As novice nursing students, how will we gain all the knowledge that we lost? Virtual lectures can easily cover all the material but I'm talking about the things that we could have learned in person through lab (i.e. specific procedures/use of devices)?
The concern about not keeping up with the hands-on learning is completely understandable. For students who have had limited clinical experience prior to the March 16 shelter-in-place order, the intention is to ensure that they are able to demonstrate competency in the required skills to do clinical work safely before we place them in the clinical setting.
The SON faculty—and faculty across all programs—are using the time during this off-campus period to plan for a return to skills lab and simulation activities. The simulation center team of educators and technicians is preparing for a high volume of use of the sim center to ensure that students will have the experiences that faculty have designed for preparedness to go back to clinical work.
If campuses remain closed into the next semester, is there a contingency for small groups to come to campus to learn and practice lab skills so we don't fall behind on in-person practice?
The University closely monitors regularly updated guidelines of the CDC and the California Public Health Department in order to determine how to keep students and faculty safe from the spread of COVID-19. At this time, student sessions for in-person learning in the labs or simulation areas will be reconvened when the campus is officially re-opened and will be structured to continue the preventive practices for virus spread.
When can we resume in-person sim lab trainings instead of doing clinical hours online?
The director of the simulation center has ongoing discussions with her team about re-opening the sim facilities at each of the campus for physical use. Her decision will be based on:
- The date that Gov. Gavin Newsom establishes for termination of the shelter in-place directive for California
- Guidelines by the CDC and public health departments for social distancing and group events
- Arrangements made with faculty from the various programs regarding what learning activities they have planned. The faculty and simulation staff are discussing and planning for activities upon return to campus
- When she can ensure that the sanitation of the rooms and equipment can be maintained
- We are planning for long sim center hours into the evening and weekends to accommodate what will likely be the rush to do in-person simulations
Can we continue submitting things from our checklist after our program starts? For example, our program starts June 2, but quarantine ends May 29 and we can’t get BLS/CPR cert done before the program starts. Same with getting a physical check-up. My doctor's office has been closed and it might only open a few days before the program starts.
There will be flexibility for completion of pre-matriculation checklist items for entering students. Communicate with your program’s admissions counselor if you are unable to do so.
What will happen to students who have their certifications expiring next semester and are unable to renew them prior to the start of summer semester due to class cancellations relating to this pandemic?
The American Heart Association has issued Interim Guidance on Extensions for AHA Instructor and Provider Cards During COVID-19 Outbreak.
"The AHA recommends that employers and regulatory bodies consider extending recognition of an AHA Provider Card beyond its renewal date, for up to 60 days. However, please know that it is ultimately up to the discretion of employers and regulatory bodies who require current AHA Provider Cards to consider allowing extensions during this time."
At this time, the requirement to renew BLS or ACLS recertification for prelicensure nursing students is waived until the AHA discontinues its interim recommendations for grace periods for expired AHA provider course completion cards.
Do you have a plan in place to test students periodically for the coronavirus once we are allowed back at clinical sites?
Testing of students, or any healthcare provider for that matter, when working in a clinical setting will be driven by the protocols established by the CDC and public health department once social distancing has been terminated. Most importantly, it will be the clinical agencies where students do their rotations and preceptorships that will determine the need for testing and screening, just as they do now. SMU will comply with any new regulation or requirement that is established.
Outside of supporting students in fulfilling their graduation requirements, is the school partnering with other institutions on a city or state level to help respond to the health crisis our community is facing? If so, what do those efforts look like?
SMU is doing everything it can to help mitigate the impacts of this health crisis on students’ enrolled in our academic programs. In addition to efforts to maintain institutional operations as well as teaching and learning in a manner that complies with shelter-in-place orders, SMU is working with organizations at the local and state levels to position faculty, staff, and students to volunteer to meet identified needs if they choose to do so. SMU’s EHI Volunteer Digest includes a list of recently identified opportunities.
What do faculty and experienced providers think about Governor Gavin Newsom's call to recruit students to help with COVID-19 patients in the California Health Corps (CHC)? Is it safe for students and patients alike? Will there be enough PPE?
Governor Newsom introduced the California Health Core Initiative on March 30. On March 31, the California BRN published a news release announcing that students can assist healthcare facilities in meeting the demands of the patient surge that is anticipated. On April 1, an email message was sent to all students from senior SMU academic leaders essentially stating: "... the decision to serve with the California Health Corps (CHC) is yours. We trust that you will make that decision based on your values, your particular situation, and your assessment of the risk and rewards of service."
Students must be aware that SMU cannot provide any assurance related to the safety of any activities performed for any organization when there is no contract in place between SMU and that organization. For this reason, it is up to each student to ensure that any activities they opt to engage in can be done in the safest possible manner (e.g. with the proper use of readily available PPE). The question posed here regarding personal and patient safety in positions offered by the CHC is one that each person should consider asking the agency who is offering an opportunity to serve in the COVID-19 workforce. Will they provide appropriate personal protective equipment (PPE) for all of their workers? What protocols are they following for healthcare provider use of PPE and social distancing?
If a student wishes advice regarding the safety of the environment in which you have been offered a position, it would be prudent to consult your course faculty, your faculty advisor, or program administrator.
Do you recommend that senior students sign up for the California Health Corps, and will my time spent working be counted as credit for clinical hours if I am hired in a student role?
On April 1, an email message from senior academic leadership was sent out to all students that essentially stated, "... the decision to serve with the California Health Corps (CHC) is yours. We trust that you will make that decision based on your values, your particular situation, and your assessment of the risk and rewards of service."
The School of Nursing has established a process by which prelicensure nursing students who are offered employment in a nursing-related position (e.g., nursing assistants, medical assistants, vocational nurse, nurse), through an agency registered with the California Health Core, are able to use hours worked in the nursing-related position to fulfill hours required for a clinical course. SMU's process has been approved by our BRN nursing education consultant, and by the university's Office of Academic Affairs.
If you have registered with the California Health Corps and are eventually offered a paid position, please communicate with your program director or chair and initiate the process with them. If you are interested in exploring the possibility of working through the CHC as a student nurse, you should also communicate with your program director or chair.
Are students covered by the school's insurance if they are hired by a clinical agency as a healthcare worker or employee through the California Health Corps or any other intermediary employer entity?
You should clearly understand the three types of insurance to take into consideration when considering a paid employment opportunity that is offered to you through the California Health Corps.
Health Insurance—You must carry health insurance while enrolled as a student at SMU. You should be covered, according to the terms of your particular policy, whether you are doing a school-related activity or work-related activity. This is the case for Anthem Blue Cross Blue Shield coverage, the health insurance purchased through SMU. Students should be aware of any personal financial responsibility they might incur by obtaining care related to any injury experienced while volunteering. This could include any co-pays, deductibles, or other cost-sharing that might be standard features of their existing health insurance coverage.
Workers compensation—Workers compensation insurance should be provided through any employer in California since California Workers’ Compensation law is a no-fault system for injuries connected with your employment, whether they are specific injuries or a disease or disabling condition. Your employer is required to pay for workers compensation insurance to cover all its employees.
Liability insurance—While SMU provides professional liability coverage for students that covers participation in formal educational experiences required by the University, this coverage does NOT extend to activities unrelated to a student's academic program. Consequently, it is up to each student to determine the existence and appropriateness of liability coverage provided by any employer.
At what point will you need to pause classes until we can return to clinical so that our class content reflects the experience in clinical?
The director of the Department of Consumer Affairs (DCA) has worked with the Board of Registered Nursing (BRN) to temporarily waive the requirement for concurrency between the theory component and the clinical component of a course. As a temporary measure to allow nursing students to progress in a timely fashion through their academic programs, direct patient care is not required to be completely concurrent with the theory component of the courses in the following nursing areas: geriatrics, medical-surgical, mental health/psychiatric, obstetrics, and pediatrics. Currently, there are no plans to alter curricular sequencing for any of the prelicensure programs, although contingency planning includes considering resequencing options. We are not considering pausing.
What are your plans for supporting students going back into acute care settings for 1:1 preceptorship experiences?
As of April 14, senior prelicensure nursing students in the last semester of their program now have the opportunity to complete or to begin preceptorship clinical experiences. These are being arranged on a case-by-case basis. There is a process established for approving and scheduling preceptorships that must be followed. Prelicensure program directors and chairs, working with the assistant dean for clinical affairs, are responsible for facilitating the process. Students must refrain from calling hospital administrators in an attempt to arrange a preceptorship. Communication between program administrators and students is key.
What has been the response from your clinical partner institutions (Kaiser, Sutter, etc.) and are they working with SMU to allow students back into clinical rotations through these established academic channels rather than hiring them through the CA Health Corps?
Communication between SMU with both our major clinical partners, Sutter Health, our parent organization, and Kaiser Permanente, was initiated, at the highest levels one week after Governor Gavin Newsom's Executive Order on March 19 to shelter in place. SMU President Ching-Hua Wang communicated with Sarah Krevans, Sutter Health CEO, and Janet Liang, executive vice president Kaiser Permanente Care Delivery, offering Samuel Merritt University's assistance—in whatever capacity is appropriate—to meet the challenges of the COVID-19 pandemic. This has resulted in ongoing communication between SMU and Sutter and Kaiser at various levels of each organization.
In the ensuing weeks, communication, specifically between the SON dean and members of her leadership team, and nursing leaders from both Sutter and Kaiser has been ongoing and specific to not only the best possible ways to return our nursing students to clinical learning experiences but also how SMU nursing students can contribute to Sutter and Kaiser's workforce needs to manage anticipated COVID-19 related patient surges.
Currently, prelicensure nursing students are being assigned to multiple patient care units in the Summit and Alta Bates hospitals of ABSMC medical center. Details about these and other student clinical placements are best provided by your program director or chair.
The assistant to the dean for clinical affairs engages daily with other Sutter chief nurse executives to arrange for student clinical placements to assist with workforce needs while allowing students to complete clinical hour requirements at other Sutter medical centers. Similarly, there are plans in progress to complete similar clinical placement arrangements in Kaiser medical centers in the Northern California region.
What is the latest update on how the California BRN is assisting nursing academic programs and their clinical partners support students' completion of programs.
This chronology of actions is provided to enable nursing students to understand the basis of the SON's decisions and actions related to prelicensure nursing curricular continuity:
Governor Gavin Newsom's March 30 Executive Order (EO) N-39-20
EO N39-20 included Order #5: "... the Director of the Department of Consumer Affairs may to the extent necessary and only for the duration of the declared emergency, waive any of the professional licensing requirements and amend scopes of practice in Division 2 of the Business and Professions Code, and any accompanying regulations ...The [DCA], in conjunction with the relevant licensing board [California BRN for example], shall provide guidance identifying the appropriate qualifications and scope of practice for each classification operating under a waiver based on sound clinical guidelines and the individual’s training, education, and work experience."
The launch of Gov. Newsom's California Health Corps (CHC) was also announced on March 30. These two actions (EO and launch of CHC) prompted all subsequent actions by the Department of Consumer Affairs (DCA) and the California Board of Registered Nursing (BRN).
California BRN News Release, March 31, and Emergency Matrix Document.
This is the key statement from the news release: “The Board of Registered Nursing advises healthcare providers and the public that nursing students can be deployed to assist in healthcare facilities today. These students will not be violating the Nursing Practice Act by providing services without a license.” The matrix document, also referred to as Nursing Services during Epidemic/Public Disaster AT-A-GLANCE, provides equivalency of standard nursing courses and nursing services roles. The BRN urged students to register in the California Health Corps (CHC) initiative to participate in COVID-19 workforce needs.
This action by the BRN provided the SON with the legal foundation and regulation language to develop a process by which prelicensure nursing students, who chose to register with the CHC and were offered a position in a healthcare agency, could use hours worked as an employee of the aforementioned agency towards fulfilling certain clinical requirements. This process is operational. Ask your program director or chair for details.
Order Waiving Restrictions on Nursing Student Clinical Hours under DCA-20-03
Guidance on Waiver of Restrictions on Nursing Student Clinical Hours under DCA-20-03
These actions by the DCA, provided April 3 and April 9, offer instructions for completing the specific documentation that the SON needs to have approved to waive BRN regulations and officially move forward with the contingency actions to allow students to progress through their program curriculum. The following list is not all-inclusive:
- A decrease by 25% of the total hours in direct patient care in a clinical course to fulfill the total clinical hours requirement
- Application of simulation learning activities for up to 50% of non-direct patient care hours in a clinical course to fulfill the total clinical hours requirement
- Flexibility in the concurrency of the students’ theory course experience with their in-person clinical experience
- Flexibility in the timeframe in which students complete all course requirements
- Allowance of hours worked as an employee for an agency registered with the California Health Corps (or other like entities) to be applied as clinical hours to complete course requirements, provided established criteria are meant
- Establishing alternatively formatted clinical learning opportunities in the clinical agencies with whom we have clinical agreements (e.g., Sutter hospitals)
- Opportunities to expand clinical learning opportunities while serving workforce need in community-based settings
- Opportunities to temporarily change curricular requirements
The SON has submitted all required documentation and will continue communicating frequently with our BRN nursing education consultant. Many of the action items listed above are operational.
Is there a backup plan for completing clinical hours?
Yes, there are several contingency plans in place and in the making for ensuring that all prelicensure nursing students are able to complete the total number of clinical hours required for each course that has both a theory and clinical component.
Contingency plans are developed based on possible return to campus dates and the ability of clinical agencies to accommodate nursing students for educational purposes. It is extremely difficult to outline specific plans because there are still so many uncertainties related to the multiple, interrelated factors upon which contingency plans are based. What we know as of this writing:
- Clinical agencies are beginning to accept students back into their institutions, in limited numbers, to complete clinical learning experiences
- Clinical agencies are working with SON leadership to arrange for nursing students to assist in patient care workforce needs while accruing clinical hours to meet course requirements
- Faculty are working continuously to bring all opportunities to fruition
- Prelicensure nursing students may use the hours worked as an employee in a healthcare services agency (especially if that position was obtained through the California Health Corps) to accrue clinical hours to meet course requirements. There is an SMU-specific process that has been designed for this purpose—students should contact their program director/chair if interested
- Prelicensure nursing students may be able to use hours worked in paid internships and disaster deployment circumstances to accrue clinical hours to meet course requirements. These are decided on a case by case basis. Students should contact their program director/chair if interested
- Faculty are exploring multiple, innovative clinical learning opportunities—born out of need to meet COVID-19-related challenges—that will provide a wide range of experiences for students in the short-, intermediate-, and long-term.
Do we have to stick together? If some students want to graduate or wait for a preceptorship and others don't, can we choose?
Due to the challenges of providing clinical placements for all students during this temporary suspension of access to clinical learning experiences plus the shelter-in-place directive, it is extremely challenging to provide clinical experiences in the traditional cohort model students started the program with.
As of this writing, there are very limited opportunities for senior students to return to 1:1 preceptorship experiences. Senior students are being offered clinical learning experiences that will allow them to fulfill clinical hour requirements for the synthesis course. Each student is free to decline the clinical experiences offered at this time (i.e., in selected Sutter hospitals), defer graduation, and wait until assignment to a 1:1 preceptorship is again possible. However, there are no guarantees as to when the opportunity to arrange for such a preceptorship will be possible.
How are graduating students going to be affected in terms of their NCLEX exam? Are we going to be able to take it still despite a pushed back graduation?
Curricular continuity plans for prelicensure students, especially those due to graduate in May and June, are still focused on maintaining an on-time graduation date. Given the extremely fluid nature of virtually all factors that will allow for program completion, it is possible that students may not finish all graduation requirements on the date anticipated thus possibly delaying submission by SMU’s registrar of documents required to be eligible to sit for the NCLEX.
Concurrent with this possible delay on the student end of the licensure exam, is the fact that there has been a COVID-19 impact on the NCLEX, which is administered by Pearson VUE. Due to the COVID-19 pandemic and measures imposed by the federal, state, and local governments, candidate testing was interrupted. NCSBN worked with Pearson VUE to reopen a limited number of testing centers as of March 25. The decision to reopen these centers speaks to the unprecedented need for nurses and their importance in the healthcare system during this time of global pandemic.
Some changes will be made to the NCLEX testing program to enable testing to resume. Key changes are addressed in the COVID-19 NCLEX FAQs, that can be found on the NCSBSN website. Students who are planning to take the NCLEX in the next few months are advised to check the NCSBN website frequently.
Will pinning ceremonies for the graduating prelicensure nursing students be conducted?
The decision to hold pinning ceremonies will be aligned with the decision regarding May commencement. As of this date, a decision regarding whether to hold the May commencement as originally scheduled has not been made by President Wang.
Will you consider omitting preceptorships since Gov. Gavin Newsom is calling for all medical professionals, including nursing students, to work and help with COVID-19?
Since the establishment of the California Health Corps (CHC) on March 30, SMU has designed a process by which prelicensure nursing students who choose to register with the CHC, and who are offered a paid position in a nursing service position by a healthcare agency, are able to accrue hours worked as an employee towards fulfillment of the clinical hours required by a preceptorship experience. Generally speaking, the number of hours worked in a paid position would be more than sufficient to meet the preceptorship requirement.
I was not able to finish my clinical hours last semester in one course due to COVID-19. What happens if I am not able meet my required number of clinical hours before the end of this semester? Will I fail?
If you are unable to complete required clinical hours due to COVID-19 circumstances, you will not fail. Faculty have been instructed to use the grade of IP or "in progress" in these extenuating circumstances. The IP grade will allow you to finish the work during the next semester without a grade or financial penalty.
I would personally like to see a clinical hour report card, showing how many hands-on hours versus simulated hours we have completed. I don't want to do more simulated hours than what will count toward my degree. Can we keep track?
Faculty across all the prelicensure have very detailed spreadsheets that track the various categories of clinical hours completed for both direct patient care and non-direct patient care. This data was sent to the BRN and is also being used to make the clinical assignments that have been made available starting April 17.
We anticipate an incremental increase in clinical learning opportunities during the COVID-19 crisis period, which will allow students to finish their programs or progress further in their programs. Eventually, we will be able to return to the pre-COVID-19 group rotation and preceptorship clinical experiences that been a standard part of the curriculum. We also hope that new types of clinical learning experiences that are being instituted during this crisis period will also become part of the standard clinical offerings. However, we truly cannot predict when a return to "normal" will occur.
If the January 2021 cohort is unable to return to clinicals for the next several months, would the administration consider letting us a do a "block" of clinicals toward the end of our program where we go to clinicals back-to-back for a couple of weeks in order to complete the required hours?
SON Faculty are tasked with doing scenario planning based on several dates for return to campus and also a return of students to clinical placements.