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Early career nurses and students cope with learning during a pandemic

Billings Gazette - 1/30/2021

Jan. 30—Last January, Ashely Vickery, a nursing student at Montana State University, was studying community health, learning about pandemics, outbreaks and public health crises.

At the time, only a few COVID-19 cases had been seen in the U.S. The pandemic seemed distant.

"We thought, 'we'll have to watch this coronavirus thing and see what happens and be prepared,'" Vickery said. "Then we left for spring break and we never came back."

MSU canceled in-person classes for the remainder of the spring semester.

Vickery didn't realize Montana was about to enter a lockdown, or that she, set to graduate in May, would be entering the workforce as a "baby nurse" during the height of a public health crisis.

While most people struggled to adjust to a "new normal," early career nurses had to quickly adapt to working under a pandemic, while nursing students say the pandemic has thrown a wrench into their education, under-preparing them for graduation.

Bigger adjustment

Vickery has worked as a nurse at Billings Clinic on the in-patient surgical floor since May, and although she previously had experience as a Certified Nursing Assistant, she said the transition was hard.

"Being a new nurse is already difficult, but then to be thrown in right in the pandemic. The normal is completely skewed," she said. "I already had a steep curve."

Vickery graduated about a month early from MSU, her licensing was fast-tracked by the state, and she felt the pressure to begin working.

"I was definitely nervous," she said. "You heard things in clinical, and you prepare. It was crazy like you'd expect, but I didn't know what normal was."

Vickery didn't work with COVID-19 patients, but said she felt the added stress of the stretched-thin staff this past fall.

"I get asked 'How is it being a nurse?' Well, I wouldn't recommend it during a pandemic," Vickery said.

Navigating the emotional and mental needs of her patients — especially when visitors weren't allowed in the hospital — has been the steepest learning curve.

"Being new at nursing you don't have skills down, you feel like you're just trying to keep track of the bare minimum and you're not able to focus and tend to the emotional aspects of patients," she said. "But connecting with people is what's fulfilling and really worthwhile."

Book learning isn't enough

Becky Anglin, an instructor and coordinator for the Montana State University Billings RN to BSN program, said she's seen the effect the pandemic has had on working nurses who are still pursuing an education.

"They're feeling the crunch of the pandemic for sure," Anglin said.

Anglin and other faculty have adjusted curriculum, deadlines and due dates to try and accommodate the busy nurses.

Anglin thinks prospective nursing students won't likely be dissuaded from entering the career after the public health crisis.

"Nursing is a field that you don't go into unless you really want to help patients and make a difference in someone's life and right now nurses are definitely doing that," she said. "I think it would be a driving force."

Despite an overall decrease in fall enrollment, MSUB did see a 14% increase in enrollment in the Bachelor's of Science in Nursing program.

Andrew Strong is in his final few months to earn his associate's degree in nursing at City College. Studying online this year was difficult and Strong feels it set him and his cohort back.

Clinicals, where students get real experience working shifts on a hospital floor typically several times per week for a semester, were canceled last fall as COVID-19 cases rose.

The school shifted to online programs that aimed to simulate the experience a student would receive in a hospital.

"One of our professors has said 'nursing is a team sport' and it is, but you can't interact in a team environment with a computer," Strong said.

Angie Finnicum, who is in the same cohort as Strong, agreed. The lack of in-person training can be a real setback when it comes to working a real hospital floor, she said.

"We kind of missed the foundation of nursing," Finnicum said.

Both Finnicum and Strong work in hospital settings; Finnicum is a phlebotomist and a medical assistant at Billings Clinic, and Strong works as a student nurse at St. Vincent Healthcare.

They agreed that without that extracurricular experience earned at the hospitals, both would have felt behind with just a few months left until graduation in their two-year program.

School administration and hospital administration "want to be cautious, but at the same time if you want people coming out of graduation with enough experience to practice safely you have to give them enough practical learning," Strong said. "I don't feel that is occurring."

Still, with just a few months before graduation and their board exam looming, both Finnicum and Strong said the idea of working in a pandemic may be intimidating but both were excited to enter the workforce.

"I'm ready to start," Finnicum said.

Learning on the job

Like Vickery, Ben Nalls, an extern nurse at St. Vincent Healthcare, had to learn a lot on the fly.

But Nalls, who works on the coronary care unit at St. Vincent, and is currently studying to get his Bachelor's of Science in Nursing from MSUB, wouldn't trade his hospital experience during the pandemic for anything.

"I've had so many opportunities to learn things I never would have had the option to, even in nursing school or before graduation, that I'm now fairly comfortable with," Nalls said.

Much of what Nalls has learned has been geared toward combating a pandemic: proper use of personal protective equipment, isolation precautions, or how to handle contaminated materials.

"It's been a fantastic opportunity to take advantage of, and to take (the pandemic) in stride and learn from it," Nalls said.

Still, the emotional and mental toll of working during a pandemic while attending college hasn't been lost on Nalls.

He's seen family members of patients struggle without visitation and desperately call for updates on their loved ones.

He's now experienced that feeling of confusion and desperation himself.

Just a few weeks ago Nalls lost his uncle to COVID-19. The loss sharply focused the pandemic in a way, even as a health care provider, he hadn't experienced before.

"It's a gut check," he said. "It flipped the coin for me so fast."

That's helped him have more patience and empathy with patients' families, he said.

And in many ways, his uncle's death has made the pandemic's politicization more frustrating for him as he navigates friends and family members who are "COVID deniers."

"I'm going to be going to my uncle's funeral next week and even there there will be people who won't wear a mask or don't believe in the pandemic," Nalls said. "I wish they could be taken to the hospital and shown what it's really like. Shown what their family members are going through and not being able to help all of them. It's emotionally exhausting, draining and defeating."

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