WEBVTT

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- [Moderator] Nicole Ozturk is a
research scientist at NCSBN.

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Dr. Ozturk received her PhD
in education psychology in 2018

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focusing on Bayesian applications to psychometric data.

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In addition, she has five years experience
drawing upon quantitative analytical techniques

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to deliver actionable data
products in an education setting.

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Dr. Ozturk's previous projects include
developing a Bayesian augmented testing algorithm,

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evaluating student competencies,
and learning outcomes in healthcare curricula.

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- [Dr. Ozturk] Good afternoon.

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I'm Nicole Ozturk and my talk is titled
"Challenges to Prelicensure RN & LPN Programs

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During the COVID-19 Pandemic."

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I will begin by outlining my talk today.

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We'll begin with a brief background as I'm
certain we're all very familiar with the details

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of the COVID-19 pandemic.

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Following this, I will discuss the
research question this project seeks to address

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along with the research design and methods.

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Next, I will review my analysis plan,
study demographic information, and results.

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Lastly, I will summarize key takeaways.

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The first case of COVID-19 identified on
January 20, 2020 has snowballed into 24 million cases

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and 400,000 deaths in the U.S. by the following year.

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The COVID pandemic has exasperated
an already dire need for competent nurses

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to meet ballooning healthcare demands.

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The pandemic has also significantly impacted the manner
in which nursing students gain the necessary knowledge,

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skills, and abilities to ensure
competent and safe practice.

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During the Fall 2020 term, many
institutions made the shift from traditional

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in-person lectures and clinicals to
online and simulated learning environments.

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State boards of nursing also took a number
of steps to address the needs of institutions

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through relaxed clinical and simulation standards.

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From Fall 2019 to fall 2020, to what extent
have prelicensure RN and LPN/VM programs

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shifted their didactic and clinical curricula to
online and simulated platforms in order to ensure

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nursing students safely continue to gain
the knowledge, skills, and abilities to provide

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safe and competent care?

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In terms of research design, we developed a
web-based survey to identify changes made

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to the clinical and didactic curricula
between Fall 2019, essentially our control year,

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and Fall 2020, our experimental year.

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We submitted our survey to deans and
directors of RN and LPN prelicensure programs

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in the U.S. between July and August 2020.

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The RN study was completed in July,
while our LPN/VN study was completed in August,

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hence why you'll notice there is an
added dimension to our LPN/VN survey.

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What originally prompted our primary research
question was as a result of COVID-19 pandemic,

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states allowed some flexibility on
clinical hours completed in simulation

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and a shift towards online instructional formats.

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We administered both surveys
via the Qualtrics survey platform.

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Both surveys were relatively short with three
domains addressing baseline institutional information

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in addition to clinical and didactic education changes.

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Respondents were asked to estimate the
percentage of clinical courses offered in simulation

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in Fall 2019 and anticipated in Fall 2020,

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the percentage of lecture-based courses offered
online in Fall 2019 and anticipated in Fall 2020.

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The LPN/VN-prelicensure survey was designed with the
same three domains, but also included additional items

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addressing difficulty in identifying clinical
sites and high fidelity virtual simulation.

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Respondents had five weeks to complete the surveys
with reminders one week after the initial submission.

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Our final sample consisted of 496 RN
prelicensure programs and 256 LPN/VN programs.

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To better understand the changes from 2019 to 2020,
non-parametric statistical tests were used to evaluate

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the change in education pre-COVID
and during the COVID-19 pandemic.

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All statistical analyses were conducted via
Python and visualizations were created in Tableau.

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As I mentioned in the previous slide,
496 RN programs responded to our web survey,

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resulting in a 24% response rate.

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This is a map of where our respondents are located.

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Similarly, 256 LPN/VN program heads responded
to our survey resulting in a 27% response rate.

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In our survey of RN programs, we
asked respondents to estimate the percentage

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of clinical courses completed in simulation during
the Fall 2019 term and the anticipated percentage

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of clinical courses to be completed
in simulation during the Fall 2020 term.

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The results were pretty evident.

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In Fall 2019, the median percentage of
clinical courses completed in simulation was 15%

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with an interquartile range or IQR of between
10% to 25%, meaning 50% of values fell into this range.

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In Fall 2020, the same programs anticipated
offering a median value of 30% of their clinical

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courses through simulation with an IQR of 20% to 50%.

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The difference between the two
medians was bound to be about 15%.

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The 2019 proportion of clinicals completed in
simulation was found to be significantly different

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relative to the anticipated offering of 2020.

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Using a Wilcoxon signed-rank test, also
known as the non-parametric paired t-test,

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to evaluate the results, the T value was
found to be 6,558 with a P value under 0.01.

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Next, in our RN survey, we asked
respondents to estimate the percentage

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of lecture-based or didactic courses completed
in an online environment during the Fall 2019 term

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and the anticipated percentage of lecture-based
course is to be completed online in the Fall 2020 term.

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The results were even more stark.

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In Fall 2019, the median percentage of
lecture-based courses delivered online was about 2%

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with an interquartile range and IQR of between 0
and 10, meaning 50% of the values were in this range.

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In Fall 2020, the same programs anticipated offering
a median value of 60% of their lecture-based courses

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online with an IQR of 30% to 100%.

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A 58% difference in median value suggests
quite a change occurred between the two terms.

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Again, it's unsurprising that the 2019
proportion  of course is delivered online

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was found to be significantly different
relative to the anticipated offering of 2020,

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via Wilcoxon signed-rank test,
with a T value of 1,750 and a P value under 0.01.

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In our survey of LPN/VN programs,
we asked respondents to estimate the percentage

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of clinical courses completed in simulation during
the Fall 2019 term and the anticipated percentage

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of clinical courses to be completed
in simulation during the Fall 2020 term.

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The results were similar to
those of the RN respondents.

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In Fall 2019, the median percentage of clinical courses
completed in simulation was 10% with an interquartile

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range or IQR of between 5 to 25,
meaning 50% of the values were in this range.

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In Fall 2020, the same programs anticipated
offering a median value of 35% of their clinical

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courses through simulation with an IQR of 17% to 50%.

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Again the differences among median
values was roughly 25%, quite a change.

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As you can imagine, the results were statistically
significant via the Wilcoxon signed-rank test

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with a T value of 1,348 and a P value under 0.01.

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We asked LPN/VN respondents to estimate the
percentage of lecture-based or didactic courses

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completed in an online environment during the
Fall 2019 term and the anticipated percentage

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of lecture-based coursest to be
completed online in the Fall 2020 term.

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The results were even more stark.

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In Fall 2019, the median percentage of lecture-based
courses delivered online was about 1%

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with an interquartile range or IQR of between 0%
and 14%, meaning 50% of values were in this range.

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In Fall 2020, the same programs anticipated offering
a median value of 50% of their lecture-based courses

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online with an IQR of 11% to 94%.

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Similar to the RN didactic courses, we see
a difference between medians at about 59%.

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As you can imagine, the results were statistically
significant via Wilcoxon signed-rank test

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with a T value of 2,369 and a P value under 0.01.

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Moving forward, 80% of LPN/VN respondents
indicated they planned to offer virtual simulation

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instruction during the Fall 2020 term.

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Among this group, we observed the median percentage
of virtual simulation offered in Fall 2019 was 4%

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which then jumped to 30% in 2020.

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The results of which were evaluated using a
Wilcoxon signed-rank test and found to be significant

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with a T value of 1,205 and a P value under 0.01.

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We asked respondents what kinds of
virtual simulation they had planned to offer.

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As noted, 87% planned to utilize online software
packages with narratives and decision making trees.

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The next most popular option was watching videos.

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Lastly, our third most popular selection was
somewhat akin to telehealth with students connecting

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remotely to perform simulated clinicals.

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Specific to our LPN/VN respondents,
we asked how difficult has it been to secure

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clinical placements for the Fall 2020
term relative to the Fall 2019 term.

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The majority of respondents, at 95%, indicated it
was either somewhat more difficult or very difficult

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to obtain clinical placements
relative to the Fall 2019 term.

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For the respondents who indicated finding clinical
placements was very difficult or more difficult

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relative to Fall 2019, we asked what
possible solutions they were exploring.

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The vast majority, at 75%, indicated they
planned to complete more clinicals and simulation

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which seem to reflect what we
were seeing in the data earlier.

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In summary, in response to the COVID-19 pandemic,
RN and LPN/VN programs have radically shifted their

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lecture-based or didactic curricula from a traditional
in-person lecture to online learning environments.

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To a more moderate degree, both RN and
LPN/VN prelicensure programs plan to offer more

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clinicals through simulation.

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The majority of LPN/VN programs have found
identifying clinical placements more difficult

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than in previous years.

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This study is part of a larger study
seeking to determine the effects of this shift

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in curricular delivery models.

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We hope to learn more about its effects
on education and employment outcomes.

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Hi.

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This is Nicole Ozturk and thank
you for listening to my presentation.

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If you have any questions, please
feel free to pop them in the chat box.

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This was part of a larger COVID-19 study
and it's still in progress with about 60

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ADN and BSN prelicensure programs.

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The larger study commenced in
Fall 2020 and it is continuing at present.

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One of the most interesting elements of our study
was the ability of our nursing leaders to make changes

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very quickly to address issues as they popped up.

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In our study, we grouped programs by the extent
to which their programs had shifted to online education

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and simulated clinical settings,
and continue to survey students and faculty

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each term to examine the outcomes as they continue on.

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Once students graduate, we're also
planning to survey the workforce outcomes

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to examine how COVID has
impacted their practice as nurses.

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So we're hoping to report more detailed findings
at the close of the study around Fall 2022.

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In addition, we are in the early stages of examining
the specific contribution of virtual simulation

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and clinical education.

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I'm not seeing any questions at this time.

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So I'd like to thank you for joining.

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Oh, sorry.

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Okay, thank you so much.

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Yes, we...

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Sue had asked if we plan to correlate our data
to NCLEX outcomes and yes, we do plan to do so.

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And I see Paulette over here has asked,
"Is there any comparison to the association of

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pass rates and changes in clinical and simulation?"

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We're hoping to take a look at that.

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We don't have anything to report at present.

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We're planning to let this cohort graduate and
then look at the results once they're finished

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with their programs.

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So I guess we'll see.

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We're really very much looking forward to the results.

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Thank you.

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Do we have any additional questions?

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Okay.

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Okay.

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It looks like there's no more questions.

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I'd like to thank you for joining me this afternoon.

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If you have any additional questions that
pop up later, please feel free to reach out.

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You can reach me at nkaminski-ozturk@ncsbn.org.

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Thank you so much and have a lovely afternoon.