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“Constantly on edge”: nursing students on the demands of working through a pandemic

New change allowing students to treat COVID-19 positive patients raises concerns about vaccination, burnout
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At 6:00 am, Caterina Bordignon, a second-year nursing student at the Lawrence S. Bloomberg Faculty of Nursing, sits in a near empty subway on her way to the hospital. Two metres from her, she sees only other frontline workers. When she arrives at her clinical community placement, after filling out her online screening and passing the security check, she feels countless pairs of eyes assessing her as she washes her hands. 

She dresses herself in her face masks, yellow scrubs, face shield, and blue gloves. “Every time I enter and exit a patient room, I remove my gown and gloves and wash my hands,” Bordignon wrote to The Varsity. “It’s an endless exercise of putting on and removing PPE (personal protective equipment).”

Breaks are taken in shifts so that people can properly distance in the lunchroom. “We are constantly on edge,” she wrote. An innocent cough by a patient causes a wave of anxiety throughout the halls. 

After her 12-hour shift, Bordignon says goodbye to her patients, knowing that given all of her PPE, they would not recognize her in the future. She changes out of her scrubs, puts them into a separate bag, and heads to the subway along with the other essential workers before doing it all again the next day. 

Bordignon’s experience with clinical placements is similar to other U of T nursing students. From their first year on, nursing students study diligently while doing clinical placements — eight- to 12-hour shifts at hospitals — that the university allocates. However, for the first time in recent memory, their education is calling them to the frontlines of a pandemic. 

How the pandemic impacted their education

When COVID-19 first swept the globe, nursing students’ clinical placements came to an abrupt end in March 2020 when hospitals cancelled on-site student training. However, when the fall 2020 semester came around, U of T was able to provide nursing students with placements again. Students recounted feeling grateful for this experience. 

“A big component of nursing school is that placement [and] really doing stuff hands-on,” Bordignon said in an interview with The Varsity. “And so when [the opportunity] was taken away, I felt like the quality [of our education] just really went down because how can you simulate that from home and online?”

She noted that being at her placement this year has been rewarding, as many nurses and clinicians have come up to tell her how happy they are to see nursing students again. “Back in March 2020, when everything changed, students being pulled from clinical was another reminder of the profound differences in healthcare settings,” Bordignon wrote. “I think that the return of students has re-established a small sense of normalcy within all this chaos.”

Julia Schafrick, a first-year nursing student, added, “I think U of T has done a really good job of making sure we all get a placement… That’s a huge win.”

However, receiving placements is a double-edged sword owing to the current shortage of vaccines in Ontario. Many frontline workers, including student nurses, have not yet received their first dose of the COVID-19 vaccine. 

At first, students understood the timeline of the vaccination program and the delays in communication from U of T. “I’m just super grateful to be there,” Schafrick said. 

However, as the school year progressed, some students expressed that they wanted more action from the university. 

“I would hope to see U of T advocating for us a little bit more in terms of… ensuring that we all get the vaccine,” Schafrick said. “[Its] focus has been on ensuring that we all get to be in the hospital and be in placement, which is awesome, and we need that. We also all need to get vaccinated.”

“We are working in direct patient care and [vaccination] needs to happen,” Schafrick continued.

On December 7, a major development in the nursing program occurred when Nadine Janes, the faculty’s undergraduate program director, emailed students that “effective this January Winter term 2021, all Bloomberg Faculty of Nursing Undergraduate BScN students within clinical practicums will be able to provide care not only to persons under investigation for COVID-19, but also for patients diagnosed with COVID-19.” 

Janes added that the faculty lifted the previous restriction that prevented students from providing direct care to patients diagnosed with COVID-19 because there has been “growth in our knowledge about COVID-19 transmission, assessment and treatment and growth in supply of PPE for students use.” However, according to the Faculty of Nursing’s Winter 2021 FAQ for Students page, students still cannot observe or participate in “aerosolized procedures with COVID-19 patients.”

Bordignon was dissatisfied with this explanation. “[In the fall] they were even very wary about us even having patients who had been tested, but the test results have not come back yet,” she wrote. “And then all of a sudden we get this email [that said we] can deal with [COVID-19] patients.”

Bordignon also mentioned that she did not hear of any times when the university consulted students. This was magnified by the larger issue looming over nursing students’ heads: if they were to directly treat patients with COVID-19, when would they be vaccinated? 

The vaccine question

U of T’s sudden decision to allow students to care for COVID-19 patients at their placements was exacerbated this winter semester when students were stripped of their ability to choose which placement they want to work at. 

“[Pre-COVID-19] we would rank the placements,” Bordignon wrote. “I was also able to rank my placements for Fall 2020, but I was not able to in Winter 2021.

She mentioned that being consulted about the decision would have gone a long way. “I’m ultimately the one that has to go to this placement.” 

Working directly with COVID-19 patients in these institutions has left students with a looming fear for their health and the health of those they come into close contact with. This fear is amplified for those who have clinical placements in institutions that do not immediately swab all patients for COVID-19. 

When asked if U of T was aware that some students were placed in these institutions, Linda Johnston, Dean of the Lawrence S. Bloomberg Faculty of Nursing, wrote to The Varsity, “Decisions around swabbing patients for Covid-19 are determined by the Infection Prevention and Control unit or IPAC and the individual clinical placement provider.” 

Schafrick commented that knowing if you are coming into contact with COVID-19 positive patients at least provides a sense of security. “Within my shift, I usually know who might be positive and who might not be positive,” she said. “It doesn’t really change how I’m providing care to them… but there’s still a comfort level in knowing.” 

Being vaccinated would also alleviate some of the concerns about being a frontline worker. Although students acknowledge that U of T is not inherently responsible for students remaining unvaccinated, the lack of communication from the university has been disheartening to some students.

“We haven’t heard anything from U of T about the vaccine at all,” Schafrick said. 

According to Johnston, “U of T is working with [the] government and our affiliated hospitals to support the vaccine rollout.” She also claimed that many nursing students at U of T have already been vaccinated, depending on their clinical placements. Johnston directed students to speak to clinical placement providers as well to help register them for vaccines. 

Schafrick hopes that regardless of the university’s actions thus far, it will do more. “Something I wish U of T would have gotten more involved in is just making sure that all of the nursing students are getting vaccinated because it’s up to the different hospitals to administer the vaccine,” she said. “And so there’s people in my placement who I’m working with who have gotten the vaccine, and I didn’t get the vaccine because thereʼs a shortage.”

“I’m kind of worried that I’m going to go through this placement and not end up having gotten it,” Schafrick continued.

The consequences of caring for COVID-19 patients while unvaccinated can be significant. “Everybody is coming home to a different scenario,” Bordignon said. Some students live with high-risk family or friends. In Bordignon’s case, she lives with someone who is over 80 years old. 

“So that’s a consideration for me,” she said. “I don’t necessarily want to go to [a COVID-19] patient’s room because what if I bring that home to somebody that is very vulnerable?”

However, since Bordignon works in a clinical community placement that’s not a hospital, she hasn’t received the vaccine yet. 

“I wish the university would coordinate a little bit better and figure out who’s getting the vaccine,” she said. Advocating on her behalf would also be an asset, given the confusion she faces about how to access a vaccine. 

“I’m not really sure how I can get the vaccine except through placement,” Bordignon added. “And since it’s not being offered by this placement, where am I supposed to get it?”

Online instruction for a hands-on program

In addition to nursing students’ fears for themselves and their families’ safety, many are experiencing unprecedentedly high levels of vulnerability and isolation. This is a consequence of online learning, as it has prevented them from growing a network of students and faculty this year. 

“I just don’t have the relationships with the other students that I would normally have,” Schafrick said. Due to the pandemic, she explained, “We weren’t really talking to other people.” 

Community is then vital for their mental health, especially for people new to nursing, such as students. 

“In nursing especially, it’s really important to have those personal connections with the other students because we see stuff that normal students are not seeing,” Schafrick said. “You might have a patient [who] dies. You might be caring for someone who has an opioid addiction, for example. You’re dealing with stuff that’s heavy. And so you need those relationships with other people to process that stuff.”

Bordignon agreed, noting that, “I think that in nursing, you really rely on the rest of your cohort as you’re going through the experience together.”

Some students also find that their online academic experience cannot compare to pre-pandemic times. Although they understand that the faculty is doing its best to compensate so quickly for the hands-on education that nursing programs usually require, there have been difficulties coordinating the synchronous schedules of classes with clinical placements. 

“I feel like there’s not really any coordination with the students of when [their placement is] and how [U of T] coordinates synchronous lectures,” Bordignon said. There can sometimes be an overlap between classes and placements. 

Johnston commented that one option provided is for students to attend synchronous sessions every other week and to watch recordings of synchronous sessions on the alternate weeks to adjust for time conflicts. 

In addition, some hands-on educational experiences cannot be replicated during the pandemic. Schafrick noted that there has been more responsibility thrust onto institutions that students are completing clinical placements at to teach them certain skills. While she still appreciates that U of T has taught them the most essential skills in the in-person labs that they attend each week, given certain physical distancing restrictions, some lessons cannot be taught in class. 

“For example, normally we would have a whole lab about IV administration… We didn’t get to have that,” Schafrick said. “Our clinical instructor at the hospital was using the hospital materials to kind of teach us the basics of that.”

Overall, though, Schafrick finds that these in-person labs and placements can also be a silver lining to her days. “We get the opportunity to leave our house and go to placement. Not everybody gets to do that,” she said. “As stressful as it might be, that is kind of a gift right now for me because I am going crazy in the house… I do get that opportunity to be with the other students who are there and be with my clinical instructor, which I feel is great.” 

Through all of the havoc of this past year, nursing students are still focusing on the positives. “I think as we keep going with this online stuff, things are going to get better in terms of organization, in terms of communication,” Schafrick said. As recent as February 3, the nursing faculty held a midterm check-in Zoom call with students.  

Bordignon noted that although the nursing program has become especially demanding, it will prepare her for the future. “We’re going to go into a pandemic, so I guess it’s good that we get some experience as a nursing student and then we’ll be ready to hit the ground running.”

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