As we face the global health worker shortage, Nursing Schools will play a critical role in developing innovative solutions.
The World Health Organization (WHO) estimates that by 2030 there will be a global shortage of approximately 18 million health workers – 20% of the workforce needed to maintain healthcare systems. As this prediction came prior to the COVID-19 crisis, these numbers may have risen. While the number of applications to nursing programs have also increased during the pandemic—Queen’s Nursing saw an over 60% spike in applications—schools face a challenge in preparing enough nurses to meet the looming demand, a task that will require creative planning and innovative program delivery. For as long as I have been an educator in nursing (over 25 years), there has been a shortage of clinical placements for students. I hate to break it to my health sciences colleagues, but this is not going to change. In fact, in the aftermath of COVID-19 it may only get worse. Though students could help mitigate staffing shortages, I am certain that placement coordinators will not want to over burden units with additional training responsibilities when staff are trying to cope in a post-pandemic world.
So, what to do?
I believe that nursing schools across Canada should brainstorm at a national-level and share ideas. We cannot assume there will be a one size fits all approach to solving placement issues; communities that nursing students work with each have unique sets of needs and demands. Nevertheless, it is beneficial for all schools to see the creative approaches some programs have adapted. Having visited many institutions, I have seen some offer six-week online learning and six-week clinical placements. Others have focused on critical thinking theory during placements, layering in professional tasks in stages. These approaches drastically reduce the amount of time students need to be embedded in a unit.
In 2012, I was one of the co-principal investigators on a Canadian study where we conducted a first-of-its-kind pilot study that replaced clinical time with a simulation. We replaced 25% of the experimental groups clinical time with a simulated learning environment. At week seven, both the experimental and control group (in-person only learning) were given medication tasks. The experimental group had significantly less near misses than the control. In 2011, the “The NCSBN National Simulation Study” followed incoming nursing students from 10 prelicensure programs across the U.S. until graduation, at which time they were assessed on competency and knowledge. It was a controlled study, looking at how replacing clinical hours with simulation may affect learning outcomes. The study found that, “there were no meaningful differences between the groups in critical thinking, clinical competency and overall readiness for practice as rated by managers after working in a clinical position”. Both studies were similar and came to the nearly the same conclusion: simulations for nursing education can be used to substitute some traditional clinical hours when executed under conditions comparable to those used within the studies.
Despite the promise that virtual simulation has shown, students do need real clinical hours. However, given placement shortages, we need to decide how to allocate these hours and optimize availabilities. When can simulation be an adequate replacement? How do we make the delivery of simulation education cost effective? Can we ensure that large volumes of students can maintain high-level quality of learning? These are all questions we need to explore.
I believe that despite its destruction, COVID-19 has also taught us that we can imagine the impossible. Who would have thought that a vaccine could be developed, manufactured, and begin to be distributed within a year? It demonstrates that great minds can find solutions. Nurses have always been at the forefront of finding high-quality ways to deliver care (often under less-than-ideal circumstances). We can address and conquer this problem, but we need to think outside of the box - maybe even out of the realm of perceived possibilities – to find new solutions. Let us look for alternatives within other professional programs, such as pharmacy, management, or education; how they are offering student access to limited placements? If we open our thinking to weigh the possibilities and see what could be, then in the end, we may find many solutions. The upcoming healthcare workforce shortage is imminent – we must do everything in our power to best to prepare while maintaining an education standard that ensures nurses will deliver high-quality care globally, in the future and always.
Dr. Kim Sears is an Associate Professor in the School of Nursing and Health Quality Programs. She has over twenty years experience in both of teaching at the post-secondary level and as a Registered Nurse. Through her nursing practice, Dr. Sears gained firsthand understanding in her field, quality and safety in healthcare, which spurred her advocacy for advancing quality care, reducing risk and improving patient safety. The majority of her work focuses on furthering the safe delivery of medications, in both the community and hospital setting for children and adults.
This article has been published as part of our Nursing Week 2021 campaign, which seeks to celebrate and amplify the voices and opinions of our nursing faculty, students, alumni and colleagues. Please note that this is an op-ed style essay, and all content shared belongs to the authors.