Courtesy of CWRU
In an attempt to limit the spread of COVID-19 across the university, three weeks before the start of the fall semester, a blanket email stated that all students who were not first years, fourth years, transfer students or nursing students would not be permitted to live on campus.
The university’s decision to let nursing students stay on campus was not coincidental. The Ohio Board of Nursing requires that nursing students must complete clinicals in-state to receive accreditation. Clinicals provide the opportunity to practice bedside manner and translate the concepts learned from class to a real-life environment, which is foundational to practicing nursing. While clinicals for nurses may appear comparable to a design project for engineers or a research project for science majors, clinicals are developed to foster empathy. Clinicals in the first and second year are heavily focused on developing bedside manner.
During this past spring semester, the requirement issued by the Ohio Board of Nursing was relaxed. However, this fall, the Board reinforced its policy that nursing students must remain on campus.
Nursing students have noted difficulties adjusting to a virtual learning environment, stretching from the fall to spring semester. One nursing student later said, “Some professors aren’t willing to work with us. In a synchronous course with weekly small quizzes and small exams, my professor refuses to post slides and recordings in lecture.”
Because of the rigid accreditation system, nursing professors must fit material within a shortened academic calendar, while nursing students are becoming burnt out early in the semester.
Michyla Lin, a third-year marketing student, conducted research tangentially related to anatomy and contacted many professors during her studies. From one of her interviews with a nursing professor, Lin said, “Some professors were struggling with adjusting their teaching style suddenly to fit a remote format.” She also emphasized that “It seems like there are a lot of communication issues between the faculty and students. With regard to how the university could better serve nursing students, it would mainly center around communication and better planning.”
Nursing professor Dr. Colleen Nikstenas acknowledges the shortcomings of nursing instruction under COVID regulations. She states, “Students are not as able to get in to work with patients, see charts and document on the care they give … they cannot get the bigger picture to go with the pathophysiology and pharmacology they learn about and how that looks on the patient. This is setting us back a bit.”
Healthcare instruction is unique from other disciplines because it cannot be easily transitioned to remote formats. Nikstenas continued, “Nursing is physical and psychosocial; we will never know the good of a nurse from just a test. The NCLEX [National Council Licensure Examination, an accreditation exam for professional nurses] only shows how much we have learned, but the program shows how much we have done.”
Beyond Case Western Reserve University’s college campus, nurses in the workforce must juggle COVID precautions on top of normal responsibilities. Besides wearing a mask during all hours on shift, nurses on floors must screen every patient who comes in and care for potentially COVID-positive patients. They are charged with saving lives in the face of our nation’s increasing apathy toward the pandemic.
Caroline Hems, a nursing alumni who graduated in 2019 and now works as a neonatal intensive care unit nurse at Golisano Children’s Hospital in Rochester, New York, does not work with COVID-positive patients, but states that her colleagues are fearful of bringing the virus into their private spheres of family and friends.
This is also a concern among those whose job it is to train future nurses. Nikstenas says, “It is something that, as instructors, we sometimes lose sight of. Not only will these future nurses have to treat new and poorly understood diseases, they could easily be victims … they are in a hugely different environment than when I started out. I did not fear going into nursing. But they might.”
The public’s lack of concern has also fostered feelings of frustration within professional nurses. “The public isn’t taking the pandemic seriously and has essentially forgotten about it. These nurses giving chest compressions and holding their patients’ hands as more and more people die certainly haven’t forgotten … those treating COVID-affected persons must cope with grief when a patient dies,” Hems said.
On the emotional struggles of patients and nurses alike, Nikstenas continued by saying that nurses have to witness “[patients] not [being] able to say goodbye to family, not seeing family for months on end, hopelessness, helplessness, and fear of relapse or anger and grief and sorrow that won’t relent for others. Nurses deal with all of that.”
So, how can we support our student and practicing nurses? Nikstenas stresses the importance of positive reinforcement: “We will need someone to make sure that we are not crying more often, or more anxiety-ridden than usual—that we each have someone to talk to.”
For prospective nursing students, the future is uncertain. Hems expressed concern for future nurses, saying, “As far as high school students thinking about nursing school, seeing how much stress and risk nurses deal with during the unknowns of a deadly pandemic may deter them from being nurses.”
To these students, Nikstenas asks: “What made you want to be a nurse in the first place? Was there really a good reason? Are you only having second thoughts now because of fear?” She continues, “We cannot stop taking care of people just because we fear the disease they have.” Harkening back to the indispensable role of nurses in the HIV/AIDS crisis of the late ‘80s and early ‘90s, she said that “some faltered, but the stalwart of us remained. Those truly called and compassionate and absolutely dedicated—they and I have stayed.”
A block from campus at University Hospitals, nurses are exhibiting that same compassion and dedication, working around the clock to assure quality care to patients. To those considering nursing, Hems says, “I hope they see the commitment and passion that nurses have during this time and want to be a part of that work. I think it could sway them in either direction depending on how they view it.”
In a time of uncertainty, Nikstenas urges nurses to take charge and continue to lead in the healthcare environment. She concludes on an optimistic note, stating “This is the ‘Year of the Nurse’ indeed! We are often the only ones allowed into the patient’s room. As a profession, we decide to care for people when they need us most … this is one of those times, but this will not be the only time.”