As Bethel transitions to online learning, the hands-on nursing department grieves the loss of cornerstone education methods while still finding ways to heal.

By Zach Walker

Mattie Miller brought frosted sugar cookies to her final clinical. They were for the other ICU nurses to eat between administering medication and assisting doctors and testing patients for COVID-19. Along with three handwritten thank-you cards, the cookies were a goodbye gift that Miller didn’t think she’d give this early.  

Like every other student at Bethel University, Miller, a senior, received an email March 16 announcing that all classroom instruction would be moved online through the end of the spring semester. Students were forced to move out of dorms early, say goodbye to friends if they had the chance and, for nursing students, hang up their scrubs. Clinicals, the cornerstone field experience for junior and senior nursing students, were canceled when the email was sent.

Clinicals will be replaced with online simulations through the end of the semester. Students will execute similar medical procedures and react to patients’ ailments in real time, but if they make a mistake, all they see is a text box.

“If we did a billion hours of [simulations], that wouldn’t mimic it,” senior nursing student Dominique Dabu said. “You can study… but you can’t learn it without being there.”

Now, students such as Miller treat patients through a computer screen instead of at the sides of hospital beds. They listen to lectures over Zoom and Google Hangouts instead of in rolling chairs in the Nursing Atrium. And for some, they won’t see their best friends, the other aspiring nurses who woke up with them before sunrise to drive to a hospital and stayed up prepping for the morning’s skills exam, until someone plans a college reunion.

When Miller read the email that her clinical was canceled, she texted her cooperating nurse and asked if she could come in one last time. The nurse, Amanda, said she was working that night from 7 p.m. to 7 a.m. Miller drove the hour from her home in Buffalo to the hospital in the Minneapolis suburbs, with a stop at Target for the cookies along the way, and worked 7 p.m. to midnight. 

Miller watched through glass as Amanda tested two patients for COVID-19, and she delivered warm towels and blankets to other nurses when she heard her name called. She set the cookies and three thank-you cards on the break room table. She also gave Amanda a bag of Skittles, the colorful candies Amanda would keep in a cup and give to the other nurses. That night, when nurses treated regular ICU patients as well as those who showed symptoms of COVID-19, Miller watched for the last time as Amanda passed out Skittles.

“One of the biggest losses is closure,” Miller said. “It’s hard to have that sudden loss.”

After Bethel’s extended spring break, students returned to being nurses. But now, their patients are virtual.

Hayley Ackermann used to wake up at 4:45 a.m. to get ready for her 6 a.m. clinical twice a week. Now, she sleeps until 7:30 and starts her day with a Google Hangouts call or by caring for a computer-animated patient through a program for juniors called Virtual Simulation or vSim. 

Ackermann completes a four-hour clinical on vSim every Tuesday and Thursday. Instead of the human patients she is used to treating, she reacts to health issues of a computer-generated man who repeats his ailments until Ackermann clicks a button or pauses the program. Like a real clinical, Ackermann’s decisions impact the well-being of the virtual patient. But if the man on the screen dies, Ackermann can start over.

She preps just as many notes on patient symptoms and possible medication and makes just as many bedside decisions. Even though she’s learning on a screen, she doesn’t want to stop learning.

“We’re shifting to a mindset of ‘You get out what you put in,’” Ackermann said.

The move to online classes means only six weeks of virtual clinicals, which does not pose a licensing or graduation problem for students as the Minnesota Board of Nursing allows up to 50 percent of clinicals to be experienced online, but if the pandemic resurfaces during the fall semester, as experts at the Yale School of Public Health and Bethel nursing professor Dave Muhovich predict, students and the nursing field alike would feel the effects. 

“Losing six weeks of a semester isn’t a big deal,” Muhovich said. “But if we can’t do clinicals in fall, it will mess up thousands.”

The Minnesota Board of Nursing, a group that manages licensure for graduating Bethel seniors, has shown support for a proposal written by The National League for Nursing that suggests allowing nursing students to work full- or part-time in medical facilities to support COVID-19 healthcare.

“This opportunity will… provide much needed clinical education to assist in meeting program requirements,” the proposal states. “It is an unparalleled opportunity for nursing students to assist the nation in a time of crisis and learn the principles of population health and emergency management.”

To try to ensure the students are still working at a high level, the nursing department modified Bethel’s decision to grade every class on a Satisfactory/Unsatisfactory scale. Instead of needing a minimum grade of D to pass a nursing class, students must finish a class, many of which are graded based on only a few exams, with a 75 percent or higher.

Muhovich has been affected by the pandemic alongside his students. He works 14-hour days from his home on the east side of St. Paul, crafting new syllabi and updating grading criteria to fit into a semester where he can’t teach in person.

He used to stand next to students in hospital rooms and evaluate how well they were treating patients during clinicals. Now, the closest he comes to walking through hospital doors with a group of students is the five times a week he sees their faces organized in a grid on his computer screen.

Aside from teaching classes on mental health and demonstrating nursing skills on life-sized mannequins, Muhovich used to wash feet of homeless residents of Northeast Minneapolis at Elim Church with students, such as Miller. Twice every month, Muhovich and his students would crouch and rinse feet with scented soapy water, trim toenails and file calluses. He described the patrons as “some of the most interesting people [with] some of the most interesting feet in the world.” 

“You usually don’t just go up to a homeless person and talk to them,” Muhovich said. “But you put their feet in warm water and the stories just pour out.”

He hasn’t heard those stories in a while. He and his students can’t go to Elim Church under COVID-19 restrictions. So, he stays home with his wife and two adult children, works more hours and walks fewer halls.

“My schedule has died,” Muhovich said. “My ability to see these young people in the halls has died. I want to be there. I’m mourning.”

Nurses, like most healthcare professionals, are used to loss. But this loss is different. For senior Dabu, the loss of her final semester means she won’t walk across the Benson Great Hall stage to receive a gold-colored pin adorned with the phrase “faith, hope, love.”

For graduating nursing students, the pinning ceremony is more important than commencement, Dabu said. Aunts and grandmothers who used to be nurses often pass their pins on to the newest nurses in their families. Nursing faculty give speeches and some stand backstage to give hugs.

570 guests had already sent in RSVPs to this year’s ceremony, which Dabu helped plan. Jay Barnes was prepared to speak. And every graduating nurse was excited to see their classmates one last time and hear their class verse, 1 Corinthians 15:58, read onstage. But when the university announced virtual commencement March 27, the pinning ceremony was canceled.

The nursing department hopes to reschedule the ceremony for the summer, and Muhovich mentioned ideas for a virtual ceremony, but no decisions have been made. 

“It’s really hard that we can’t celebrate together,” Dabu said. “Even the people who annoyed [us], we still love them.”

Junior Sam Johnson still sees his friends in Google Hangouts calls. And he stays connected to his professors through their daily devotion forums on Moodle or the Bible stories they tell at the beginning of a virtual class.

During an online lecture of 40 students for Nursing Care of Individuals II, commonly called “Med-Surg,” Dr. Kristin Sandau shared the story of Jesus’s loaves and fish miracle from the book of Matthew. Then she told the students that it’s OK to hurt.

“It’s OK to be upset,” Sandau said. “It’s OK to have emotions.”

COVID-19 stole clinicals. It hid the faces of classmates behind grainy webcams. And it ripped future pins from the collars of future nurses. But it didn’t take everything.

Miller already has a job secured for the fall working as a registered nurse on a solid organ transplant unit at Mayo Clinic in Rochester. 

Dabu babysits a 2-year-old and a 6-year-old and gains experience toward her goal of becoming a pediatric nurse.

Johnson reads professors’ devotionals on Moodle.

Ackermann still works. She drives to a Minneapolis hospital three days each week to treat patients on the cardiac floor as a nursing assistant. She cares for patients such as the man who was told he has cancer and only two weeks to live and whose family members can’t visit him due to COVID-19. And the woman who suffered a stroke and mumbled the word “Psalms” when Ackermann asked about her favorite book in the Bible that was sitting beside the bed. When the woman answered, Ackermann picked up the Bible and started reading. 

At home, Ackermann keeps a journal. Inside the blue cover are prayers for the patients she can’t see anymore. 

“I can still pray with them,” Ackermann said. “That’s my way of connecting.”