Practice Tip of the Week | Clinical Rotations for Nursing Students During a Pandemic
Tuesday, April 7, 2020
Posted by: Kanaka Sathasivan
By Stephanie Woods RN, PhD, Clarissa Gomez, PhD
Contributor: Cindy Zolnierek, PhD, RN, CAE
As the COVID-19 pandemic spreads throughout Texas, nurses have wondered what role students can play and chief nursing officers have been forced to examine the existing clinical experiences for students. Some facilities have canceled student rotations while others have put students to good use in screening and intake processes. Above all, the safety of the students must be considered.
Laws and regulations
The Texas Nursing Practice Act and the Texas Board of Nursing rules do not address the role of nursing students during a public health crisis. Regulations do not prohibit nursing students from learning experiences in clinical settings during times of national emergency. Yet, many health care organizations have closed their doors to clinical rotations of nursing students during the pandemic due to concerns about:
- The numbers of individuals entering their facilities and potential transmission of the coronavirus
- Increased numbers of care providers accessing and utilizing limited supplies of personal protective equipment
- Inexperience of nursing students in infection prevention and control practices
The nursing community supports the appropriate utilization of nursing students to augment the workforce as well as to enable students to achieve the clinical requirements needed to complete their course of study and sit for the licensure exam (link policy brief). Likewise, the BON and Texas governor have implemented waivers to facilitate the ability of nursing student to complete their studies and obtain permits to practice.
Benefits of student rotations
The case for allowing nursing students to remain in clinical experiences during a pandemic is a logical one. Allowing nursing students to remain in clinical rotations with a priority on graduating seniors may alleviate the already devastating nursing shortage and provide some relief to nurses on the front lines during the COVID-19 pandemic.
In Texas COVID-19 is projected to peak during late April and early May and spread may continue well into the summer months. Given that the peak coincides with May graduations, deans and chief nursing officers must consider the importance of keeping senior nursing students in clinical rotations. T
In addition, experiences in actual clinical settings will strengthen new graduates’ ability to clinically reason and contribute to their success on NCLEX (so they are able to enter the workforce fully licensed) as well as their actual skills and performance as a new graduate nurse.
The majority of graduating seniors are assigned to preceptors in their last clinical course. Employers could easily recruit precepted seniors and allow them to remain with their preceptor upon hire as a graduate nurse (GN). This continuity will provide a safety net for the new nurse and build teams with an experienced nurse to care for highly complex patients.
Risks of student rotations
However, employers and deans must also consider the risk to students and patients when continuing clinical rotations. Introducing students into the clinical environment increases the potential exposure of a whole group of people to coronavirus. School liability for exposure may be a concern.
Students also face the same ethical duty to themselves as licensed nurses and may believe the potential exposure to infection in a clinical environment may expose themselves or others to an unreasonable risk and request an accommodation or excuse from clinical assignments.
Clear, accurate and timely communication is challenging in the best of situations. During a pandemic which immediately threatens the availability of critical resources as well as staffing models and deliver of care, organizations are already struggling with communicating changes and maintaining fidelity within their workforce. Students introduce an additional layer of complexity to communication.
In addition, students add to the number of people accessing and utilizing PPE supplies. As heath care organizations and supply chains report a large increase in demand during this pandemic, efforts have been deployed to limit access and extend PPE usability. Every student added is another person that needs protection.
The future of Texas’ nursing workforce
Regardless of the negative aspects listed here, we encourage employers to continue offering clinical rotations. Every health care organization and nursing school has a responsibility to find a solution that best meets the need of the community they serve. Partnerships between employers, educators and community stakeholders can help provide guidance for what role students should play during this pandemic.
Having graduate nurses who are unprepared for their first jobs during a pandemic comes with high risk. However, continuing forward with clinical rotations may be difficult for students and employers. Students are concerned about childcare with schools closed. They are struggling to learn through online courses, meet deadlines and protect their own personal safety along with their families.
However, despite these concerns, we have heard from faculty committed to graduating well-prepared students, and we have heard from students who are eager to help during this crisis. The need for health care professionals created by COVID-19 will only grow, and continued support of clinical experiences is an investment in the future of the nursing workforce.