Yale leaders talk about COVID-19: School of Nursing Dean Ann Kurth
This interview is part of a running series.
How has the Yale School of Nursing (YSN) responded to the COVID-19 crisis?
Nurses are the frontline and backbone of health care delivery in the U.S. and worldwide. This remains true for the COVID crisis. While the number of ventilators a facility has is vitally important, it’s also crucial that there are critical care nurses to staff them and to provide 24/7 care for the patients in the beds. Nurses are the essential element in patient management during the pandemic, not just for COVID-19 care, but also for keeping vital non-COVID care going.
Here in Connecticut, members of the School of Nursing community, along with our colleagues in public health and medicine, began to mobilize as soon as the likely impact of COVID-19 became evident. YSN faculty and staff have been incredible in stepping up and supporting our students while keeping the operations of the school going.
YSN surveyed our students, faculty, and staff to determine who could provide surge-capacity support for Yale Health Plan (YHP) and Yale New Haven Hospital (YNHH), and over 300 people volunteered. The students and faculty will be deployable to different care sites to help with triaging, testing, and bedside care, and staff are ready to support non-patient-facing needs.
Many of our faculty and students already work at YHP, YNHH, HAVEN Free Clinic, and other area hospitals and outpatient clinics, and they are directly involved treating the surge of COVID-19 patients we are seeing. It is crucial that we have sufficient personal protective equipment (PPE) so that nurses and other health workers do not get infected and taken out of the workforce. We need all hands on deck, and new ways of thinking about health care delivery during this crisis. This is a message that Beth Beckman, YSN associate dean for clinical partnerships and YNHHS chief nursing executive, has also pointed out; she was one of the first healthcare workers publicly identified with COVID-19 in Connecticut.
I serve as a member of President Salovey’s COVID-19 advisory group, and we are communicating with deans of other schools of nursing to coordinate efforts in Connecticut and nationwide. Yale Nursing is part of a coalition of leading schools of nursing that is urging our advanced practice nursing credentialing organizations to be more flexible around requirements, such as number of hours spent with patients, given that most health systems and nursing schools now have had to suspend in-person clinical experiences for students. Notably, governors and U.S. Secretary of Health and Human Services Alex Azar also are calling for removal of state-level restrictions that have held advanced practice registered nurses (APRNs) back from providing care to the full level of their education. We must ensure that amidst this crisis, our students can enter a health workforce that needs nurses now more than ever, and that allows APRNs to deliver needed care without unnecessary constraints.
How is nursing education affected by moving all spring courses online?
I am deeply appreciative of our faculty and students, who have weathered this change with the grace and nimbleness characteristic of the nursing profession. It has been a true team effort within our community, as we shifted our teaching and clinical experiences to online formats. With nursing students across the U.S. moving to online education, a natural experiment of a scale never seen before is underway. The COVID crisis calls for innovative ways of delivering clinical experiences, and I can see a major shift in how we do that down the road, long after we get through this first wave of the COVID-19 pandemic.
YSN has been using online learning tools for several years now, particularly in the Doctor of Nursing (DNP) program. The DNP program was the first hybrid program at Yale (one combining online course work with on-campus experiences). For students working to complete their Master of Science degree in nursing, a key part of their education comes from clinical rotations at hospitals, clinics, and other settings. This is where students become proficient in translating the knowledge gained in the classroom into practice. They get tangible training and mentoring from their dedicated preceptors, and they learn the skills of advanced practice nursing. But across Connecticut and the nation, there is an unconscionable shortage of personal protective equipment (PPE). As mentioned, many of our usual clinical site partners did not have enough PPE for their own staff, and asked students to stop coming. So YSN, like many other schools of nursing, has had to suspend onsite clinicals for now. Our first priority is the safety of our students and patients.
YSN students are eager to answer the call to duty posed by COVID-19, and they are working with faculty to complete clinical training using state-of-the-art virtual simulation programs offered by our highly creative and credentialed clinical simulation faculty. The faculty is investigating ways to use virtual reality, blended learning, online case studies, and other new approaches to clinician education, and the opportunities presented for interprofessional education across our health sciences schools (i.e. nursing, medical, and PA students learning together).
How are nurses uniquely positioned to provide care during the COVID-19 pandemic?
Early last year, Johnson & Johnson released a PSA highlighting the nurse-driven ideas and innovations that were the turning points in different world crises: Florence Nightingale introducing sanitary practices during the Crimean War; Jean Ward discovering that sunlight and phototherapy can cure jaundice; nurses offering compassionate care to HIV+ and AIDS patients at the start of that pandemic. YSN brought the hospice model to the U.S., an example of our clinical and scientific innovation. We will see this again with COVID-19.
Nurses make up more than half of the global health care workforce, and deliver up to 80% of all health care services. When the history of this pandemic is written, good nursing care will have been found to have been a key indicator of survival. Because of nurses’ work on the frontlines, where they are stretching their bodies and minds to the maximum, we are already seeing them innovating to create safer environments for themselves and their patients.
Our faculty are collaborating on novel ways to produce personal protective equipment (PPE) with partners across campus and New Haven, including colleagues at the School of Engineering and Applied Science and businesses in the city. YSN has developed a text-message survey tool to stay in communication with health care workers who have been exposed to or diagnosed with COVID-19; this will help local health systems plan for workforce availability as the cases in and around New Haven continue to climb. Nurses will learn, study, advocate, and innovate to get our world through the COVID pandemic. We will face this pandemic together, emerge with many sobering lessons learned, and be more prepared for the next global health crisis.