In Face of Coronavirus, Hospitals Canceling
On-Site Training for Nursing, Med Students

Barbara Feder Ostrov

March 17, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's  Coronavirus Resource Center.

Yet another casualty of the COVID-19 pandemic may be the clinical training that's so essential for America's future nurses and doctors.

As university campuses close and disease prevention efforts intensify, hospitals, nursing homes and other health care venues in California and nationally are canceling clinical rotations for student nurses — and, in some cases, medical students. The rationale is to protect both students and patients from getting sick and to reserve personal protective equipment, including masks, that may be in short supply.

But medical educators worry the students won't get the hours of direct patient care experience required to graduate on time, slowing the pipeline of new health care professionals precisely at a time when the country may need them most.

"We are in unprecedented times," said Dr. John Prescott, chief academic officer of the Association of American Medical Colleges. "Medical education hasn't faced anything quite like this since the beginning of the second World War."

The risk that hospitals and other health care facilities fear was underscored this month when an instructor was diagnosed with COVID-19 after bringing a group of nursing students to the Kirkland, Washington, nursing home where at least 63 residents have been stricken by the illness — 29 of them fatally, as of Monday afternoon. Those students are now in self-quarantine.

On March 5, Kaiser Permanente requested that nursing schools temporarily discontinue student clinical rotations in its 21 medical centers in Northern California. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.) "We are in a dynamic situation and our highest priority is ensuring the safety of KP members, staff and students participating in clinical training," a Kaiser Permanente executive wrote in an email to the nursing schools obtained by KHN.

A spokeswoman for the health system, which serves 4.4 million Northern Californians, confirmed the cancellations.

Two other large hospital chains in California, Adventist Health and Dignity Health, soon followed suit.

As a result, the nursing schools at the University of California-Davis and Samuel Merritt University have had to scramble to find new clinical training opportunities for dozens of students. Some landed at the University of California-Davis' medical center or clinics and others at Veterans Affairs hospitals.

Nursing education leaders in California appealed to the state's Board of Registered Nursing on Thursday to ease the number of on-site clinical hours required for student nurses to graduate and allow them to learn from simulations instead.

State law requires nursing students to receive 75% of their clinical training in health care settings such as hospitals or nursing homes approved by the board; only 25% can be completed using simulations, such as computerized mannequins. The educators, in a letter to the board, requested that students be allowed to do 50% of their training through simulation.

"Many schools in California are experiencing serious clinical displacement. The effects of the lost clinical hours will be devastating to the students we serve," more than 60 officials from community colleges and nurse training programs around the state said in the letter.

As of Monday, Board of Registered Nursing officials had not responded to a request for comment.

Even before the COVID-19 pandemic, some private nursing schools had pressed state regulators to allow more simulation training, arguing it has advanced to the point where it can be as effective as training in a hospital or clinic.

The move to cancel clinical training is the opposite of what happened during the 1918 flu pandemic, when student nurses were called to hospitals to care for patients. Some fell sick and died along with those in their care.

Most hospitals have not canceled clinical rotations for doctors-in-training, but some have, and Prescott, of the Association of American Medical Colleges, said more may do so in the coming weeks.

On Thursday, the University of Arkansas for Medical Sciences asked all its students to immediately leave their clinical rotations to prevent the spread of COVID-19. The University of North Carolina School of Medicine canceled clinical rotations for visiting students from other medical schools from March 30 to April 24.

The University of Pennsylvania has suspended clinical rotations for some medical students, as has the University of Minnesota. SUNY Downstate College of Medicine also suspended emergency room rotations for its medical students.

Some teaching hospitals have banned medical students from emergency and intensive care units while allowing them elsewhere in their facilities.

For medical students in the University of California system, clinical training continues for now, but they've been directed to avoid contact with suspected or confirmed COVID-19 patients, as have medical students across the nation.

One Baltimore nursing student learned Friday that her psychiatric nursing rotation had been canceled for at least two weeks. She must complete more than 100 more clinical hours before graduation in May and has no idea whether her school, the University of Maryland, would be able to quickly find her a new placement.

"I understand why they did it, for the precaution and the liability," said the 26-year-old, who asked that her name not be used to protect her future career prospects. "But I had eight shifts scheduled in those two weeks. I'm in a kind of panic mode, worried I'm not going to finish in time for graduation."

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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