One of the things that made the first year of the pandemic so difficult for nurses like Sharff was that there was no escaping it. Restaurants were closed. It felt unsafe to go anywhere on vacation—not that she could have taken time off. TV news and social media feeds were consumed by the virus. And worried family and friends were constantly calling with frantic questions. “Coming home was not recovery,” she says. “You were the resource for everyone; that was draining. You never got that mental downtime.”
Nurses did what they could to care for themselves. Sharff got rid of cable and stopped watching the news. Perry learned how to play the violin. “If I could focus on notes, I wasn’t focusing on other things, like the fact that in my last shift I helped intubate multiple people and sent them up to the ICU, and I have no idea how they’re doing.”
Hearing about more and more nurses burning out as the crisis dragged on gave faculty a heightened awareness that teaching their students self-care skills was imperative. Brown, who spent the early part of her nursing career on the front lines of the AIDS epidemic, remembered what it was like to care for scores of dying patients whom others were afraid of, day after day after day. “Nurses have to be healthy first. That came across loud and clear at all levels,” she says. “We have to be more conscious of the health of our students—their mental health, their physical health, all kinds of health.”
Dean Laurie Badzek, whose nursing background is in ethics and health policy, was increasingly concerned about the students’ well-being. “Every study I saw showed increased use of alcohol or other things,” she says. “We really needed to pull them all back and give them a refresh, start them off in a new way.”
The college added the MINDSTRONG for Students course into the sophomore year BSN curriculum, and it was made available to any junior, senior, graduate student, faculty, and staff member who wanted to take it. Created by researchers at Ohio State University, MINDSTRONG teaches students how to cope with stress, regulate their emotions, and build mental resiliency.
“We built it right into a core course because we thought that’s how critical it was,” says Evans of MINDSTRONG, which the college is slowly refining based on student and faculty feedback. “We know nurses are getting burned out, we know nurses are leaving the field, and we want to make sure our students are equipped with the perseverance to do well and to be able to take care of themselves.”
Students and faculty saw firsthand the strain on nurses when they resumed limited clinical rounds that fall. Garrison recalls that the 60-bed unit at UPMC Altoona where he led students on rounds that semester had COVID patients at the far end of the hallway. There were just a few at first, but as the semester wore on the makeshift barrier between COVID patients and “regular” ones kept getting closer. By the last week, there were just eight non-COVID patients the students could tend to on rounds.
The rest were off-limits, because Penn State students were not allowed to care for patients with COVID. To make sure they still got some experience with the virus, Garrison, the college’s simulation lab director, programmed one of the sim manikins to create a COVID patient: a 63-year-old overweight male with Type 2 diabetes and worsening symptoms. “I can make his lungs sound congested, his O2 levels drop, all kinds of things,” Garrison says. “Simulation has really enhanced our ability to educate our students.” During the COVID sim session, students don the required PPE, do an assessment, listen to their patient’s lungs, analyze chest X-rays and diagnostic test results, and communicate with the physician.
Clinical sites that typically allowed 10 or 12 students per clinical section were allowing only four or five. Students rotated between in-person care with their professors and working on virtual sims. With less time spent at the bedside, faculty spent more time helping their students practice how to approach patients, get them to answer questions, and walk them through procedures. They also engaged students from other disciplines—those studying medicine, nutrition, social work—to role-play the coordination of patient care during sim exercises. “We have much more content on what we call interprofessional education,” Brown says.
One of the clinical rounds DeSanto was most looking forward to, labor and delivery and pediatrics, was still closed to students, so she settled for sim sessions, caring for a lifelike patient simulator designed as a pregnant woman in labor. The professor can control the manikin’s changing symptoms and what it says, whether the labor goes smoothly or has sudden complications. “In the moment you’re like, ‘Oh my god, this is kinda stressful,’” DeSanto recalls. That stress is by design, to give students the chance to learn how to handle themselves in an emergency, and how to handle high-acuity but low-incident issues, such as cardiac arrest or placenta previa, before a real life is on the line.
DeSanto did get real-world nursing experience, and a big boost of professional pride, when the vaccines began rolling out. Nursing students at all campuses helped administer vaccines to community members at free clinics across the state during the spring of 2021. “That was super rewarding, to feel like you were giving back,” she says.
With the vaccines came a wave of cautious relief to health care workers everywhere, and more clinical sites began opening to students, though in smaller numbers than was typical pre-pandemic. In January 2021, Perry took a job as a clinical nurse educator at her hospital while continuing to work part-time in the ER. In her new role, she got to work with Penn State students returning to clinical rounds. They followed strict requirements regarding PPE, including wearing P100 respirator masks during their entire shifts. Perry was impressed with the students’ attitudes: “They were always happy to be there, ready to learn, asking questions.” The aspiring nurses told Perry the areas they’d missed, like behavioral health and labor and delivery, because of limited clinical round opportunities, and she tried to find them relevant experience with patients who came through the ER.