Senior nursing students began their final preceptorships throughout the Sacramento Region in January 2020 as they do every semester. This was what they were waiting for: the final clinical experience consisting of 200+ hours spent with an expert preceptor at one clinical site. This experience is where they put it all together to hone their critical thinking skills, develop organizational competencies, and begin that all-important transition to Registered Nurse. The senior preceptorship is not only critical for the development of critical nursing skills, these hours in clinical are required for the student nurse to graduate and sit for their licensure exam. This is an exciting and essential time!
But in March 2020, COVID led to unprecedented disruption in the lives of nursing students throughout the region. One by one, faced with the challenges and uncertainty of a global pandemic, area hospitals began to pause student placements in their facilities along with many across California. This greatly affected all students in nursing programs as clinical structures and experiences changed immediately and without warning for some. However, no group of students was impacted more than the senior students completing their preceptorships.
For this group, the stakes were astronomical. If they were not able to complete the required hours, these students would have to take an incomplete grade in the final clinical class and finish the class over Summer or Fall. The real-life impact for these students would mean that they would not be able to sit for board exams as planned in the Spring. Their exam would have to be postponed until the end of the next fall semester, likely January 2021. This would mean no license until then, no ability to join a new graduate nurse residency program, and no ability to get a nursing job for several months as they awaited the ability to complete clinical hours. At the University of California Davis Medical Center, this was recognized as fundamentally unacceptable. In collaboration with and amazing support from, nursing leadership, the staff in the Center for Professional Practice of Nursing sprang into action to ensure that these students would all be placed within our facility.
This was no small feat as the department and the hospital, like those around us, were also very busy supporting our nursing staff with education as the COVID protocols and patient surge staffing needs evolved. However, the staff was universal in the belief that the right course of action at this time required that we support these nursing students in the completion of their clinical experiences and welcome them into our profession with a clear model of care and compassion for all patients, families, colleagues, and students. This is who we are.
Through the early weeks of 2020, CPPN was able to more than double the number of senior students placed in our facility, ending the semester with 88 individual nursing students placed in preceptorships. To make this happen in record time so that the students could complete all hours within the semester window, CPPN staff worked numerous hours organizing student placements, completing access requirements, orienting faculty and students to our environment, and providing training on our equipment. This ensured that the students were not only able to transition to UCD for their preceptorship, but they were set up for success in this new environment. Preceptors across the organization were also engaged and willing to meet this moment with the student nurses. Preceptors rose to this unprecedented challenge. Each student worked 1:1 with their preceptor to complete 200+ hours of clinical time, a vital element in putting the past several years of nursing school together, completing their initial education, earning the right to sit for the licensure exam, and finally realizing their dream of becoming a Registered Nurse.
At the end of the semester, it was learned that all-important pinning ceremonies would not take place due to COVID-19 restrictions. The pinning ceremony marks the culmination of the student's journey through school and welcomes them into the fellowship of nursing. It is a pivotal and poignant moment. Every nurse treasures their pinning ceremony memory. The fact that these students would not have a pinning ceremony to treasure themselves was unthinkable.
The work was not done yet. Recognition and celebration were still in order. To celebrate the students' achievement, CPPN staff took an idea that originated with preceptors on the Davis 7 Pediatric unit and extended it to all by inviting graduating students to participate in pinning ceremonies planned on their unit. Over a period of one week, 20 ceremonies were planned and facilitated by CPPN on 16 units throughout the organization, both during day and night shift. The ceremonies included 47 preceptors and 44 newly graduating student nurses. Each was unique and special, with the student's preceptor pinning them, an honor to both after building their relationship over the hours together. Filming and photography were done to ensure every student had their memories documented to share with loved ones who could not be there. Moving speeches were made. Sparkling cider was toasted to the graduating students' successes. At one, a student sang triumphantly. At another, families participated in Zoom calls to watch remotely. At a third, staff lined the halls to honor the student's achievement as her preceptor gifted her "Notes on Nursing" by Florence Nightingale on Nightingale's 200th birthday. It was evident that these students had looked forward to this day for years, recognized the importance of it, and treasured the memory already. After all the ceremonies were complete, CPPN staff carefully edited all the video and photographs and individually sent to each student with permission to share widely with their family and friends. CPPN staff then devoted personal time to create a special video to share in honor of this unique moment and recognition of the significant efforts made by leadership and preceptors, who took these students under their wings while the pandemic brought new challenges and threats every day (https://youtu.be/k-pllsUNyG8).
This was the culmination of work on the part of many to support these students. However, more than just the technical/practical element of completion of their hours, these students will now carry into their nursing practice this model of action in support of a culture of caring that, in elevating and holding one another, we create the context for caring and holding our patients and families. The work of the entire CPPN team in making this happen demonstrates the amazing commitment each team member has to the profession of nursing and the culture of caring in which we practice.