Nursing students return to hospitals, but lack skills from spring’s virtual clinicals

ALBANY, N.Y. — Instead of wearing scrubs, they sat at home in pajamas. Instead of placing Foley catheters in patients, they watched a video demonstration. And instead of effectively learning and practicing the range of precise skills needed for the best patient care, they felt confused and discouraged.

Few careers require more hands-on learning than nursing. But this was not the experience of nursing students this spring. Much of what inspires selfless dedication among nurses disappeared as COVID-19 spread across the state.

“When you first sign up to go to nursing school you're like, ‘Yeah, I want to help people, I can't wait,’” said Grace Catena, a senior at Russell Sage College. “I didn't know I was signing up to deal with a pandemic.”

Hospital restrictions put in place by Gov. Andrew Cuomo in March limited the ability of nursing students throughout the state to complete their spring semester clinical hours. Now, they have returned for in-person training amid the worst health crisis they may ever see.

Many students said they fell behind in essential skills when they were left to learn from virtual simulations. Catena, who missed her entire psychiatric clinical rotation in the spring, highlighted how it is important for students to be in the hospital with real patients.

“You can watch a video and see how to place an NG tube and how to place a Foley,” Catena said, “but if you're not doing it hands on, it's not going to really click with you.”

Rosa Luna, a senior in the nursing program at Hudson Valley Community College, said skills she was working on pre-pandemic, such as patient interaction and administering medicine, will need to be reinforced.

“The stuff that we're reading in the book, some of it is hard to understand completely without seeing it in person, so I feel like I'm only getting half of the education,” Luna said. “When you're out of a routine, it does take some time to get into that routine again.”

Beyond just learning, Luna said the opportunity to practice is “the fun part” of nursing school.

Debbie Campagna, a professor of senior level nursing at HVCC who oversees her students at St. Peter’s Hospital, said that while faculty and students had to adapt, the spring proved hybrid learning can work.

“They felt a little cheated,” Campagna said. “They were a little upset, but you know, it was out of everyone’s hands.”

Union College bioethics professor Robert Baker said he believes students should have been allowed to continue working and learning in person because “desperate times require desperate measures.”

“Usually my answer would be no, but given the context, we’ve got a shortage of health care professionals,” Baker said. “Lots of people have to be quarantined so they can’t practice. So we need [students] on the front right now.”

For the fall semester, students have been allowed to attend clinicals in person, but Catena said hospital placements were received late and many smaller health care facilities, especially those with older populations, have opted not to invite students back.

Before beginning fall clinicals, Catena was able to practice the skills she learned virtually in a lab with her instructor.

Prya Sookhlall, who is completing her capstone, where she works full shifts with a preceptor, in labor and delivery at Bellevue Woman's Center and will graduate from Russell Sage in December, entered this semester feeling nervous, but took steps to feel more prepared.

“There was a huge amount of time that passed since I practiced any skills in the hospital or even on the dummies in lab,” Sookhlall said. “In preparation [for] capstone I rewatched some videos online of nurses doing certain skills which was helpful in making me feel somewhat prepared to go back into the hospital.”

Though the coronavirus is still a concern, Sookhlall said it isn’t too apparent, especially because her ward doesn’t have COVID-19 patients.

“Honestly, being in the hospital now feels relatively normal,” Sookhlall said. “It’s just the difference of having to wear PPE now so I feel there can be difficulty with communication and trying to support your patient completely.”

To protect against the spread of the virus, Sookhlall said there is a temperature and symptom screening upon entry and she is provided a new face mask each day. She also wears a face shield provided by the college.

Unushah Khan, a senior in the Siena College Baldwin Nursing Program who completed the National Council Licensure Examination in June, started working as an RN in the postpartum unit at St. Peter’s in July. She said working in the hospitals feels “regular,” because her work requires proximity to patients.

“When I’m out and about, I see people masked everywhere and they're social distancing,” Khan said. “But when I’m in the hospital and I’m dealing with patients and I have to help moms breastfeed, I have to be close to them.”

Since Khan already completed her RN-based coursework, she doesn’t feel remote learning impacted her job performance. Now she is using the flexibility of her research-based courses to her advantage.

“[This semester is] not really skill-based, so there's nothing that I could’ve learned now that would've helped me in my practice,” Khan said. “I try to talk about and read articles and write on topics that pertain to my practice right now, which is maternity, which really helps.”

Campagna recognized that students now face different challenges than colleagues who graduated and trained before the pandemic.

“I've been doing this for 43 years, so my passion has always been there,” Campagna said. “But I think that [current students] are going to have a hard time transitioning to an RN role with limited time on the floor.”

Despite the hurdles, Luna said the pandemic serves as a learning tool.

“Right now I don't have the responsibility that a nurse has, I’m just observing,” Luna said. “I'm not glad that COVID-19 is here, but at least it gives me the experience that maybe other nurses didn't have when they were practicing.”

Khan said she wished she had been able to work in the hospital during the height of the pandemic — both as a learning experience and a way to serve the community.

“I wish I could be of help in any sort of way, to … help nurses that were burnt out and overwhelmed,” Khan said. “Knowing I could be helpful with my skills and everything I learned, and I could sit at home was hard for me to swallow.”

The appreciation the public has shown front-line workers during this time “humbled” Khan and made her all the more passionate about nursing as a career that can make a difference.

“I was even more committed to nursing [because of the pandemic], I was even more happy in my decision,” Khan said. “The pandemic really highlighted our role and really put out there [that] nurses are really important in this field and they do a lot for patients.”