How Has COVID Changed Nursing School?

By Nina Chamlou

Published on August 18, 2021

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Before the pandemic, economists predicted a nursing shortage that would grow until 2030. The Bureau of Labor Statistics projects the number of job openings for registered nurses (RNs) to increase from 3.1 million in 2019 to 3.3 million in 2029. So, what have COVID's changes to nursing school and the profession been? Experts fear the global health crisis could exacerbate the shortage further.

The Nursing Shortage and the Pandemic

According to a 2020 NSI Nursing Solutions survey of 1,490 RNs, 94% of respondents indicated some degree of burnout because of the pandemic. As a result, 22% said they would like to retire sooner. Twenty-one percent said they would like to transfer to a non-patient care area. And 10% said they would like to leave the profession entirely.

"For that reason, I do believe that we will have a shortage of bedside nurses for the foreseeable future," said Dr. Deborah Kelly, chair and nurse administrator for the department of nursing at Clarion University of Pennsylvania. But she also noted that despite the mass of burnt-out nurses leaving the field, an increased interest in nursing is brewing.

"There have been a lot of positive stories about the impact nurses have had during this crisis," she said. "I think that the pandemic has inspired people to become nurses."

Student enrollment in nursing actually increased in 2020, according to the American Association of Colleges of Nursing. And last year, "nurse" was the number one term people searched on Google for "how to become" queries, according to Google trends.

Donna Meyer, CEO of the Organization for Associate Degree Nursing (OADN), agrees with Dr. Kelly."In all types of nursing programs, whether it be at a community college or university level, strong enrollments continue," she said. "There definitely is still ​an interest in nursing."

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The Pandemic's Effect on Nursing Education

Nursing was not immune to the migration to virtual classes seen across academia in 2020. According to the National Student Nurses' Association, 75% of nursing programs switched to online learning due to the pandemic — one of COVID's changes to nursing schools. While lectures can be moved online easily, clinical experiences, where students work alongside RNs, presented a more difficult challenge.

During the onset of COVID-19, healthcare facilities that host students began limiting clinical experiences. Or, they stopped offering clinicals altogether. This was mainly due to concern about spreading the virus — and because working RNs were already stretched thin.

In response, the National Council of State Boards of Nursing (NCSBN) provided recommendations for how state boards of nursing might adjust their requirements. These state boards set the educational standards that nursing programs must base their curricula on.

"Many of the boards provided waivers, which increased the ability to do more virtual simulations to reduce the required onsite clinical hours," Meyer said. "That is not a norm that's been done in the past."

Innovations in health simulation technology can reduce the lack of clinical placement opportunities — which was a problem before the pandemic, and will likely continue afterward. Rather than requiring students to complete all of their clinical sessions in person, a percentage of them could be done virtually. In theory, this would provide more clinical placements.

Some educators worry substitutes may not prepare students well enough for their nursing licensure exams or for the realities of life as a nurse. But a study by the NCSBN found that replacing up to half of in-person clinicals with high-quality simulations produced comparable educational outcomes among graduates.

Fortunately, most of the community colleges that OADN works with were still able to graduate students on time, Meyer said. "Maybe some were delayed by six to eight weeks, but most of the Boards of Nursing understood the situation and tried to work with the schools of nursing as well as the accrediting bodies."

As far as whether COVID's changes to nursing school will continue in the post-pandemic world, only time will tell. But Meyer thinks so.

"I definitely think that virtual simulations will continue to be used to help students," she said. "I think the pandemic just reinforced [the value of incorporating] simulation and online learning."

But it will not totally solve the limitations that nursing programs face in terms of enrollment. Faculty shortages also limit schools. According to a 2019 survey from AACN a total of 1,715 faculty vacancies were identified in a survey of 871 nursing schools across the nation.

The required ratio for faculty to student depends on the state, but usually ranges from 8-1 to 10-1. These ratios can result in the need for a large number of professors.

Nursing programs look for faculty members with significant clinical and research experience. This criteria often makes older, more experienced nurses the best candidates. But as the Baby Boomer generation of nurses retire, the pool of candidates continues to shrink.

Additionally, in 2018, the National Organization of Nurse Practitioner Faculties announced that by 2025, all entry-level nurse practitioner education programs will switch from requiring a master's to a doctorate. And the latter usually requires 1-2 more years in school than the former.

Earning a doctorate requires a significant investment of time and money from nurses who wish to become educators. Yet careers in clinical practice usually pay higher salaries than careers in academia.

The American Association of Nurse Practitioners reported an average nurse practitioner base salary of $110,000 in 2020. The average salary for an assistant professor of nursing was $79,440 for the same year, according to the AACN.Therefore, unless schools can offer greater salaries, experienced nurses have less of a financial incentive to teach.

"And that's probably one of the biggest challenges — the discrepancy in salary between clinical practice and academia," Meyer said.

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