WEBVTT 00:00:12.000 --> 00:00:18.610 position:50% align:middle - [Michelle] Welcome back for our final session of the day, a panel discussion on the influence of the 00:00:18.610 --> 00:00:24.750 position:50% align:middle pandemic on APRN education, raising the question, can we go back? 00:00:24.750 --> 00:00:26.320 position:50% align:middle And should we? 00:00:26.320 --> 00:00:32.100 position:50% align:middle There will be a Q&A session so you'll be able to ask our panelists questions after they 00:00:32.100 --> 00:00:34.750 position:50% align:middle finish their presentations. 00:00:34.750 --> 00:00:39.629 position:50% align:middle So please join me in welcoming our panelists. 00:00:42.930 --> 00:00:51.780 position:50% align:middle I'd like you all to join me in welcoming Carol Delville, Ira Kantrowitz-Gordon, Maribeth Massie, 00:00:51.780 --> 00:00:58.210 position:50% align:middle and Charlie Yingling. So we're going to have Ira kick us off at this point. 00:00:58.210 --> 00:01:00.840 position:50% align:middle So Ira, take it away. 00:01:00.840 --> 00:01:02.590 position:50% align:middle - [Ira] Thank you, Michelle. 00:01:02.590 --> 00:01:10.890 position:50% align:middle I'm a track lead for nurse midwifery education at the University of Washington in Seattle. 00:01:10.890 --> 00:01:19.890 position:50% align:middle So our experience of the COVID pandemic was somewhat, well, everyone's had quite a challenging experience. 00:01:19.890 --> 00:01:26.880 position:50% align:middle The Seattle area was the first part of the country to identify the infections and so we had a very early 00:01:26.880 --> 00:01:32.980 position:50% align:middle experience with shutting down back in early March of 2020. 00:01:32.980 --> 00:01:39.840 position:50% align:middle And for our nurse midwifery education program, this was both good and bad timing. 00:01:39.840 --> 00:01:47.180 position:50% align:middle Our clinical sequence actually ends in March so our students who were about to graduate just kind of snuck 00:01:47.180 --> 00:01:54.300 position:50% align:middle in without having the pandemic impact their ability to get their clinical education. 00:01:54.300 --> 00:02:00.380 position:50% align:middle So it was good for them and they were able to graduate although we had no graduation ceremonies for them that 00:02:00.380 --> 00:02:02.400 position:50% align:middle were in-person, of course. 00:02:02.400 --> 00:02:08.780 position:50% align:middle But the next cohort was just about to start their clinical sequence and they ended up being basically 00:02:08.780 --> 00:02:17.340 position:50% align:middle shut out of clinical for at least an academic quarter as everyone reacted to the suddenness of the growing 00:02:17.340 --> 00:02:27.580 position:50% align:middle pandemic and the feeling based on…from clinical sites that they could not take students because that would 00:02:27.580 --> 00:02:34.610 position:50% align:middle just add exposures to everybody, staff, patients, and the students themselves, 00:02:34.610 --> 00:02:37.160 position:50% align:middle so at risk of catching COVID. 00:02:37.160 --> 00:02:44.490 position:50% align:middle So we were faced with very quickly having to deal with not being able to place our students in clinical and 00:02:44.490 --> 00:02:49.010 position:50% align:middle not being able to have in-person classes either. 00:02:49.010 --> 00:02:57.590 position:50% align:middle So we had to do this rapid shift towards online education and making up for missing clinical 00:02:57.590 --> 00:03:05.720 position:50% align:middle by engaging in remote activities which included doing more online simulations, 00:03:05.720 --> 00:03:09.850 position:50% align:middle learning about telehealth and doing simulated telehealth, more case studies. 00:03:09.850 --> 00:03:19.320 position:50% align:middle We even practiced suturing for birth lacerations on Zoom, doing one-on-one sessions with our students 00:03:19.320 --> 00:03:24.160 position:50% align:middle to really like maneuver our cameras so that they could see my hands and then, you know, 00:03:24.160 --> 00:03:27.800 position:50% align:middle they would turn their camera around so that I could give them immediate feedback. 00:03:27.800 --> 00:03:34.720 position:50% align:middle And we just did everything we could while they could not get into clinical to help them be extra prepared so 00:03:34.720 --> 00:03:41.200 position:50% align:middle that when they got into clinical, they would be able to hit the ground running with…to be 00:03:41.200 --> 00:03:45.470 position:50% align:middle able to maximize their clinical experiences. 00:03:45.470 --> 00:03:55.490 position:50% align:middle So this was a rapid turnaround in how we delivered education and really offering…trying to offer more 00:03:55.490 --> 00:03:58.610 position:50% align:middle support to our students despite all the uncertainties. 00:03:58.610 --> 00:04:08.510 position:50% align:middle So we had weekly open forums on Zoom with our students within the midwifery track to keep it more personal 00:04:08.510 --> 00:04:13.840 position:50% align:middle but to also just, even if we didn't have the answers, we could at least say we didn't have the answers so 00:04:13.840 --> 00:04:18.740 position:50% align:middle that they would know that we were working on it, we were trying, we were trying to get 00:04:18.740 --> 00:04:21.540 position:50% align:middle them into clinical. 00:04:21.540 --> 00:04:26.770 position:50% align:middle As the pandemic moved on, fortunately by the beginning of the summer quarter, 00:04:26.770 --> 00:04:32.810 position:50% align:middle so a quarter later, we were able to get just about all of our students back into clinical. 00:04:32.810 --> 00:04:37.980 position:50% align:middle So they were, at that point, a quarter behind and we encouraged them but did not 00:04:37.980 --> 00:04:44.230 position:50% align:middle require them to take every additional clinical opportunity they could, 00:04:44.230 --> 00:04:51.690 position:50% align:middle whether it was working extra shifts or working during their breaks between quarters to get 00:04:51.690 --> 00:04:54.640 position:50% align:middle [inaudible 00:04:52] hours making up for. 00:04:54.640 --> 00:05:03.440 position:50% align:middle And so by the time we come around to last month where, you know, it's been a whole year and this cohort that 00:05:03.440 --> 00:05:12.210 position:50% align:middle really got their clinical education through the pandemic, 90% of them were able to graduate on time. 00:05:12.210 --> 00:05:19.020 position:50% align:middle We had one student who hard to know but likely would have needed the extra time anyway even 00:05:19.020 --> 00:05:20.440 position:50% align:middle without a pandemic. 00:05:20.440 --> 00:05:24.990 position:50% align:middle So that, in many ways, was a great success. 00:05:24.990 --> 00:05:31.190 position:50% align:middle And now, we are just about to start our next clinical cohort and they are fully into clinical and they are 00:05:31.190 --> 00:05:34.870 position:50% align:middle all…anyone who wants to be is now vaccinated. 00:05:34.870 --> 00:05:46.340 position:50% align:middle So, fingers crossed, we have made it through this experience without major 00:05:46.340 --> 00:05:51.500 position:50% align:middle impacts on the progression of our students in terms of graduating on time. 00:05:51.500 --> 00:05:56.010 position:50% align:middle I think, you know, if you ask them about their experience of going through this pandemic, you know, 00:05:56.010 --> 00:05:59.300 position:50% align:middle they would talk about a whole lot of additional stress. 00:05:59.300 --> 00:06:07.370 position:50% align:middle There have been some students earlier in the program who have decided because family members got laid off, 00:06:07.370 --> 00:06:11.590 position:50% align:middle as nurses, they are more able to support their families. 00:06:11.590 --> 00:06:19.680 position:50% align:middle So some students have decided to either go part time or take a leave of absence to get through this, 00:06:19.680 --> 00:06:26.960 position:50% align:middle this tough times, with the hopes of them returning back into their program or getting back into full time 00:06:26.960 --> 00:06:31.950 position:50% align:middle education perhaps by next year. 00:06:31.950 --> 00:06:38.130 position:50% align:middle Probably our biggest challenge, like I've alluded to, has been finding placements of our students 00:06:38.130 --> 00:06:39.420 position:50% align:middle during the pandemic. 00:06:39.420 --> 00:06:44.890 position:50% align:middle Even though the governor of Washington State was very clear that nursing students were considered essential 00:06:44.890 --> 00:06:51.990 position:50% align:middle personnel and should be allowed to continue, that message did not have any enforcement 00:06:51.990 --> 00:06:58.670 position:50% align:middle attached to it. So every institution had variable responses to that. 00:06:58.670 --> 00:07:07.570 position:50% align:middle And this was particularly acute at the undergraduate level but we had a lot of different communications 00:07:07.570 --> 00:07:13.830 position:50% align:middle where we would have, you know, at the clinic level, they may have been willing to allow students, 00:07:13.830 --> 00:07:20.520 position:50% align:middle graduate students in and midwifery students, DNP students, but then at the regional level for large 00:07:20.520 --> 00:07:23.690 position:50% align:middle healthcare organizations, they may have put out a different message 00:07:23.690 --> 00:07:27.830 position:50% align:middle about delaying the re-entry of advanced practice students. 00:07:27.830 --> 00:07:32.710 position:50% align:middle And then also in midwifery, you have the unique challenge of our students are 00:07:32.710 --> 00:07:38.590 position:50% align:middle placed in the outpatient setting with midwifery practices but also, have to be allowed into the 00:07:38.590 --> 00:07:46.730 position:50% align:middle inpatient setting, which is, most of the time, a hospital which may be a different institution 00:07:46.730 --> 00:07:53.270 position:50% align:middle with different rules and different understandings of when students should be allowed back in. 00:07:53.270 --> 00:07:59.110 position:50% align:middle We also saw that there was a real difference in how medical students and medical residents were treated and 00:07:59.110 --> 00:08:04.590 position:50% align:middle that they were more likely to be allowed back in compared to advanced practice nursing 00:08:04.590 --> 00:08:10.310 position:50% align:middle and midwifery students. 00:08:10.310 --> 00:08:18.510 position:50% align:middle There were also challenges at the university level where the university wanted to be very protective 00:08:18.510 --> 00:08:23.890 position:50% align:middle of students to reduce their potential for getting sick and being exposed to COVID. 00:08:23.890 --> 00:08:31.920 position:50% align:middle So we had to take a stepwise approach to get approvals from the university to allow our students 00:08:31.920 --> 00:08:33.310 position:50% align:middle back into clinical. 00:08:33.310 --> 00:08:42.020 position:50% align:middle And at one point, this required a direct faculty supervision of students to make sure that they were 00:08:42.020 --> 00:08:44.730 position:50% align:middle wearing their PPE appropriately in clinical. 00:08:44.730 --> 00:08:51.950 position:50% align:middle As you can imagine, that would be a huge burden on faculty to be present for every student because we 00:08:51.950 --> 00:08:54.530 position:50% align:middle don't have multiple students at the same placement usually. 00:08:54.530 --> 00:08:55.720 position:50% align:middle They're spread out. 00:08:55.720 --> 00:09:04.910 position:50% align:middle So we worked quickly to make sure that our clinical preceptors were, if they weren't already considered 00:09:04.910 --> 00:09:10.400 position:50% align:middle clinical faculty, that we would rapidly get them onboarded as clinical faculty so that we would meet 00:09:10.400 --> 00:09:16.990 position:50% align:middle this university-imposed requirement of faculty supervision for effective PPE. 00:09:16.990 --> 00:09:24.550 position:50% align:middle Fortunately, that requirement also went away quickly as the university got used to having nursing students back 00:09:24.550 --> 00:09:30.140 position:50% align:middle in clinical and as they even got more comfortable, the rules kind of relaxed and then as we all got more 00:09:30.140 --> 00:09:35.590 position:50% align:middle comfortable with the pandemic, it become much easier and those requirements 00:09:35.590 --> 00:09:38.120 position:50% align:middle basically went away. 00:09:38.120 --> 00:09:44.770 position:50% align:middle So I think it's been a really evolving, challenging situation but to wrap it up, 00:09:44.770 --> 00:09:51.980 position:50% align:middle I would say that many of the changes we've made in delivering our education through online, 00:09:51.980 --> 00:09:58.840 position:50% align:middle I'm very hopeful that we will…even when we go back to fully in-person classes, hopefully in the fall, 00:09:58.840 --> 00:10:06.470 position:50% align:middle we will take with us some of the flexibility and that we have achieved through hybrid education as well 00:10:06.470 --> 00:10:17.370 position:50% align:middle as the increased accessibility that that provides for students when they can't make it to class in person. 00:10:17.370 --> 00:10:22.420 position:50% align:middle - Thank you very much, Ira, for sharing your experiences. 00:10:22.420 --> 00:10:25.770 position:50% align:middle Now, we're going to go to Carol. 00:10:25.770 --> 00:10:27.920 position:50% align:middle - [Carol] Hi, everybody. 00:10:27.920 --> 00:10:33.540 position:50% align:middle At the start of spring break 2020, the adult geriatric clinical nurse specialist program 00:10:33.540 --> 00:10:38.800 position:50% align:middle at UT closed for two weeks according to the students but from the faculty perspective, 00:10:38.800 --> 00:10:44.110 position:50% align:middle we had two weeks to prepare to reopen to a new world of online teaching. 00:10:44.110 --> 00:10:50.160 position:50% align:middle We are designed to be 100% in-person on campus so this was a major shift for the faculty as well 00:10:50.160 --> 00:10:55.890 position:50% align:middle as the students, and one that typically would require the Texas Board of Nursing approval to make such 00:10:55.890 --> 00:10:57.940 position:50% align:middle a program shift. 00:10:57.940 --> 00:11:04.180 position:50% align:middle Our 36 students were spread out over 30 clinical sites, every single one of them closed that semester and 00:11:04.180 --> 00:11:08.500 position:50% align:middle remained closed to mid-summer. 00:11:08.500 --> 00:11:15.230 position:50% align:middle And then even now that the long-term care centers, assisted living, which are primary sources 00:11:15.230 --> 00:11:19.000 position:50% align:middle for gerontology experiences have remained closed. 00:11:19.000 --> 00:11:25.290 position:50% align:middle One fortunate aspect of our program is we have 615 clinical hours for our students. 00:11:25.290 --> 00:11:32.570 position:50% align:middle So in March, when the program essentially shut down clinical sites, our graduating cohort already had 00:11:32.570 --> 00:11:40.140 position:50% align:middle over the 500 hours required but we still needed to work with those first year students who at that point, 00:11:40.140 --> 00:11:44.900 position:50% align:middle were in their acute care rotations and intensive care and in the hospitals, 00:11:44.900 --> 00:11:48.840 position:50% align:middle to make sure that they had adequate clinical experiences. 00:11:48.840 --> 00:11:50.510 position:50% align:middle Our simulation lab was running 24/7. 00:11:50.510 --> 00:11:59.940 position:50% align:middle We have a large undergrad cohort so we did turn to some virtual case software and used those in both Teams and 00:11:59.940 --> 00:12:06.790 position:50% align:middle in one-on-one Zoom sessions to determine the competency-based evaluations and the student's ability 00:12:06.790 --> 00:12:09.770 position:50% align:middle to progress on that. 00:12:09.770 --> 00:12:13.350 position:50% align:middle And that meant IT was just our bread and butter. 00:12:13.350 --> 00:12:21.070 position:50% align:middle We had students that lacked adequate internet, some students needed some sponsorship and grants 00:12:21.070 --> 00:12:28.500 position:50% align:middle to upgrade their internet service or loaner laptops and equipment to be able to support the complexity of the 00:12:28.500 --> 00:12:31.100 position:50% align:middle software that we were using. 00:12:31.100 --> 00:12:38.440 position:50% align:middle And just to cap that off, when the ANCC exam sites closed and they weren't able 00:12:38.440 --> 00:12:43.950 position:50% align:middle to test, the graduating cohort said, "So how are we going to start looking for jobs?" 00:12:43.950 --> 00:12:50.290 position:50% align:middle The state of Texas actually expanded provisional licenses from 25 days to 6 months and 00:12:50.290 --> 00:12:52.400 position:50% align:middle then later, 9 months. 00:12:52.400 --> 00:12:57.810 position:50% align:middle The problem with that, though, was prescription authority was not included in those 00:12:57.810 --> 00:13:04.530 position:50% align:middle provisional licenses and most of the positions that were open to our students did require 00:13:04.530 --> 00:13:06.830 position:50% align:middle prescriptive authority ability. 00:13:06.830 --> 00:13:12.030 position:50% align:middle So the barriers we ran into, technology access, some of our students, 00:13:12.030 --> 00:13:17.690 position:50% align:middle all of our students basically returned home and they may not have had a high quality internet 00:13:17.690 --> 00:13:19.760 position:50% align:middle accessibility at home. 00:13:19.760 --> 00:13:28.060 position:50% align:middle For faculty flipping over classroom format, we found the ideal way was to break up those didactic 00:13:28.060 --> 00:13:35.630 position:50% align:middle lectures into voiceover PowerPoints, Panopto videos, Ted Talks, separate for each objective of the lecture 00:13:35.630 --> 00:13:39.230 position:50% align:middle so that they were very short and concise and focused. 00:13:39.230 --> 00:13:47.260 position:50% align:middle And then when we did get together for the Zoom session, we were able to do some front load survey questions and 00:13:47.260 --> 00:13:53.360 position:50% align:middle do case applications and really test the student's ability to apply the material. 00:13:53.360 --> 00:13:59.980 position:50% align:middle The other fortunate piece for me was our students as AGCNSs are really not just focused on the 00:13:59.980 --> 00:14:03.590 position:50% align:middle patient level, we also have this nursing and the system levels. 00:14:03.590 --> 00:14:08.740 position:50% align:middle So when the pandemic hit, we paired with our clinical sites to write some of the 00:14:08.740 --> 00:14:15.180 position:50% align:middle policies and protocols and procedures that they needed for admitting patients during COVID, 00:14:15.180 --> 00:14:19.480 position:50% align:middle for dealing with PPE, staffing issues that occurred as a result 00:14:19.480 --> 00:14:21.330 position:50% align:middle of COVID infections. 00:14:21.330 --> 00:14:27.070 position:50% align:middle The students got some real firsthand disaster nurse experience in writing those policies, 00:14:27.070 --> 00:14:29.700 position:50% align:middle procedures, and protocols. 00:14:29.700 --> 00:14:38.570 position:50% align:middle An unexpected impact of the COVID pandemic was the fact that a number of APRNs in our communities were laid 00:14:38.570 --> 00:14:47.240 position:50% align:middle off or furloughed because of the decrease in clinical site patient visits. 00:14:47.240 --> 00:14:56.540 position:50% align:middle And as a result, the employment in APRN positions for the new grads really was greatly reduced and only now, 00:14:56.540 --> 00:15:01.330 position:50% align:middle is the majority of the class employed in an APRN position. 00:15:01.330 --> 00:15:08.190 position:50% align:middle The other thing that we've definitely noticed is that students who started with the on-campus experience have 00:15:08.190 --> 00:15:11.050 position:50% align:middle been much more engaged in these Zoom sessions. 00:15:11.050 --> 00:15:16.400 position:50% align:middle They log in early, they request additional Zoom sessions for teamwork, 00:15:16.400 --> 00:15:18.920 position:50% align:middle they actually hold Zoom lunches together. 00:15:18.920 --> 00:15:25.590 position:50% align:middle Whereas the students that have only experienced the online format this year have only really started 00:15:25.590 --> 00:15:32.450 position:50% align:middle engaging since we've been able to return to the hospital site and work one-on-one with those students. 00:15:32.450 --> 00:15:36.220 position:50% align:middle Additional impact, one student did have to drop back a year. 00:15:36.220 --> 00:15:41.320 position:50% align:middle Both of her parents were hospitalized long-term for COVID. 00:15:41.320 --> 00:15:47.990 position:50% align:middle Thirty-three percent of our students, that first spring, tested positive for COVID and that 00:15:47.990 --> 00:15:56.180 position:50% align:middle did impact the completion date of that semester but they did…everyone had a timely graduation. 00:15:56.180 --> 00:16:02.220 position:50% align:middle We did extend the time they could complete their clinical hours for the fall semester so they were able 00:16:02.220 --> 00:16:05.140 position:50% align:middle to start in August instead of September. 00:16:05.140 --> 00:16:10.950 position:50% align:middle So with great diligence, the faculty managed to place all of our students 00:16:10.950 --> 00:16:17.190 position:50% align:middle with clinical preceptors but whereas that would normally take between 50 and 60 contacts, 00:16:17.190 --> 00:16:25.070 position:50% align:middle it took over 600 contacts with clinical agencies to find them preceptors. 00:16:25.070 --> 00:16:34.880 position:50% align:middle Other barriers we faced besides the technology and the impact of the pandemic was probably PPE. 00:16:34.880 --> 00:16:40.460 position:50% align:middle When all of the research labs on campus closed, they were basically stripped of all of their personal 00:16:40.460 --> 00:16:49.120 position:50% align:middle protective equipment and it was distributed to those clinics that needed…those students that needed it 00:16:49.120 --> 00:16:52.310 position:50% align:middle for simulation lab and other clinical experiences. 00:16:52.310 --> 00:16:58.180 position:50% align:middle In the fall, we have had to provide PPE for our students in clinical sites. 00:16:58.180 --> 00:17:04.850 position:50% align:middle We check with the site as to what is their requirement for that PPE and our simulation lab has been able to do 00:17:04.850 --> 00:17:10.580 position:50% align:middle the fit-testing for both students and faculty to get that. 00:17:10.580 --> 00:17:19.900 position:50% align:middle The state really did come through for us both in that extension of the temporary licenses for our CNSs and 00:17:19.900 --> 00:17:28.850 position:50% align:middle more importantly, they didn't require us to recertify the program when we switched to the online platform. 00:17:28.850 --> 00:17:35.810 position:50% align:middle We are planning on going back to class, fingers crossed, in the fall semester, 00:17:35.810 --> 00:17:44.310 position:50% align:middle all things willing but we have learned a lot about the flexibility of the program, 00:17:44.310 --> 00:17:51.180 position:50% align:middle felt flipping the classwork to use that class time more constructively for student evaluation and the 00:17:51.180 --> 00:17:54.830 position:50% align:middle importance of the one-on-one time with the student. 00:17:54.830 --> 00:18:04.320 position:50% align:middle It has increased faculty burden but we feel we've gotten better outcomes from our students. 00:18:04.320 --> 00:18:09.550 position:50% align:middle - Thank you very much, Carol, for sharing your experiences and the barriers you faced 00:18:09.550 --> 00:18:15.420 position:50% align:middle and how you've overcome them in your CNS program there in Texas. 00:18:15.420 --> 00:18:22.500 position:50% align:middle Next, we'd like to go to Maribeth Massie who will talk with us about her CRNA program. 00:18:22.500 --> 00:18:29.010 position:50% align:middle - [Maribeth] Thanks, Michelle, I really appreciate it, and thank you for everybody here for allowing me 00:18:29.010 --> 00:18:31.720 position:50% align:middle to share our experiences here at Columbia. 00:18:31.720 --> 00:18:36.880 position:50% align:middle As you can imagine, in New York City, it was the height of the pandemic and everything was 00:18:36.880 --> 00:18:37.910 position:50% align:middle happening so quickly. 00:18:37.910 --> 00:18:44.380 position:50% align:middle So within a week, we had our students essentially pulled out of the hospitals either because the elective 00:18:44.380 --> 00:18:49.470 position:50% align:middle cases were all canceled at that time so there weren't a lot of cases or the hospitals were just trying to get 00:18:49.470 --> 00:18:51.150 position:50% align:middle rid of all of their trainees there. 00:18:51.150 --> 00:18:55.320 position:50% align:middle So our nurse anesthesia residents were pulled out, some were able to stay. 00:18:55.320 --> 00:19:01.280 position:50% align:middle So those that were doing trauma rotations or OB rotations were still able to stay in. 00:19:01.280 --> 00:19:06.050 position:50% align:middle And what we did for them and going forward throughout the next couple of months, 00:19:06.050 --> 00:19:12.660 position:50% align:middle we created a COVID opt in-opt out sheet because some of the students had elderly parents with coexisting 00:19:12.660 --> 00:19:16.982 position:50% align:middle diseases at home or, you know, children that had some kind of a disease, 00:19:16.982 --> 00:19:19.360 position:50% align:middle or themselves they had issues. 00:19:19.360 --> 00:19:25.830 position:50% align:middle And so we wanted to make sure that they could be out of the clinical setting if they wanted to at the sites 00:19:25.830 --> 00:19:27.840 position:50% align:middle that we were able to still send them to. 00:19:27.840 --> 00:19:29.950 position:50% align:middle They didn't have to go if they didn't want to. 00:19:29.950 --> 00:19:35.260 position:50% align:middle So that was, I think, a really big addition when we looked at the legality 00:19:35.260 --> 00:19:41.250 position:50% align:middle of it all, what could we do, what couldn't we do, and, you know, we learned a lot from that episode. 00:19:41.250 --> 00:19:45.200 position:50% align:middle And then, you know, I was concerned, we all were concerned with the health and safety of our 00:19:45.200 --> 00:19:47.060 position:50% align:middle nurse anesthesia residents. 00:19:47.060 --> 00:19:51.550 position:50% align:middle As others said, you know, several did get COVID throughout this entire period 00:19:51.550 --> 00:19:58.050 position:50% align:middle for months but I could tell you, Columbia was really great as a whole with testing and 00:19:58.050 --> 00:20:01.840 position:50% align:middle the protocols that were put in place and then eventually, the vaccinations. 00:20:01.840 --> 00:20:06.900 position:50% align:middle So all of my nurse anesthesia residents were vaccinated, I want to say, 00:20:06.900 --> 00:20:13.240 position:50% align:middle by early January or a lot of them did get vaccinations farther outside. 00:20:13.240 --> 00:20:17.550 position:50% align:middle But that cancellation of elective cases was really hard. 00:20:17.550 --> 00:20:23.900 position:50% align:middle So we continue didactic classes but our program is front-loaded so that means that the majority of their 00:20:23.900 --> 00:20:25.830 position:50% align:middle didactic is the first year. 00:20:25.830 --> 00:20:29.980 position:50% align:middle So for those second year students, the ones that were set to complete the program 00:20:29.980 --> 00:20:33.180 position:50% align:middle in August, they did that. 00:20:33.180 --> 00:20:35.460 position:50% align:middle They only had like two classes. 00:20:35.460 --> 00:20:41.080 position:50% align:middle And so we moved one of their summer classes into spring, so while they were still out of clinical. 00:20:41.080 --> 00:20:44.200 position:50% align:middle We were able to get that class essentially out of the way. 00:20:44.200 --> 00:20:45.850 position:50% align:middle It was a board review class. 00:20:45.850 --> 00:20:48.690 position:50% align:middle So that helped them with testing purposes. 00:20:48.690 --> 00:20:53.850 position:50% align:middle So when we thought they'd be able to go back to clinical in the summer, then they could be there, 00:20:53.850 --> 00:20:59.460 position:50% align:middle you know, a choice is seven days a week to try to get as much clinical experience as they could. 00:20:59.460 --> 00:21:06.210 position:50% align:middle As everybody else has said, you know, getting up to speed with virtual sessions and flipped 00:21:06.210 --> 00:21:10.000 position:50% align:middle classrooms and trying to change that all around was a little difficult. 00:21:10.000 --> 00:21:16.490 position:50% align:middle Our simulation lab closed down too and we weren't able to get back in it until late July. 00:21:16.490 --> 00:21:22.650 position:50% align:middle And that was huge because our classes in that first year, we have a lot of simulation paired with that. 00:21:22.650 --> 00:21:24.210 position:50% align:middle So we really had to work on that. 00:21:24.210 --> 00:21:30.290 position:50% align:middle But I can tell you, out of all of this came a lot of rays of sunshine along the way. 00:21:30.290 --> 00:21:38.070 position:50% align:middle Our students are all experienced ICU nurses with, on average, three to five years of ICU experience and 00:21:38.070 --> 00:21:44.570 position:50% align:middle the majority of them all went back either to their respective ICUs where they were working to help out or 00:21:44.570 --> 00:21:47.500 position:50% align:middle they took travel assignments to other ICUs. 00:21:47.500 --> 00:21:51.460 position:50% align:middle And all, the same time, they were taking their coursework. 00:21:51.460 --> 00:21:56.150 position:50% align:middle So that was pretty impressive that they decided to go ahead and do this. 00:21:56.150 --> 00:21:58.800 position:50% align:middle That was our first and second year students. 00:21:58.800 --> 00:21:59.980 position:50% align:middle We all got up to speed. 00:21:59.980 --> 00:22:06.050 position:50% align:middle So as far as faculty goes, we learned, you know, new things, which is always good for our neurons 00:22:06.050 --> 00:22:07.510 position:50% align:middle to keep growing along the way. 00:22:07.510 --> 00:22:13.330 position:50% align:middle And I definitely think that we will keep some of the virtual hybrid learning ways. 00:22:13.330 --> 00:22:20.240 position:50% align:middle We're doing that, especially recording lectures so we could have more case studies, case reports, 00:22:20.240 --> 00:22:25.340 position:50% align:middle more question and answer kind of things when we're actually in with the students. 00:22:25.340 --> 00:22:29.090 position:50% align:middle We were lucky at Columbia because we were able to rearrange the course delivery. 00:22:29.090 --> 00:22:35.200 position:50% align:middle So we were able to… we changed the course times, had some courses in the evenings rather than the days 00:22:35.200 --> 00:22:39.310 position:50% align:middle so the majority of students could make classes since they were working. 00:22:39.310 --> 00:22:45.300 position:50% align:middle And we didn't have any pushback from the university for that. 00:22:45.300 --> 00:22:50.380 position:50% align:middle One of the biggest things that I think we learned from all of this is that we got to know each other better, 00:22:50.380 --> 00:22:54.450 position:50% align:middle the students, the faculty, and the staff, because there was so much…obviously, 00:22:54.450 --> 00:23:01.300 position:50% align:middle we all were experiencing the anxiety, the isolation that went along with the pandemic. 00:23:01.300 --> 00:23:04.860 position:50% align:middle And then with the addition of everything from the social and justice standpoint, 00:23:04.860 --> 00:23:06.850 position:50% align:middle we needed to talk to each other. 00:23:06.850 --> 00:23:13.840 position:50% align:middle So we, both Columbia and our National Association, the American Association of Nurse Anesthetists had 00:23:13.840 --> 00:23:20.940 position:50% align:middle great resources for COVID in general but also for the mental health and wellbeing of our students and 00:23:20.940 --> 00:23:22.780 position:50% align:middle of us too, right? 00:23:22.780 --> 00:23:26.820 position:50% align:middle So we ended up calling them compassion conversations and it was just a chance, 00:23:26.820 --> 00:23:32.320 position:50% align:middle you didn't have to be on there but I got to tell you, almost every single solitary nurse anesthesia resident 00:23:32.320 --> 00:23:35.310 position:50% align:middle and faculty were on these weekly calls. 00:23:35.310 --> 00:23:40.610 position:50% align:middle They were held on early evenings so if somebody wanted, you know, a glass of wine or a cup of tea, you know, 00:23:40.610 --> 00:23:41.950 position:50% align:middle they could have that. 00:23:41.950 --> 00:23:45.580 position:50% align:middle And if you wanted to talk, you could, if you wanted to vent, otherwise, 00:23:45.580 --> 00:23:49.970 position:50% align:middle we were all there to listen and maybe give some input and advice along the way. 00:23:49.970 --> 00:23:54.400 position:50% align:middle So I can tell you right now, that is definitely something that we'll consider 00:23:54.400 --> 00:24:00.230 position:50% align:middle because one of the things, moving forward, that I'm worried about is the burnout of the ICU RNs 00:24:00.230 --> 00:24:02.600 position:50% align:middle that are going to be starting the programs. 00:24:02.600 --> 00:24:07.240 position:50% align:middle They lived through, you know, all the pandemic, everything that happened in the ICUs, 00:24:07.240 --> 00:24:12.410 position:50% align:middle and now they're going to be starting, you know, for any of us, this applies to all of our 00:24:12.410 --> 00:24:18.050 position:50% align:middle incoming students, they're going to be living our rigorous programs and that's a worry. 00:24:18.050 --> 00:24:22.460 position:50% align:middle But just so you know, as far as clinical goes, we were able to get those senior students when they 00:24:22.460 --> 00:24:29.880 position:50% align:middle were supposed to complete the program in August, we got them back, the majority of them back in mid-May. 00:24:29.880 --> 00:24:36.940 position:50% align:middle People that signed the COVID opt out, they decided they didn't want to go back into clinical at the time. 00:24:36.940 --> 00:24:43.340 position:50% align:middle They didn't have to so they…but everybody was back in the clinical setting by late June, early July. 00:24:43.340 --> 00:24:48.730 position:50% align:middle So all of our students were able to complete the program by the end of September. 00:24:48.730 --> 00:24:54.140 position:50% align:middle Normally, it would have been the end of August, and they all were able to, you know, I guess, 00:24:54.140 --> 00:24:58.930 position:50% align:middle essentially view the virtual graduation in October. 00:24:58.930 --> 00:25:04.360 position:50% align:middle Because we didn't have all our clinical sites back up and running, they weren't allowing a lot of, you know, 00:25:04.360 --> 00:25:07.040 position:50% align:middle trainees back in in the New York City area. 00:25:07.040 --> 00:25:14.240 position:50% align:middle We had to push back the start of our then second-year students until mid-August to mid-September. 00:25:14.240 --> 00:25:16.120 position:50% align:middle They were supposed to start mid-May. 00:25:16.120 --> 00:25:21.230 position:50% align:middle So out of all the students, I think they probably experienced the most stress and 00:25:21.230 --> 00:25:24.730 position:50% align:middle angst and anxiety because they didn't know when they were going to start, 00:25:24.730 --> 00:25:28.820 position:50% align:middle they didn't know when they were going to be able to finish the program. 00:25:28.820 --> 00:25:34.640 position:50% align:middle On top of all that, starting in January of this year, we increased their clinical hours. 00:25:34.640 --> 00:25:39.000 position:50% align:middle Normally, we would say, you know, a 40 clinical-hour week but we've increased it to a 00:25:39.000 --> 00:25:42.790 position:50% align:middle minimum of 48 hours to a maximum of 64. 00:25:42.790 --> 00:25:48.280 position:50% align:middle So because they all voted, we were very democratic, and they wanted to be able to finish the 00:25:48.280 --> 00:25:52.710 position:50% align:middle program on time. So that's definitely been a stressor along the way. 00:25:52.710 --> 00:25:57.200 position:50% align:middle We've had several clinical sites that have not come back up to speed yet and unfortunately, 00:25:57.200 --> 00:26:01.030 position:50% align:middle those are our specialty rotations like open heart, OB, and peads. 00:26:01.030 --> 00:26:07.890 position:50% align:middle And so we've had to rearrange the clinical schedule and send some of the residents farther out to clinical 00:26:07.890 --> 00:26:10.110 position:50% align:middle sites which has definitely been a burden. 00:26:10.110 --> 00:26:19.120 position:50% align:middle They're getting Airbnbs to be at a site for a month, you know, getting licenses in different states has 00:26:19.120 --> 00:26:20.380 position:50% align:middle been difficult also. 00:26:20.380 --> 00:26:24.840 position:50% align:middle In the beginning, state boards of nursing, so like New Jersey, they would allow any license. 00:26:24.840 --> 00:26:31.340 position:50% align:middle So that wasn't a difficulty, that was for, you know, licensed CRNAs and for our students but then, 00:26:31.340 --> 00:26:33.180 position:50% align:middle it has gone back. 00:26:33.180 --> 00:26:35.200 position:50% align:middle So that's made it a little bit more difficult. 00:26:35.200 --> 00:26:38.720 position:50% align:middle So going forward, I definitely see, as others have said, 00:26:38.720 --> 00:26:48.430 position:50% align:middle a hybrid more approach to be able to have classes and I definitely see us using more of like anesthesia 00:26:48.430 --> 00:26:53.160 position:50% align:middle simulator kind of work online and fit-testing. 00:26:53.160 --> 00:26:55.500 position:50% align:middle That was another thing that we'll have going forward. 00:26:55.500 --> 00:26:58.840 position:50% align:middle We'll have all of our classes before they start clinical fit-tested. 00:26:58.840 --> 00:27:02.450 position:50% align:middle So we have that documentation along the way too. 00:27:02.450 --> 00:27:06.500 position:50% align:middle Thank you for letting me share with you. 00:27:06.500 --> 00:27:11.460 position:50% align:middle - Thank you, Maribeth, for sharing your lessons learned and the adaptations 00:27:11.460 --> 00:27:13.460 position:50% align:middle that your program made. 00:27:13.460 --> 00:27:19.130 position:50% align:middle Next, we're going to go to Charlie Yingling, and he's going to talk with us about his NP program. 00:27:19.130 --> 00:27:22.450 position:50% align:middle - [Charlie] Thank you so much, Michelle. 00:27:22.450 --> 00:27:24.040 position:50% align:middle I'm Charlie Yingling. 00:27:24.040 --> 00:27:27.990 position:50% align:middle I'm the Associate Dean for Practice and Community Partnerships at the University of Illinois, Chicago. 00:27:27.990 --> 00:27:33.140 position:50% align:middle And I don't want to bury the lead so I'll start just with the title of this session, which is, 00:27:33.140 --> 00:27:34.430 position:50% align:middle can we go back, and should we. 00:27:34.430 --> 00:27:35.670 position:50% align:middle The answer is no. 00:27:35.670 --> 00:27:37.040 position:50% align:middle We can't go back and no, we shouldn't. 00:27:37.040 --> 00:27:42.790 position:50% align:middle And I'll talk a little bit about what we experienced at University of Illinois. 00:27:42.790 --> 00:27:47.730 position:50% align:middle One of the projects that I'm very involved in is a HRSA grant funded under the advancement of education 00:27:47.730 --> 00:27:50.410 position:50% align:middle workforce or a new funding mechanism. 00:27:50.410 --> 00:27:56.920 position:50% align:middle And a key element of that project was to integrate more telehealth into our family and psychiatric 00:27:56.920 --> 00:27:58.710 position:50% align:middle nurse practitioner programs. 00:27:58.710 --> 00:28:04.740 position:50% align:middle And I had to look back at my calendar in preparing for this conversation today because it was March 11, 00:28:04.740 --> 00:28:11.290 position:50% align:middle 2020 that we had this rather fortuitous telehealth seminar for our FNP and psych NP students. 00:28:11.290 --> 00:28:16.190 position:50% align:middle And as I recall on that day, we had heard something about this virus and we were 00:28:16.190 --> 00:28:19.550 position:50% align:middle kind of thinking like that probably is something to watch. 00:28:19.550 --> 00:28:25.550 position:50% align:middle And then it was nine days later that the governor of Illinois issued the Illinois stay at home order, 00:28:25.550 --> 00:28:28.630 position:50% align:middle which is really when, for us, when everything changed. 00:28:28.630 --> 00:28:34.390 position:50% align:middle And so I look back on that and think, well, we really got lucky that we had them all for a day 00:28:34.390 --> 00:28:38.650 position:50% align:middle because beginning on March 20, so many of our clinical experiences were 00:28:38.650 --> 00:28:40.910 position:50% align:middle moving to telehealth. 00:28:40.910 --> 00:28:46.180 position:50% align:middle We are a health sciences university and so we never formally closed clinical sites to students, 00:28:46.180 --> 00:28:48.050 position:50% align:middle at least within our system. 00:28:48.050 --> 00:28:54.040 position:50% align:middle But in practice, things were effectively closed because with social distancing and the lack of clarity, 00:28:54.040 --> 00:28:59.460 position:50% align:middle a lack of understanding on what was safe, it did not make sense for students to be 00:28:59.460 --> 00:29:02.190 position:50% align:middle in clinical sites. 00:29:02.190 --> 00:29:08.920 position:50% align:middle When this began, we work on a nine-month calendar and so most of our students graduate… And happily, 00:29:08.920 --> 00:29:17.210 position:50% align:middle across the NP programs, almost everyone was able to graduate between, you know, 00:29:17.210 --> 00:29:20.200 position:50% align:middle in time for that May graduation. 00:29:20.200 --> 00:29:27.090 position:50% align:middle We did have to do some creative telehealth experiences for students to satisfy ours but as is the case 00:29:27.090 --> 00:29:30.200 position:50% align:middle with some of the other speakers, most of our programs are over that 500-hour threshold. 00:29:30.200 --> 00:29:37.140 position:50% align:middle And so we could plug in simulation as needed for whatever curriculum requirements we had in excess 00:29:37.140 --> 00:29:38.100 position:50% align:middle of 500 hours. 00:29:38.100 --> 00:29:41.650 position:50% align:middle But I do want to talk a little bit, though, about some of the benefits of being in the academic 00:29:41.650 --> 00:29:45.420 position:50% align:middle system and having a stronger [inaudible]. 00:29:45.420 --> 00:29:50.140 position:50% align:middle We refer to these as sort of our owned and operated sites, although we have a lot more latitude 00:29:50.140 --> 00:29:52.590 position:50% align:middle with our student experiences. 00:29:52.590 --> 00:29:57.760 position:50% align:middle Example is the College of Nursing, our faculty and students set up the employee health 00:29:57.760 --> 00:30:01.890 position:50% align:middle COVID screening line in partnership with employee health service. 00:30:01.890 --> 00:30:06.520 position:50% align:middle Simultaneously, another faculty member and group of students were setting up the employee testing site also 00:30:06.520 --> 00:30:09.260 position:50% align:middle in partnership with our employee health services. 00:30:09.260 --> 00:30:14.770 position:50% align:middle And so we were able to get a lot of experiences both on the systems focused practicum as well as direct care 00:30:14.770 --> 00:30:21.050 position:50% align:middle experiences doing those COVID screenings remotely as well as doing on-site testing. 00:30:21.050 --> 00:30:26.900 position:50% align:middle Certainly, as others have mentioned, Zoom became our friend if it wasn't already. 00:30:26.900 --> 00:30:33.680 position:50% align:middle We going into this already had a hybrid program and so our…our faculty and our students were very accustomed 00:30:33.680 --> 00:30:35.540 position:50% align:middle to online learning. 00:30:35.540 --> 00:30:41.440 position:50% align:middle Our programs are offered across the State of Illinois so we cover a wide geographic area and so it wasn't new 00:30:41.440 --> 00:30:50.990 position:50% align:middle to us to be offering distance teaching or move our case studies and course meetings to Zoom. 00:30:50.990 --> 00:30:57.090 position:50% align:middle What was really contentious and remains contentious is the use of online proctoring. 00:30:57.090 --> 00:31:06.430 position:50% align:middle And I'll spare the editorial on it but there's a lot of concern about built-in racism in online proctoring 00:31:06.430 --> 00:31:12.630 position:50% align:middle software as well as not meeting the needs of students with differing abilities. 00:31:12.630 --> 00:31:17.430 position:50% align:middle And so that's a conversation we're continuing to have and I don't know that we'll continue to use online 00:31:17.430 --> 00:31:23.420 position:50% align:middle proctoring systems but it is something that our students and faculty alike have a great number 00:31:23.420 --> 00:31:24.750 position:50% align:middle of concerns with. 00:31:24.750 --> 00:31:28.680 position:50% align:middle So that's just kind of on the didactic side. 00:31:28.680 --> 00:31:34.590 position:50% align:middle As I referenced earlier, we did move really quickly to telehealth, 00:31:34.590 --> 00:31:36.240 position:50% align:middle particularly in our nursing faculty practice. 00:31:36.240 --> 00:31:40.270 position:50% align:middle Happily, we had a group of students who were both trained already on how to do telehealth and so it was 00:31:40.270 --> 00:31:46.400 position:50% align:middle within that first week of that stay at home order that we moved all of our visits to telehealth. 00:31:46.400 --> 00:31:54.340 position:50% align:middle We do have a large number of psychiatric providers here and so those visits moved very naturally to telehealth. 00:31:54.340 --> 00:31:59.510 position:50% align:middle And again, happily in Illinois, we see a large proportion of Medicaid patients at our 00:31:59.510 --> 00:32:04.470 position:50% align:middle practices and our governor did authorize full payment of Medicaid rates via whether it was 00:32:04.470 --> 00:32:05.890 position:50% align:middle by telephone or video. 00:32:05.890 --> 00:32:12.430 position:50% align:middle And I think that anyone who's used telehealth and populations that are traditionally underserved knows 00:32:12.430 --> 00:32:17.020 position:50% align:middle that there are some challenges with broadband and data plans. 00:32:17.020 --> 00:32:22.080 position:50% align:middle So phone-based telehealth was used both in practice as well as in teaching. 00:32:22.080 --> 00:32:26.670 position:50% align:middle The other thing I would take away from all of this is the importance of our strong 00:32:26.670 --> 00:32:28.460 position:50% align:middle academic practice partnerships. 00:32:28.460 --> 00:32:32.470 position:50% align:middle Two of our primary health system partners never stopped taking our pre-licensure students. 00:32:32.470 --> 00:32:36.100 position:50% align:middle Even at the height of the pandemic, our pre-licensure students were still doing clinicals. 00:32:36.100 --> 00:32:40.090 position:50% align:middle But it wasn't necessarily true for APRN students, though. 00:32:40.090 --> 00:32:45.900 position:50% align:middle In our community settings, those with which we…those practices with which we 00:32:45.900 --> 00:32:50.790 position:50% align:middle already had strong academic practice partnerships, be it through faculty practice experiences, 00:32:50.790 --> 00:32:56.160 position:50% align:middle be it through formal contracts, we were able to get up to speed much more quickly when 00:32:56.160 --> 00:32:58.340 position:50% align:middle we had those relationships in place. 00:32:58.340 --> 00:33:03.310 position:50% align:middle And I think that's a key takeaway that we already know the importance of academic practice partnerships in NP 00:33:03.310 --> 00:33:09.620 position:50% align:middle education but this can improve, why we must continue to nurture those partnerships 00:33:09.620 --> 00:33:10.480 position:50% align:middle and grow them. 00:33:10.480 --> 00:33:14.080 position:50% align:middle In those settings where we had those strong partnerships, we were able to get students back 00:33:14.080 --> 00:33:17.360 position:50% align:middle into clinical in May or June, which in the family nurse practitioner program, 00:33:17.360 --> 00:33:19.910 position:50% align:middle students start their first clinical rotation this summer. 00:33:19.910 --> 00:33:22.270 position:50% align:middle That lined up very well for them. 00:33:22.270 --> 00:33:26.540 position:50% align:middle On the psychiatric nurse practitioner program, that's usually about the middle of the year and they 00:33:26.540 --> 00:33:28.440 position:50% align:middle don't typically have clinicals in the summer. 00:33:28.440 --> 00:33:30.830 position:50% align:middle So we had a little bit of breathing room for our psych NP students. 00:33:30.830 --> 00:33:37.710 position:50% align:middle Again, as I mentioned before, most of our graduates in May of 2020 cohort made it, 00:33:37.710 --> 00:33:43.450 position:50% align:middle and the August and December 2020 cohorts, which are much, much, much smaller than May, again, 00:33:43.450 --> 00:33:45.640 position:50% align:middle most of those guys did just fine. 00:33:45.640 --> 00:33:50.450 position:50% align:middle As others have referenced, all of our students are practicing nurses. 00:33:50.450 --> 00:33:53.190 position:50% align:middle Very few of them are full time students. 00:33:53.190 --> 00:34:03.390 position:50% align:middle And the experience of being a practicing nurse in this pandemic was brutal and I cannot say enough how 00:34:03.390 --> 00:34:10.610 position:50% align:middle resilient our students demonstrated themselves to be, one, sticking with school and continue, though, 00:34:10.610 --> 00:34:14.390 position:50% align:middle a handful did have to decelerate for reasons that others have referenced. 00:34:14.390 --> 00:34:21.840 position:50% align:middle But it's something that the emotional toll of being a nurse throughout this time as well as being a 00:34:21.840 --> 00:34:23.980 position:50% align:middle graduate student, it's extraordinary. 00:34:23.980 --> 00:34:32.390 position:50% align:middle And the fact that they persevere really speaks to how hard these graduate students are working. 00:34:32.390 --> 00:34:35.910 position:50% align:middle One of the challenges associated with completion, of course, is getting those clinical hours in. 00:34:35.910 --> 00:34:43.680 position:50% align:middle And we know, as it's been referenced earlier in this conference about NP education currently 00:34:43.680 --> 00:34:48.830 position:50% align:middle being attendance-based, that you do your 500 hours or more and that is 00:34:48.830 --> 00:34:50.170 position:50% align:middle basically the requirement. 00:34:50.170 --> 00:34:56.580 position:50% align:middle We don't have a competency-based education where we can break apart the specific competencies that you need 00:34:56.580 --> 00:35:03.650 position:50% align:middle to help you meet those through simulation, through activities outside of the clinical setting. 00:35:03.650 --> 00:35:11.620 position:50% align:middle So we had to take off…we did do a lot of effort to sort of round out those hours that the students were getting 00:35:11.620 --> 00:35:16.870 position:50% align:middle because the reality was that even when they were back in clinical, the experience was not the same as it was 00:35:16.870 --> 00:35:19.080 position:50% align:middle in the before times. 00:35:19.080 --> 00:35:26.690 position:50% align:middle They were having much more focused experiences and they weren't getting all of that sort of on the job learning 00:35:26.690 --> 00:35:32.590 position:50% align:middle that one gets just by showing up to clinicals such as how to get a prior authorization, 00:35:32.590 --> 00:35:37.660 position:50% align:middle how to deal with disability paperwork, how to deal with afterhours call. 00:35:37.660 --> 00:35:41.680 position:50% align:middle And so that was one we're really proud of how our faculty handled this. 00:35:41.680 --> 00:35:48.420 position:50% align:middle We worked with our academic practice partnerships to really inventory the traits of what…we asked them, 00:35:48.420 --> 00:35:53.750 position:50% align:middle you know, what are the traits that you see in a new graduate nurse practitioner that tells you this person 00:35:53.750 --> 00:35:55.100 position:50% align:middle is prepared for the job? 00:35:55.100 --> 00:36:01.450 position:50% align:middle And so working from that list of traits, which we loosely would have defined as competencies, 00:36:01.450 --> 00:36:05.730 position:50% align:middle we identified the specific content that we needed to deliver to the students to help 00:36:05.730 --> 00:36:08.440 position:50% align:middle build those competencies. 00:36:08.440 --> 00:36:15.090 position:50% align:middle And again, it's the softer elements of NP practice and often, the administrative elements of NP practice that 00:36:15.090 --> 00:36:18.980 position:50% align:middle we built into a series called community health outside the exam room. 00:36:18.980 --> 00:36:23.980 position:50% align:middle And we offered that by Zoom on Thursday evenings throughout the summer and fall semesters and we 00:36:23.980 --> 00:36:29.420 position:50% align:middle continue that with the spring semester, introducing new topics each semester to really try 00:36:29.420 --> 00:36:34.080 position:50% align:middle to round out what are functionally very constrained direct care experiences anymore. 00:36:34.080 --> 00:36:38.560 position:50% align:middle But despite all of these challenges, there's a number of opportunities that arose. 00:36:38.560 --> 00:36:45.010 position:50% align:middle With all of our work in coordinating vaccine response and coordinating testing response, 00:36:45.010 --> 00:36:50.190 position:50% align:middle we had an array of opportunities for students, particularly pre-licensure students, 00:36:50.190 --> 00:36:51.740 position:50% align:middle but for NP students as well. 00:36:51.740 --> 00:36:59.220 position:50% align:middle We're an all DNP program and building the plane while we're flying is very much a systems-focused practicum 00:36:59.220 --> 00:37:00.390 position:50% align:middle for our students. 00:37:00.390 --> 00:37:07.490 position:50% align:middle And so for any of our students doing DNP projects, everything became COVID overnight. 00:37:07.490 --> 00:37:12.120 position:50% align:middle And they really contributed to our college as well as our university response, 00:37:12.120 --> 00:37:17.590 position:50% align:middle and there's three of them in my clinic right now giving vaccines to hundreds of people who will be marching 00:37:17.590 --> 00:37:19.520 position:50% align:middle through this place today. 00:37:19.520 --> 00:37:25.610 position:50% align:middle And our students and faculty really were the architects of what today is a high volume COVID vaccine clinic 00:37:25.610 --> 00:37:28.190 position:50% align:middle for our community and they're running it. 00:37:28.190 --> 00:37:30.740 position:50% align:middle Other barriers were about PPE. 00:37:30.740 --> 00:37:33.770 position:50% align:middle As everyone has said, PPE was a nightmare. 00:37:33.770 --> 00:37:37.760 position:50% align:middle I went and redid our simulation center around a weekend early in the pandemic distrained, 00:37:37.760 --> 00:37:42.110 position:50% align:middle squeeze out what it could to bring to our faculty practice and their College of Dentistry organized the 00:37:42.110 --> 00:37:44.470 position:50% align:middle clandestine order of N95s from China. 00:37:44.470 --> 00:37:48.720 position:50% align:middle I still do not know what all went on with that but they brought a great supplier of N95s 00:37:48.720 --> 00:37:49.930 position:50% align:middle into the health system. 00:37:49.930 --> 00:37:55.630 position:50% align:middle And so as others have referenced there, those were barriers too with our smaller community 00:37:55.630 --> 00:38:00.760 position:50% align:middle partners who didn't have access to a plane to bring N95s from China. 00:38:00.760 --> 00:38:04.870 position:50% align:middle We were having to send our students with their own PPE. 00:38:04.870 --> 00:38:10.140 position:50% align:middle So I'll stop there to allow time for Q&A and again, thank you for the opportunity to lobby on this panel. 00:38:10.140 --> 00:38:13.370 position:50% align:middle I appreciate it. 00:38:13.370 --> 00:38:17.380 position:50% align:middle - Thank you very much, Charlie, for sharing your experiences and identifying 00:38:17.380 --> 00:38:19.410 position:50% align:middle opportunities that came from it. 00:38:19.410 --> 00:38:21.300 position:50% align:middle I appreciate that. 00:38:21.300 --> 00:38:29.980 position:50% align:middle Now, we are going to begin our Q&A session and all four of our panelists will be available to respond 00:38:29.980 --> 00:38:31.710 position:50% align:middle to your questions. 00:38:31.710 --> 00:38:36.290 position:50% align:middle We already have quite a few questions in the Q&A function but if you come up with another one, 00:38:36.290 --> 00:38:39.160 position:50% align:middle please continue to add your questions there. 00:38:39.160 --> 00:38:43.860 position:50% align:middle So the first question, and it doesn't specify a panelist so I would just ask 00:38:43.860 --> 00:38:51.590 position:50% align:middle all of you to share your insights and input, from Sharon Friedman Yurovich, her question is, 00:38:51.590 --> 00:38:58.880 position:50% align:middle could you share which simulation software you utilized with your students to adjunct or enhance their 00:38:58.880 --> 00:39:01.760 position:50% align:middle on-site clinical experiences? 00:39:01.760 --> 00:39:06.840 position:50% align:middle And maybe we'll just go around starting with Carol just as we see you on the screen. 00:39:06.840 --> 00:39:17.370 position:50% align:middle - We used i-Human and Shadow Health both, but I don't think we used them exactly the 00:39:17.370 --> 00:39:20.230 position:50% align:middle way they intended. 00:39:20.230 --> 00:39:24.418 position:50% align:middle - Okay. Ira? 00:39:34.100 --> 00:39:38.170 position:50% align:middle Ira, you may be on mute. 00:39:38.170 --> 00:39:40.400 position:50% align:middle - Sorry about that. For midwifery… 00:39:40.400 --> 00:39:41.860 position:50% align:middle - Better, thank you. 00:39:41.860 --> 00:39:43.830 position:50% align:middle - Welcome. 00:39:43.830 --> 00:39:50.550 position:50% align:middle Many of these platforms do not have as much of a focus on the specific kind of experiences that we would 00:39:50.550 --> 00:39:51.740 position:50% align:middle like to use in midwifery. 00:39:51.740 --> 00:39:59.290 position:50% align:middle So while we had those software platforms available for our DNP program generally, 00:39:59.290 --> 00:40:02.360 position:50% align:middle our faculty in midwifery used those less. 00:40:02.360 --> 00:40:15.430 position:50% align:middle But we developed…we worked one-on-one with students to get them other kinds of experiences where we would…we 00:40:15.430 --> 00:40:22.230 position:50% align:middle send pelvic models with fetuses and placentas to all of our student homes so that they could practice skills 00:40:22.230 --> 00:40:30.590 position:50% align:middle using those models and we would do them…we would have various activities with faculty on Zoom using those 00:40:30.590 --> 00:40:34.751 position:50% align:middle models and we did the same thing with suturing. 00:40:34.751 --> 00:40:37.845 position:50% align:middle - Thank you. Maribeth? 00:40:37.845 --> 00:40:43.520 position:50% align:middle - Unfortunately, there's not that much anesthesia simulation software that's out there, 00:40:43.520 --> 00:40:46.360 position:50% align:middle and what is out there is really, really expensive. 00:40:46.360 --> 00:40:49.160 position:50% align:middle But we did purchase one platform, it was called Anesoft, 00:40:49.160 --> 00:40:50.990 position:50% align:middle and it's an anesthesia simulator. 00:40:50.990 --> 00:40:56.430 position:50% align:middle And you could control all the dials, you could do all the, 00:40:56.430 --> 00:40:59.840 position:50% align:middle essentially the tasks and the skills, you can make decisions, you know, 00:40:59.840 --> 00:41:01.440 position:50% align:middle if the blood pressure is low, etc. 00:41:01.440 --> 00:41:08.120 position:50% align:middle So that was very worthwhile and we used that with students and went over different case studies and, 00:41:08.120 --> 00:41:11.590 position:50% align:middle you know, would have a case set up for that and look at it. 00:41:11.590 --> 00:41:17.550 position:50% align:middle I know the School of Nursing did use i-Human and several other different platforms. 00:41:17.550 --> 00:41:19.500 position:50% align:middle We had looked at using Shadow Health. 00:41:19.500 --> 00:41:23.610 position:50% align:middle They don't have any anesthesia related, really applicable. 00:41:23.610 --> 00:41:26.520 position:50% align:middle I had used it in a prior position. 00:41:26.520 --> 00:41:33.120 position:50% align:middle So we did not go there but it is good for pre-op evaluation so we did use it for that. 00:41:33.120 --> 00:41:42.430 position:50% align:middle Other than that, we would send videos and then we would dissect the videos as a class with the faculty and that 00:41:42.430 --> 00:41:44.000 position:50% align:middle would work very well also. 00:41:44.000 --> 00:41:48.710 position:50% align:middle So we were able to use, you know, piece together some of the forms for simulation. 00:41:48.710 --> 00:41:50.530 position:50% align:middle It was just a little bit more difficult. 00:41:50.530 --> 00:41:57.630 position:50% align:middle Oh, we also purchased a regional anesthesia subscription, [inaudible 00:41:55] the New York State 00:41:57.630 --> 00:42:02.340 position:50% align:middle Association of Regional Anesthetics and that, the students were able to get a lot of information 00:42:02.340 --> 00:42:06.950 position:50% align:middle from there also. - Thank you. Charlie? 00:42:06.950 --> 00:42:11.240 position:50% align:middle - So our College of Nursing did subscribe to i-Human. 00:42:11.240 --> 00:42:13.660 position:50% align:middle We weren't using it as much in the nurse practitioner programs. 00:42:13.660 --> 00:42:17.990 position:50% align:middle Our simulation that we did do was working with actors over Zoom. 00:42:17.990 --> 00:42:23.210 position:50% align:middle Chicago has a rich pool of improvisational actors, many of them were happy to find work. 00:42:23.210 --> 00:42:31.160 position:50% align:middle And so we did a lot of scenarios and formative simulation rather than summative. 00:42:31.160 --> 00:42:35.570 position:50% align:middle We did move standardized patients as well to Zoom understanding, of course, 00:42:35.570 --> 00:42:40.860 position:50% align:middle there's no physical assessment but there's plenty that we could do on that platform. 00:42:40.860 --> 00:42:45.350 position:50% align:middle We did also, for our psychiatric nurse practitioner students, purchase a product called Symptom Media, 00:42:45.350 --> 00:42:51.540 position:50% align:middle which is not an interactive simulation platform but rather a series of recordings of specific psychiatric 00:42:51.540 --> 00:42:58.000 position:50% align:middle conditions that allow the student to use some of the assessment skills. 00:42:58.000 --> 00:43:01.140 position:50% align:middle - Thank you. Charlie, I think this question is for you. 00:43:01.140 --> 00:43:02.900 position:50% align:middle It's from Sarah McCumber. 00:43:02.900 --> 00:43:08.510 position:50% align:middle And she asks, if students have concern about online proctoring, how are you addressing 00:43:08.510 --> 00:43:10.210 position:50% align:middle test security concerns? 00:43:10.210 --> 00:43:13.510 position:50% align:middle - That is an excellent question, Sarah. 00:43:13.510 --> 00:43:17.450 position:50% align:middle And, you know, we are still using it for that very reason. 00:43:17.450 --> 00:43:23.690 position:50% align:middle And, you know, the reality that sort of counterpoint on this, of course, is when you go take your boards, 00:43:23.690 --> 00:43:28.880 position:50% align:middle when you go take your NCLEX or your pre-licensure, you will be in a proctored environment. 00:43:28.880 --> 00:43:31.720 position:50% align:middle It is no different than that. 00:43:31.720 --> 00:43:37.700 position:50% align:middle What the other side of that is that there are other ways to demonstrate mastery of content 00:43:37.700 --> 00:43:40.300 position:50% align:middle aside from multiple choice examinations. 00:43:40.300 --> 00:43:46.230 position:50% align:middle And so I agree wholeheartedly that if you're using a multiple choice examination, 00:43:46.230 --> 00:43:49.080 position:50% align:middle there has to be some degree of test security. 00:43:49.080 --> 00:43:57.640 position:50% align:middle I think the flaws with the online proctoring services have to do with the artificial intelligence and the 00:43:57.640 --> 00:44:05.200 position:50% align:middle algorithms built into them but I think that the challenge to us as faculty is how can we evaluate 00:44:05.200 --> 00:44:11.170 position:50% align:middle students for mastery of content in ways other than multiple choice exams. 00:44:11.170 --> 00:44:17.280 position:50% align:middle But I do share the opinion that when a multiple choice test is the only way to demonstrate mastery, 00:44:17.280 --> 00:44:18.660 position:50% align:middle it needs to be in a proctored environment. 00:44:18.660 --> 00:44:21.310 position:50% align:middle - Thank you. 00:44:21.310 --> 00:44:23.070 position:50% align:middle Maribeth, I noticed you were nodding. 00:44:23.070 --> 00:44:25.760 position:50% align:middle Did you have a comment on this question? 00:44:25.760 --> 00:44:28.570 position:50% align:middle - Thank you, Michelle. Yes. 00:44:28.570 --> 00:44:34.180 position:50% align:middle We did look at all that software from ExamSoft monitor to ProctorU and several others, 00:44:34.180 --> 00:44:39.130 position:50% align:middle but that is a big concern, is that there is an issue with the artificial 00:44:39.130 --> 00:44:41.900 position:50% align:middle intelligence especially with other races. 00:44:41.900 --> 00:44:48.180 position:50% align:middle And so we decided not to go with that and every program, essentially what we did is, 00:44:48.180 --> 00:44:52.190 position:50% align:middle and we wrote policies for this and now it's, you know, standard in the handbook, 00:44:52.190 --> 00:44:54.240 position:50% align:middle is we had them use two devices. 00:44:54.240 --> 00:44:59.750 position:50% align:middle And so they would do their ExamSoft on their computer screen and then they have to have another device setup 00:44:59.750 --> 00:45:03.010 position:50% align:middle so we could see their work environment and we would check it. 00:45:03.010 --> 00:45:09.810 position:50% align:middle And the faculty, if you wanted more TAs or proctors, we could get that from the university. 00:45:09.810 --> 00:45:15.070 position:50% align:middle I think a lot of us in the nurse anesthesia program, the class size was, you know, 37 to 40. 00:45:15.070 --> 00:45:21.810 position:50% align:middle So we felt like we could monitor well enough on ExamSoft or on Zoom. 00:45:21.810 --> 00:45:27.000 position:50% align:middle So they would log in to ExamSoft and then they would take Zoom from their other device and we would say, 00:45:27.000 --> 00:45:29.610 position:50% align:middle you know, "You're good to go, we see your full work environment." 00:45:29.610 --> 00:45:33.430 position:50% align:middle And then at the end, they would have to show that they were done with their 00:45:33.430 --> 00:45:34.910 position:50% align:middle exams off screen. 00:45:34.910 --> 00:45:38.570 position:50% align:middle So sure, could somebody have something on their wall? 00:45:38.570 --> 00:45:39.940 position:50% align:middle They could do that. 00:45:39.940 --> 00:45:44.150 position:50% align:middle But, you know, I got to tell you, from looking at the grades and the way everything 00:45:44.150 --> 00:45:47.450 position:50% align:middle leveled out, it does not necessarily seem like that. 00:45:47.450 --> 00:45:55.720 position:50% align:middle But still, we technically can't be sure about test integrity but we sort of took like a much more 00:45:55.720 --> 00:46:01.210 position:50% align:middle like grass, like roots kind of level, not as fancy as it sounds like Charles had used. 00:46:01.210 --> 00:46:04.890 position:50% align:middle - Thank you. 00:46:04.890 --> 00:46:07.370 position:50% align:middle Ira, did you have a comment? 00:46:07.370 --> 00:46:13.670 position:50% align:middle - Yes, I think at the University of Washington, we use Proctorio, which is a, you know, 00:46:13.670 --> 00:46:17.240 position:50% align:middle a similar platform for exam security. 00:46:17.240 --> 00:46:28.780 position:50% align:middle But what we did during and continue to do during the pandemic is we have allowed our students to shift 00:46:28.780 --> 00:46:38.350 position:50% align:middle from a graded course to satisfactory, not satisfactory, without any knowledge of the faculty so that it takes 00:46:38.350 --> 00:46:46.060 position:50% align:middle some of the pressure off in an environment where our students are experiencing such extreme stress. 00:46:46.060 --> 00:46:52.530 position:50% align:middle This was something that our university allowed us to do, to give them the freedom to take some 00:46:52.530 --> 00:46:56.160 position:50% align:middle of that pressure off. 00:46:56.160 --> 00:47:03.490 position:50% align:middle I like to think of this as really a compassionate approach towards, you know, giving them that freedom. 00:47:03.490 --> 00:47:08.560 position:50% align:middle And so, you know, many…as a faculty, I don't know who has made this choice or not. 00:47:08.560 --> 00:47:10.430 position:50% align:middle I just grade them the same. 00:47:10.430 --> 00:47:17.070 position:50% align:middle And if they chose to go for the satisfactory or not satisfactory route, that would just be handled 00:47:17.070 --> 00:47:18.990 position:50% align:middle at the registrar level. 00:47:18.990 --> 00:47:25.660 position:50% align:middle So it's just one…it's a little thing but it really made a big difference to have that option for our students. 00:47:25.660 --> 00:47:28.610 position:50% align:middle - Thank you. 00:47:28.610 --> 00:47:32.090 position:50% align:middle And Carol, would you like to comment on this question? 00:47:32.090 --> 00:47:40.070 position:50% align:middle - We've been using Proctorio, added work from faculty perspective because we do 00:47:40.070 --> 00:47:48.350 position:50% align:middle require faculty to review all of the videos whether or not the program has flagged them. 00:47:48.350 --> 00:47:54.040 position:50% align:middle If we see something, we have a one-on-one with the student and we discuss 00:47:54.040 --> 00:47:55.060 position:50% align:middle anything we've seen. 00:47:55.060 --> 00:48:02.410 position:50% align:middle The CNS program, we haven't detected anything except for one student received a phone call during the visit 00:48:02.410 --> 00:48:05.220 position:50% align:middle and she immediately picked up her phone and called the faculty and she goes, 00:48:05.220 --> 00:48:08.270 position:50% align:middle "I made a mistake and I answered my phone." 00:48:08.270 --> 00:48:12.580 position:50% align:middle So they were very upfront about it. 00:48:12.580 --> 00:48:15.760 position:50% align:middle - Thank you. 00:48:15.760 --> 00:48:22.630 position:50% align:middle Our next question is specifically to Charlie but I would be interested in other's insights 00:48:22.630 --> 00:48:24.580 position:50% align:middle on this as well. 00:48:24.580 --> 00:48:30.380 position:50% align:middle It's from Rita D'oused and she's asking, can you discuss a bit more about the racism 00:48:30.380 --> 00:48:33.140 position:50% align:middle in online proctoring? 00:48:33.140 --> 00:48:34.220 position:50% align:middle - Sure. 00:48:34.220 --> 00:48:36.460 position:50% align:middle I should thank you, Rita, a great question and I really should 00:48:36.460 --> 00:48:41.170 position:50% align:middle [inaudible 00:48:36] say, I am far from expert on this topic. 00:48:41.170 --> 00:48:48.340 position:50% align:middle What I have read and what I understand is that the algorithms that identify whether or not an individual 00:48:48.340 --> 00:48:55.450 position:50% align:middle is looking at their device versus turning away do not as accurately capture the movement of people 00:48:55.450 --> 00:49:01.810 position:50% align:middle with darker skin. And so this has been a lot of the criticism that on some of these platforms, 00:49:01.810 --> 00:49:09.780 position:50% align:middle they were flagging people with darker skin as looking around the room more based on failing of the AI. 00:49:09.780 --> 00:49:14.910 position:50% align:middle The other criticism aside from the racism piece that I've heard, and again, 00:49:14.910 --> 00:49:19.460 position:50% align:middle please understand that I'm not an expert on this, the students have shared, it's just the anxiety, 00:49:19.460 --> 00:49:23.310 position:50% align:middle as was just shared of, "Oh, my goodness, I accidentally picked up my phone, 00:49:23.310 --> 00:49:25.110 position:50% align:middle I need to immediately call my faculty." 00:49:25.110 --> 00:49:30.690 position:50% align:middle You can imagine how that changes your train of thought. 00:49:30.690 --> 00:49:37.520 position:50% align:middle And please know that I'm not advocating for or against online proctoring but rather just sharing 00:49:37.520 --> 00:49:42.350 position:50% align:middle what the conversations we've had at University of Illinois, Chicago have been. 00:49:42.350 --> 00:49:44.820 position:50% align:middle - Thank you. 00:49:44.820 --> 00:49:46.400 position:50% align:middle I'm just going to go around the room. 00:49:46.400 --> 00:49:51.010 position:50% align:middle Maribeth, do you have any comments on that? - No. 00:49:51.010 --> 00:49:59.670 position:50% align:middle I mean, it sounds…it is a service that is very cumbersome and as Carol was saying, you know, 00:49:59.670 --> 00:50:05.090 position:50% align:middle we were talking about we were going to have to review all the videos and we, as a faculty, 00:50:05.090 --> 00:50:09.830 position:50% align:middle just decided that that wasn't the way to go and we'd stay with our, you know, 00:50:09.830 --> 00:50:13.793 position:50% align:middle essentially do it yourself kind of techniques. 00:50:13.793 --> 00:50:15.180 position:50% align:middle - Ira? 00:50:15.180 --> 00:50:27.100 position:50% align:middle - I think the technology has to be critically examined and the way we…I can't imagine having to review 00:50:27.100 --> 00:50:28.310 position:50% align:middle every single video. 00:50:28.310 --> 00:50:30.570 position:50% align:middle That would be extremely time consuming. 00:50:30.570 --> 00:50:38.880 position:50% align:middle But when I've used Proctorio, I've taken a look at the scoring or the flagging 00:50:38.880 --> 00:50:45.550 position:50% align:middle of certain videos and I take a look and I always approach it with a high level of skepticism that the 00:50:45.550 --> 00:50:47.170 position:50% align:middle student has actually done anything wrong. 00:50:47.170 --> 00:50:53.220 position:50% align:middle And I review the videos and I've never actually seen anyone do anything that looked like cheating to me. 00:50:53.220 --> 00:51:04.320 position:50% align:middle So I think the need to proctor exams is not going to go away but we have…before the pandemic, 00:51:04.320 --> 00:51:09.320 position:50% align:middle students had the option of coming to campus and just being proctored by, you know, 00:51:09.320 --> 00:51:16.730 position:50% align:middle live people in a room taking the test together or they could stay home and do it on online and be 00:51:16.730 --> 00:51:18.670 position:50% align:middle proctored by Proctorio. 00:51:18.670 --> 00:51:22.840 position:50% align:middle And again, by giving students choices, they found what was most comfortable for them. 00:51:22.840 --> 00:51:28.780 position:50% align:middle We have sometimes distanced students who need to drive three hours to come to campus and for them, 00:51:28.780 --> 00:51:32.780 position:50% align:middle they really appreciated the ability to be proctored at home online. 00:51:32.780 --> 00:51:37.000 position:50% align:middle And for other students who really did not feel comfortable with that, who lived closer, 00:51:37.000 --> 00:51:39.790 position:50% align:middle it was much better for them to just come to campus. 00:51:39.790 --> 00:51:48.380 position:50% align:middle So I think again, if we keep the student experience in mind and provide them opportunities for choices, 00:51:48.380 --> 00:51:53.340 position:50% align:middle even if their choice wouldn't change much, the fact that they had a choice can make a difference 00:51:53.340 --> 00:51:57.610 position:50% align:middle for how they feel about the experience. 00:51:57.610 --> 00:51:59.100 position:50% align:middle - Carol? 00:51:59.100 --> 00:52:07.190 position:50% align:middle - The big feedback from the students from us was online testing provided them with more flexibility. 00:52:07.190 --> 00:52:13.730 position:50% align:middle Many of them are parents or caregivers or have increased work shift with COVID. 00:52:13.730 --> 00:52:21.210 position:50% align:middle So we didn't require them to take it in a set two-hour period as be prior to the pandemic. 00:52:21.210 --> 00:52:31.140 position:50% align:middle We gave them a much more broad 24-hour period but we also lowered the stakes of those exams by having more 00:52:31.140 --> 00:52:38.380 position:50% align:middle in-class assignments and more in-class spot survey quizzes. 00:52:38.380 --> 00:52:42.020 position:50% align:middle So we hadn't seen any change in the grading scale. 00:52:42.020 --> 00:52:46.750 position:50% align:middle The students expressed a great deal of appreciation for the flexibility. 00:52:46.750 --> 00:52:54.320 position:50% align:middle They said how much it really lowered their stress to be able to wait until the kids got tucked in the bed or 00:52:54.320 --> 00:52:58.680 position:50% align:middle that type of thing. 00:52:58.680 --> 00:53:03.780 position:50% align:middle - Thank you. This is going to be our last question, and it's from Sean Degarmo. 00:53:03.780 --> 00:53:10.540 position:50% align:middle And he asks, are programs having trouble regaining access to clinical sites while other students such 00:53:10.540 --> 00:53:17.720 position:50% align:middle as PAs, pharmacy, medical students, and residents have been permitted to return? 00:53:17.720 --> 00:53:20.070 position:50% align:middle Why don't we start with Carol? 00:53:20.070 --> 00:53:26.090 position:50% align:middle - Initially, I would have said yes, but we've been pairing with our sites very closely 00:53:26.090 --> 00:53:32.750 position:50% align:middle first to help them with COVID testing and now, we're helping them with the vaccine administration 00:53:32.750 --> 00:53:36.620 position:50% align:middle initially with the preceptors and then with their patient populations. 00:53:36.620 --> 00:53:41.150 position:50% align:middle So they're gradually opening up more and more. 00:53:41.150 --> 00:53:44.846 position:50% align:middle So that's a real positive. 00:53:44.846 --> 00:53:47.710 position:50% align:middle - Thank you. Ira? 00:53:47.710 --> 00:53:55.650 position:50% align:middle - I think where we are in the pandemic right now, we really have returned to a more normal situation 00:53:55.650 --> 00:53:57.580 position:50% align:middle with being able to place our students. 00:53:57.580 --> 00:54:02.800 position:50% align:middle I think the clinical sites have really relaxed quite a bit, particularly now that we have 00:54:02.800 --> 00:54:04.210 position:50% align:middle vaccinations coming out. 00:54:04.210 --> 00:54:13.480 position:50% align:middle So we're close to the ability to get all of our students placed. 00:54:13.480 --> 00:54:17.080 position:50% align:middle It's always been a struggle to get enough clinical placements for our students. 00:54:17.080 --> 00:54:21.490 position:50% align:middle We always have to work really hard and probably harder than would be ideal. 00:54:21.490 --> 00:54:24.790 position:50% align:middle If I could change the world, that would be one thing that I would change was I would 00:54:24.790 --> 00:54:31.220 position:50% align:middle make it a lot easier for midwifery and advanced practice programs to place their students, 00:54:31.220 --> 00:54:33.660 position:50% align:middle you know, nationally. 00:54:33.660 --> 00:54:39.740 position:50% align:middle It was much harder earlier on during the pandemic where we were basically shut down and that's where there was 00:54:39.740 --> 00:54:45.620 position:50% align:middle inequity with medical residents, medical students having a much easier time particularly 00:54:45.620 --> 00:54:52.230 position:50% align:middle when the academic medical centers had such a much closer alignment between schools of medicine and 00:54:52.230 --> 00:54:59.095 position:50% align:middle academic medical centers than schools of nursing have with academic medical centers. 00:54:59.095 --> 00:55:01.590 position:50% align:middle - Thank you. Maribeth? 00:55:01.590 --> 00:55:03.840 position:50% align:middle - And I echo what Ira said. 00:55:03.840 --> 00:55:11.650 position:50% align:middle It was frustrating initially because they allowed the physician anesthesia residents to stay on doing cases 00:55:11.650 --> 00:55:17.020 position:50% align:middle and our nurse anesthesia residents weren't allowed, were told they couldn't be there. 00:55:17.020 --> 00:55:19.290 position:50% align:middle So that was somewhat frustrating. 00:55:19.290 --> 00:55:21.550 position:50% align:middle But now, they're back to the majority of our sites. 00:55:21.550 --> 00:55:26.890 position:50% align:middle I think we have five sites that still…they're just saying, "No, not yet. We're not settled yet." 00:55:26.890 --> 00:55:32.980 position:50% align:middle And that's been frustrating but also, the positive that came out of it is we've been able 00:55:32.980 --> 00:55:40.240 position:50% align:middle to open up other clinical sites and they're ready to take our students and that's been a great opportunity. 00:55:40.240 --> 00:55:45.360 position:50% align:middle And, you know, when you talk to the sites, I mean, it's the same thing for all our programs. 00:55:45.360 --> 00:55:49.720 position:50% align:middle When your students rotate through, that's your chance to see, you know, 00:55:49.720 --> 00:55:53.930 position:50% align:middle if you want to hire them in the future and their chance to see if it's a place they want to work at. 00:55:53.930 --> 00:55:56.420 position:50% align:middle So it's definitely a recruitment tool. 00:55:56.420 --> 00:56:01.200 position:50% align:middle And we have had sites coming to us saying, "Hey, why don't you bring your students here?" 00:56:01.200 --> 00:56:05.375 position:50% align:middle So that has been very positive. 00:56:05.375 --> 00:56:06.780 position:50% align:middle - Great. Charlie? 00:56:06.780 --> 00:56:12.200 position:50% align:middle - Yeah, echoing Ira and Maribeth, early on, we certainly saw a preference for medical students even 00:56:12.200 --> 00:56:19.190 position:50% align:middle within our own health system but I would say that that's largely dissipated at this point and we're far 00:56:19.190 --> 00:56:23.740 position:50% align:middle from back to completely normal, we're much further along. 00:56:23.740 --> 00:56:29.570 position:50% align:middle And I would echo Ira's sentiments that we need a federal solution to the problem of nurse practitioner 00:56:29.570 --> 00:56:35.650 position:50% align:middle in clinical learning and yeah, we scramble every semester but happily, you know, 00:56:35.650 --> 00:56:39.350 position:50% align:middle so far so good. 00:56:39.350 --> 00:56:46.950 position:50% align:middle - Well, we want to say thank you so much to our panelists, Charlie Yingling, Maribeth Massie, 00:56:46.950 --> 00:56:52.590 position:50% align:middle Ira Kantrowitz-Gordon, and Carol Delville for a terrific panel discussion. 00:56:52.590 --> 00:56:54.390 position:50% align:middle Thank you so very much. 00:56:54.390 --> 00:56:56.620 position:50% align:middle - Thank you for the opportunity. 00:56:56.620 --> 00:56:58.670 position:50% align:middle - Yes, thank you very much, everybody. 00:56:58.670 --> 00:57:01.480 position:50% align:middle - Thank you. 00:57:28.100 --> 00:57:35.300 position:50% align:middle - We'd like to thank you all for joining us today and hopefully, we'll be able to meet in person next year. 00:57:35.300 --> 00:57:41.640 position:50% align:middle We appreciate, so very much, all the speakers that presented today. 00:57:41.640 --> 00:57:45.630 position:50% align:middle We just felt like we had a terrific meeting. 00:57:45.630 --> 00:57:51.390 position:50% align:middle Thank you also to all the NCSBN staff that contributed to this meeting. 00:57:51.390 --> 00:58:02.229 position:50% align:middle So we'd like to just say have a great rest of your day and goodbye and again, thank you for joining us.