California nursing students close to graduation won a state waiver to complete their training and join the workforce to help slow the coronavirus pandemic.
Still, some say the loosened regulations don’t go far enough in helping them complete their training.
The California Board of Registered Nursing on Friday loosened regulations that will allow nearly 9,000 nursing students to graduate by completing half of the normally required clinical training online instead of in hospitals with patients. The board is responding to a major push in California to increase the number of health professionals available to combat the epidemic. The state has experienced a shortage of health care workers in several areas. Last week, Gov. Gavin Newsom created the California Health Corps to encourage students and health care professionals to volunteer and fight the pandemic. More than 81,879 people have applied for the corps, as of Monday, Newsom said.
The students are required to shadow and train under practicing nurses and doctors in hospitals and health care facilities. The board reduced the requirement for that clinical training spent directly with patients from 75 percent to 50 percent for students in obstetrics, pediatrics, mental health or psychiatric courses.
For students in geriatrics and medical-surgical classes, the board will allow up to 50 percent of patient care to happen through clinical simulations if they can show that their training was interrupted by the pandemic. The health care situations and incidents can be recreated online, especially since many campuses have moved their in-person instruction online. Currently, 25 percent of clinical rotations can be completed with simulations. Students rotate their clinical training with patients across different departments such as an emergency room or pediatrics.
“We are sympathetic to the predicament nursing students are in during this time of uncertainty,” said Kimberly Kirchmeyer, director of the Department of Consumer Affairs, which oversees the nursing board. “It was necessary to waive these requirements to meet the ongoing needs of California’s health care system and allow nursing students to graduate on time.”
But for some nursing students, especially those are not near graduation, the loosened regulations still don’t solve their problem and could delay thousands of them from completing on-time, said Sharon Goldfarb, dean of health sciences at the College of Marin in Kentfield, north of San Francisco, and president of the northern division of the California Organization of Associate Degree Nursing.
These nursing students are unable to complete 50 percent of their clinical rotations with patients, because health care facilities have suspended their training programs offered through the colleges. The American Association of Medical Colleges and other medical organizations have recommended suspending clinical rotations because hospitals are dealing with a national shortage of personal protective equipment needed by doctors and nurses taking on COVID-19 patients.
“The reality is that a lot of schools don’t have hospital partners at this point,” Goldfarb said. “A lot of hospitals are not taking any students in any allied health fields.”
Goldfarb said she doesn’t fault the health care facilities for suspending these programs and that they’re making sure everyone is as safe as possible as they respond to the pandemic. But the board could have temporarily allowed zero percent of clinical training to involve direct patient care while the coronavirus pandemic persists since many hospitals and health care facilities have suspended their clinical training programs.
The nursing board is encouraging health care facilities to work with colleges to find placements for these students, according to the consumer affairs agency.
Lorraine Crichton, a first-year nursing student at Napa Valley College, said she is going into her geriatric clinical rotation this term, but the board’s waiver doesn’t go far enough in helping her stay on track and complete her two-year program on-time.
“We can do 50 percent virtual simulation for geriatrics, but we still need 50 percent direct patient care,” said Crichton. “And so far, there is no place within a 50-mile radius letting students come anywhere near the hospitals. They’ve kicked everyone out. Even if they just let us volunteer and let those hours count, it would help tremendously.”
Crichton, who has worked as a certified nursing assistant for the last four years, signed up for the new California Health Corps, but she said there is little information about how volunteering would apply to her nursing program.
Goldfarb, who also volunteered to join the Health Corps, said the initiative left too many unanswered questions for students such as when and where they would be placed and whether the placement would meet their clinical requirements.
Instead, Goldfarb said her college has been trying to get second-year nursing students placed in health care facilities.
“We’re scrambling,” she said. “We’re literally begging and we’ve gotten students less than ideal placements. The students are testing for COVID-19 and they’re in full protective gear. I wouldn’t send them if they weren’t, but taking temperatures is not a meaningful clinical experience.”
Goldfarb said her nursing students would get a more robust education if they were allowed more clinical simulations.
As for her first-year nursing students, Goldfarb said there’s nothing available for them.
Crichton said if the board doesn’t waive the total amount of time spent directly with patients, she expects to be delayed about a year from graduating and joining the workforce.
“It doesn’t just delay us but the class behind us,” she said. “It creates a whole domino effect.”