The COVID-19 pandemic has forced our hospitals to see anyone entering their premises — whether patient, visitor, or staff — as a potential vector of infection. Their response has been impressive. Each day brings expansion of virtual services and other creative ways to deliver care safely. However, even with rigorous adherence to pre-screening, screening, personal protective equipment and physical distancing, the risk of introducing COVID-19 can only be reduced, not eliminated.
The risks and benefits of all programs within hospitals are under scrutiny, including the externship rotations of nursing students. Difficult decisions must be made.
Irrespective of the pandemic, the care hospitals deliver is increasingly dependent on nurses. Unfortunately, it is safe to assume that COVID-19 will accelerate nurse attrition. Our nursing shortage will be getting worse very quickly. The demand and supply curves are moving in opposite directions.
As it stands, we know that nurses already leave hospital nursing in alarming numbers. For every early-career nurse working outside of the hospital setting, three work within the hospital setting. By middle age, however, that ratio is one to one. The inability to retain nurses is a huge and expensive problem, which threatens our system of care. The reasons they leave are not well studied but easy to surmise. Almost certainly, burnout, stress, workload, and life balance top the list, all of which are being made worse by the pressures of the COVID-19 pandemic.
While there is still much to learn about the recruitment and retention of nurses, it is well established that hospital energies focused early in a nurse’s career are well spent. Hospitals that host externships for nursing students have a better chance of hiring their choice. Graduating nurses prefer familiar hospitals for their first job. Hospitals that provide mentorship and preceptorship support programs to early career nurses are more successful in retaining their nurses. Moreover, nurses that teach enjoy nursing more, and are more likely to stay in nursing.
The supply of nurses depends on hospitals. Although nurse education is evolving daily, with virtual training and simulation, there will never be a substitute for hands-on, in-person clinical experience. If nursing students cannot access hospital rotations, they simply cannot develop the skills and competencies necessary to nurse.
It will be tempting for hospitals to press pause on nursing externships. The nursing student adds little to the delivery of essential care. While screening and pre-screening will help, like everyone else entering the hospital, the nursing student will still bring some risk of infection. It is easy to understand the temptation.
Such thinking is short term. The better thinking is to consider the nurse student as being as essential as the nurse. Whereas one hospital might falsely sense a benefit from pausing its externships, if all did so, the supply chain of nurses would be interrupted. Although it will be for the hospitals to determine, the minimal risk of well-screened nursing students continuing their rotations needs to be assessed in this broad context.