As COVID-19 Surges, Help Nursing Students Finish Training Now

Even in good times, the United States does not have enough nurses. Now, as the COVID-19 crisis intensifies and surging patient loads threaten to overwhelm hospitals across the country, health care and education leaders must take immediate action to ensure that everyone capable of making a contribution to the pandemic response can do so.

Many states are taking emergency measures to boost the supply of nurses and other patient care providers. These include efforts to encourage retirees to return to work, allow out-of-state license holders to practice on a short-term basis, and temporarily waive re-licensure requirements for working professionals.

Yet at this critical time, a valuable source of emerging talent is being blocked. Hospitals around the nation are canceling clinical rotations for nursing students. They cite the need to limit hospital access to essential staff and to ensure that all resources—including incumbent workers and equipment—are focused on the crisis.

This is a mistake. Sidelining nursing students right now cuts off a critical supply of health care workers just when emergency demand is skyrocketing.

In California, where as many as 14,000 nursing students may be sidelined, the predicament has garnered the attention of the news media and higher ed observers. With an estimated 280,000 students enrolled in U.S. nursing schools, we must take rapid action nationwide.

How to Get Nursing Students to Work

To meet the immediate needs of our health care system, nursing students who are nearly finished with their studies should be fast-tracked into the field. Here are five steps that state officials and health care leaders should take.

1. Hospitals should restart clinical training for nursing students who are close to completing their programs.

These students are best positioned to lend a helping hand now. In Oregon, where disruptions in clinicals occurred at 15 of 17 community colleges, hospitals have begun to restart clinicals and are also hiring students as patient care technicians, according to state community college officials.

2. State nursing boards should permit greater flexibility in how students and their program providers meet clinical expectations.

In California, the state nursing board requires that patient care account for 75 percent of clinical hours. Nursing students, advocacy groups, and college leaders in California and elsewhere have asked their state nursing boards to allow students to fulfill more of their clinical hours through simulated activities at on-campus laboratories or in virtual settings. The state nursing boards in Oregon and Texas have granted such accommodations.

Importantly, the U.S. Department of Education has issued guidance encouraging accrediting bodies to provide maximum flexibility when it comes to determining whether colleges are complying with program objectives, including clinical hours. When the COVID-19 crisis passes, national and state health care experts should revisit the question and determine whether it still makes sense to require students to complete most of their clinical hours in direct patient care, when simulated activities offer a good alternative.

Permanently changing the guidelines could be one way to address persistent concerns about the limited number of clinical slots—a situation that contributes to the nation’s nursing shortage.

However, it is important to remember that simulated learning platforms can be expensive and that teachers need additional training to properly use them. As part of future recovery and stimulus packages, Congress should consider allocating funds to nursing programs, particularly those offered by community colleges, for purchase of such equipment.

3. Governors and state higher education agencies should exempt campus laboratories from orders to cease in-person classroom instruction.

Allowing nursing students to fulfill more of their clinical requirements through simulated activities would be all for naught if campus laboratories are shuttered or if colleges are not able to quickly adapt and adopt virtual learning platforms. Colleges should be permitted to continue teaching students in lab settings during the current crisis (while adhering to social distancing norms and scheduling extra cleanings, of course).

The Oregon Higher Education Coordinating Commission provided guidance allowing colleges and universities to do that, after the governor issued an order suspending in-person instructional activities due to the coronavirus. Similar allowances should be made for other students training for frontline health care fields, such as nurse assistants, and other public service workers, including firefighters and police officers.

4. States and professional licensing organizations should revisit rules and procedures for administering exams required for licensure and to work.

Pearson VUE, which administers the National Council Licensure Exam (NCLEX) to license and relicense nurses, temporarily cancelled testing dates in March but then reopened the program after instituting new social distancing measures at testing sites. As a general rule, however, it would be sensible for test administrators and states to come up with contingency plans for situations like this. For instance, the Educational Testing Service (ETS) is now administering the GRE remotely, complete with an online proctor. Meanwhile, Texas has extended the length of time that recent graduates can practice before passing their licensure exams from 75 days to six months.

5. States should create strong health and social safety nets for nursing students and other patient care professionals serving on the front lines of the COVID pandemic.

It is imperative that nursing students and their fellow health care providers have access to a sufficient supply of personal protective equipment. Moreover, states should reduce or waive licensing fees for nurses—a move that’s especially important at a time when members of nurses’ families could be among those affected by the massive job losses occurring throughout the U.S. economy. In addition, states should guarantee access to child care services for nursing students who are balancing work and family responsibilities, as Vermont has done for all workers deemed essential.

Finally, just as some grocery and pharmacy companies are increasing wages for their workers during this crisis, states should support nursing students and nurses already working in the field by making them eligible for student loan repayment benefits for health care professionals.

Addressing an Immediate Need, Preserving Talent Pipeline for the Future

Halting nursing programs at this time not only limits the health care system’s ability to respond to the COVID-19 crisis, it also could have longer-term repercussions on the next generation of nursing students. The situation is particularly troubling for low-income and first-generation students enrolled in programs at community colleges and technical colleges. Their rates of college completion already precipitously decline when their education is interrupted or they experience financial hardship. COVID-19 may inflict both types of pain at once if clinical training cancellations put their studies and career pursuits on hold.

Now more than ever before, our nation cannot afford to have nursing students defer or forgo their aspirations of starting health care careers.