Virtual Clinical: PSU Nursing Students Graduate Early to Help Combat COVID-19

Ten senior nursing students recently graduated a month early to be the first in New Hampshire to join the frontlines, allowing them to begin working in the state’s hospitals and other health care settings. Through a group effort by the New Hampshire Board of Nursing (NHBON), the Governor’s Office, and partners across the PSU campus, they will work as graduate nurses while awaiting temporary licensing and preparing for the National Clinical Licensing Exam (NCLEX). 

“This was a true team effort on the part of students, staff, faculty, Government Relations, and the Registrar’s Office,” said President Donald Birx. 

Plymouth State University continues to be on the forefront of higher education innovation and reform as it responds to the coronavirus pandemic. While the transition to remote learning posed a unique challenge of adapting clinical to meet accreditation and Board of Nursing requirements, the nursing programfound a creative solution through virtual simulations. 

“We had already been looking into simulations as a way to make up clinical hours on snow days, so we had some options up our sleeves,” says Jean Coffey, PhD, APRN, FAAN, who directs the program. “It was a quick turnaround. We had them up and running shortly after spring break.”  

This brief window of time required a lot of moving parts to come together quickly. The program first asked students for their input. “Our students wanted to move forward with this plan,” Coffey says. “Their desire to do it pushed us to make it happen.”  

By the time PSU had moved to remote learning, most junior and senior nursing students had fulfilled 60–75 percent or more of their clinical experience in the traditional hospital setting. The next step was to identify the number of clinical hours each student needed to complete through these virtual exercises.  

Utilizing current products available to its students and exploring open source options, the program then had to vet virtual simulations for their adherence to the New Hampshire Board of Nursing (NHBON) guidelines. PSU ultimately leveraged four key simulations, all accompanied by synchronous pre-briefs and debriefs to highlight learning objectives.  

The first, Sentinel City, allowed nursing students to adopt an avatar to evaluate the community resources available to its citizens. They assessed strengths and needs in safety, transportation, nutrition, health and social services, and recreational options.  

In the COVID-19 Body Interact Program, students had 20 minutes to assess and treat a patient admitted with respiratory symptoms. The patient’s condition changed in response to the treatment plan. “This simulation really hit home,” says Coffey. “Students were able to see the reality of COVID-19 and the outcome of their decisions without risking harm to themselves or to patients.”  

Another simulation, Turbulent Sky, presented an emergency response scene. Nursing students were called to triage wounded victims as the result of an airplane’s hard landing.   

The fourth simulation was led by Professors Gelinas and Reynolds,who ran a full six-hour virtual pediatrics clinical. Students and faculty preconferenced, went into the clinical setting dressed in their scrubs, took care of patients, and met afterwards to discuss what they had learned. “We practice the ‘suspension of disbelief,’ which means that all participants get into character and behave as if they would in the hospital,” says Coffey. 

“These simulations were created to mimic the hospital setting,” adds Abigail Buchanan ’21, who participated in all simulations but Sentinel City. “I cared for a child recovering from an appendectomy and three children being treated for bronchiolitis, diabetic ketoacidosis, and meningitis, respectively. After each experience, I completed clinical paperwork as if I had been on the hospital floor. Given the current situation, these simulations were as close to real clinical as we could be.”   

While the virtual component certainly adds another layer, the Nursing Program is no stranger to simulations. In March 2019, it piloted the Community Action Poverty Simulation (CAPS), which features role-players of low-income families based on real clients. Last May, the nursing, theatre, and counseling programs ran a disaster management simulation in which students, faculty, and an experiencedEMS professional triaged and treated role-play victims. These exercises create collaborative, experiential learning environments in alignment with PSU’s Cluster approach.  

In addition to these simulations, nursing faculty strived to deliver interactive content. Students investigated several case studies, formulating care plans for patients. They gave presentations via Zoom, and faculty and students alike rose to the challenge.  

“We were lucky to have professors who went the extra mile to make sure we had the resources to continue our learning and to progress in the program,” Buchanan says. “Every professor I’ve worked with has gone above and beyond for their students.”  

Seven of the 10 graduates will be testing in New Hampshire. Among them is Marshall Mosher ’20, who will be working in the emergency department at Littleton Regional Hospital where he completed his capstone.  

“This final semester proved challenging, but our concerns as students were held in high regard,” says Mosher. “I am feeling prepared and excited to join the Littleton team.”