VUSN Students Experience Virtual Clinical Care in an Age of Social Distancing

What do you do with 154 nursing students who are suddenly unable to participate in the hands-on clinical care that makes up 60 percent of their education each week?

That was the challenge facing Mary Ann Jessee, PhD, director of PreSpecialty education at Vanderbilt University School of Nursing (VUSN), and the 30-plus faculty who instruct those first-year (prelicensure) nursing students in patient care.

With the spread of COVID-19, the students' clinical education in hospitals, clinics and other facilities was suspended in mid-March. VUSN was unwilling to postpone clinical learning and possibly delay the students' path to becoming advanced practice registered nurses - so faculty got creative.

"For a couple of weeks, we had been determining what we would do if students weren't able to be in the clinical setting," Jessee said, adding she brainstormed with course coordinators, Erin Rodgers, DNP, and Heather Robbins, DNP, on what a virtual experience might look like for students and how that would translate to traditional clinical learning.

"Could we use the Simulation Lab and have the students participate by telling someone in the lab what to do?" the trio wondered. VUSN Simulation Lab Director Jo Ellen Holt, DNP, responded enthusiastically with suggestions. The result was a virtual live-streamed learning experience with students using their instructors and Simulation Lab staff as avatars to interact with the school's high-fidelity nursing mannequins to provide patient care.

"One instructor acted as the student's eyes, ears and hands while another observed and coached, just as they would do with actual patients in the clinical setting," Rodgers said. "Students instructed their avatar on what to do, step-by-step. The avatar reported the results, and then the students as a group evaluated whether that skill was implemented correctly and discussed the outcome."

The students joined the simulations via video conferencing, working in the same six-student cohorts as for their in-person clinical learning. Each student experienced directing the avatar and discussed the scenario with their group.

"What we're trying to mirror is the typical direct patient care experience and clinical conference, but in a virtual format," Jessee said. "We had to determine how to recreate those patient interactions, and in those, ensure that students had the ability to conduct assessments, prioritize patient needs, make decisions about care, implement that care and evaluate the results."

Throughout the simulation, the instructor is observing and coaching, just as they would with actual patients. "In the virtual clinical experience, the faculty member can't see the student doing the assessment or preparing for safe medication administration. The student needs to explain it before the avatar acts so the faculty can see that the student knows how to do it. This allows faculty to assess the same competencies in the virtual simulation as in the clinical setting."

The School of Nursing's PreSpecialty program is for students with undergraduate degrees in a field other than nursing. They spend 12 months in intense generalist nursing learning, then spend 12-18 months gaining specialty education. In addition to directing the PreSpecialty level, Jessee serves as assistant dean for academics, generalist nursing practice.

The virtual clinical simulation is only one strategy the PreSpecialty faculty are using for clinical skills. The school also uses the Virtual Healthcare Experience portal, developed by Canadian schools of nursing to engage students in highly complex scenarios using actors, as well as materials from the Institute for Healthcare Improvement, ReelDX videos and faculty-created case studies.

VUSN PreSpecialty clinical faculty created multiple virtual clinical simulations to support pediatric, adult, obstetric and psychiatric-mental health care. Students whose clinical experiences did not require the simulation lab participated in similar virtual situations within a simulated home or office setting.

Before starting the virtual curriculum, VUSN consulted the Tennessee Board of Nursing and the Commission on Collegiate Nursing Education (CCNE) to determine how the simulations would relate to the students' future licensing. "They sent us confirmation that simulation can be used one-to-one in place of direct patient care," Jessee said. "Every hour that students are logging in these virtual activities counts toward their preparation for the national council licensure examination, NCLEX."

Student reaction has been positive. In addition to finding the simulations valuable, students have noted they feel supported in keeping their educational dreams on track thanks to the innovation. The faculty also judged the simulations successful. "We were able to develop meaningful, realistic virtual experiences that would provide students with opportunities to learn and demonstrate competency in essential clinical thinking skills," Jessee said.

Although she doesn't know of other schools that have created similar virtual clinical simulations, Jessee said that nursing schools across the country are developing various creative learning experiences. "We're all working to enable on-time graduation of nurses to fill vacancies in the nursing workforce," she said. "Our students won't miss a beat."

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Vanderbilt University School of Nursing