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| Coronavirus May Keep California’s Nursing Students From Graduating | Coronavirus May Keep California’s Nursing Students From Graduating |
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| For Sharon Goldfarb, a nurse educator in California, crisis care is second nature: She worked at a Harlem H.I.V. clinic during the AIDS epidemic, at ground zero after Sept. 11 and in New Orleans after Hurricane Katrina. When the coronavirus outbreak began to spread, she was ready to prepare her 85 nursing students for front-line care, if necessary. | For Sharon Goldfarb, a nurse educator in California, crisis care is second nature: She worked at a Harlem H.I.V. clinic during the AIDS epidemic, at ground zero after Sept. 11 and in New Orleans after Hurricane Katrina. When the coronavirus outbreak began to spread, she was ready to prepare her 85 nursing students for front-line care, if necessary. |
| Then the calls came from local hospitals: They no longer wanted nursing students to come for clinical rotations, primarily because of public health advisories on limiting the spread of the virus. Not only would her students be unable to help — most would not be able to graduate on time. | Then the calls came from local hospitals: They no longer wanted nursing students to come for clinical rotations, primarily because of public health advisories on limiting the spread of the virus. Not only would her students be unable to help — most would not be able to graduate on time. |
| The United States is facing a nursing shortfall, and California will be especially hard hit; the state’s vacancy rate for registered nurses is now above 4 percent. The coronavirus will place a tremendous strain on already understaffed hospitals. Yet a growing number of hospitals are discontinuing clinical rotations for the state’s nursing students. The California Board of Registered Nursing requires that 75 percent of a nursing student’s clinical education be completed with patient contact during hospital rotations. Dr. Goldfarb, dean of health sciences at College of Marin, said that if the state did not change that requirement or encourage hospitals to find clinical roles for nursing students, there would be few nursing students graduating in the coming months. | The United States is facing a nursing shortfall, and California will be especially hard hit; the state’s vacancy rate for registered nurses is now above 4 percent. The coronavirus will place a tremendous strain on already understaffed hospitals. Yet a growing number of hospitals are discontinuing clinical rotations for the state’s nursing students. The California Board of Registered Nursing requires that 75 percent of a nursing student’s clinical education be completed with patient contact during hospital rotations. Dr. Goldfarb, dean of health sciences at College of Marin, said that if the state did not change that requirement or encourage hospitals to find clinical roles for nursing students, there would be few nursing students graduating in the coming months. |
| “They’re trying to marshal the resources they have as wisely as they can,” Dr. Goldfarb said of the nursing schools’ clinical partners. “They’re working with limited resources, in people and supplies.” Still, she added, “We’re looking at 14,000 nursing students not graduating in the time of most dire need I’ve seen in my years as a professional nurse. It’s incredibly shortsighted.” | “They’re trying to marshal the resources they have as wisely as they can,” Dr. Goldfarb said of the nursing schools’ clinical partners. “They’re working with limited resources, in people and supplies.” Still, she added, “We’re looking at 14,000 nursing students not graduating in the time of most dire need I’ve seen in my years as a professional nurse. It’s incredibly shortsighted.” |
| For their part, the facilities that typically take in nursing students are scrambling to protect the health of their patients and work force. “In accordance with directives from county and state officials, we have restricted all nonessential personnel from our inpatient facilities, which includes students in clinical nursing rotations,” said Anna Kiger, chief nurse officer at the North California health system Sutter Health. She added that some student involvement in ambulatory settings could be arranged, with proper precautions. | For their part, the facilities that typically take in nursing students are scrambling to protect the health of their patients and work force. “In accordance with directives from county and state officials, we have restricted all nonessential personnel from our inpatient facilities, which includes students in clinical nursing rotations,” said Anna Kiger, chief nurse officer at the North California health system Sutter Health. She added that some student involvement in ambulatory settings could be arranged, with proper precautions. |
| A spokesman for Kaiser Permanente, another clinical partner for the nursing schools, said that all of the decisions they had made were meant “to limit the spread of the virus to our members, staff and the public.” | A spokesman for Kaiser Permanente, another clinical partner for the nursing schools, said that all of the decisions they had made were meant “to limit the spread of the virus to our members, staff and the public.” |
| California’s nursing students, for their part, are frustrated that their hands are tied as the number of coronavirus cases rises. “We see all the posts about staffing shortages, and I’m sitting at home thinking I could be helping,” said Sarah Joseph, 27, a nursing student in the health sciences department at the College of Marin who was supposed to graduate in May. “The nurses in clinical settings are on the front lines and we desperately want to be with them, because that’s what we went into nursing to do. But we’re being pushed out.” | California’s nursing students, for their part, are frustrated that their hands are tied as the number of coronavirus cases rises. “We see all the posts about staffing shortages, and I’m sitting at home thinking I could be helping,” said Sarah Joseph, 27, a nursing student in the health sciences department at the College of Marin who was supposed to graduate in May. “The nurses in clinical settings are on the front lines and we desperately want to be with them, because that’s what we went into nursing to do. But we’re being pushed out.” |
| In a letter last week to Gov. Gavin Newsom, the deans of several nursing schools called on California to temporarily lift the rule requiring 75 percent in-person care and instead allow nursing students to complete their graduation requirements through 50 percent simulations, which use mannequins, videos and online platforms for training. | In a letter last week to Gov. Gavin Newsom, the deans of several nursing schools called on California to temporarily lift the rule requiring 75 percent in-person care and instead allow nursing students to complete their graduation requirements through 50 percent simulations, which use mannequins, videos and online platforms for training. |
| “With swift and temporary action, we can keep California’s nursing students on track and prevent a decline in the overall number of registered nurses in our state,” wrote Robyn Nelson, dean of the College of Nursing at West Coast University. Dr. Nelson has had more than 3,600 nursing students displaced by the clinical policy change; she said the temporary rule change can be enacted through use of the governor’s emergency powers. | “With swift and temporary action, we can keep California’s nursing students on track and prevent a decline in the overall number of registered nurses in our state,” wrote Robyn Nelson, dean of the College of Nursing at West Coast University. Dr. Nelson has had more than 3,600 nursing students displaced by the clinical policy change; she said the temporary rule change can be enacted through use of the governor’s emergency powers. |
| On Sunday, California nursing students released a petition on Change.org asking the Board of Registered Nursing to “find an alternate solution” to clinical hour requirements; it has gathered more than 43,000 signatories so far. | On Sunday, California nursing students released a petition on Change.org asking the Board of Registered Nursing to “find an alternate solution” to clinical hour requirements; it has gathered more than 43,000 signatories so far. |
| A spokesman for the California Department of Consumer Affairs said on Wednesday that the department and the nursing board “are monitoring the situation and are looking into various options,” adding, “To date, we are still bound by our regulation.” | A spokesman for the California Department of Consumer Affairs said on Wednesday that the department and the nursing board “are monitoring the situation and are looking into various options,” adding, “To date, we are still bound by our regulation.” |
| Donna Meyer, chief executive officer of the Organization for Associate Degree Nursing, said that allowing nursing students to temporarily meet requirements through simulations was a simple solution, and desperately needed. A 2014 study from the National Council of State Boards of Nursing found that substituting 50 percent of clinical experience with simulations had no significant effect on “knowledge acquisition and clinical performance.” | Donna Meyer, chief executive officer of the Organization for Associate Degree Nursing, said that allowing nursing students to temporarily meet requirements through simulations was a simple solution, and desperately needed. A 2014 study from the National Council of State Boards of Nursing found that substituting 50 percent of clinical experience with simulations had no significant effect on “knowledge acquisition and clinical performance.” |
| But many nursing students and educators are not just calling for a change in licensing requirements; they also want to return to rotations, to provide clinical assistance where possible as hospital intake surges. In a survey of nursing students at the College of Marin this week, 85 percent of respondents reported that they would be willing to provide front-line care throughout the coronavirus outbreak. | But many nursing students and educators are not just calling for a change in licensing requirements; they also want to return to rotations, to provide clinical assistance where possible as hospital intake surges. In a survey of nursing students at the College of Marin this week, 85 percent of respondents reported that they would be willing to provide front-line care throughout the coronavirus outbreak. |
| Ms. Joseph, the nursing student, was scheduled this spring to complete her preceptorship in labor and delivery, which is now canceled. Her disappointment at the delayed graduation quickly turned to frustration. She said that she could play a useful role at a clinic without directly treating coronavirus patients — helping the triage nurses take patient vitals, distributing masks, assisting with screening questions, communicating with patients’ families and visitors. Instead, she is in her apartment, wondering when she will be able to return to work. | Ms. Joseph, the nursing student, was scheduled this spring to complete her preceptorship in labor and delivery, which is now canceled. Her disappointment at the delayed graduation quickly turned to frustration. She said that she could play a useful role at a clinic without directly treating coronavirus patients — helping the triage nurses take patient vitals, distributing masks, assisting with screening questions, communicating with patients’ families and visitors. Instead, she is in her apartment, wondering when she will be able to return to work. |
| Paige Hilt, 24, another nursing student in California, was set to graduate in May. “Of course it’s scary, but as nurses we encounter people with different illnesses all the time,” she said. “We don’t know how bad this is going to get, and we need as many people as possible. Not to mention a lot of nurses are older, and what happens when they get sick?” | Paige Hilt, 24, another nursing student in California, was set to graduate in May. “Of course it’s scary, but as nurses we encounter people with different illnesses all the time,” she said. “We don’t know how bad this is going to get, and we need as many people as possible. Not to mention a lot of nurses are older, and what happens when they get sick?” |
| Updated June 22, 2020 | Updated June 22, 2020 |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| Joanne Spetz, a professor at the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, said her research indicated that patient numbers would far outstrip hospital staff capacity in the coming months, as coronavirus cases continue to rise. There are nearly four million registered nurses in the United States, but only 20 percent work in critical care. More nurses will need to be freed to move into intensive care units, meaning others will need to be ready to take their places. | |
| Dr. Spetz said that states and nurse licensing boards should be preparing by easing licensing requirements for registered nurses who need to cross state lines, and ensuring medical workers have emergency child care. In the meantime, the need is simple: to prepare as many nurses and nursing students as possible to help. | Dr. Spetz said that states and nurse licensing boards should be preparing by easing licensing requirements for registered nurses who need to cross state lines, and ensuring medical workers have emergency child care. In the meantime, the need is simple: to prepare as many nurses and nursing students as possible to help. |
| “Students of all health professions have knowledge and training already,” Dr. Spetz said. “There are going to be many roles they’ll be useful in as we rapidly deploy in an emergency.” | “Students of all health professions have knowledge and training already,” Dr. Spetz said. “There are going to be many roles they’ll be useful in as we rapidly deploy in an emergency.” |
| Each day on her way to the office, Dr. Goldfarb passes a poster with the face of a smiling World War I nurse. “Wanted: 20,000 nurses,” it reads. A sense of duty is ingrained in the nursing profession, she said. Even during the 1918 Spanish flu pandemic, student nurses were called to hospitals to care for the ill. | Each day on her way to the office, Dr. Goldfarb passes a poster with the face of a smiling World War I nurse. “Wanted: 20,000 nurses,” it reads. A sense of duty is ingrained in the nursing profession, she said. Even during the 1918 Spanish flu pandemic, student nurses were called to hospitals to care for the ill. |
| “We walk toward what most people walk away from,” Dr. Goldfarb said. Now she wonders: Will her students be able to do the same? | “We walk toward what most people walk away from,” Dr. Goldfarb said. Now she wonders: Will her students be able to do the same? |