CSUB nursing clinicals adapt for COVID-19

Nursing students press on in the midst of pandemic

Por California State University, Bakersfield

23 de November de 2020

While most of 2020 has gone remote, there are some things that have no virtual substitute. As most California State University, Bakersfield students are getting used to Zoom classes and even faculty research continues from home or in nearly empty laboratories, nursing students remain in a unique position of needing not only hands-on, in-person learning experiences but not so socially distant interactions as well.

Part of CSUB’s School of Natural Sciences, Mathematics, and Engineering, the nursing department has about 180 undergraduate students, all of them with clinical sessions essential to earning their degree and preparing them for a career helping patients. This fall, nursing students were allowed back on campus and in hospitals for the first time since the campus closed in March.

CSUB nursing clinicals adapt for COVID-19

“You cannot do nursing without hands-on skills, there’s just no way to do it,” said Krystal Ball, an assistant professor in the department and an Intensive Care Unit nurse at Adventist Health. “It’s like trying to teach a welder how to weld over Zoom. You can’t do it! We’ve been very excited and honored that the campus and the Chancellor’s Office have been supportive of us being able to move forward with our students and be able to give them a great education.”

Depending on their year in the program, nursing students’ clinicals range from simulations with peers and mannequins on campus to specialties like critical care, mental health, pediatrics, and obstetrics at local hospitals and other medical facilities. On campus, Ball leads a foundational level clinical session for sophomores, students who are in the first year of the three-year program.

The adjustments for COVID start before students even step foot on campus: students complete a self-screening from home and are only allowed on campus if they are cleared to do so. Once there, their temperatures are checked, they get a new mask, and they enter the building one by one. Inside, they work in small groups of eight to 12 students and rotate from one instructor’s lab to the next. Half of the 60 first-year students are there in the morning, the other half in the afternoon.

Over the term, students have learned about different body systems – skin, cardiac, skeletal, and lungs, among others – culminating in a final head-to-toe exam, “the cornerstone of every nurse’s career,” Ball explained, because a nurse has to assess a patient before they can do anything. Students perform the exams on each other, taking turns as nurse and patient.

“Each time we get up and rotate, we have to clean the classroom,” said Emrah Ister, a first-year nursing student. “It’s a lot of cleaning, but we’re all happy to do it. Other than that, we try to be careful. We do not take off our masks. If we have a 10- or 15-minute break, we go outside but we try to distance ourselves, we don’t really get close to each other.”

Since March, Ister, 38, has been taking her classes from home while helping her three children with their own schoolwork. It’s been difficult, she said, but she hopes they see her determination as an example to follow in their own education. It was her kids who inspired her to become a nurse, so she could better understand a rare genetic illness they live with. Now, they motivate her to keep going.

“We are trying to do our best,” she said. “I cannot just say it’s me working hard, because I see how they’re affected also by my studying. In one way, it’s good, because they see even at this age I don’t give up, I try to do my best. But there are times when we cannot do the things they want to do because I’m studying.”

As a future nurse, Ister understands the importance of staying safe during the pandemic. Her clinical classes are the rare occasions she leaves her home and tend to be the highlight of her week.

“We all want to be there, we all want to learn,” Ister said. “Whenever I go to clinical, I feel so good about it. All this time I’ve been home; I’m still very careful. Whenever it’s about going to the hospital or clinical, we’re like, ‘Yay, it’s clinical day!’ We are all excited and motivated. We want to be helpful, and we want to be part of the team.”

Junior and senior students are also back in clinicals in the hospital setting. Unlike the sophomores, they have something to compare COVID-era clinicals to from their previous years.

“My clinical experience at the hospital last year pre-COVID is a completely different world compared to my experience with clinicals during the pandemic,” said Kaelsun Tyiska, a junior and second-year nursing student currently doing clinical rotations in labor and delivery and psych. “Each week is filled with uncertainty because I never know if this will be my last day at the hospital.”

Tyiska, 21, recalled the middle of the spring semester when he and his classmates were pulled from their clinicals in hospitals. Though they were allowed to come back this term, he’s aware things can change fast this year. Like the first-year nursing students, he and his cohort have to do a health screening before they’re allowed in the hospital and then have their temperature checked before changing into a new pair of scrubs and an N95 mask.

“Each hour spent at the hospital is something none of us takes for granted,” Tyiska said. “The most important aspect of getting through this semester regarding clinical has been the team effort amongst my cohort and faculty. We have been having to rely heavily on teamwork more than ever.”

With so much time in the hospital, Tyiska realized the danger he posed to his high-risk mother, who spent much of the pandemic pregnant and was recently diagnosed with Valley Fever, so he decided to move out to keep her and his new baby sister safe. They have been his biggest motivation, he said.

Though most parts of clinicals need to be done in-person, the nursing faculty has found ways to present some of the information learned in clinicals remotely. Virtual simulation programs offer a remote way for students to practice and even talk with patients, asking them questions to which the patient can respond. It’s state-of-the-art technology that lets students complete some clinical time from the safety of their homes.

Adapting for COVID regulations has been a lot of extra work for Ball and her colleagues, but it’s been worth it to keep everyone safe and learning. Plus, some new elements of the classes worked so well that they will stick around in the future, like watching an instructional video before coming to class and applying what they saw with hands-on skills.

“The students really are getting as good if not sometimes better than what we were doing last year,” Ball said. “We’ve had to adjust to certain things. You know how they say, ‘Necessity is the mother of innovation?’ We have created some things that have worked so well that we’re not changing.”

Though the last year has been stressful for students and faculty alike, both are grateful the nursing program is still able to continue at a time when many CSU nursing programs are not. Ball said CSUB’s program has also managed to maintain its higher level of clinical experience. In an ordinary year, clinicals at CSUB are about 85 percent real-life care and only about 15 percent simulations; though the California Board of Registered Nursing allows programs to go 50 percent simulation during COVID, CSUB students are still doing about 75 percent live care, Ball estimated.

“It’s so pivotal that the students are given an opportunity to practice on real patients,” Ball said. “They will learn more from their mistakes than they will learn from the things they do right. But those mistakes are made with faculty present and we catch those mistakes before they get to the patient. It’s the learning opportunity; it’s being able to watch working nurses take care of patients.”

The nursing students have impressed Ball with their resilience, adapting to the year’s challenges and pushing on toward their goals. Their education might be different this year, but 2020 has underscored the importance of their chosen profession.

“I am really excited to start my career as a nurse even more than before the pandemic hit,” Tyiska said. “It’s a bit nerve-wracking to think that in a couple years I am going to be working as a nurse but working with the brave nurses at the hospital each week and being taught by faculty that is teaching us and also working through this pandemic at the same time is truly inspiring. Their hard work and determination really rub off of them and I can't help but to be excited to become as great as them one day.”

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Footnotes

Story by Kelly Ardis, communications specialist for the School of Natural Sciences, Mathematics and Engineering (NSME); Photos by Juan Rodriguez, Videographer/Photographer

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FootNotes

Story by Kelly Ardis, communications specialist for the School of Natural Sciences, Mathematics and Engineering (NSME); Photos by Juan Rodriguez, Videographer/Photographer

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CSUB nursing clinicals adapt for COVID-19

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