key: cord-0877201-ckrf1odc authors: Murray, Marianne title: Unanticipated pandemic partnerships: Accreditation, education and regulation date: 2021-07-23 journal: Teach Learn Nurs DOI: 10.1016/j.teln.2021.06.018 sha: db0940f8d81df0915e4530eecc3b0f3d52bcb904 doc_id: 877201 cord_uid: ckrf1odc nan Unanticipated pandemic partnerships: Accreditation, education and regulation The pandemic has instigated enormous change that affected all aspects of daily life. We even have a new pandemic vocabulary that has developed in the last two years; PPE burn rate, contact tracing, flattening the curve, and zoom bombing; more recent phrases include: variant, vaccine passport, and the new normal. Additionally, the pandemic has introduced us to a completely virtual world, where we work, socialize, shop, celebrate, and say goodbye. A world developed through innovation and necessity. The necessity to social distance, to mask up, and to isolate. Nursing education was not immune to the mass change in daily life caused by the pandemic. Nurse educators were faced with unexpected barriers, and nursing students were faced with not accomplishing program outcomes (Redden, 2020) . Placing students in clinical facilities was no longer an option. Students were not able to come onto campus to learn, and graduated students experienced delayed access to the national licensing exam (Benton et al., 2020) . The fundamental needs of nursing educators and students required collaboration with state regulators and accreditors to ensure successful transitions for students to complete programs and join the profession. I would argue these newly forged pandemic partnerships were as innovative as some of the technological advances that occurred in the same timeframe. This editorial reflects the stress and turmoil that the pandemic caused in nursing education, regulation, and accreditation over 2020-2021, the national nursing organizations and statewide responses to the plight of nursing programs, and future partnerships in nursing education. As the number of positive COVID-19 patients began to climb in the first quarter of 2020, many states enacted shelter in place executive orders, which had a domino effect on healthcare, facilities, workers, and students. Hospitals began to prepare for significant numbers of COVID-19 positive patients by mobilizing disaster readiness plans that required more human resources, and focus. Healthcare workers became "front line workers" risking exposure to the virus when on the job and isolating themselves from loved ones to prevent the spread of infection. Student clinical experiences became stymied as resources were refocused on meeting the community's needs and ensuring viral exposure mitigation plans (Benton et al., 2020) . Nursing education program deans and directors became distressed by the sudden lack of clinical teaching environments. No alternatives were available as the lockdown continued and hospitals and clinics closed their doors to any visitors. With a bleak outlook for the near future, nursing education program leaders began to reach out to the state boards of nursing for help with regulatory easement and solutionbased assistance in dealing with the restricted clinical environment. Many state boards of nursing responded quickly to the plight of nursing program administrators with either specific clinical practice advisory opinions or general statements. For instance, the Boards of Nursing in Arkansas, Delaware, and Maine offered nursing program administrators flexibility in finding appropriate alternate clinical experience with the caveat that schools would need to maintain detailed records of the changes that were made, and how the changes would allow students to meet the end of program student learning outcomes (National Council for State Boards of Nursing [NCSBN], 2020). For many nursing programs, the obvious choice of clinical replacement was in the form of simulation. Since the NCSBN national simulation study published in 2014 (Hayden et al., 2014) and the followup, NCSBN guidelines for simulation in pre-licensure (Alexander et al., 2015) , nursing programs have been incorporating simulation into the curriculum to provide nursing students a safe space to learn, and hone in on certain behaviors or procedures. Simulation can provide a comprehensive assessment of students' critical thinking and clinical competency (Hayden et al., 2014) . Increasing simulation in the nursing curriculum seemed like the best method to ensure that students would receive clinical experiences to meet the end of program outcomes. In many states, implementing more simulation into programs required permission from the boards of nursing as well as formal communication with national accreditors. The Accreditation Commission for Education in Nursing (ACEN) reported that there was an increase in programs use of simulation, some programs initiated simulation experiences for the first time, and others incorporated virtual simulation experiences (Ard et al., 2021) . In California where only 25% of the clinical experience could be simulation-based, the push to increase the availability of simulation as an active learning strategy to replace clinical hours became national news. Petitions and pressure from nursing students, outcry related to a delay in graduating nursing students, and fear from the healthcare industry leaders that there would be a dwindling healthcare provider workforce resources outlined the need for all agencies to consider innovative solutions to these issues (Redden, 2020) . Not only were hospitals closing their doors to nursing students, but actual campus closures impeded the availability of teaching resources for nurse educators and students. Faculty were expected to pivot from the traditional in-class learning environment to using an online learning management system to teach. This transition to distance learning technology may have been one of the biggest hurdles that both nurse educators and nursing students endured together. Results from a study of first-semester nursing student stress related to the transitioning learning environment during the COVID-19 pandemic indicated that 80% of students had distress and anxiety related to the effects that COVID-19 had on their academics and almost 70% Teaching and Learning in Nursing journal homepage: www.journals.elsevier.com/ teaching-and-learning-in-nursing of students were distressed because of the inconsistency and deviation from the original education plan (Fitzgerald & Konrad, 2021) . Compounding the issue with the transition to online learning for faculty, was the steep learning curve from traditional methods of classroom lecture to the blended online learning environment. Intentionally transitioning a traditional course to an online course requires understanding the instructional design principles and can take months to complete. Most faculty were given days to weeks to make the changes and considering that the average age of most faculty is between 50 and 75 years of age, the learning curve was often insurmountable (American Association of Nurse Educators [AACN], 2020). A qualitative study of students' experiences of remote learning during the pandemic shed light on the struggles of faculty and students. "I would say that my professors really struggled with having online access. They weren't as tech-savvy as one would need to be to do a full-day online class. So a lot of the time we either didn't have a lecture or. . . they would just send out their lecture notes and say, you know, 'here they are read them when you can' and obviously, that didn't work" (Wallace et al., 2021, p.3) . For nursing administrators moving to online virtual teaching typically meant requesting permissions and filling out substantive change forms from state boards of nursing and national nursing accreditors. Still, because of state emergency declarations and the national emergency declaration, and subsequent waivers, the administrative burden was decreased in this regard (Ard et al., 2021) . However, it increased the need for nursing administrators to scramble to provide resources for faculty such as online learning management platforms, contracting with online proctoring services, and ensuring that both the students and the faculty were supported, that lines of communication were open, and information was being shared readily. National nursing organizations like the Organization for Associate Degree Nursing (OADN) recognized the strain on nurse educators and rapidly organized and provided resources that could help educators with transitioning content and clinical. OADN created a comprehensive web page to help nurse administrators and faculty and provided current resources with topics like online teaching, conducting safe clinical and labs, virtual simulations and for nurse administrators, evidence to inform regulatory changes (Organization for Associate Degree Nursing, n.d.). Many nurse educators were unfamiliar with virtual simulation and sought out resources to aid in understanding how to best utilize and integrate virtual simulation into the curriculum. OADN created Virtual Simulation Review (VSR) a structured database that provides comprehensive reviews of virtual simulation resources and uses International Nursing Association for Clinical Simulation and Learning (INACSL) Standards as a best practice measurement. Additionally, the OADN simulation task force, ensured that the virtual simulation products included diversity, equity, and inclusion and highlighted resources that include inclusive learning experiences (Organization for Associate Degree Nursing, n.d). The resources provided and compiled by OADN area highly valued toolkit for nurse educators and administrators. Finally, another barrier for nursing administrators and students was the lack of availability of the NCLEX exam due to the state emergency declarations to shelter in place. Exam locations were closed immediately, and nursing graduates were faced with a stalemate of perhaps graduating from school but unable to practice because they could not sit for the national certification examination. This situation felt like a national emergency as the waitlist for nursing graduates to take the NCLEX exam stretched out to a six-month wait while the nation stayed in lockdown status. Understanding the importance of access, National Council of State Boards of Nursing (NCSBN) NCLEX experts began to systematically evaluate methods to speed up access to the exam while evaluating the actual length of the exam to decrease the traditional six-hour window required for the exam. NCSBN representatives worked tirelessly with local state government authorities to facilitate exam access as an essential service so that students would have access to tests (Benton et al., 2020) . In other states such as Ohio and Indiana, the state government waived the NCLEX requirement so that students could start work immediately after graduation with 90-day temporary licensure (NCSBN, 2020) . This past academic year has profoundly affected nursing education programs, nursing administrators, nursing students, nursing educators, state boards of nursing, accreditors, and national organizations like OADN. The collective goals forged partnerships among these members. These goals included ensuring that nurses continued to be educated at the highest level, preventing public harm, and ensuring that students were successful in achieving the end of program nursing outcomes for graduation and preparation to complete the NCLEX exam for licensure successfully. In December, the Tri-Council for Nurses (2021), held a virtual summit identifying critical issues in nursing education, practice, and regulation. This summit provided a platform to explore how collaborative measures might be used to pursue solutions. Recommendations from the summit encourage nurse educators to become innovators by embracing distance learning technology, becoming familiar with blended learning teaching modalities, and developing flipped classroom designs while ensuring high-quality education for students. They also encourage communities to work with nursing program administrators to seek innovative strategies to facilitate active clinical learning environments not dependent on acute care facilities or face-to-face education delivery. There is much to be learned from our collective experiences during the pandemic. We have all stretched our personal and professional limitations, learned many new points of information, and developed resiliency in the face of adversity. We may have entered the new normal and feel as though things will return to a place we were all familiar within 2019. Still, I would caution that we should move onward, continuing to work together, to maintain these partnerships, to recognize individual and collective strengths, to embrace innovation, and give each other grace. There is much work yet to be accomplished together. Marianne Murray, DNP, RN, CHSE Director of Nursing Programs/ Professor Alaska Pacific University E-mail address: mariannemurray99@gmail.com NCSBN simulation guidelines for prelicensure nursing programs AACN fact sheet-Nursing faculty shortage Responding to the pandemic: Nursing education and the ACEN Lessons learned and insights gained: A regulatory analysis of the impacts, challenges, and responses to COVID-19 Transition in learning during COVID-19: Student nurse anxiety, stress, and resource support The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education Changes in education requirements for nursing programs during COVID-19 Organization for Associate Degree Nursing. (n.d.). Virtual simulation reviews Organization for Associate Degree Nursing. (n.d.). COVID-19 initiative Clinical training for nurses sidelined. Inside Higher ED Transforming together: Implications and opportunities from the COVID-19 pandemic for nursing education, practice and regulation. American Nurses Foundation Nursing student experiences of remote learning during the COVID-19 pandemic