The final semester for Harford Community College students pursuing an associate’s degree in nursing is typically reserved for the “practicum,” a period in which students work with patients in a hospital setting under nurse’s guidance.
“You’re the nurse,” said fourth-semester student Kristin Beatty, who noted that students “have someone there that is guiding you and helping you in your experience.”
Beatty and her classmates have not been able to do that during the spring 2020 semester, though, as HCC officials have closed the Bel Air campus to students and switched to all-online instruction to help limit the spread of the coronavirus. Online instruction has been happening since March 23, and it will continue through the summer session, according to the college’s website.
Students typically work with a nurse preceptor during their 100-hour practicum and are “immersed in the role of the RN and have the opportunity to practice and develop their skills” under the preceptor’s supervision, Jessica Powers, assistant professor of nursing, wrote in an email.
“The intense focus of this experience increases students’ confidence and facilitates transition into practice,” Powers added.
Another fourth-semester student, Georgia Garcia, noted that “our lovely professors" have provided an alternative so students can still gain experience from working with patients, that being virtual simulations.
Garcia, 21, of Abingdon, said the sims are “really educational, and I am very glad we have an opportunity to learn.”
The college is using the trademark vSim for Nursing program, which gives students “the opportunity to make decisions and provide interventions like a nurse would in the clinical setting,” according to Powers.
Students are presented with an interactive video scenario that shows patients presenting with varied conditions. The students must determine how they will provide care based on the scenario, and the system gives them feedback on what they did right and how they can improve, according to the students. They also can “reflect on the experience and engage in discussion with faculty to help them learn even more,” Powers wrote.
“Harford Community [College] has really prepared us for these scenarios, so I felt well prepared going into them,” Garcia said.
Beatty, 35, of Forest Hill, said the virtual patients are not real people, so students have room to “mess up” and redo the simulations multiple times and improve their skills.
“Even though it’s not hands on, it’s giving me the opportunity to [improve] my organizational skills, in planning my patients’ care,” she said.
Student nurses learn how to plan out daily care routines for patients on their shift, handle multiple patients at the same time and prioritize treatment based on each person’s needs.
“It’s helping you prioritize your care and organize how your day would go,” Beatty said.
Chris Schemm, another fourth-semester student, said the simulations are “pretty interesting” and that students are told “in bullet-point form” how they can improve. He praised the education he has received through the two-year associate’s program.
“I’d say it’s helpful, but for me, myself, I’d rather work in a hospital face-to-face with patients and get that kind of experience,” said Schemm, 29, of the White Hall area.
All three students, Beatty, Garcia and Schemm, are in the ATB, or associate’s to bachelor’s, degree program, meaning they are dually enrolled in the HCC and Towson University nursing programs.
Towson and HCC have operated a “2+2” partnership since 2014, through which students can earn an associate’s degree at the community college and then pursue a bachelor’s from Towson through upper-level classes. Harford graduates can take classes, including nursing, in the Towson University in Northeastern Maryland, or TUNE, building on the west side of the HCC campus.
Beatty, Garcia and Schemm, as well as others in the ATB program, are slated to earn an associate’s and bachelor’s degree in nursing once they complete the two-and-a-half-year program in December. There could be opportunities to complete a practicum during the fall 2020 semester, depending on conditions related to the pandemic, according to the students.
They also had opportunities for hands-on instruction and training in past semesters through clinical rotations. Students visited medical facilities in groups and worked with faculty and medical professionals in areas related to what they were studying in class at the time.
Beatty said she spent one clinical rotation in labor and delivery of newborns. She plans to train to be a nurse midwife after she earns her bachelor’s degree and eventually work in that field.
Beatty has two step-children and three biological children, and her three youngest were delivered by the same midwife. She described the experience as “great” and “holistic.”
“I really appreciate the way they care for their patients, the way that they nurture their patients,” Beatty said of nurse midwives, who can provide care either in a hospital or home setting.
She praised nurse midwives as having “a passion for promoting women’s health care and being advocates for women in general.”
“I think it’s going to be a way for me to still do labor and delivery, but also promote women’s health at the same time,” Beatty said.
She noted that her midwife has volunteered to be her preceptor when she starts midwifery school. A preceptor is someone with experience in the medical field who serves as a teacher and mentor to students, as well as people who are making a transition to a new field of service, a person who will “help me before I can fully be on my own” on the hospital floor, Beatty said.
Schemm recalled “daily huddles” during his most recent clinical rotation earlier in the spring semester, as hospital staff discussed patient care amid the increasing number of cases of COVID-19, the potentially fatal respiratory disease caused by the novel coronavirus. One topic of discussion was ensuring health care workers had enough PPE, or personal protective equipment.
“That is very essential for health care workers, if they’re going to be in close proximity ... taking care of patients that have been diagnosed with this virus,” said Schemm, who wants to be a surgical nurse.
Garcia, who wants to be in the field of pediatric oncology and work with children with cancer, recalled getting a boost from a patient while on a clinical rotation during her second semester.
“A patient had told me I was going to make a great nurse, and they were really proud of me,” Garcia said.
Garcia gives credit to her instructors, as well as the classroom facilities in the “wonderful” Darlington Hall at HCC. Darlington Hall, which opened in 2015, is the central location for nursing and allied health programs.
It has equipment such as an ambulance simulator and suites set up as hospital rooms with mannequins designed to simulate adult, child and infant patients with a variety of programmable medical needs.
“I like to say that I’ve learned from the greatest,” Garcia said. “We have wonderful lab staff and clinical instructors.”
Instructors and staff “have taught us so much,” such as conducting a “head-to-toe” physical assessment of a patient, taking vital signs such as temperature and blood pressure, developing their bedside manner, as well as keeping themselves safe, according to Garcia.
“They’ve been with us from Day One to our very last day, and they’ve given us nothing but the best advice to take out into the field,” she said.
Working during a pandemic
It is “kind of concerning” that the COVID-19 pandemic is happening as Schemm and his classmates come to the latter part of their education in nursing and that they could “go from school right into a health care setting” where health care workers are battling a highly-contagious disease.
More than 9,200 health care workers in the U.S. had been infected with COVID-19 as of April 9, based on confirmed cases reported to the U.S. Centers for Disease Control and Prevention. The CDC report, dated April 17, acknowledges that “this is likely an underestimation because [health care worker] status was available for only 16% of reported cases nationwide.” At least 27 workers have died from COVID-19, according to the report.
There also have been reports of hospital workers suffering from fatigue, burnout and mental health issues as they struggle to keep patients alive, keep themselves safe and deal with multiple patient deaths.
Beatty said she has heard from friends who work in the medical field and how COVID-19 has affected their lives, such as forcing them to isolate themselves from their families so they do not risk infecting their loved ones.
People she knows, who work with COVID-19 patients, have been ensuring they take all precautions when at work, such as wearing PPE, and taking additional precautions when they get home such as not wearing their work shoes in the house and showering immediately.
“I’m afraid for a lot of people to get burnt out,” she said.
She said she is “fearful” for herself, as well, since she has had asthma since childhood and her daughter has “major breathing problems.” People with underlying health conditions, such as respiratory issues, are at greater risk from COVID-19.
“I am hoping, by the time I get out there, it’s not going to be as prevalent as it is now, but there is a fear that it could be,” Beatty said.
She is president of the Student Nurses’ Association at HCC, and the organization typically does community outreach events which have not been possible during the pandemic. She and her fellow association members are working to find ways to support local first responders, health care workers and hospitals through donations.
Schemm, who stresses the need for hospital workers to have enough PPE, lives with his parents and is concerned for their health during the pandemic.
He usually wears a mask while in the grocery store and keeps a bottle of hand sanitizer and sanitary wipes in his car, plus he has a designated spot in the house for his groceries.
If he has been out in public for an extended period of time, he will go straight from his car to his parents’ basement, put his clothes in the laundry and take a shower. He also wipes down any surfaces in the house that he touches.
All of these precautions come before he starts working in the medical field.
“If it’s still pretty prevalent, I just worry about the possibility of bringing this home with me,” Schemm said. “There are precautions I take, but you can’t really foresee everything.”
The pandemic has been a topic of discussion in HCC nursing classes, and students and instructors talk about matters such as “disaster nursing” — providing care during situations such as a natural disaster or a pandemic — and ensuring that nurses and other medical workers practice “self care,” according to Garcia.
Beatty said some training simulations have involved patients with COVID-19, plus she has read up on the disease.
The disease has been “an important topic in the classroom,” as students read articles in medical journals and conducted simulations with COVID-19 patients, plus discussed their concerns about entering the workforce during the pandemic, according to Powers.
She noted that many students have prior experience in the health care field, such as licensed practical nurses, technicians, security guards and other jobs, and a number have signed up to assist in the field through “emergency staffing pools.”
“For the most part, they are excited about getting out there and helping,” Powers stated.
Burnout and stress were, “unfortunately,” common in the nursing field well before the pandemic, according to Powers.
“We teach our students strategies to manage stress and burnout throughout our program,” she stated. “As they enter the workforce, we will continue to remind them to take care of themselves so that they can provide great care to patients.”
Garcia praised the many health care workers who are doing their part to battle COVID-19, including doctors, nurses, certified nursing assistants, licensed practical nurses, physicians’ assistants, respiratory therapists, physical therapists, occupational therapists, social workers and others.
“There are so many people,” she said. “[They] are truly heroes and are very inspirational for those who are starting their nursing journey.”
Each student had a different path that brought them to study nursing, but they have a common desire — helping others.
Schemm has long been interested in medicine, science and technology. As a child, he and his sister watched medical documentaries and television shows, recalling that “we both have a fondness for shows like ‘Scrubs.’”
He earned a bachelor’s degree in biology from Salisbury University on the Eastern Shore in 2015, and he particularly enjoyed classes on human anatomy and how organisms interact with the human body.
He worked as a lab technician after college, testing drinking water and wastewater samples. His lab company worked on a contract basis for many entities, including Harford County Public Schools, residential customers in Cecil and Harford counties, churches, campsites, even the IKEA distribution center in Perryville.
The laboratory work was interesting for Schemm, but he “had nursing on my mind.” He wanted to work in a science-based field but also help people, so he “decided to go for it” and pursue nursing.
“It’s just been great, applying the knowledge from my previous career as a lab technician,” Schemm said. “I really enjoyed the science aspect, but I felt like I was missing something; I like interaction with people, and through nursing, it’s sort of scratching that itch in a way.”
He recalled a time when his father experienced health issues serious enough to put him in the hospital. Schemm was able to interact with some of the nurses caring for his dad.
“They were very approachable and they answered my questions, and [those] of any other family member,” Schemm said.
He noted that much less time and money is needed to train to be a nurse, compared to the many years of schooling required to become a doctor. He also highlighted the holistic level of care nurses provide for their patients — beyond tending to just their medical needs — as a key reason for pursuing the nursing profession.
“Nurses are the ones that are advocating for patients — essentially, they’re a caregiver, too,” said Schemm, who noted that doctors also serve as patient advocates.
More and more men are working in nursing, traditionally a female-dominated profession. Schemm was able to interact with male nurses when his father was hospitalized, as well as during his clinical rotations.
He said there have been few issues, although he recalled being mistaken for a doctor on one clinical shift, even though he was wearing a badge that identified him as a nursing student.
“I think it’s a little beneficial, now that there are more and more men that are becoming nurses,” Schemm said.
Seventy-nine nursing students are scheduled to graduate from HCC this month, including 16 men and 63 women, according to Powers.
Beatty’s mother is a retired nurse who spent about 25 years in the profession and worked as a charge nurse, handling many night shifts and being on call.
“She definitely has been supportive — she still knows everything,” she said of her mother.
Beatty has previously worked in the field of patient care as a certified optician with the Katzen Eye Group. She became a stay-at-home mom seven years ago when her youngest child was born.
“I’ve always had compassion and I always like helping people, and I think of myself as a people person,” she said.
Garcia is the first in her family to go into nursing. She said she has “a strong passion to help others who are sick, who are ill — I’ve just always loved helping people.”
She enjoys seeing patients getting “back on their feet and going back out into the world and living their lives.”
“When you help someone who is sick and you see them get better, it brings a smile to my face,” she said.
Garcia recalled when a boy whose family lives next door to hers was being treated for cancer. She said the boy is now healthy, a middle school student and “loves to play baseball.” The care that nurses provided to him, as well as his family, during treatment was a key factor in what inspired Garcia to consider the profession.
“He’s such a sweet kid, and I’ve always just been interested in helping people ... just to see what a wonderful job the nurses did of taking care of him, and how special that was to that family, inspired me to look more into that field,” Garcia said.
Harford Community College typically holds a “pinning ceremony” at the end of each semester, as well as the summer session, to honor those who have earned an associate’s degree in nursing — 50 graduates were honored in December during the fall 2019 semester pinning ceremony, according to the HCC website.
The pinning ceremony for the spring 2020 graduates, scheduled for May 19, will not happen in the live format as initially planned because of the pandemic. Faculty, staff and class representatives are developing plans for an alternate pinning ceremony, as “these soon-to-be graduates have worked incredibly hard and they deserve to be recognized,” Powers stated.
“As far as how to prepare students to enter the health care field in its current state, realistically this is something unprecedented,” Powers wrote. “I’m confident that we’ve done our best to give them a great start, but they will need to continue their professional development and learn throughout their long careers as nurses.”