National Policy Brief: U.S. Nursing Leadership Supports Practice/Academic & Partnerships to Assist the Nursing Workforce during the COVID-19 Crisis

The Connecticut League for Nursing’s Council of Deans & Directors Supports that National Policy Brief and Highlights below how our Colleges and Universities can Partner with Practice Settings to Support a Robust and Safe Nursing Workforce during the COVID-9 Crisis and Aftermath.
Purpose
This policy brief is a collaborative effort of nursing leaders who propose & support academic/practice partnerships between health care facilities and pre-licensure registered nursing (RN) and practical/vocational nursing (PN/VN) programs across the country during the COVID-19 crisis. This is one potential model to consider. It is not mandated, rather an innovative approach to meeting academic and workforce needs.

• The proposed model requires cautious evaluation at the local level with a clear understanding that:
  The participation of student nurses and faculty is voluntary and must comply with any additional requirements mandated in state emergency response provisions or through existing Occupational Safety and Health Administration (OSHA) requirements;
• The safety for all front-line providers of services across multiple points of care must be safeguarded through appropriate and prevailing infection control practices

Context
COVID-19 is a virus affecting the entire world. To date, thousands of people in the U.S. have tested positive for the disease, and it is anticipated that many more will be affected in the near future. After observing the pattern of the virus, the U.S. anticipates an overabundance of patients inundating hospitals and possibly overwhelming the entire U.S. healthcare system.

• A significant demand is being placed on the entire nursing workforce, and this is anticipated to increase at an alarming rate.
• Simultaneously, the pandemic has affected pre-licensure RN and PN/VN nursing students across the country. Clinical experiences with patients are an essential part of every nursing program curriculum and are mandated by the State Boards of Nursing for licensure. Many hospitals and health care facilities have determined that pre-licensure RN and PN/VN nursing students should not be in contact with patients and have discontinued student clinical experiences in their facility. Without this valuable experience, all nursing students will have a deficit in their education, are unable to meet their program requirements and will not be eligible for graduation at a time when RNs and PN/VNs are needed in the healthcare.

Proposal
Health care facilities and nursing education programs are encouraged to partner during the COVID-19 crisis.
CLN’s Response:
For the past 12 months the leadership of the Schools & Program of Nursing and of Acute Care practice Settings in Connecticut have been actively engaged in work to address:

• Promoting and Empowering Bedside Nursing
• Models to Embed Resources for Clinical Instruction
• Graduate Education & Counseling for Professional Development and
• Better understand the Nursing Workforce Demographics through EDUCATION, SUPPLY and DEMAND survey results- In January 2020, a Full Proposal was sent by the CT Center for Nursing Workforce, Inc. to the Dept. of Labor and in March 2020 to the Governor’s Office to fund these comprehensive Data Collection, Analysis, and Dissemination initiatives so that proactive nursing and healthcare workforce planning can be a top priority for the state to build a robust and sustainable nursing and healthcare workforce in Connecticut.

Workgroups have produced and disseminated white papers, partnership models and publications to all of the Chief Nursing Officers, Professional Development Nurse Educators, Deans & Directors and Faculty showcasing models to support a robust and sustainable nursing workforce in Connecticut. Among these options proposing solutions to enhance the Connecticut nursing workforce, the Council of Deans & Directors have proposed models as how nursing students directly supervised by nursing faculty can be utilized to support the COVID-19 response efforts.

Pre-licensure RN students from diploma, associate degree and baccalaureate degree nursing programs and PN/VN students from certificate nursing programs could augment and support nursing services in health care facilities.
CLN’s Response:
Propose that our pre-licensure nursing students and associated faculty from our Schools/Programs of Nursing augment the nursing workforce within healthcare facilities in the following areas:

• Increasing the number of Nurse Technicians or Nursing Assistants within the workforce with Sophomore, Junior and Senior level students using educationally sound approaches (see attached for an example of a model of engagement- Fairfield Univ.)
• Increasing the number of Graduate Nurses (GNs) (academically prepared, yet not licensed) within the workforce with newly graduating students in light of balancing the remainder of their nursing education and need to study for the National Licensing Exam (NCLEX), and
• Increasing the number of licensed Registered Nurses in the workforce by working with nurses re-entering practice via CLN’s 100% Online RN Refresher Course to support new hires into the practice settings.

Nursing students would be employed by the facility on a full- or part-time basis and work in the role of a student nurse for compensation and, in conjunction with the student’s nursing education program, would receive academic credit toward meeting clinical requirements.

• Programs would be developed in collaboration with academic and practice partners
• Nursing faculty must be engaged to supervise the work of the students’ in these programs if credit is awarded for this work

Nursing students would be required to be enrolled in a State Board of Nursing approved (or its equivalent) RN or PN/VN pre-licensure program.
CLN’s Response:
Connecticut practice settings would dictate the employment relationship directly with the pre-licensure student, and the awarding of academic credit for such experiences (Capstone’s) would be decided upon by each academic institution in alignment with current University/College policies and practices.
Moreover, NOT all students may choose to engage in these academic/employment opportunities as their participation is NOT mandatory.

Benefits:
This opportunity will not only provide much needed clinical education to assist in meeting program requirements, it is an unparalleled opportunity for nursing students to assist the nation in a time of crisis and learn the principles of population health and emergency management. This academic-practice model demonstrates that in the midst of a periling disruption in the environment, such as COVID-19, continuous innovation can occur.


Policy Recommendations:
1. Health care facilities and nursing programs are encouraged to promulgate plans to take advantage of this opportunity and make every effort to reach out to eligible nursing students and inform them of the opportunity.
CLN’s Response:
Practice Setting will share opportunities with the CT Nurses’ Association, CT Center for Nursing Workforce & CT League for Nursing- RN Student Day Attendees if registered directly with CLN, CT Center for Nursing Workforce to promote; and via their organization’s website, social media, and other communication platforms.
2. Health care facilities and nursing programs are encouraged to collaborate to identify ways to accomplish appropriate faculty supervision of the nursing student-employee to achieve the final learning outcomes of the nursing program. For example,
CLN’s Response:
Options for Engagement & Collaboration:

• The healthcare facility hires the Nursing Program Faculty to oversee the nursing student/employee
• The Nurse Program Faculty holds a joint appointment between the School and the health care facility
• The health care facility provides Preceptors to oversee the nursing student/employee with Nursing Program Faculty oversight in accordance with established CT regulation.

The above examples illustrate a few ways in which the Connecticut School & Programs of Nursing can support growth and development of the incumbent:

• Nursing faculty can oversee the employee who is a current nursing student to ensure competence, confidence and safety in performing Nurse Tech tasks,
• Nursing faculty can engage in a joint appointment to oversee and support employed Graduate Nurses to ensure competence, confidence and safety in the role of a new nurse,
• Nurse faculty can act as a supervisor to practice nurse preceptors to ensure educational best-practices are applied to the newly licensed RN Residency and Onboarding experiences, and
• Nurse faculty can act as an extension of the practice-based nursing education departments servicing the entry level, experienced nurse and advanced practice nurse with safe and quality care.

3. Nursing program leaders/faculty are encouraged to work with health care facility representatives to align clinical skills and competencies with the nursing student-employee work role/responsibilities.
CLN’s Response:
CT’s Schools and Programs of Nursing utilize the Massachusetts Nurse of the Future Core Competencies (MA DOE, 2016) in their curriculum design as well as other best-practice competency models including QSEN.


4. Nursing student-employees must have planned clinical practice experiences that enable the students to attain new knowledge and demonstrate achievement of the final learning outcomes of the nursing program.
CLN’s Response:
The Schools and Programs of Nursing have compiled best-practices, virtual experiences, and simulation that have been distributed to all faculty to ensure that program objectives and outcomes will be met at the end of the final year of study and program completion. As Simulation is an everchanging modality for nursing education, it is imperative that Connecticut Colleges/Universities have the needed resources to ensure program excellence. Through the Healthcare Simulation Network of CT (HSNCT) supported by the Connecticut League for Nursing, leaders of the Simulation Centers can best identify and recommend the critical resources for a robust Simulated Learning experiences that will meet program outcomes at all level.


5. Nursing programs should consult with their State Board of Nursing to ensure clinical requirement regulations would be met with this opportunity and experience.
CLN’s Response:
Through the Council of Deans & Directors, the CT SBEN approved a motion during the March 18, 2020 Nursing Board meeting to approve the use of alternative clinical experiences for nursing students of advanced standing.
6. Nursing programs are responsible for informing nursing students of the risks and responsibilities associated with working in a healthcare facility at this time. Additionally, nursing programs are responsible for communicating with students about their rights to be protected from infection and their options for completing the clinical practice requirements of the nursing program.
CLN’s Response:
Schools and Program of Nursing will not be soliciting students directly to participate in these voluntary work experiences.
Endorsement by National Nursing Organizations and Associations:

• National Council of State Boards of Nursing (NCSBN)
• National League for Nursing (NLN)
• American Organization of Nursing Leadership (AONL)
• Accreditation Commission for Education in Nursing, Inc (ACEN)
• Organization for Associate Degree Nursing (OADN)
• NLN Commission for Nursing Education Accreditation (CNEA)
• American Association of Colleges of Nursing (AACN)
• Commission on Collegiate Nursing Education (CCNE)
• National Student Nurses' Association (NSNA)
• American Nurses Association (ANA)