There have been memes and internet jokes all year about the future doctors and nurses of America who are graduating from 2020’s online-only version of higher education. An entire cohort of future clinicians saw their education take a major, unexpected detour onto Zoom and remote technology during the COVID-19 pandemic.
COVID-19 forced us to grapple with a longstanding question in the world of clinical education: How much high-quality learning can happen virtually?
Health-science schools are increasingly offering online programs and investing in clinical simulation centers. Students learn clinical skills on robot mannequins that have beating hearts, breathing lungs and can even give birth. They can dissect bodies with touch screens, perform procedures with gestures, and, some argue, learn how to care for patients just as well as they could in clinics.
During the initial months of the COVID-19 pandemic, the California Board of Registered Nursing increased the allowable virtual clinical hours for nursing students from 25% to 50%. This was a necessary change given the urgency of graduating new nurses to help with the pandemic amid America’s longstanding shortage of registered nurses, but as nursing educators, we know that it’s impossible to simulate what it feels like to have someone’s life in your hands in Zoom break-out rooms or with robots.
Although there were missed opportunities in 2020 with the increased virtual clinical hours, we’re optimistic about the nursing students of 2020. They’ll be a very special group of health care workers because of their pandemic education, rather than in spite of it.
Over the holidays, we volunteered with nursing students to help give some of the very first COVID-19 vaccines to front line health care workers in Los Angeles. For most students, this was their first-ever real-world experience in nursing school. They showed up to the clinic dressed in masks and scrubs, nervous but eager to learn. They executed the process beautifully, from the technical aspects of giving intramuscular injections to the art of having conversations with recipients about what to expect from an mRNA vaccine.
Getting to give the new COVID-19 vaccines in one of the darkest moments of the pandemic as their nursing “first” was a profound experience for our students. It could never be replicated by a simulation or virtual class. But the conversations we had about the pandemic made clear to us that these future nurses were already well on their way to becoming highly effective clinicians before they ever set foot in the vaccine clinic.
Students in the health professions in 2020 are getting to see first-hand the intricacies of how health care systems work and where there are structural inequalities that need fixing. They understand how the upstream actions of people in communities translate far downstream to hospitalizations or even death – true of COVID-19 and many other health conditions they will encounter in their future practice.
They understand how science – like vaccine development – goes from an idea, to a research study, to a treatment, and that even then that there is a science to rolling out treatments and communicating science to the public. They see how public health, public policy and ethics intersect with clinical care, and why it matters for clinicians to play a role in health policy. They know how high the stakes are for creating a better future for health care.
It can take new clinicians months or years of practice before they understand the structural aspects of health care, where they fit in and how to solve problems they encounter. But the nurses educated in 2020 get it now.
They’re learning important lessons about what it means to be a health care provider even in a virtual world, and their in-person clinical experiences in the unusual circumstances a pandemic will shape their practice for years to come. We’ll be lucky to have them taking care of us in the future, whether that’s in a hospital, a research lab or in health policy.
Kristen Choi, a child/adolescent psychiatric nurse, is an assistant professor at the UCLA School of Nursing and UCLA Fielding School of Public Health, krchoi@ucla.edu. Barbara Demman, an acute care nurse practitioner, is a lecturer at the UCLA School of Nursing, bdemman@sonnet.ucla.edu. Charlene Niemi, a registered nurse, is an assistant professor in the Nursing Program at California State University Channel Islands and a lecturer at the UCLA School of Nursing, cniemi@sonnet.ucla.edu.