How Nursing Midwifery Schools Across the United States Have Adapted During COVID-19

BY SUSAN SINCLAIR, RN, MSN

Midwifery Week Special Issue | OCTOBER 2020

The years a student is in nursing school are challenging and exciting—a span of time that builds the foundation for a student’s nursing practice. It is no surprise that these challenges have increased during COVID-19. As everyone knows, the pandemic has introduced a myriad of uncertainties and has forced nursing schools to change and adapt their requirements. This article will address ways nursing and midwifery schools throughout the U.S. have adapted, a current student’s experience, tips for students, and long-term projections for nursing education.

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Clinicals have always been a cornerstone to nursing education whether formally or informally. In the 1870s, nursing “clinicals” entailed direct patient care and learning on the job while being part of hospital staff. The student was primarily an employee and secondly a student. Nursing education has come a long way.

However, at the height of COVID-19, hands-on direct patient care was not permissible. Therefore, creativity and more in-depth utilization of online learning and simulation occurred in nursing and midwifery schools alike. Perhaps never before in history did nursing simulation labs receive more attention and use.

Deborah Zbegner, PhD, CRNP, is dean of the Passan School of Nursing at Wilkes University. In an interview she stated, “each clinical course at Wilkes has hands-on simulations that students must

complete. All simulations are tested using Lasater’s clinical judgment rubric to measure program outcomes related to clinical judgment. In addition, the Creighton Instrument is used to evaluate the graded simulations and measures clinical competence.”

In a March 2020 memo to the midwifery program directors, chair of the Accreditation Commission for Midwifery Education board for review, Gretchen Mettler, PhD, CNM, advised, “…the issue is clinical competence. Students need to demonstrate competence.” Like undergraduate and graduate nursing programs, midwifery programs are required to document how they meet their curriculum and program goals and objectives.

During the COVID-19 pandemic, educators have had their work cut out for them. Fortunately, there are resources to aid educators in adapting to a simulation and

online-focused education. One resource that assists in keeping track of various states’ changes to nursing curriculum requirements is the National Council of State Boards of Nursing. They have devoted a website that provides links to changes in each state.

Another resource for educators is Wolters Kluwer’s “Transitioning to Online Learning in the Age of Social Distancing,” which provides many links, podcasts, blogs, and webinars such as transitioning to online learning, bulking up an educator’s simulation curricula, and tips for teaching. Springer Publishing Company also offers nursing educators a variety of resources for those making the switch to online teaching.

There are several tips for students to help them succeed in learning online. Students must try to stay organized and acknowledge that this is a different learning landscape. Schools

However, at the height of COVID-19, handson direct patient care was not permissible. Therefore, creativity and more in-depth utilization of online learning and simulation occurred in nursing and midwifery schools alike.

are utilizing web-based video conferencing to connect with peers and teachers; become familiar with the programs. According to Tonya Nicholson, DNP, CNM, WHNP-BC, CNE, associate dean of Midwifery and Women’s Health at Frontier Nursing University, “the most important thing: don’t go MIA. Reach out to faculty…and be forthright if something is going on.”

Other adaptations nursing schools are undertaking are loosening assignment and project deadlines. “We have allowed two academic hiatuses [if needed] to allow students who have to work,” says Nicholson. “There is a fine line between leniency and asking for trouble, so in the end, all students must be safe to practice.” This has been a good strategy to enable working nurses to continue their education while working during the pandemic.

What do these adaptations mean for nursing schools in the long term? It is difficult to say, but online learning may be here to stay, especially if the pandemic returns. It is possible entire cohorts may be suspended for a specific time period. The health care structure as a whole may be shifting, which may impact

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nursing schools and the nursing workforce.

Karen Cotter, PhD, RN, CNE, is associate dean for prelicensure programs at Louise Herrington School of Nursing at Baylor University. “As we look forward to Fall 2020, with so much uncertainty about the extent and impact of the pandemic, we have a lot of these tools [intensive virtual simulation] now in our arsenal, and will more easily launch them to meet the needs of our students,” she says. Cotter does not anticipate much difference in how students will prepare for NCLEX.

According to Nicholson, Frontier University will keep providing its first midwifery clinical course online. She has noted that students have responded positively. “We cover history-taking and establishing rapport, then demonstrate the skills. Our students

have provided feedback that by the end of the clinical their confidence is improved.” As mentioned above, some changes in curricula made during COVID-19 may stick in the long term.

Other adaptations nursing schools are undertaking are loosening assignment and project deadlines. “We have allowed two academic hiatuses [if needed] to allow students who have to work,” says Nicholson.

How are Students Adapting to These Abrupt Changes in their Education?

We interviewed Rachel (R.), a student who just completed her freshman year at Gwynedd Mercy University, a four-year university located in Gwynedd Valley, Pennsylvania. The interviewee’s name has been changed to protect her privacy.

Like all colleges in the United States, your college campus closed for spring semester 2020 and summer courses are all online. What was it like for you when this closure was first announced in March?

“In a way, I was watching other colleges shut down and myself and other students were confused. We didn’t know if school was going to continue. It was confusing and frustrating. Some teachers were prepared [with providing work to do], others were not.”

Should nursing students care about not having clinicals?“Students should definitely be worried…now we will be relying more on textbooks.”

How can students study differently now that there are no hands-on labs?“We can practice blood pressures on friends or family. There are simulation websites. It’s difficult because to be a nurse we need the hands-on.”

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Only time will tell if online learning and simulationintensive learning will be the permanent “normal.”

Students have also adapted and changed their framework for education. Only time will tell if online learning and simulation-intensive learning will be the permanent “normal.” Students need more support than ever to overcome these challenges to graduate and be safe practitioners.