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There’s no pause button in the nursing profession.

Crucial—sometimes life-saving—decisions are made moment to moment in healthcare, and nursing students need to be ready for that challenge when they enter the workforce.

When the coronavirus began to spread in the U.S., hospitals, nursing homes and other clinical agencies sent students away to begin preparing for the uncertainty and potential influx of patients brought on by the pandemic. University of Wisconsin Oshkosh College of Nursing (CON) leaders then had to think on their feet and find alternate ways to ensure that students got the necessary exposure to clinical experience. To help students develop and use their critical-thinking skills, simulations of patient situations went virtual.

This presented an unusual opportunity: While putting their knowledge and skills to the test, nursing students now had the ability to not only press pause on a situation to think it through. But they also could repeat procedures more than once—something often out of the question in a real-life clinical setting.

“Unfortunately, as a nurse in a physical patient setting, we cannot stop to think about what to do next, we cannot hit pause and replay,” said Jenna Maki, a junior nursing student and Oshkosh Student Nurses Association president. “We have to know what to do in a moment’s time in order to keep our patients safe and alive.”

That, of course, is different than when practicing virtually.

For example, Maki said, at one point during an exercise her virtual patient’s oxygen saturation was decreasing and his breathing difficulty was increasing. To take a moment to consider how to react, she was able to click a literal pause button and then make a decision—then unpause and do what was needed to get the patient’s baseline oxygen saturation level and maintain his airway.

“I was able to think about what to do ahead of time in case the patient continued to deteriorate,” Maki said. “Not only was I able to do this several times throughout the simulation, but I could also redo the simulation altogether—completely start over and do it different and do it better than the time before.”

Maki said she was thankful the CON faculty and staff made the transition less stressful than she anticipated in the midst of the escalating coronavirus situation.

Shelly Lancaster, associate professor and director of the pre-licensure program, was among those who had to adapt on the fly with some 600 undergraduates in a variety of clinical settings. Obviously, she said, getting hands-on experience in a healthcare facility is ideal—but there are upsides to alternative routes.

“Virtual simulations and the virtual world are a safe place for student learning— mistakes can happen without adverse patient outcomes,” Lancaster said.

The students also are now part of a select group who’ll begin their careers in the near future with different experiences than those who came before.

“The pandemic has changed care delivery in this nation and across the world,” Lancaster said. “Understanding how to care virtually for patients is a skill our students will carry with them as they enter the profession.”

When clinical experiences for nurse anesthetist students were halted in March, the class of 2020 had met all of its clinical requirements, so they remained on track and graduated in the spring. The 2021 class had put in 10 months of clinical work when the pandemic hit. That was on hold until June, when elective surgical cases resumed. In the meantime, educators provided them with weekly case studies and an online simulation day, where skills and case studies were presented to small groups with multiple faculty members facilitating sessions through the Collaborate Ultra software.

“Having the technology readily available to provide both clinical and didactic coursework online via Collaborate Ultra and Microsoft Teams worked really well,” said Molly Condit, an assistant professor in the nurse anesthesia emphasis program. “To be able to interact with the students frequently was a huge plus.”

CON faculty also were able to hold weekly virtual town halls with each of the cohorts to check in and provide updates.

For the spring graduates, it was a final semester unlike any other. And for those with further to go, it was an obstacle that may or may not need to be dealt with in the months ahead.

“Our students are fantastic—and resilient,” Lancaster said. “That is a sound quality for a future nurse.”