If the fight against COVID-19 is becoming the equivalent of a health-care war, then the Mankato area might be Parris Island or Fort Benning.
Nursing students are being trained by the hundreds at five local colleges, and dozens are set to graduate in May. When they enter the workforce, some of the young nurses may be walking into hospitals, nursing homes or other health care facilities overwhelmed with very ill and contagious patients.
Worried? Scared? Regretting their career choice?
Not even close, said Gabby Hess, a senior nursing student at Minnesota State University. She and her fellow seniors have been watching news reports from hospitals in New York and other hard-hit areas, and what they’re mainly feeling is a desperation to pitch in.
“With the almost four years of nursing school we’ve had, we just feel like we could really help right now,” Hess said. “We would love to be able to go in right now and be helping.”
In hard-hit Italy, about 20% of all health care workers have been infected by the novel coronavirus. In Minnesota, about 1 in 5 confirmed COVID-19 cases is a health care worker. Computer models predict the epidemic will peak in Minnesota in May or June, so help from those fresh-out-of-school nurses could be critical.
“I think they will be in high demand because the current workforce is going to be stressed,” said Sara Traylor, director of nursing at Bethany Lutheran College in Mankato.
Bethany is the newest nursing school in the area and has three senior nursing students to contribute to the cause when the semester ends in May. Minnesota State University has 36. Gustavus Adolphus College in St. Peter another 32. South Central College in North Mankato has 29 set to become registered nurses. Another 10 SCC students are on track to become licensed practical nurses.
Rasmussen College’s Mankato campus is a few weeks ahead of the others, having just graduated 26 students who are a licensing exam away from becoming registered nurses with associate degrees. Another eight have graduated with a bachelor’s degree in nursing.
Rasmussen Vice President of Nursing Joan Rich thought back to her first nursing job years ago in a newborn intensive care unit.
“It is intimidating anytime you go out there for a first job, let alone being turned loose into a pandemic,” Rich said.
So she gets a bit choked up thinking about sending students into the current health care environment. It’s not that she’s worried they’re unready; it’s because she’s proud of their eagerness to join the effort.
“We’ve gotten some amazing emails from our students,” Rich said. “They’re just chomping at the bit to go out and help.”
Until recently, it looked like the epidemic would undermine the ability of nursing schools to inject more health care professionals into the battle. Nursing students finish their academic careers with a semester-long preceptorship — essentially a mentorship in a community health care setting under the direction of an experienced nurse — that’s a part of the standards set by the Minnesota Board of Nursing.
COVID-19, though, was canceling those preceptorships across the state. Hospitals and clinics were trying to keep unnecessary people out of their facilities, worried about outsiders bringing the novel coronavirus into the facility and infecting patients and staff. Virtually every facility is also working to stockpile masks, gowns and other personal protective equipment, commonly called PPE, for nurses and doctors for when the epidemic worsens.
“They don’t have enough PPE for their own staff, let alone the students in addition,” said Tricia Young, chair of the School of Nursing at MSU.
Working with the Board of Nursing, the schools came up with some adjustments to the standards that allow those final hours of clinical experience to be replaced with online simulations of medical emergencies and other health care scenarios. MSU was particularly well set up for the change because of its high-tech Maverick Family Nursing Simulation Center. The simulations involve “patients” experiencing heart failure, stroke, a gastro-intestinal bleed in an emergency department and many more.
Hess said she and her classmates upon learning that 120 hours of clinical experience were going to be replaced with simulations were skeptical.
“I can speak for a lot of us. We were really nervous,” Hess said. “I mean 120 hours is a lot of experience. Without that, are we going to be ready?”
After two days of watching videos of previous nursing students conducting the lifelike simulations, Hess is feeling better about her final semester. The students can closely watch the performance of the former nursing students in the videos and hold an online debriefing after each simulation, dissecting the actions and decisions of the participants.
“It’s actually been amazing,” she said.
And it’s not like the graduating nurses are losing all of their clinical experience. Young said the senior nursing students have completed hundreds of hours of real-life learning at hospitals, mental health facilities and county public health agencies in previous semesters.
That’s the case at South Central College, too, said Candy Mortenson-Klimpel, interim director of nursing at the school.
“I’m confident that they’ve had a lot of experience, and we’re finishing as strongly as we can,” she said. “I feel they’re in a good position to be successful.”
Before they can begin practicing, however, nursing graduates must pass a national licensing examination. The closely monitored tests, which traditionally can take up to six hours to complete, can’t be taken online, and the pandemic had shut down the testing sites until recently.
Some of the sites are reopening, but social-distancing has cut in half the number of students being tested in each session.
At Rasmussen, which operates on a quarter system, their most recent batch of nursing graduates received their diplomas last month. Because those students couldn’t immediately take the test, the school has been offering refresher materials and practice tests.
“We’re trying to keep them engaged,” Rich said.
Hess said she and her friends at MSU will grab the first opportunity they get to take the exam and enter the workforce.
“We want to get out there as soon as possible,” she said. “We feel a little helpless not being able to be out there at the hospitals, helping the other nurses and the doctors and everyone.”
In the distant past, the tests were given only a couple of times a year and nurses were allowed to begin their careers on a provisional status while they waited for a chance to pass the exam and become an official registered nurse. Reviving that practice has been discussed in light of the pandemic.
“That would take an order from Gov. Walz,” Young said.
Nursing schools, like virtually every other educational institution shut down by the pandemic, have been focused on how to resume classes online and how to allow seniors to obtain their degrees on schedule. Now that those courses are underway, other issues are coming to the forefront.
“We’re just starting to think about, ‘How do we prepare them for this?’” said Gustavus Nursing Department Chair Heidi Meyer, referring to the chaotic pandemic scenarios the new graduates might find themselves working in. “... Making sure they’re safe not only physically but emotionally.”
The extroverts in the program are showing confidence and impatience to put their education and skills to use when the public might need them the most.
“The ones I hear from are the ones who are ready to go,” Meyer said. “It’s the quieter ones, honestly, I don’t know how they’re feeling.”
It doesn’t appear job opportunities will be in short supply. Some countries are recruiting furloughed airline flight crews, typically well-trained in first aid, to work in hospitals as COVID-19 cases skyrocket.
“They’re needed,” Meyer said of the nursing graduates. “But it’s a scary time.”
Young said the new nurses, just like the veterans, will need to support one another.
“Nurses bear witness to suffering — it is what we do — and to the extent that this causes us to suffer, we are here to help each other out,” she said.
Hess said the young women and men who go into the field are already a little bit unique.
“With nursing, you have to put everyone else before yourself. I’m sure that’s why a lot of us aren’t really scared about starting working,” she said. “This is kind of what we’ve prepared to do. With the help of the faculty and the program in general, we’re ready for that.”
Hess said her godmother, who is an RN and an MSU grad, inspired her to go into nursing. Her parents don’t work in health care, and she knows they’ll be worried if she ends up on the front lines of caring for COVID-19 patients.
“I would say more, though, that they’re proud of me — that they raised someone who’s willing to go out and help people at a time like this.”