Hey, what's up you guys. It is time for the final episode of
season nine of Nursing Uncensored. This interview was recorded in June of twenty twenty
two, and it's the last one that I recorded when Nursing Uncensored headquarters was
still up in Minneapolis. I guess it's the perfect way to end the season.
A lot can change in a year, and our guest for this episode,
doctor Audrey Snyder, is a perfect example of that. At the time
we recorded this, she was the Dean of Practice and Innovation for the College
Nursing at the University of North Carolina, Greensboro, but she recently announced that
she's now the Associate Dean for Community Engagement and Academic Partnerships at the same institution,
so congratulations to her. We also talk about the new ENDCLX in this
episode, but it was recorded before the new ENDCLX was being given, so
unfortunately we don't really have a lot of info about it. But this episode
is still super engaging and entertaining, so don't let that tetoria. We're already
working on season ten of the Nursing on Sunsored podcast, and if you're a
fan of the show, but you don't like ads, you should check out
the Breakroom on Patreon. For five bucks a month. You can listen to
the episodes about any commercials and enjoy some other cool perks too. You can
even sign up now and listen to this episode ad free. Join at nu
breakroom dot com And for those of you who like to continue to listen for
free, just sit back, relax and enjoy. Welcome to Nursing on sunsored.
It's me Adrian back again and today we are going to have a discussion
about nursing education. I know that a lot of you listening are nursing students
about to graduate. Maybe you know this is the spring season, so maybe
the mclex is coming up for you, or maybe you're just thinking about getting
into nursing. But in any case, this discussion is going to be very
valuable. Today I have with me Audrey Snyder. She is the Associate Dean
for Experiential Learning and Innovation at the University of North Carolina at Greensboro. Audrey,
welcome, it's good to see you today. Thank you, Adrian,
and how are you. I am well, glad to hear it, glad
to hear it. Well. Before we jump into things, would you like
to tell us a little bit about yourself and how you came to be in
the role that you're in now. So my background as a nurse spans many
different areas. When I was growing up, I actually wanted to be a
paramedic, not a nurse, but growing up in a very rural area where
it was felt that the role in prehospital care that by gender being a female,
that that was not an appropriate career option to look at or even being
allowed to take an EMT class or volunteer. So I decided I would go
into nursing. And my grandmother was my first teacher. She was at home
with us, actually in a hospital bed for nine years, being cared for
my family before she passed away, and I learned so much from her as
a patient. She had always also been a lay midwife, and so I
learned a lot about natural means of caring for people, herbs and things like
that. And I feel like that that was my first nursing lessons were actually
from her as my grandmother and as my patient as a family member helping to
care for her. But I have spanned a critical care er flight nursing and
then became a nurse practitioner, and soon after I became a nurse practitioner,
was tapped in for a faculty position and have continued to merge being a nurse
practitioner as well as a faculty member for many years. And I came to
the University of North Carolina, Greensboro three years ago to a newly created role,
and I love this role. It's the Associate Dean for Experiential Learning an
innovation and it gives me a lot of freedom to explore things that perhaps faculty
have these great ideas, but they might not have time in a busy academic
semester to explore how we collaborate with community partners, how we find other opportunities
for students, and so it's let me do a lot of work in that
area. I also focus on opportunities for study abroad and looking at short term
student experiences, for example in Appalachia. Of course, the pandemic has taken
an impact on all of those things, so we've been able to focus on
a few other community collaborations. In the meantime, the future of nursing and
many other areas is now saying that we need to move from our traditional acute
care focus and teachings, which is what the in collects our Nursing Board exam
focuses on to have more of a community focus in our nursing education, and
we're moving that way, which is really good to see. I think there's
a lot of synergy happening to have the thoughts about how we move to more
community and ensure that our students have opportunities in public health and community health.
It's wonderful just hearing about the experiences that you had in your youth and in
your home with your family. I mean, there's like a million questions I
would love to talk about that, so I'm going to try really hard to
stick to topic today. It sounds like you have such an interesting diverse and
a background that maybe a lot of people haven't experienced, you know, especially
in that region. I mean, I'm so fascinated at Appalachia in general and
the history and healthcare in that area as well. I've only driven through,
I've never actually visited the area, so I'll try not to digress too much.
But suddenly all of the questions are firing off in my mind. But
I do love hearing what you're saying about the community focus and public health because
It's true more and more of the focus is not just on the treatment of
things that have already happened and are happening acutely. But you know, people
are sicker, people are having more and more chronic illness. So we need
to look at what we can't keep up by just treating things that have already
happened and are already happening, but looking at those systemic ways they're occurring,
and how we can treat commune unities and populations instead of just the people that
are coming into the hospital already very very ill. So so many things that
I would love to talk about. I would love to first kind of talk
about what you all experienced down there as kind of well, let's back it
up even further. Would you kind of just describe for our listeners, you
know, maybe what traditional nursing education looked like before COVID, And I know
it differs from institution to institution and by region and by discipline. You know,
we have undergraduate nursing, graduate nursing. There's different levels, but in
general, I think there's kind of a formula or a format for nursing education.
So can you maybe talk just a little bit about kind of the I'm
going to call it the old way, even though it's not that old,
but kind of the old way of nursing education, the pre COVID way,
if you will, right, And I just want to say that, you
know, nursing education from my global ry, as you say, template perspective
hasn't really changed in the last twenty five to thirty years, but now a
lot of forces are coming together to help us change that. Yes. So
you know, traditionally and even in the day when I took my board,
I did a diploma based school and then went back to get my bachelor's,
my master's in p certificate, my PhD in nursing. So everyone whether they
take an associated degree program, a diploma program, or a bachelor's program in
nursing, they all take the same nursing Board exam, the kles. And
you know, in the day when I took my exams, it was two
days of testing, and it was four exams, and so you had a
med surch exam that was four hours long, you had a psych exam that
was four hours long, you had a women's health exam that was four hours
long, and a pediatric exam that was four hours long. And of course
today, you know, our graduates go in and it's computerized, and they
log in and they get really anxious when they get cut off in the sixties
on the numbers of questions because of how these computerized modeling works. As if
they're doing really good on questions, you get harder questions if you continue to
answer those. And that a point they say, yes, you know enough
that you know, we can give you a certificate that you have passed this
board exam so that you can then apply to your Board of Nursing to get
licensed. And I think that what that means is that you end up with
let's say you have a class of one hundred and twenty students. Forty of
them want to go into OB and forty of them want to go into pediatrics,
and another forty want to go into ICU, and there's not as many
who want to go into medical surgical nursing, which is where the largest number
of nursing positions are in a hospital. But let's talk about beyond that.
The number of positions that may be out there in public health are in community
based care. You know, one of my colleagues that graduated with me in
the early eighties from a diploma program, has an amazing job working in a
nurse run clinic. There's no physician in the clinic. It's a rural environment,
and if by her assessment, this patient needs to be seen by the
physician, and it's for people who are uninsured or underinsured. They also have
mechanisms of doing the assessment to see what resources are available and how we could
get these clients covered on care for medical, psych etc. And she uses
telehealth to connect these clients in with a provider, you know. So she's
the one who helps manages the equipment on the side with the patient and connects
them in with that higher level of care. But there are many things that
she does to help focus on diabetes management, on hypertension management. She has
a lot of education with nutrition with clients and then helping clients find resources.
Because we know that with the continuing escalation of I'm trying to think of the
correct word here, but that the cost of living is increasing exponentially right now,
you know, twelve point eight percent just in the last year. That
people who are on a limited budget. That impacts how nutritious you know,
what nutritious foods can they buy and how they might be able to cook,
and it just has added stress for everyone. But to think about this nurse
and how much autonomy she has in her role and what a difference she's making
in the lives of the clients that she's worked with, it's just amazing.
And I think globally we just have to think differently about what is a nurse's
role. And you know, I think that because a lot of check the
boxes in nursing school has focused traditionally on skills and skill building, but in
reality, there's so many of those skills are maybe never done again when they
get out of school, or done infrequently when a nursing student graduates and gets
into a role. And yes, depending upon where you work, there may
be really high tech skills you need in the ICU or you're working in the
emergency room and you have to be able to run the rapid infuse or on
a trauma things like that. But in the skills we're learning in nursing school,
we really are changing how we teach those skills to focus more on critical
decision making, on interpersonal communication to ensure that what you as a nurse,
what you're seeing and what you're understanding with your patient is to eximinated to the
rest of the healthcare team so that they understand. You know, one of
the challenges I found when I have clinicals with students in an ACTE care environment.
You know, there's just this disconnect with oh, I have to make
a phone call and talk to the physician, And so I make sure that
any of the patients we're working with that the students practice running through that call
with me and then we make that call because we want them to feel comfortable
with those conversations, to really share what they're seeing, because they are the
eyes, the ears, the nose. You know, many nurses can walk
into a room and go, I smell pseudomonas for example. So so you
know, it's really important that our nurses feel comfortable with how to communicate,
how to assess, critically, think, but how to communicate that information to
the other part. The other part of the healthcare team and us really focus
on integration of how we work together as a team because it's not a solo
world out there, which also gets back to a lot of things that we've
done in nursing school. Focus on an individual person and how that individual person
performs, and so we're shifting like how does the team perform and really focus
on what we're doing in simulation that there's a team approach to what we're doing,
and let's work on those team building skills that they are going to need
as they navigate the future of nursing. The other thing is is that nursing
education in many ways globally has not kept pace with the changes that are happening
in healthcare. And yes, and you mentioned the coronavirus pandemic and what's changed
and what we've seen is, for example, telehealth telehealth has blossomed. Some
of the challenges are the ability of our older population to util lies telehealth.
And I saw this even with my mother and her having her cardiology visits via
telehealth and sitting with her so that she could go through which buttons she has
to push to make sure that even on her phone, that she can get
to a video where the physician can see her and talk with her. And
so, you know, one of the things that we do with some of
our students is actually teaching the older population how to use technology, because that
use of technology is what's going to be their avenue of more rapid access to
a provider. You know, a big focus on teaching is so important.
And you know, years ago in my nursing education, I had a completely
separate class that was just on nutrition, and nutrition has been more integrated today
into the nursing curriculum. But I just had an honor student complete a project,
and this was a study that was funded by the American Heart Association with
a local food bank, where it was an evaluation of a six week program
for women who are under resourced on looking at teaching cooking techniques and nutrition and
healthcare together and looking at whether we could decrease cardiovascular risk for those women.
And out of the study, what she found, even though it was a
small cohortive clients that participated, is that the nutrition education was what made the
biggest difference. And so you know, there's a big wave now on nutritionist
medicine, and so in nursing, we really need to think about what we're
teaching to our clients and how we look at what we put into our bodies
and how that impacts our health and well being, and that again being a
big piece of what we as nurses do in education with our clients. I
think that one of the things that you said that's so important is that this
is how people gain access because so much of navigating the world, there's so
much information out there, and so the way that nurses present this really gives
people a path to understand how they can access what they truly need accessing,
whether that be face to face interactions with a provider, knowing what is best
for them in their bodies, their diet, with their medications, because just
giving someone the option to google something can be overwhelming, and if they don't
have a high level of basic literacy medical literacy, that can become problematic for
people, people who then maybe feel so overwhelmed they just give up, and
that does nothing to improve their quality of life, the quality of their health,
the quality of their communities. Because we all know as a nurse,
I think every one of us has had that family member, that friend,
that neighbors say hey, you're a nurse, what would you do about this?
Or hey, can you look at this patch of skin? Or what
do you think about this medication that my doctor put me on. We've all
had those questions asked of us, and you know, oftentimes we feel really
glad when we're able to give information that's helpful and that actually improves. Someone
says, hey, you know, that's really wonderful. I really needed that
information or I acted upon that information you gave me, and now I have
seen it. You know, I've taken this A, B, and C
steps and it's really helped. It's you know, I'm seeing less swelling,
I'm feeling more energetic, my medications are working better. Those things are tangible
improvements in people's lives that all stem from nurses in the community, whether it
be in our personal lives or in our professional capacity. And I think it's
so important what you're talking about. That shift is even more critical now that
we see that telehealth COVID is not entirely going away. I don't know what
the future holds for us ever getting back to the state of normal that we
remember, and so it's important that we keep these gateways open and that we
make these paths for people more accessible. And it sounds like that's kind of
the shift that is happening, and I think it's really inspiring, not only
because we have the power to make this change, but also look at the
opportunity this opens up. If you would have said telehealth to a nurse fifteen
years ago, they would have thought, oh, telephone, you know,
you call on the telephone and look at what it is now, you know,
now that we're able well to face to face. I mean, I
have a friend who's a nurse practitioner and she's been doing telehealth and she loves
it because she can be at home in her you know, in her professional
attire and take you know, take appointments with her patients. And then when
her patients, you know, when her appointments are done, she goes into
her kitchen, she makes her lunch, then she comes back, she does
her charting and her notes and her assessments, and that's her work day.
And so it's given her freedom. It's given her patients freedom to not have
to trek across town, across county to go to see her for their basic
care. So it's it's really, you know, it sounds dramatic to say
it's transforming lives, but it is. It's a lot easier to be on
time and compliant with your appointments when you just have to go to your phone
or your computer. So I think that that really is beautiful, and you
bring up really great and valid ways that these things are changed. So I
think that so valuable, so valuable well, and I believe that especially in
the rural environment. And I know one of the challenges in the rural environment
is just the infrastructure for technology. And we've seen the government pass some legislation
that's going to put significant amounts of money into being able to get Wi Fi
accessibility more in our rural areas and interconnect those rural communities with our larger communities.
From that perspective, but even today, when you think about one,
does a person have a vehicle, you know, what are the challenges to
get to an appointment do they have or can they just put themselves in their
car and go, or do they have to rely on public transportation or are
they relying on someone else in the family, our friend, to pick them
up and take them to an appointment. And then today with gas prices,
perhaps previously there was a community group or an agency that might provide those free
rides, and now today they might be saying, sorry that we don't have
the budget to do as many transports as we did before. And we know
that only certain types of insurance will cover that transportation to an appointment for someone.
So these are all, you know, things that tell ahealth is helping
to change. And with COVID, you know, there was this fear of
going into a doctor's office or a fear of going into the emergency room.
And I saw physician colleagues and emergency medicine doing ads to say, if you're
having chest pain, if you're having neurosymptoms, we still want you to come
to the er. But that's because people were afraid of getting you know,
COVID. Well, of course, now we have vaccines, not that everyone
is vaccinated, but vaccines are really helping to mitigate some of that risk.
And you know, if someone does get sick, hopefully it's a less severe
illness as opposed to the early days of the pandemic. But what I've seen
is growth. I have colleagues who actually started a nurse practitioner home health agency
where they are on telemedicine and the nurses are in the home, but they're
actually caring for patients that are at almost ICU phase in their homes with technology.
And so what we're seeing is a completely different blossoming of telehealth and a
decrease in cost to care for these patients. So again a means of trying
to decrease healthcare costs, decrease expenditure for people, and just you know,
I think one of the challenges has been that legislatively, there were a lot
of waivers during the pandemic which allowed for telehealth to be covered or even crossing
state lines, and some of that has gone away, So there's new legislation
being enacted to try and keep that flexibility. You might say, with telehealth
provider coverage, we still have really good coverage from a psychmental health perspective,
but for a lot of other things we don't have as good of coverage.
So unless someone's paying out a pocket, there may not be the same access.
But we're hopeful for the future because there's a lot of studies that are
looking at analysis of the impact of the use of telehealth jarring the coronavirus pandemic,
and I think that will give us good data to go back to the
legislators and say this really is working and this is the needs of the future.
But that also means that in nursing education, our students need to graduate
with compigencies in use of telehealth equipment and telehealth technology and comfortable in safety factors
for going into people's homes. So there's a lot of nuance, as you
might say, but that also is great opportunity. Absolutely, and I think
that when we talk about telehealth, we can also talk about telecommuting or even
as far as students go, like you know, online schooling. We saw
a huge change. And I remember when I was at the time that the
pandemic began. I was in Iowa City at the University of Iowa, and
I remember that there, you know, I knew a lot of teaching assistants
and teachers at the time that suddenly had to you know, modify their courses
to be online. And so now we're at a place where the anticipation,
you're the expectation is that a lot of courses are now just offered online.
So we went from this place where it was kind of this scramble to make
things online that had never been online before, and now I'm seeing a lot
of folks that are opting to be online. So students that had had never
taken an online class before were terrified of it are now. You know,
some people still prefer, you know, a tangible book in a classroom space,
but more and more I'm hearing from students that they love the freedom that
that kind of classroom gives them. And so can you talk a little bit
about the experiences and some of the things you've seen from both the educators standpoint
and student feedback about how we've seen online school change over the course of the
last almost three three years now. Basically, yeah, and so I think
that you know, very early on in the pandemic, a lot of us
had to revert to online courses. And if you had a smaller class of
students and you were online, that worked really well because you you know,
you can put everybody on the screen at one time. When it became difficult
is when the class has one hundred and twenty students in it, and if
you're in you know, an auditorium, you can see everybody, and as
a faculty member, you can see the glazed over stair or the furrowed brow
I'm not getting that information. And that would give you a way to say
it a different way. Whereas in online learning, many times, if it
was a modeled on a traditional classroom setting, you might have five screens of
students and you can't see them all at once at the same time, because
technology wasn't as advanced three years ago as it even as today, as far
as Wi Fi connections and connectivity, and of course everybody was working from home
and you know traditional K through twelve taking classes from home, and then of
course students in college taking classes from home. That you know, we saw
overwhelming the kind of like cable system connectivity and many times in order for students
to stay on they had to take their picture off. So then again as
a faculty, remember you're not seeing them, so you know, in these
large classes, so I think you know, in smaller class sizes, yes,
but also what we've seen as an evolution of some asynchronous learning that is
occurring online, which is still getting to the key concepts and the key standards
of learning outcomes. Simulation has taken a major shift with online as opposed to
in person. So yes, we have these fancy simulation labs and you know,
humanized models that can you know, talk and breathe and pee and put
out you know, chest tube secretions and all of those things. And what
we're going to see, I think for the future is more virtual reality simulations
are augmented reality simulations, and so those could be done anywhere, and that
may also be beneficial. At the same time, the ability, you know,
when you set up something in a simulation lab, the time and the
energy and the effort, and many times students can only go through something once
or twice. But if you have it and it's virtual and you've got augmented
reality, so the student does it one time, then you give them a
chance to do it again, and maybe they pick up on things they did
in the first time, you know, are they tune into a different aspect
of the assessment or what they need to do, and so you know,
the future is going to be competency based learning. And so again, if
a student can demonstrate competency and we have the ability to evaluate that, then
we don't spend time holding that student back from moving forward in other areas.
So that's also a shift. I think that we're then we're at this you
know, precipice of you know, diving into you know, how we truly
can change curriculum to be competency based for the students. And I believe a
lot of s elation is going to help us with that. How do you
think preparation for the ENDCLEX has changed? Like I do know that the ENDCLEX
has recently or is about to maybe I'm not quite sure. About the timeline.
But I know there's a lot of talk about the new ENDCLX. Yeah,
I know that's causing anxiety for some relief for others. So can you
share your insights on that. Yeah, So next Gen, the next generation
ENCLUX is about to come out, and I do not have the exact timing
in my head either. But what that means is, you know, and
again the goal is not to teach to an exam, but nursing education is
very different from a student taking a chemistry class or a biology class or some
other health sciences class because most programs do not have a board exam to pass
in order to continue on in your career goals. So again looking at how
the next gen curriculum is there, and I think you know, over the
next year, most faculty, if they haven't already, we'll be doing crosswalks
of their curriculums for next gen, for the Essentials of Nursing, for the
new AACN guidelines, and so depending upon what program you're in. You know,
even for the MPs, there's new guidance out for MP education and so
crosswalking the curriculum amongst all of the different pieces of regulatory guidance as well as
board exams. I know, previously I was the director of an MP program
and we had five different bodies that we needed to ensure our curriculum adhered to
guidance for And so, you know, lots of time students think, you
know, oh, it's easy being a faculty member. In the hard it's
the student, But in reality they need to know that, you know,
we're constantly having to evolve based upon what's evolving out there around us, and
so ensuring that what we're what we're giving students meets all of these guidance.
But at the same time, in reality, what is the goal that a
nurse can graduate with good assessment skills, critical thinking skills, good communication skills,
and good documentation skills? In my mind, those are four areas that
I think, you know, every nurse that comes out of a program needs
to really be able to focus on. And it's not the technical skills necessarily,
as to you know, the goal with us graduating good nurses, nurses
that you say, yes, you can take care of me or you can
take care of my family member when you graduate, and that will come out
and be good stewards in being a nurse. And caring for individuals, for
communities, for the whole population. See indeed, and I think I think
that we we this might be a this might be a little bit of a
controversial statement. It's coming from me, not from you. I think you
can tell the difference between a nurse that has those skills and a nurse that
just studied to pass the test. You can tell the difference between someone who
has really kind of come from a program that really wants that comprehension to be
well rounded, focused on the critical thinking, the assessment portion, knowing what
to do with that information aside from just reason out what the right answer is
from that question. I think that it's very and and I think that plays
out in those simulations, whether it be in person, virtual online, whatever
the case may be. You can walk into a room and you can know
what it means and what the labs are and you know what this different thing
indicates. But when you're looking at a person in front of you and they're
having these symptoms and they're making these complaints, and you're seeing all of these
different things that these bits of data coming at you, and knowing how to
synthesize that and knowing what to do for that human being in front of you.
It becomes very overwhelming, very quickly. And I think that nursing education
needs to to do a service to our new nurses and our students. We
need to be giving them the tools to take all of those little bits of
information and be able to look at an entire situation. And as a nursing
student, I hated case studies. I will be honest. I hated it
when they gave you all of this and I thought, Oh, they're trying
to trick me by throwing in this information and this information that I don't need.
But really, now as a nurse, I see that it's not trying
to trick you. It's giving you a whole person, giving you an entire
life and body and situation to look at, and then deciding which of those
things are relevant in that moment and what you're going to do with that information.
And so on one hand, when I found out that there's this new
gen end CLEX coming out, I thought, well, man, that makes
me kind of irrelevant as a tutor because I will not be taking this new
gen. So I was a little for selfish reasons, I was disappointed,
but I also thought, this is actually a really good move because as a
good test taker, even in my early days of nursing school, I was
scoring really high one or practice exams, you know, predictor exams, because
I was kind of good at the end clex style of question answering. But
that didn't mean that I was competent to be a nurse after two semesters of
nursing school. And so it makes me really glad to see that this evolution
is occur and that we're guiding students through this curriculum of being able to work
through this information and knowing what to do with all of this information and making
them good critical thinkers and making them good team players. It makes me think
of situations in my job today where just to play out a situation, just
really briefly, I received an admission, a patient came to me. I
work nightshift, so patient came to me in the middle of the night.
The orders came in. I needed to start a hepprin drip and get labs
drawn and start fluids, and there were all these things that needed to be
executed and they were all very important. Now I'm a float nurse at a
hospital I've been at for less than a year, so I'm always going to
different units, and so you never it's not like being on a team where
you say, Peggy's great with IVY sticks, and you know Martha knows how
to find all the equipment and get all that like, you don't necessarily know
who your great sources of different things are. But when I was on this
unit and I admitted this person, I didn't even have to ask. And
each of the nurses that were on with me that night, I turned and
I said, hey, can you find me an extra IV pump? She
had already gotten one, it was already in the room. Can you get
me some IV tubing? She's like, oh yeah, I already primed the
IV tubing. I'm going to get these fluids running. Someone else had already
called the IVY team and they were on their way to get an IV started.
And I was getting the hepron and getting looking over those orders and looking
at the protocol so I could get the hepron going based on the labs they
like. It all came together instead of me by myself scrambling to get all
of these things and all of this equipment. And when that happens, it's
not just yes, it was easier on me. But that patient's treatment fell
into place so much faster. We got those labs drawn faster, he got
his pain medication master, he got the answers the physician was called up quicker.
It made a difference in the amount of time it took for that patient
to receive the care that the physician ordered. And so these aren't just like
paper what am I trying to say? These aren't just like benchmarks are trying
to meet on paper. This translates into real life outcomes for our patients.
And so I think that these things that we're talking about, even though we're
talking about like oh, yes, like better attrition rates and better end clex
pass rates. Yeah, but what does that look like in the at the
bedside, in the home health you know, treating ICU level patients at home.
This like literally has better quality outcomes for people. And so that's what's
so exciting to me. That's why this topic interests me. Like, yes,
we can talk about education, and some people find that really boring,
but this is so exciting for the profession because of the implications it has for
our future care. So what are some things that you see sticking around?
Some things that you see that maybe like you, we've talked about virtual,
virtual simulation, things like that. What are some things that have come out
of this pandemic that you see as being improvements, if you will, for
lack of a better term, things that maybe we might not have done had
we not been forced into this quarantine life so to speak. Well, I
do think as we discussed, you know, learning remotely, more simulation that's
virtual, more focus on competency another thing that I think came out of the
pandemic, at least for us here locally, even though I feel like prior
to the pandemic we thought we had good wraparound services for students, and the
pandemic showed us we didn't. And that I'm not familiar with that term wrap
around. Yeah, So when you have students, so our university is ranked
number one in the state for upward mobility, and so that means we get
a lot of first generation college students. And so when you have someone who
doesn't have someone in their family who's been to college, who knows what it's
like to navigate doing a bachelor's program, or they have no one in their
family who's a nurse, our healthcare provider, and so they don't have someone
to go home and talk to about the case they had today and to get
more gleanings of information, or just to have someone to vent to about you
know, what's been happening. Many times, students who are generation may not
have learned well how to study at a college level, for example, or
they may not have good psychosocial support compared to someone who's not first gen for
example, are someone who comes from an underserved background. And I know that
during the pandemic, I had students who their parents were divorced and then remarried
and they were kicked out of their dorm with COVID, and so then they're
at home, and home means that their stepmother has a two year old in
the house, and they're trying to attend classes with a two year old running
around, And then they're trying to take their exams online, and so they're
sitting in the bathroom with the door shut to take their exam because that's the
only place that they could have enough quiet to be able to do their sam
oh and other students who had no Wi Fi in their rural environment and who
were driving to you know, coffee shops that hadn't turned their Wi Fi off
and sitting in the parking lot of the coffee shop to do their class or
to do their schoolwork online. And so you know, finding out that we
needed to do Wi Fi hotspots for some students so that they would be able
to be in class and be able to have enough time to do all their
work. Supporting students, you know, with some technology, you know,
some students did not have laptops. So again so thinking about and I know
some colleges every student is mandated to have a laptop, or as a part
of their student fees they get a laptop. You know, there's lots of
different iterations of that sort of work being done. But we also you know,
thinking about the mental health support for students who you know, we have
not just your traditional age college student, if there is a traditional age anymore.
But if you think about you know, most people finish high school,
maybe take a year off and then go to college or go straight into college
from high school. But you know, I have students who are in their
fifties who are coming back to school to be a nurse. We have a
veteran's Access program, so we have students who have significant lived experience who may
have been Army vets for example, I mean army medics for example. There's
lots of students who are not taking just a traditional pathway to an education in
nursing. But to think about, you know, you have someone who has
children at home and they're having to the parents. When students were in online
schooling, the parents were responsible for ensuring their students were getting online and students
were doing their school work while they're trying to be in school and do their
schoolwork at the same time. And so you know, these significant challenges so
psychosocial support for the students. And then again there's been this kind of I
think historical tradition and nursing where well, if this is the way it was
for me, this is the way it's going to be for the next one.
And I completely disagree with that and this idea, especially in emergency medicine,
which is where I spent a good part of my nursing career. You've
got to be tough, and you know, you just step up to the
plate and you do what has to be done and you kind of, you
know, put your emotions on the back burner. And you know, now
today having processes for debriefing and we're doing that with our students, is debriefing
with our students, having processes where you find out what's happening in a student's
life so that you really know what their challenges might be, and then looking
at what resources we have as an institution that we can refer those students students
too, just as we would in a medical environment with our patients. Where
do we refer our patients to to get the resources in the support they need.
We need to be doing that with our students. And so you know,
tutoring, and we flipped tutoring to online. Of course tutoring had been
in person, so we flipped to online during the pandemic. And I think
we'll have a mixture of that going forward because for some things it's a whole
lot easier in person if you can sit down and you know, write,
I mean, their definitely you know whiteboards online that you can use, but
still I think that's an area. But having that, you know, tutoring
support, mental health support, and then just understanding the lived experience of the
student during COVID and now post COVID and what are those challenges and how we
can help them. I think that in a way the more that we help
students figure out how to problem solve with patients, we can also help them
figure out how to problem solves solve in their own lives. And students come
with just like our patients, they come with a lot of baggage that they're
working through. And so especially when you're if you deal with the that program,
the Veterans Access program, you know, so again being sensitive to everyone
and thinking about that concept of trauma informed care and how do we use trauma
informed care with our students as faculty. And I've worked with veterans that are
now amazing nurses that had medic and combat experience. I myself got my nursing
degree or got my nursing license at thirty five years old. My most of
my nursing class I did in the evening and week or a night and weekend
program, and the majority of my class were in their thirties and forties.
And so, while we definitely want to support our like you said, kind
of the traditional right out of high school student, we have to expect that
nursing is a wonderful profession. There's a lot of opportunity for lots of different
people, and supporting that is wonderful. The thing that made it possible for
me to continue I went to community college before doing an RN to BSN bridge
program, and the thing that made my ability to go to school that much
easier was the fact that I had a social worker at the college or an
advisor that referred me to a mileage reimbursement program. Because my community college,
the campus that had the nursing labs and the nursing program, was like thirty
miles away from the city I was living in, and I was using some
one else's vehicle to get to and from classes for two years, and so
that that one program of mileage reimbursement was Without it, I probably wouldn't have
been able to afford to get to and from so little things like that that
if that person hadn't told me about it, I might have had a very
different outcome. So that that social knowing the person's life, knowing what support
they need outside of the academic is huge in people's lives, like I truly
credit that hugely with my being able to be a nurse at all. And
so it's really important that you talk about those things and that you recognize those
things because that is such a that is such a huge component of it,
and I think that that's a big thing. I another episode was with an
LPN and we talked about how for her nursing was a way out of making
a minimum wage job, and she loves it. It wasn't just a job
for her, but it's it's not just about you know, I have a
dream of being a nurse and it's been my lifelong calling. For some people,
it is a means to a better life, and that is so important
that we make it possible for people that don't have the traditional route of going
to a for year college or a for your university. So it makes me
happy that more and more institutions are picking up on that and are actively carrying
through on that. So I think that's a lot of hope for a lot
of students that otherwise might not might not pursue this in the state with the
same sense of optimism, you know, right, and you know I have
concerns that we have. That was a report it came out about ten days
ago that said that our our exodus of nursing from nursing, the greatest numbers
are now in that less than thirty five age groups, whereas traditionally it's been
the older age group. So, you know, after working in the hospital
for thirty years on concrete under you know, tile over, concrete floors and
all of the lifting that nurses do. You know, changes in physical health
you know, mean that people tend to they try to phase into a job
that maybe is less physically demanding, but there are fewer of those in a
hospital setting, etc. But we've seen, especially with COVID and the fact
that COVID impacted older people more than younger people initially in the strains that we
had, that there was a significant number of older nurses retiring, and so
you would think that this would be the large number, but the strain and
the stress on younger nurses has been significant, and so for many of them,
they've made the decision nursing isn't where I want to be. And I
feel like that if we did, globally in healthcare a better job of respecting,
honoring, and understanding the needs of our nurses, that we will do
a better job of retaining those nurses. And some of that, yes,
and sometimes the going back to school is a means of getting re energized and
focused and to find another avenue or you know, and there's times when I
have nursing students that you know, in their junior year they're like, I'm
going to be a CRNA or I'm going to be a nurse practitioner, and
so you know, they've got those goals. But to get to those goals,
they still have to practice, you know, and get that nursing foundational
experience to build up on in a graduate program. So I do think that
looking at ways that we help students be more resilient while they're in school,
if we can help them with those tools, then when they graduate, I
believe that they can carry that toolbox with them to help them when they encounter
difficult situations as a new graduate nurse. And it sounds like, you know,
the unit that you were talking to, where everybody came together to take
care of that patient, that was amazing. I want to share a kind
of just the opposite spectrum of having a friend recently who is older, who
is a nurse. She had a knee replacement and you know, she's been
a nurse for forty some years. She's still working as a nurse even though
she's in her seventies, and she had her knee replacement. She had to
spend a night in the hospital. She had an issue, whether the person
didn't respond plus or not, or she had too much pain medicine on board,
but she had an issue of incontinence and her dressing was wet, and
she had pushed the call bell and waited and waited for someone to respond.
Nurse comes in the room ten minutes before shift change and says she can't do
anything about it because she has to go and give report. And this was
a nurse who only had three months of experience as a nurse, so new
grad apparently never reported off that it was an issue. She waited, she
again pressed the call bell to try and get someone to help her. You
know, this is you know, from six o'clock in the morning until nine
thirty when the occupational therapist shows up to do her therapy, and the occupational
therapy has changed her and helped her get into a clean bed and to get
her dressing out of dressing changed. And so this was a nursing failure,
complete nursing failure for her. And she was lived and of course they wanted
her to stay another night in the hospital and she refused. She said,
I'm going home. I will take care of me. My friends will take
care of me. I will not stay another night. And so you know,
we have to think about what's the endpoint. And again, how humiliating
for someone who is continent, who's never had issues with incontinent and to have
this situation. And then again, if you think about skin breakdown, the
potential for additional wound section, yes, all of the complications that can occur,
and so realize that you know, taking the time to do the right
thing at the right time, are getting someone else to help do that,
you know, And if everyone who was going off shift just coalesced and quickly
came in and change the bed and got the dressing changed, that would have
been such a different perspective for her. She was humiliated. And so to
think about how does the patient feel, you know, how does this human
being feel in this case? And so, you know, I want graduates
to go out not only competent in their knowledge and in their skills, in
their communication skills and their assessment skills and their documentation skills, but also in
being able to rally and to meet the needs of those patients, because that's
really important. But I also want them to be able to think about population
health and public health, and for example, you know, what we're trying
to do right now is collaborations with public health in our community because what we're
seeing is, even especially after the pandemic, changes in morbidity and mortality and
maternal child health in persons who are of color, and so trying to place
a community focus on a community perspective on this. Recently in the media,
issues with formula, the ability, accessibility, prices going up. What's that
impact? And I can just remember being an ear nurse years ago when sometimes
some of the challenges for the patients we took care of is that the problem
was associated with parents not mixing formula to the specifications because they didn't have the
ability to buy more formula, and so dilute formula that impacts the nutrition and
the health of a child. And so there's so many things we can't just
address the nursing care for the person in the hospital, and if we don't
ask the questions, we don't know, you know, asking questions about how
will this person take care of themselves when they get home, who's going to
be their support financially, how are they going to be able to forward the
supplies that they might need. You know, you find out interesting things if
you ask simple questions like what's your biggest challenge going to be to get home?
Because then you find out, well, they're living in their car,
and their car is parked in the Walmart parking lot and they get their hygiene
in the Walmart women's bathroom. You know, So finding out getting to know
people, getting to know your patients their challenges by asking simple questions and spending
that time with them is so important. And as nurses, we're going to
know that information and rallying the healthcare team to find resources for that patient before
we discharge them or once they're in the community. You know, knowing,
for example, and a housing authority site that this patient's been discharged from the
hospital, or how to visit to the er. Can the nurse from the
center visit this patient at home and check in, do they understand their discharge
instructions? Did they have the mechanism to get their prescriptions filled? You know,
as this someone who used public transportation to get home and they didn't have
the money to have them stop at a twenty four hour pharmacy that's ten miles
away to get their prescription filled and then pay the waiting fees to then get
them home. So, yes, they've come home, they have an infection,
but they've never filled their antibiotics, you know. So really thinking about
how we are that conduit of knowledge, that conduit of knowledge from the patient
to the healthcare team, that conduit of knowledge to the patient about how to
care for themselves and what are the most important things to help them in this
journey back to health. And it's a two way street, you know.
And I feel like we're kind of maybe that you know, hub that is
sending information both ways as nurses and as much as our students and our new
nurses you know, can learn how to do that and do that well,
and it's making a difference. And I have a story that I heard for
the first time as a new graduate at my very first Emergency Nurses Association conference,
and it's the story of a girl who's at the seashore and the girl
is walking the seashore and the seashore is scattered with starfish, and a gentleman
comes up to her and he's he's watching her. He sees her throwing something
in the ocean, and as he gets closer, he sees that she's stooping
down and she's picking up the starfish, and she's throwing the starfish into the
waves, and she keeps coming in. There's starfish everywhere, and he says
to her, you can't possibly throw all the starfish back in the oshan,
why are you even doing this? You know it's impossible. And her response
to the gentleman is it made a difference for that one, as she's throwing
one into the waves again. And I think as nurses, we need to
realize that every day we make a nurse, do we make a difference for
that one patient or that one population, and it exponentially grows. I am
a little choked up. I wish it was here on my desk. I
have a stark fish pin that was given to me when I was a new
nurse, and I got that same story, and it brings tears to my
eyes every time I hear it. That is true. You can't save the
world, but you can help the person that's right in front of you.
And I think that is a beautiful and profound message. So I can't throw
all the starfish back in the water, but you can help the one that's
in your hand. Absolutely, Audrey, it is wonderful talking to you.
I could do this all day long. The information that you've shared is beautiful
and wonderful, and I kind of want to end it there because I think
that is such a beautiful and profound story, and I think that this message
is important, and I hope all the students that are out there listening really
take this to heart. Nursing education is difficult, but in the end,
there is a lot that we can do and a lot of difference that we
make. Before you go, will you tell people if they would like to
learn more information about your program or I mean, if you have any way
that people can learn more get in touch with you, any information, n
links or anything that you have that you would like to share. Sure,
So I'm on LinkedIn just with my name Audrey Snyder. You can find me
on the UNCG dot edu website. My email is a E s N y
D E and the number two And even though my name last name is Snyder,
there's no R in there. So a E S N y D E
two at UNCG dot EPU and I am happy to do whatever I can to
help persons along disjourney in nursing because it is a journey, and I wish
you all much success as a student are as a nurse in the area that
you're in. Go out and make a difference. Thank you so much,
and thank you for joining me on Nursing con Fencored and everyone. Thank you
for listening, and I will catch you next time. The Nursing Uncensored podcast,
like nursing itself, can be intense. We don't censor, but we
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