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The Fellows Speak

In the time of COVID…

Taub, Leslie-Faith Morritt PhD, ANP-C, GNP-BC, CDE, CBSM, CME (DOT), FAANP (Clinical Associate Professor and Director of the NYU Meyers AGPCNP Program)1

Editor(s): Dirubbo, Nancy E. DNP, FNP, FAANP

Author Information
Journal of the American Association of Nurse Practitioners: January 2021 - Volume 33 - Issue 1 - p 2-4
doi: 10.1097/JXX.0000000000000568
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Abstract

Spring of 2020 presented additional unexpected burdens for nurse practitioner (NP) students and faculty especially for those of us practicing in COVID-19 hot spots such as New York City. On April 29, 2020, The New York Times banner for a two page feature was entitled, “‘Patients Have Panic in Their Eyes: Voices from a Covid-19 Unit. Nurses from N.Y.U. Langone [Hospital] describe the toll the coronavirus is taking on their patients, and on themselves” (Gonzalez & Nasseri, 2020). The exhausted nurse cradling a water bottle and sitting on a tiny hospital outdoor deck with her face to the sun and her hair wrapped up in a surgical cap was my student. The senior staff registered nurse (RN) nursing her baby in her car went to the accelerated Bachelor of Science in Nursing program at NYU Meyers School of Nursing with my former student who is now one of my seminar leaders. The young nurse, masked and talking on her cell phone wrapped in a plastic baggy was also in my class. We were under siege by a virulent virus that was overwhelming the infrastructures of world-class hospitals in New York City and this virus was no respecter of persons.

My Spring 2020 cohort of graduating NYU Adult-Gerontology Primary Care NP students were frantic to make the minimum of 500 hours of clinical to meet certification requirements before the University recalled all the students from their clinical sites in the wake of the outbreak and we immediately went to a Zoom platform for classes. My students were having a tough time managing their emotions, family life, fear for themselves and their patients, and the struggle to complete their graduate program. I related to this experience because I graduated in the time of another deadly virus…HIV. At that time, we also did not know about transmission and lots of our patients were dying. I recall removing my shoes at the front door and stripping down so I would not bring the virus into my home and to my small children. That was 36 years ago.

This summer, my new cohort of RN to Adult-Gerontology Primary Care NP students started their first clinical course with me in Geriatric Syndromes, with class on Zoom and clinicals in real time. Over my 10 years as an Associate Clinical Professor at NYU Meyers teaching graduate students, I had many colleagues and clinical partners who took my students into their practices. When the large facilities would only take their own employees for clinicals, I queried all of my 40 students to know what facilities might place them. Colleagues went to practice managers and School Affiliations Coordinators in their facilities requesting that they be allowed to take my students (even ones that were not employees in their facility).

Even Governor Cuomo understood that clinicals kept these needed professionals moving forward as he modified the education laws so that “any health care facility was authorized to allow students, in programs to become licensed in New York State to practice as a health care professional, to volunteer at the health care facility for educational credit as if the student had secured a placement under a clinical affiliation agreement, without entering into any such clinical affiliation agreement” (NYSEd.gov., 2020). Large New York facilities were more circumspect because, although they provided tuition reimbursement to their employees and so had a vested interest in these RNs, there were the issues of the costs of frequent COVID testing and personal protective equipment for those who were not their employees.

I am the Director of the second largest NP program at the NYU School of Nursing and so my pre-COVID class was given in an amphitheater that seats 160. It is a state-of-the-art classroom with three huge screens and a sound system and students gravitated to the seats in the back. On Zoom, now I see them all clearly. My policy is mandatory attendance and I saw that John (not his real name) was exhausted, unshaven, and with his eyes closed. He was not doing well on his quizzes and this was the antithesis of what I knew about this Bachelor of Science to Doctor of Nursing Practice student. Some emailed me that they returned home to other states to take care of ill or dying parents. I needed to support these students educationally and emotionally or I could lose them, as more subtle victims of this virus.

My last assignment in Geriatric Syndromes for my new cohort was a four-page paper explaining how life had changed for them, as an RN studying to become a Primary Care NP during the global COVID pandemic. They were to address changes at home (family, shopping, interacting with social peers), changes at work (assignments, emotional issues, protective gear), changes at school (Zoom classes, career change, clinical assignments), changes in self-care (mental and physical) health care of themselves and their significant others. They were to organize the themes they discussed among the group (this was a small group assignment) and provide real-world examples of their challenges and how they addressed them. They were to discuss the societal changes they expect to occur because of this episode in history (what it means to be a nurse, a primary care provider, a front lines health care worker, a parent, a spouse). Finally, they were to explain what they were thankful for, and what they still despaired about. I opened the flood gates. These RNs that went in to care for COVID patients every workday were applauded at 7 pm every night in the streets of New York with a city-wide tribute to their contributions (Northwell Health, 2020).

I got this email from one of my students, “My father passed away last week. I wanted to thank you for your understanding and support throughout his decline. It is much appreciated.” This student went home to be with her Dad and when she couldn't attend class, I sent her Zoom videos of our class and I asked my colleague, our Palliative Care program director, to reach out to her. She is still in the program and she managed all the work. I believe it was because she got the support she did.

Another of my students wrote about leaving mid-shift with symptoms, only to find out she was COVID positive a week before her mid-term in another class. After 3 weeks of being cared for by her fiancé, she was to find he also got COVID from her and she had her turn to manage his spiking temperatures and shortness of breath. Many found they did not want to expose older parents and stayed away from the family home. Another student related that after many shifts of being double masked, she had permanent skin damage that would require laser therapy. She told of extreme fatigue from the lack of sleep, the strenuous work of codes that were back to back, the headaches from lack of fluids, and the pain behind her ears from the masks elastic ear pieces that began to radiate to the front of her face. She wrote, “Although there were tears shed out of personal physical despair, there were far more instances (of tears) for the suffering, the dead, and the families and friends we watched and heard say goodbye over FaceTime.”

My colleague and I asked ourselves what the pedagogy of teaching NP students should be in a pandemic and how it was influenced by the social, political, and psychological development of learners. We divided this class of 100 into two groups, Primary Care and Acute Care, so we could focus on what learning was most relevant to them and to keep the class as personal as we could. We gave eight low-stake quizzes instead of a midterm and final, and we recorded classes for students who were ill or went home to care for family members. We formed groups of four students who did homework case studies within the group so they could support each other and work to the strengths of the group. I made time before Zoom class to allow the students to discuss clinical assignments and other questions and I deferred their Capstone start to the Fall semester. I called each of my advisees individually so I could hear what their challenges were.

My eight seminar leaders are all working NPs and so their experiences were similar to our students and they knew I depended on them to precept students because many of the facilities were not certain when they would open to students. I needed close to 80 placements for the Fall semester…and getting agreements in place and commitments to take students at this late date was an example of brinksmanship. I have international students and many bilingual students and my colleague and I worked to get small practices in Chinatown, Korean neighborhoods, and Spanish neighborhood clinics and practices to take these students. Mostly responses were excellent because there is a real need in immigrant communities to have language congruent providers. Occasionally, we were met with the same fear that all communities have such as when one such practice refused my student because she worked in a hospital full time and the provider's staff was afraid of contracting COVID from this student. I put my classes online for the Fall, updated my syllabi, and contacted IT for support for secure exams.

As I write this near the end of the fall semester, we are experiencing a resurgence of COVID (Goldstein, 2020). New York Mayor de Blasio anticipates our city may become an orange zone again, reflecting an increasing risk. Uncertainty still colors our lives, and I draw strength from the ethos of our profession because I am certain that this time will be looked on as the crucible that demonstrated to society that NPs are integral to the health care of our nation. As we provide leadership for our students through this crisis, we must remember to model resilience and provide support.

References

Goldstein J. (2020, November 20). This is how the outbreak is resurging across New York City. New York Times. https://www.nytimes.com/2020/11/20/nyregion/covid-19-nyc.html?auth=login-email&login=email.
Gonzalez D., Nasseri S. (2020, April 29). Patients have panic in their eyes: Voices from a Covid-19 unit. New York Times. https://www.nytimes.com/2020/04/29/nyregion/coronavirus-nyc-hospitals.html.
Northwell Health. (2020, April 8). NYC ritual offers support to front line heroes during COVID-19 crisis. https://www.youtube.com/watch?v=eq4WqsIKZX8.
NYSEd.gov. Office of the Professions. (2020). COVID-19 pandemic and professional practice executive orders EO #202.28. http://www.op.nysed.gov/COVID-19_EO.html.
Keywords:

Clinical placements; COVID-19; nurse practitioner student; pandemic

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