Leadership in healthcare has never been more important than during the COVID-19 pandemic. As healthcare organizations struggled to provide care and conserve personal protective equipment (PPE), nursing students were displaced from clinical learning environments. A large, public academic medical center in New York City was designated as a COVID-only hospital and faced numerous challenges, particularly related to supply, demand, and distribution of essential supplies. This article describes how the academic-practice partnership between the medical center and its affiliated university was reenvisioned during the COVID-19 pandemic. Faculty and hospital leadership coordinated efforts to identify areas in which students could provide support without draining essential resources.
Baccalaureate nursing education should prepare graduates who are competent in patient-centered care, teamwork and collaboration, evidence-based practice (EBP), quality improvement (QI), safety, and informatics.1 Clinical judgment and the development of leadership skills are linked to quality care and patient outcomes. Effective communication, delegation, supervision, and teamwork are consistent with Quality and Safety Education for Nurses (QSEN) competencies.2 The National Academy of Medicine has identified patient safety, QI, and innovative educational models for improved outcomes as priorities for more than 2 decades.3 Numerous organizations have supported nursing education reform, as well as an increased focus on implementing evidence-based approaches in clinical practice to improve patient outcomes.2,3 The gap between theory and practice is an area for improvement in health professionals' education.
Developing higher-order competencies, such as interprofessional collaboration and leadership, in baccalaureate nursing students is challenging because students are striving to master the essential knowledge and skills required for entry into practice. It's important to provide opportunities for students to observe leadership in action, participate as members of teams, and improve their confidence. The integration of leadership courses into baccalaureate curricula has been recommended; however, there's little research on effective methods to teach or evaluate these competencies.2,4
Similarly, baccalaureate nursing students are expected to understand and implement evidence-based clinical practices; however, there are limited occasions to do so.5 Academic-practice partnerships have been shown to meet numerous goals in both settings. These partnerships can provide rich opportunities for students to engage in immersive clinical learning experiences, interprofessional communication and collaboration, and innovative QI and EBP initiatives.5
Academic-practice partnerships are especially important during the ongoing COVID-19 pandemic. Identifying and implementing improved methods of care in a compressed timeframe have been hallmarks of the pandemic. Staff morale has suffered and leaders are striving to find ways to help staff cope and manage demands. This crisis has also had an impact on health professionals' education. The displacement of students from clinical learning environments has presented challenges for student learning opportunities and left many feeling helpless.6
The university affiliated with the academic medical center has an accelerated baccalaureate nursing program. All students take a leadership course in the final semester, and many participate in a variety of volunteer opportunities throughout their program. Before the pandemic, an honors program was offered in collaboration with the academic medical center. Students in this cohort were placed on dedicated educational units for clinical rotations and engaged in unit-based QI initiatives facilitated by hospital leadership and nursing faculty. Students were enrolled in the third semester of a four-semester program during the spring of 2020 when they were displaced from clinical agencies for the remainder of the term.
Two nursing student leaders from the honors cohort led the student effort, and the authors of this article were the faculty and hospital liaisons. Students were recruited via email from the university's College of Nursing and School of Health Professions, making this an interprofessional collaboration.
To streamline the process, two nursing student leaders created and managed a shared self-scheduling document. Faculty coordinated with hospital leadership to confirm scheduling needs; “shifts” were set up to allow for a “handoff” between students. An online orientation module was created and required for all participants. Students were expected to review the CDC guidelines and webinar on infection control and precautions during the COVID-19 pandemic before participation and sign an attestation and waiver. Links to all forms and requirements were sent to students via the recruitment email. All documentation was kept in a shared file online, monitored by the faculty liaison.
After thoughtful consideration, it was decided that students would be kept out of direct care situations to conserve PPE and minimize risks. Having been designated as a COVID-only hospital, the hospital was forced to redefine unit-based patient assignments, redeploy staff, and build additional triage and short-term stay areas in tents. This increased the total number of patient care areas in need of essential supplies. Delivery and supply of PPE was unpredictable, as was usage by unit. Units were submitting paper requests for supplies, and staff were manually attempting to keep track of deliveries. Clearly, this system wasn't sustainable.
The decision was made to have students focus on developing and implementing an organized system for PPE inventory management and distribution. Students reported to the director of surgical services, who managed all PPE inventory. Students created an online, shared spreadsheet to track inventory and unit usage. Each day, students tallied the supplies on hand, adding in new deliveries and donations. As unit requests for supplies were collected, students packaged supplies for distribution to the units and noted it on the spreadsheet. This allowed for tighter control over supply distribution and monitoring of “burn rate” by unit and the hospital. In turn, the data collected will allow for better planning, prediction of future need, and ordering of supplies.
Once this system was established, students assisted with the creation of dashboards and compiling data for other metrics required by regulatory agencies.7,8 Students collected and organized raw data forms on surgical attire and surgical environment measures. They completed data entry and assisted with analysis to determine compliance rates for the surgical services and infection control departments.
Over 3.5 months, 16 baccalaureate nursing students and five students from the School of Health Professions participated in the initiative. The student-developed tracking systems were used by students and hospital personnel for both PPE and dashboard metric data. Although this initiative was voluntary and self-directed by our students, we were able to tie these experiences to their organizational and systems leadership course and their EBP course.
Students were able to use skills in EBP implementing an initiative using the Plan-Do-Study-Act cycle (PDSA) from their research course.9 The objective (P) was to develop a system for managing PPE inventory during COVID-19. Initially, there was no organized system in place; units were submitting paper requests for PPE, which were then delivered (D-S). Students collaborated to develop a spreadsheet to track inventory and distribution of PPE to each unit (A).
Once in place, the system was modified to calculate daily and weekly usage and then predict future needs. This informed the ordering of supplies, as well as the identification of units in need of targeted in-service training for appropriate PPE usage. Students also collated data collected on the safety of the surgical environment and compliance with surgical attire. These data were used for evaluation of QI and safety measures and dashboard reporting metrics.
Throughout the experience, students interacted and collaborated with hospital leadership, unit-based teams, members of the healthcare system, and faculty. They met with the faculty liaison and hospital leadership weekly to debrief and plan for the next cycle. Reflective discussion was a component of the leadership course; students who participated in this initiative were able to share their experiences with their peers. Many incorporated the project into their résumé and cover letter for a professional growth or leadership assignment.
Putting theory into practice
This innovative approach to an academic-practice partnership met the needs of multiple stakeholders. Typically, in an academic-practice partnership, hospital staff members bear additional responsibilities related to student training. In this initiative, students had opportunities to help relieve the hospital of some essential tasks during a time of crisis. Student feedback was positive and hospital morale was given a boost. Although students weren't permitted to provide direct patient care, they felt they were able to make contributions and help during the pandemic.
The students also gained firsthand experience with QI processes in an acute care environment. They were able to see the actualization of regulatory requirements, including how and why metrics are captured and used to develop improvement processes. This experience allowed the students to establish professional connections to facilitate their transition to practice. They put theory into practice, following the PDSA cycle to develop the most effective methods to impact care delivery and patient outcomes.
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7. Centers for Disease Control and Prevention. Infection control guidance. 2021. www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
9. Institute for Healthcare Improvement. How to improve. www.ihi.org/resources/Pages/HowtoImprove/default.aspx