewed as an opportunity to provide care to our students by offering an alternative pedagogical approach. Students needed learning and clinical alternatives to be accessible, feasible, safe, compassionate and rigorous. With the multitude of moving parts involved in nursing education, there was a tremendous need for collaboration among stakeholders. State boards of nursing, higher education accrediting bodies, school administrators, hospital administrators, faculty and students began working together identify issues and create solutions in order to remove obstacles and create significant opportunities for innovative learning.

I count myself lucky in many ways during this pandemic. Working for a forward-thinking institution that thrives on delivering high quality education using current and cutting edge technology is near the top of that list. That technology-based culture made the transition to a completely online format readily achievable and even exciting. The support and resources available to students and faculty were remarkable.

However, shifting courses from on-ground to online was only the beginning. With the online-education stage set, teachers had a responsibility to help student’s manage expectations and fears while they learned to navigate their new normal. Previously established norms, expectations, relationships and patterns were gone, and in some ways it was like starting over. Classes were held on Zoom, assignments were refined or eliminated to ensure they were manageable with limited physical resources stress, and new assignments were created to replace what had been lost.

My students are mere weeks away from receiving their Bachelor of Science in Nursing (BSN) degrees and embarking on a new career in one of the most trusted and respected professions. Typically, this final semester is a time of reflection, achievement, excitement and anticipation – but this semester felt markedly different.

Our students were on spring break when the switch to online learning occurred. At first, like everyone, we thought it would be a brief bump in the road and we would be back together well before graduation. Although it was clear that COVID-19 was a serious issue, it felt somewhat like an extended break.

Finding our way, as eductors and students

The reality became clear in the following weeks. Students were faced with unprecedented challenges that had nothing to do with their nursing education. They had find a place to go, move out of their dorms, teach their children, and sort through a mountain of misinformation to find the truth about the global pandemic and how it would affect their lives.

Educationally, students had mounting pressure related to their degree completion requirements. How would they complete their clinical hours when they were no longer able to go to their assigned hospitals? Did they have enough bandwidth to attend virtual classes? Would they have access to teachers and resources? How would they continue to learn? Would they be able to do this?

These were just a few of their concerns, and they were constantly accompanied by fears about health, finances, graduating on time, and transitioning into an overwhelmed and exhausted workforce. One of my students noted that COVID-19 has caused her to wonder what her transition into nursing will be like. Will a strained workforce result in nurse preceptors who have “minimal time for teaching and explaining?”

Christie Harrington DeanThrough it all, the wellbeing of students and faculty was at the core of every step we took, and student success remained our focus. While there were certain to be missteps, my student Christie Harrington Dean validated our efforts, noting that “educators took this crisis and kept the students in mind always.” However formidable the sense of uncertainty, there is one constant about nurses – we always find a way. Armed with that innate truth, my students did just that. They found a way.

How in the world can we replace clinical experience?

While didactic learning is an essential element in nursing education, the clinical experience is arguably the more crucial, especially for those students nearing graduation. The ability to safely implement skills and theory learned during the program is the ultimate desired outcome of nursing education.

Prof. Mariea Snell, DNP, MSN, FNP-CAs seniors, my students are required to complete 120 hours of clinical experience during their final semester. COVID-19 effectively eliminated the possibility of students completing clincials at their assigned hospitals because healthcare facilities had to limit both patient and visitor exposure. Just like in the classroom setting, we needed to develop acceptable replacement experiences for clinical experience. Initially, we planned simulations for when students and faculty were allowed back on campus, but that option was quickly eliminated.

In an effort to give students innovative experiences, I reached out to my colleague Dr. Mariea Snell, Assistant Professor of Nursing and Assistant Director of Doctor of Nursing Practice (DNP) Programs at Maryville University, who has years of experience as a Family Nurse Practitioner in telehealth. I simply asked if she believed we could use telehealth as a clinical replacement and have it ready in the short amount of time remaining.

Tim Shinabery, MBA, BSN, RNDr. Snell enthusiastically agreed that it was possible and offered to help create this experience. With approval from administration and guidance from simulation coordinator Tim Shinabery, we set to work creating a complex and rich telehealth clinical experience.

Prior to their telehealth visit, we gave students basic information about their patient and the reason for the planned telehealth visit. Students were expected to prepare for their scenario by reviewing and familiarizing themselves with their patients’ health history, present illness/chief complaint, medications and other essential information. Scenarios involved patients requiring diabetic medication follow-up, wound management involving two additional follow-up visits, and post-hospitalization related to congestive heart failure. Students assumed the role of the telehealth RN caring for the patient expertly portrayed by Tim.

The scenarios gave students the opportunity to experience telehealth nursing and explore the inherent differences between providing in-person (team) nursing care and virtual (solo) nursing care. As Christie noted, “It was scary to have a sim without peers to help but also really put a spotlight on prep and critical thinking.”

Students were tasked with, and evaluated on, their ability to use critical thinking skills, obtain pertinent information, prioritize care, provide appropriate patient teaching, and accurately noting what information to pass to the provider. The students, staff and faculty who participated felt the experience was enriching and appropriate for senior-level students. Student feedback included: “This scenario truly challenged my nursing skills and the way I can provide patient care” and “Telehealth is booming and it was beneficial to experience this type of health care intervention.”

An unexpected lesson

As a teacher, you typically find a great sense of pride and accomplishment when your students succeed in their academic endeavors. That sense of pride was simply overwhelming this semester as I watched my students apply new skills and practice critical thinking in a way I could never have foreseen. This is why I teach! Their success and dedication bolstered my choice to educate at a time where many of us were struggling with a feeling of educator guilt.

As teachers continued to support and educate, students continued to succeed and excel. Fears were allayed, myths were dispelled, and a new sense of hope emerged. Teachers were making a difference and meeting a need – not in the hospital but in the world of virtual education as educators, advisers, voices of reason, and friendly faces.

There’s no doubt that COVID-19 has had a negative impact on daily life, but in the world of education, there is a silver lining to be found. Educators from across the university found an absolute need to think outside the box. While we are always encouraged to do so, education, like any other profession can often rely on the status quo. COVID-19 took business as usual off the table and provided an opportunity to try things we had never considered before and implement strategies that had perhaps been dreamed of but deemed impossible.

Emmy ByrdThe lasting changes to nursing education that will result from this pandemic remain to be seen, but they will be significant and far reaching. My student Emmy Byrd, who will be working at a local children’s hospital after graduation, noted that COVID-19 has caused her to wonder what her transition into nursing will be like. Will a strained workforce result in nurse preceptors who have “minimal time for teaching and explaining.” Although she is understandable anxious, she states, in true nursing fashion, that this crisis has fortified her desire to be a nurse and “made me more eager to get out on the floor and help.”

Christie eloquently summed up her resolve to enter the profession:

This generation of new nurses is the best equipped to handle a crisis. We are adaptable, tech-savvy, and above all want to help. We see the injustices in the system: social, environmental and healthcare. This is what called us to serve and we will take the steps into the Covid unknown.

So we end as we began. We all step into the COVID-unknown with one significant difference: we now know that we are all right where we should be, whether that’s the hospital or the classroom, doing exactly what we should be doing in the best way possible.

After all, that’s what nurses do.

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Written by

Jennifer Brunworth, EdD, MSN, RN

Written by

Jennifer Brunworth, EdD, MSN, RN

Dr. Jennifer Brunworth is Assistant Professor of Nursing and the Institutional Review Board Administrator at Maryville University in St. Louis, Missouri. She has been a nurse for 16 years and an educator for the past 5 years. She teaches nursing in the bachelor’s, master’s and doctoral programs at Maryville University.

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