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How Nursing Schools Are Overcoming Obstacles to Clinical Training During COVID-19

Due to the outbreak of COVID-19, many facilities are limiting or refusing clinical rotations. Here, we share some ways that nursing educators are successfully adapting their teaching strategies.

As a result of the coronavirus (COVID-19) pandemic, the majority of nursing schools in the United States have had to transition to remote learning until further notice or even for the remainder of the academic year. This change, as well as obstacles presented by intensified safety measures in hospitals, nursing homes, and other healthcare environments, has led to a reduction or complete cancellation of clinical rotations for nursing students.

In many areas, the class of 2020 healthcare workers is in limbo – unable to fulfill their required patient care hours to graduate and unable to help on healthcare's frontlines. Fortunately, some educators are turning to eLearning and simulation-based training to provide a substitute for clinical training that their learners would otherwise lose entirely. State-level regulatory bodies are providing the necessary support to validate their efforts.

Here are some ways that nursing schools are keeping students on track to meet their clinical requirements:

E-Learning as an Interim Solution

Without the ability to teach a typical class or provide hands-on clinical training, nursing educators have almost unanimously adopted eLearning as their primary teaching method. Specifically, a large portion of nursing schools are now assigning virtual simulations, which are designed to mimic real nursing scenarios.

Requiring only an internet-enabled computer, learners can interact with a patient in a safe, realistic online environment. Throughout the virtual simulations, learners are provided with personalized feedback based on the actions they take. And, as an added bonus, learners can repeat the simulation until they feel confident and competent treating the patient.

Among the many benefits of virtual simulation is that it is engaging. That's a paramount factor when competing against any number of diversions in people's home environments during this time.

Video Recorded Simulations

In addition to using eLearning, institutions with an established simulation lab are relying on video recorded simulations to support learners' clinical understanding. This involves educators recording themselves participating in a simulated patient case and then hosting a live debriefing session with the learners.

In order to make this a rich learning experience for viewers, the ideal video recording system not only captures audio and video, but also captures annotations, patient monitors, and simulator data (if using one). However, the most impactful part of this learning method (and, arguably, any simulation) is the debrief. Through active participation and dialogue, learners can put themselves in the provider's shoes and dissect each part of the clinical pathway taken.

Increased Flexibility for Clinical Education Hours

Though universities and colleges are using online methods to substitute for hands-on training, ultimately each state-level Nursing Regulatory Body (NRB) dictates whether these alternatives will count toward license requirements. Some NRBs have now begun implementing changes to the educational requirements that will provide more online flexibility and allow students to graduate on time.

Some examples of these changes:
  • In Arizona, nursing programs can apply for waivers to substitute online teaching for in-person teaching and to replace clinical experiences with simulation.
  • In California, programs can use up to 50% simulation for clinical practice (with some stipulations).
  • In Michigan, nursing programs can replace clinical experiences with 100% virtual simulation or other clinically-related online activities through the end of 2020.

Note: In 2014, the National Council of State Boards of Nursing (NCSBN) published a study showing that simulation experiences could successfully substitute for up to 50% of traditional clinical hours. Some NRBs accepted the NCSBN’s guidelines, while others maintained much lower simulation thresholds until now.

Suspended Requirements for Initial Licensure or Renewal

In addition to increasing the flexiblility of educational methods, some state NRBs have temporarily suspended requirements for initial licensure or for license renewal. This is in response to the rising concern that the pipeline of new healthcare workers is halting when the country needs them most.

For example, Pennsylvania has announced that nursing school graduates who have been unable to sit for the licensure exams due to cancellations caused by COVID-19 will be authorized to practice under the supervison of a registered nurse (RN).1 And, practicing RNs are being granted 90-day extensions on their RN graduate or temporary permits.

By prioritizing senior nursing students, who are closer to graduation, nursing schools are prepping them to be able to enter the field as soon as possible.

If you’re in Nursing education or any kind of healthcare training, we can help during this time. Please reach out to us. We can guide you through ways you can continue to teach virtually and offer your students the experience necessary to meet your learning requirements.

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  1. Explore Clarion. (2020). Pa suspends some nursing licensing requirements to aid coronavirus response. Retrieved from

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