Health-Care Students on the Front Lines

A group of students studying and training in health-care disciplines at the Lake Washington Institute of Technology, a public institution in Kirkland, Wash., which has been hard hit by the coronavirus, has been self-quarantined at home for 14 days after possible exposure to the virus in health-care settings. Four students at Los Rios Community College District, in California, were directed by public health authorities to self-quarantine after being exposed to the virus in the course of their professional medical duties.

As the virus continues to spread to other parts of the country, public health officials and college administrators in allied health departments are urging special precautions for students studying for careers in the health professions and working along with or training under those on the front lines of the coronavirus outbreak.

After widespread news reports that 17 nursing students, one student studying to be a physical therapy assistant and four professors at the Lake Washington Institute might have been exposed to the virus -- the college said a group had visited a long-term nursing facility where seven residents have died of COVID-19, the illness caused by the new coronavirus) -- leaders in nursing education said it’s now more important than ever to emphasize preventative precautions and infection-control protocols in the classroom and in clinical settings.

“From the very first course our nursing students take, which is usually health assessment, we reinforce preventive precautions so that they protect themselves from exposure,” said Ann H. Cary, chair of the Board of Directors for the American Association of Colleges of Nursing and dean of the Marieb College of Health and Human Services at Florida Gulf Coast University. “We are emphasizing that now more than ever that you can’t have a lapse in the way that you approach patients. The hand-washing techniques are critically important not only in classes but especially when they go into the clinical areas. We’re working with clinical partners in each of our areas to determine what are additional protocols that will be in place at those institutions and ensuring that our students are oriented toward the additional protocols.”

Tener Goodwin Veenema, a professor of nursing and public health at Johns Hopkins University whose research focuses on disaster medicine and emergency preparedness, said one of the big challenges for nursing schools nationwide is that the trend toward accelerated, shorter-duration programs limits what gets taught in the curriculum.

“There are a limited number of hours and topics that can be covered,” she said. “We have nursing students who are probably getting probably less than one hour, maybe an hour and a half in their entire curriculum on how you go about responding to a public health emergency. What we as nurse educators need to do is ensure that all nursing students have the knowledge, the skills and the abilities that they will need either on a clinical rotation or when they enter the workforce to keep themselves safe and to keep patient safe.”

Goodwin Veenema said nurses need knowledge and skills in infection-containment strategies, surveillance and detection of illness, protocols for quarantining and isolating patients, and how to select appropriate levels of protective gear and take it on and off without contamination.

“We’ve seen it with Ebola, and we’ve seen it with SARS [severe acute respiratory syndrome], where health-care professionals are disproportionately impacted by this virus because they are exposed to it more frequently and in all probability end up having a higher biological load,” she said. “There really is a lot for nurses to know because the nursing profession will be the front-line responders and will be receiving patients in the emergency department and screening patients and their families in private offices and community health centers.”

Donna Meyer, chief executive officer for the Organization for Associate Degree Nursing, said via email that “nursing students learn proper handwashing techniques, and other elements such as isolation techniques, the use of masks, gowns, gloves, and ventilation that prevent or slow the spread of infectious diseases from the moment they enter a nursing program of study. This is reinforced throughout a nursing program and techniques are applied in all clinical settings, such as hospitals, long-term care, and community settings.”

Meyer added that nursing programs build their curricula around topics covered on the licensing exam.

“Safety and infection control is a part of the licensing exam focusing on how the nurse protects clients and health care personnel from health and environmental hazards,” she said. “Nursing curriculums adapt and present any current issues as needed (such as Covid-19),” following guidelines from the Centers for Disease Control and Prevention and the World Health Organization. “Additionally, Nursing Deans/Directors collaborate with their local clinical partners to assess the current status of public health issues in the communities. Nursing students follow the best practices of the clinical setting they are in and are expected to learn and follow the protocol of the setting [where] they are practicing.”

In addition to preparing students for the new challenges they may face in clinical settings, nursing program administrators are also thinking about what might happen if their students’ clinical education gets disrupted by the coronavirus -- if students are asked not to report to hospitals or other health-care settings as an infection-control measure. Cary, of the American Association of Colleges of Nursing, said programs are exploring the idea of having students practice their skills in simulation labs.

“If that’s not going to be enough, we have to think about how to focus concentrated learning experiences for students at another time,” she said.

Cary also stressed that these concerns are similar to those of other medical and health-care programs. For example, she said, if a college has a clinical lab program, “they have to take extraordinary precautions as well, as those students are actually conducting testing on clinical lab samples. Physical therapy, occupational therapy, even our health-care administrator students as they walk into clinical facilities -- everybody is responsible for implementing the protocols.”

As for medical schools, John Prescott, the chief academic officer for the Association of American Medical Colleges, said the association "is working closely with our member medical schools and teaching hospitals who are actively preparing for and responding to the coronavirus and is gathering information on how they are involving learners in patient care."

"We know that medical schools have appropriate plans and policies already in place to safeguard the well-being of their students and communities, to ensure the continuity of their education and research missions, and are following guidance from the Centers for Disease Control and Prevention," Prescott said.