WEBVTT 00:00:04.951 --> 00:00:08.850 position:50% align:middle - [Brendan] I know there are a number of new faces, many who are possibly attending annual meeting 00:00:08.850 --> 00:00:09.680 position:50% align:middle for the first time. 00:00:09.680 --> 00:00:15.580 position:50% align:middle So, my name is Brendan Martin, and I am the director of research here at NCSBN. 00:00:15.580 --> 00:00:21.490 position:50% align:middle And I really just want to say it's been a pleasure getting to see so many familiar faces, and honestly, 00:00:21.490 --> 00:00:25.220 position:50% align:middle getting the opportunity to meet so many new folks these past couple days. 00:00:25.220 --> 00:00:27.150 position:50% align:middle I really hope you found the same experience. 00:00:27.150 --> 00:00:28.470 position:50% align:middle I hope it's been a productive meeting. 00:00:28.470 --> 00:00:33.160 position:50% align:middle I hope you have had the opportunity to really network with your peers because even though we are two and a 00:00:33.160 --> 00:00:37.220 position:50% align:middle half years out from the onset of the pandemic, I truly do not take these opportunities 00:00:37.220 --> 00:00:38.520 position:50% align:middle for granted anymore. 00:00:38.520 --> 00:00:42.150 position:50% align:middle We were kind of, you know, left in the cold wastelands of virtual meetings 00:00:42.150 --> 00:00:46.160 position:50% align:middle and presentations, and so, I'm just really excited and I'm energized by the 00:00:46.160 --> 00:00:49.800 position:50% align:middle opportunity to really get to engage with you in person. 00:00:49.800 --> 00:00:56.760 position:50% align:middle But I am here today to discuss the results of one of our recently completed COVID-19 studies entitled, 00:00:56.760 --> 00:01:01.240 position:50% align:middle "Assessing the Impact of the COVID-19 Pandemic on Pre-Licensure Nursing Education." 00:01:01.240 --> 00:01:05.900 position:50% align:middle So this was a national study of RN programs around the United States. 00:01:05.900 --> 00:01:10.790 position:50% align:middle Before I kick things off though, I would be truly remiss if I did not mention that this 00:01:10.790 --> 00:01:17.380 position:50% align:middle is really an excellent example of interdepartmental collaboration, yet again, at NCSBN. 00:01:17.380 --> 00:01:21.860 position:50% align:middle While the research team did put considerable resources and time into this particular study, 00:01:21.860 --> 00:01:26.350 position:50% align:middle as we did for the workforce study, we are also deeply indebted to Dr. Nancy Spector, 00:01:26.350 --> 00:01:32.960 position:50% align:middle who I know is here somewhere in the wasteland of the dark, and her team in nursing education for their 00:01:32.960 --> 00:01:38.770 position:50% align:middle support for what I jokingly refer to as a very long two-and-a-half-year study. 00:01:38.770 --> 00:01:42.170 position:50% align:middle But without further ado, let's just jump right in. 00:01:42.170 --> 00:01:46.490 position:50% align:middle So, for today's presentation, I'm really just going to cover a few major points 00:01:46.490 --> 00:01:52.270 position:50% align:middle because we do recognize the results for this survey really took on the format of a JNR supplement 00:01:52.270 --> 00:01:54.490 position:50% align:middle of over 60-plus pages. 00:01:54.490 --> 00:01:58.880 position:50% align:middle So there's a bit of a heavy lift associated with trying to review that amount of material. 00:01:58.880 --> 00:02:03.990 position:50% align:middle So, I wanted to provide you with some targeted information hoping that by giving you that 00:02:03.990 --> 00:02:07.360 position:50% align:middle general overview, it would facilitate further discussion and questions. 00:02:07.360 --> 00:02:13.950 position:50% align:middle So, to do that, I'm going to start by providing a bit of background on this study so that you are all very, 00:02:13.950 --> 00:02:17.690 position:50% align:middle very clear on why we wanted to pursue this study in the first place, and really, ultimately, 00:02:17.690 --> 00:02:21.770 position:50% align:middle what we hoped to achieve when we set out to do this analysis. 00:02:21.770 --> 00:02:25.870 position:50% align:middle I'll then share a brief overview of the study methodology, just making sure that that's working, 00:02:25.870 --> 00:02:32.530 position:50% align:middle so that you are clear on how we composed our sample, went about collecting our data, and then, ultimately, 00:02:32.530 --> 00:02:36.540 position:50% align:middle how we analyzed our responses before we get into the meat of the presentation, 00:02:36.540 --> 00:02:40.000 position:50% align:middle in which I will discuss kind of the broad strokes of the results. 00:02:40.000 --> 00:02:43.830 position:50% align:middle And in particular, at the end, I'll try to make clear how they kind of intersect 00:02:43.830 --> 00:02:47.980 position:50% align:middle with or align with other evidence on this particular topic. 00:02:47.980 --> 00:02:51.870 position:50% align:middle And then, again, we will open the floor to any questions or comments that you might have, 00:02:51.870 --> 00:02:53.190 position:50% align:middle a little bit of extra time. 00:02:53.190 --> 00:02:58.440 position:50% align:middle So, again, if you're enthusiastic on this topic as well, we can revisit workforce and we can kind of show 00:02:58.440 --> 00:03:02.670 position:50% align:middle how these two studies ultimately do align. 00:03:02.670 --> 00:03:09.670 position:50% align:middle So, to provide context for my discussion today, I would, first, like to transport you all back 00:03:09.670 --> 00:03:13.820 position:50% align:middle to early 2020, and in particular, the first few weeks of the pandemic. 00:03:13.820 --> 00:03:18.660 position:50% align:middle And so, I think it's official now, Richard, we're the first to really bring COVID up as a topic. 00:03:18.660 --> 00:03:22.960 position:50% align:middle So we are the Debbie Downers of this year's annual meeting. 00:03:22.960 --> 00:03:29.230 position:50% align:middle But, typically, the research department spearheads about 30 to 40 active research studies. 00:03:29.230 --> 00:03:36.930 position:50% align:middle So, that kind of constitutes the core of our research agenda, but it was in early April 2020 that we began 00:03:36.930 --> 00:03:39.280 position:50% align:middle to really, truly recognize, right? 00:03:39.280 --> 00:03:42.780 position:50% align:middle We were all, same as I think a lot of people in this room probably think to ourselves, 00:03:42.780 --> 00:03:44.860 position:50% align:middle by the time we get to summer, we'll be in the clear. 00:03:44.860 --> 00:03:46.770 position:50% align:middle This will be fantastic. 00:03:46.770 --> 00:03:51.470 position:50% align:middle After a couple of weeks and a formal shutdown of an entire...the third largest city in the country, 00:03:51.470 --> 00:03:58.040 position:50% align:middle we began to recognize the potential for, really, the broad and possibly enduring effects of the pandemic 00:03:58.040 --> 00:04:00.180 position:50% align:middle on nursing as a profession. 00:04:00.180 --> 00:04:04.950 position:50% align:middle So what we did in the research department is we really circled the wagons, so to speak. 00:04:04.950 --> 00:04:09.510 position:50% align:middle And, in counseling together, we developed what was ultimately a targeted, and yet, 00:04:09.510 --> 00:04:15.450 position:50% align:middle we feel expansive research agenda focused exclusively on the results of the pandemic or the effects 00:04:15.450 --> 00:04:17.190 position:50% align:middle of the pandemic. 00:04:17.190 --> 00:04:20.700 position:50% align:middle This became, in real-time, really our singular priority. 00:04:20.700 --> 00:04:25.220 position:50% align:middle But now as we look back retrospectively, I think we're pretty clear-eyed about the fact that 00:04:25.220 --> 00:04:31.060 position:50% align:middle this became one of our major investments of time and resources within the department for the past two 00:04:31.060 --> 00:04:32.500 position:50% align:middle to three years. 00:04:32.500 --> 00:04:36.680 position:50% align:middle So, as you can see on the slide in front of you, the research agenda included over 10 00:04:36.680 --> 00:04:38.560 position:50% align:middle applied research studies. 00:04:38.560 --> 00:04:43.920 position:50% align:middle These ranged in terms of their timeline, their scope, their design, their samples. 00:04:43.920 --> 00:04:48.100 position:50% align:middle The reason for that is because the topics broadly ranged as well. 00:04:48.100 --> 00:04:50.750 position:50% align:middle So, we were interested in pre-licensure nursing education. 00:04:50.750 --> 00:04:53.520 position:50% align:middle We were interested in early career in [inaudible 00:04:52] practice. 00:04:53.520 --> 00:04:55.270 position:50% align:middle We were interested in workforce trends. 00:04:55.270 --> 00:04:57.860 position:50% align:middle That interest is very durable. 00:04:57.860 --> 00:05:03.940 position:50% align:middle But the biggest takeaway was really that we wanted to...as best as humanly possible, we are only human, 00:05:03.940 --> 00:05:09.720 position:50% align:middle we wanted to capture the effects of the pandemic, really, on every single level of nursing. 00:05:09.720 --> 00:05:11.030 position:50% align:middle That was our goal. 00:05:11.030 --> 00:05:13.030 position:50% align:middle That's what we set out to do. 00:05:13.030 --> 00:05:16.510 position:50% align:middle We are very gratified that this past April, as Richard mentioned, 00:05:16.510 --> 00:05:21.940 position:50% align:middle we published the results of the majority, not exactly all but the majority of these studies in a 00:05:21.940 --> 00:05:25.350 position:50% align:middle special COVID-19 edition of the "Journal of Nursing Regulation." 00:05:25.350 --> 00:05:27.710 position:50% align:middle So Richard made the plug for the 2024 workforce. 00:05:27.710 --> 00:05:33.080 position:50% align:middle I will also make the plug for going to the "Journal of Nursing Regulation" website, 00:05:33.080 --> 00:05:36.990 position:50% align:middle perusing those table of contents for the April edition and the July edition. 00:05:36.990 --> 00:05:42.340 position:50% align:middle And if you see a study that is of interest to you, Elsevier continues to make that free access content 00:05:42.340 --> 00:05:44.520 position:50% align:middle for the pandemic-related material. 00:05:44.520 --> 00:05:49.340 position:50% align:middle Download that information, really dig into it, and if you have questions after today's event, 00:05:49.340 --> 00:05:52.290 position:50% align:middle after you know this meeting closes, please follow up with us. 00:05:52.290 --> 00:05:56.110 position:50% align:middle We love that collaboration. 00:05:56.110 --> 00:06:01.300 position:50% align:middle So, as Richard mentioned, one of the principle, and therefore, most critical studies really assessing 00:06:01.300 --> 00:06:06.400 position:50% align:middle the effects of the pandemic on the workforce was the National Nursing Workforce survey. 00:06:06.400 --> 00:06:08.110 position:50% align:middle So, I don't think we can underscore this enough. 00:06:08.110 --> 00:06:11.570 position:50% align:middle Every time we get an opportunity, I like to make this statement. 00:06:11.570 --> 00:06:16.720 position:50% align:middle The 2022 National Nursing Workforce Survey represented the largest, the most rigorous, 00:06:16.720 --> 00:06:20.020 position:50% align:middle and the most comprehensive assessment of the U.S. 00:06:20.020 --> 00:06:24.550 position:50% align:middle nursing workforce in the entire country since the onset of the pandemic in March 2020. 00:06:24.550 --> 00:06:31.850 position:50% align:middle But, if you remember, in April 2020, we anticipated that the effects of the pandemic would 00:06:31.850 --> 00:06:35.460 position:50% align:middle obviously not be limited to the current workforce. 00:06:35.460 --> 00:06:40.010 position:50% align:middle So, in parallel, what we did is we pursued a longitudinal assessment, or certainly, 00:06:40.010 --> 00:06:46.380 position:50% align:middle we at least tried to design one for pre-licensure nursing programs across the United States. 00:06:46.380 --> 00:06:50.660 position:50% align:middle The primary objective of that study, so the study that I'm about to walk you through, 00:06:50.660 --> 00:06:55.520 position:50% align:middle some of the results for was to assess the impact of the institutional, academic, 00:06:55.520 --> 00:07:00.000 position:50% align:middle and demographic characteristics on pre-licensure nursing students, academic, post-graduation, 00:07:00.000 --> 00:07:02.770 position:50% align:middle and early career outcomes during the pandemic. 00:07:02.770 --> 00:07:06.670 position:50% align:middle So, I can't get through that without chuckling a little bit just because I think, as you can see, 00:07:06.670 --> 00:07:08.830 position:50% align:middle we set the bar exceedingly low for ourselves. 00:07:08.830 --> 00:07:13.510 position:50% align:middle We were not trying to achieve too much at all. 00:07:13.510 --> 00:07:16.410 position:50% align:middle So, who comprised our sample? 00:07:16.410 --> 00:07:17.660 position:50% align:middle That is an excellent question. 00:07:17.660 --> 00:07:22.760 position:50% align:middle I think I couldn't have planted a better question in my own presentation for that. 00:07:22.760 --> 00:07:28.880 position:50% align:middle This cross-sectional study utilized a four-phased longitudinal design to assess the academic, 00:07:28.880 --> 00:07:33.300 position:50% align:middle the standardized outcomes, and the early career outcomes for pre-licensure nursing 00:07:33.300 --> 00:07:39.660 position:50% align:middle students entering the core of their nursing curriculum in fall 2020, and with an anticipated graduation 00:07:39.660 --> 00:07:41.900 position:50% align:middle in spring 2022. 00:07:41.900 --> 00:07:48.000 position:50% align:middle So when you consider the entire arc of the research, really from July 2020 to December 2022, 00:07:48.000 --> 00:07:54.700 position:50% align:middle this was in effect, a two-and-a-half-year-long study of 51 pre-licensure programs, 00:07:54.700 --> 00:08:00.210 position:50% align:middle including over 1,100 participants across 27 U.S. states. 00:08:00.210 --> 00:08:04.400 position:50% align:middle Because of the scope and the size of the sample for this particular study, 00:08:04.400 --> 00:08:12.790 position:50% align:middle this mixed methods study was able to leverage over 4,000 course-based observations supplemented 00:08:12.790 --> 00:08:19.000 position:50% align:middle by hundreds of early career observations and the rich personal narratives of over 60 00:08:19.000 --> 00:08:20.230 position:50% align:middle focus group participants. 00:08:20.230 --> 00:08:23.320 position:50% align:middle So, this goes back to Lin's earlier comments regarding the workforce. 00:08:23.320 --> 00:08:27.520 position:50% align:middle We did have the qualitative component built into this. 00:08:27.520 --> 00:08:32.260 position:50% align:middle For a longitudinal analysis, the one thing I like to do upfront is to give you 00:08:32.260 --> 00:08:37.010 position:50% align:middle transparency into when we entered the field, what activities were we engaged in, 00:08:37.010 --> 00:08:41.390 position:50% align:middle what were we looking to achieve at those points in time, and whether or not any of those activities were 00:08:41.390 --> 00:08:46.340 position:50% align:middle really happening in real-time at the same time, kind of in parallel. 00:08:46.340 --> 00:08:51.360 position:50% align:middle So, from this diagram, you can see really a timeframe for the entire study 00:08:51.360 --> 00:08:52.860 position:50% align:middle from start to finish. 00:08:52.860 --> 00:08:57.150 position:50% align:middle So, I'll start reading left or right. 00:08:57.150 --> 00:09:04.550 position:50% align:middle So, in July 2020, we conducted email-based outreach via Qualtrics to all administrators at pre-licensure RN 00:09:04.550 --> 00:09:07.100 position:50% align:middle programs around the country. 00:09:07.100 --> 00:09:12.470 position:50% align:middle In total, we had over 500 program representatives respond to that initial outreach, 00:09:12.470 --> 00:09:17.760 position:50% align:middle and they ultimately provided absolutely critical information, not only to inform our study but point 00:09:17.760 --> 00:09:23.490 position:50% align:middle in time as to what was going on with our planned instruct...or delivery of educational materials for the 00:09:23.490 --> 00:09:27.770 position:50% align:middle fall 2020 term in light of the onset of the pandemic. 00:09:27.770 --> 00:09:33.210 position:50% align:middle We also used this survey outreach as kind of a springboard and a formal recruitment tool to try 00:09:33.210 --> 00:09:37.690 position:50% align:middle to encourage and educate folks to then participate in our longitudinal analysis, 00:09:37.690 --> 00:09:40.490 position:50% align:middle which launched later in the fall. 00:09:40.490 --> 00:09:44.960 position:50% align:middle The period of within-program data collection, you can see kicked off formally in August 2020, 00:09:44.960 --> 00:09:48.570 position:50% align:middle and then that ran all the way through the end of May 2022. 00:09:48.570 --> 00:09:53.860 position:50% align:middle So, that constituted our within-program data collection period. 00:09:53.860 --> 00:10:01.020 position:50% align:middle In June 2022, that was a major inflection point in our data collection process for this particular study 00:10:01.020 --> 00:10:06.960 position:50% align:middle because we pivoted away from within-data program collection for students and faculty-reported outcomes 00:10:06.960 --> 00:10:10.160 position:50% align:middle to that early career tracking phase of the study. 00:10:10.160 --> 00:10:14.230 position:50% align:middle There were two intervals that we were primarily interested in for that phase. 00:10:14.230 --> 00:10:19.210 position:50% align:middle One at three months following graduation, and then again at six months following graduation. 00:10:19.210 --> 00:10:22.340 position:50% align:middle So, that carried forward all the way to November 2022. 00:10:22.340 --> 00:10:29.020 position:50% align:middle In parallel, you can see that's when we also conducted in kind of that early career data tracking phase, 00:10:29.020 --> 00:10:31.270 position:50% align:middle our focus group participant data. 00:10:31.270 --> 00:10:34.120 position:50% align:middle So, that was from June 2022 to August 2022. 00:10:34.120 --> 00:10:36.320 position:50% align:middle A lot of 2022s here. 00:10:36.320 --> 00:10:42.870 position:50% align:middle And then, data collection formally closed at the beginning of December. 00:10:42.870 --> 00:10:47.850 position:50% align:middle Regarding the methodology, the study utilized a combination of student and faculty 00:10:47.850 --> 00:10:53.140 position:50% align:middle self-report data in real-time via email-based surveys using Qualtrics. 00:10:53.140 --> 00:10:57.070 position:50% align:middle We used a combination of in-house and externally validated instruments. 00:10:57.070 --> 00:11:00.540 position:50% align:middle For those of you who may not be familiar, in-house is just kind of short form for these were 00:11:00.540 --> 00:11:05.430 position:50% align:middle custom survey instruments that we developed internal to the research department at NCSBN. 00:11:05.430 --> 00:11:07.700 position:50% align:middle We use these in a very limited fashion. 00:11:07.700 --> 00:11:12.690 position:50% align:middle We really just wanted to use those instruments to collect baseline demographic and practice or 00:11:12.690 --> 00:11:16.650 position:50% align:middle professional information, as well as general descriptors of the courses in which 00:11:16.650 --> 00:11:20.080 position:50% align:middle students were enrolled, and ultimately, the faculty would be teaching. 00:11:20.080 --> 00:11:24.960 position:50% align:middle We then limited our collection on student outcomes associated with learning, engagement, 00:11:24.960 --> 00:11:30.360 position:50% align:middle clinical preparedness, practice proficiency, etc., to the externally validated instruments. 00:11:30.360 --> 00:11:34.870 position:50% align:middle As some of you know in this room, collection within an end-of-program standardized test 00:11:34.870 --> 00:11:40.780 position:50% align:middle scores was then facilitated through direct coordination with individual research site coordinators. 00:11:40.780 --> 00:11:46.440 position:50% align:middle So, these folks were often the faculty or the administrators who volunteered, think about that, 00:11:46.440 --> 00:11:53.520 position:50% align:middle volunteered in fall 2020 to serve as their primary point of contact for their program throughout the 00:11:53.520 --> 00:11:56.880 position:50% align:middle duration of their participation in this study. 00:11:56.880 --> 00:12:02.350 position:50% align:middle All quantitative survey findings were then supplemented with qualitative focus group findings. 00:12:02.350 --> 00:12:06.090 position:50% align:middle The focus groups were generated based on a purposeful sample of the students, faculty, 00:12:06.090 --> 00:12:11.030 position:50% align:middle and administrators who had participated or consented to participate in earlier stages of the research. 00:12:11.030 --> 00:12:15.050 position:50% align:middle In particular, that longitudinal data kickoff in August 2020. 00:12:15.050 --> 00:12:21.760 position:50% align:middle Participants were placed into three distinct groups based on their primary responsibilities, so faculty, 00:12:21.760 --> 00:12:23.630 position:50% align:middle students, and administrators. 00:12:23.630 --> 00:12:28.180 position:50% align:middle One of the questions that might occur to you immediately, "What happens if somebody wore two hats?" 00:12:28.180 --> 00:12:30.900 position:50% align:middle That did come up in our recruitment for the focus groups. 00:12:30.900 --> 00:12:35.250 position:50% align:middle Oftentimes, it was an individual faculty member who also had administrative responsibilities. 00:12:35.250 --> 00:12:38.710 position:50% align:middle In that particular instance, we asked them to reflect on where the majority of their 00:12:38.710 --> 00:12:44.130 position:50% align:middle time and responsibilities really lied, and then, we asked them to self-select based on that information. 00:12:44.130 --> 00:12:46.910 position:50% align:middle I'm not going to get into the weeds on this last one. 00:12:46.910 --> 00:12:51.140 position:50% align:middle We employed various statistical measures for this particular analysis. 00:12:51.140 --> 00:12:56.530 position:50% align:middle So, our unit of measurement transitioned from one stage of the study to another. 00:12:56.530 --> 00:12:59.490 position:50% align:middle So, in some instances, our unit of measurement was the institution, 00:12:59.490 --> 00:13:01.200 position:50% align:middle in which case, obviously, we only had 51. 00:13:01.200 --> 00:13:04.770 position:50% align:middle In other instances, it was the observations, in which case, we had thousands and 00:13:04.770 --> 00:13:05.990 position:50% align:middle thousands and thousands. 00:13:05.990 --> 00:13:07.330 position:50% align:middle In some cases, it was the students. 00:13:07.330 --> 00:13:09.293 position:50% align:middle We had a little over 700. 00:13:09.293 --> 00:13:13.170 position:50% align:middle So, for that reason, we employed a range of statistical techniques 00:13:13.170 --> 00:13:17.410 position:50% align:middle from simpler descriptive and non-parametric methods, all the way up to generalized estimating 00:13:17.410 --> 00:13:21.610 position:50% align:middle equation models, which allowed us to really capture the repeated measures design, and then, 00:13:21.610 --> 00:13:23.780 position:50% align:middle detailed textual analysis. 00:13:23.780 --> 00:13:29.640 position:50% align:middle This really allowed us to sufficiently approach and kind of dig our teeth into the student, the faculty, 00:13:29.640 --> 00:13:32.950 position:50% align:middle and the institution-level data. 00:13:32.950 --> 00:13:39.550 position:50% align:middle So, like the workforce survey, we would argue, this study certainly represents one of the most 00:13:39.550 --> 00:13:46.200 position:50% align:middle comprehensive and rigorous assessments of pre-licensure nursing education in the United States since the onset 00:13:46.200 --> 00:13:47.300 position:50% align:middle of the pandemic. 00:13:47.300 --> 00:13:51.510 position:50% align:middle If you have not had the opportunity, I would highly encourage you to download a copy of this 00:13:51.510 --> 00:13:52.880 position:50% align:middle from the JNR website. 00:13:52.880 --> 00:13:58.510 position:50% align:middle It is free, and the information is provided in front of you, and this whole presentation will be provided 00:13:58.510 --> 00:14:04.650 position:50% align:middle to you following the conclusion of this meeting as kind of a living, breathing resource. 00:14:04.650 --> 00:14:06.470 position:50% align:middle Finally, the findings. 00:14:06.470 --> 00:14:10.450 position:50% align:middle So, the results of our work ultimately confirmed. 00:14:10.450 --> 00:14:13.960 position:50% align:middle Obviously, the impact of the pandemic was not limited to the current U.S. 00:14:13.960 --> 00:14:15.370 position:50% align:middle nursing workforce. 00:14:15.370 --> 00:14:22.140 position:50% align:middle During our July 2020 outreach, over 80% of pre-licensure RN programs indicated that 00:14:22.140 --> 00:14:27.290 position:50% align:middle they were going to incorporate some level of virtual simulation for the fall 2020 term. 00:14:27.290 --> 00:14:32.600 position:50% align:middle And while that sounds like a lot, and I think that is a lot, the magnitude of this shift, 00:14:32.600 --> 00:14:39.190 position:50% align:middle I think, is perhaps most underscored by the number of raw programs that indicated that they incorporated no 00:14:39.190 --> 00:14:43.390 position:50% align:middle virtual simulation pre and post-COVID-19 onset. 00:14:43.390 --> 00:14:49.380 position:50% align:middle That number fell from 130 in fall 2019 to just 11 in our survey in fall 2020. 00:14:49.380 --> 00:14:54.440 position:50% align:middle On the slide in front of you, you can see the mean usage of face-to-face 00:14:54.440 --> 00:14:59.290 position:50% align:middle high-fidelity simulation and virtual simulation and how that changed term over term over the 00:14:59.290 --> 00:15:00.965 position:50% align:middle two-year study period. 00:15:00.965 --> 00:15:04.050 position:50% align:middle There's two things to notice about this particular graph. 00:15:04.050 --> 00:15:09.570 position:50% align:middle The first is that those proportions in any given term, stack or additive. 00:15:09.570 --> 00:15:14.100 position:50% align:middle And so that's how we add up to the higher kind of summary academic year figure that corresponds to that 00:15:14.100 --> 00:15:15.790 position:50% align:middle vertical dotted line. 00:15:15.790 --> 00:15:19.070 position:50% align:middle The other thing that I would just draw your attention to because I think it kind of aligns with our own 00:15:19.070 --> 00:15:25.470 position:50% align:middle personal and professional experience in particular of kind of that initial heightened period of the pandemic. 00:15:25.470 --> 00:15:29.590 position:50% align:middle In that, you can see there was an initial spike in the employment of simulation, and then, 00:15:29.590 --> 00:15:34.696 position:50% align:middle that waned a bit even into the only the second academic year of the study. 00:15:34.696 --> 00:15:41.506 position:50% align:middle A consistent trend that emerged from our results were the superior outcomes documented by both students 00:15:41.506 --> 00:15:43.036 position:50% align:middle and faculty alike. 00:15:43.036 --> 00:15:51.276 position:50% align:middle It was very uniform for in-person clinicals and that face-to-face high-fidelity simulation vis-a-vis 00:15:51.276 --> 00:15:54.136 position:50% align:middle virtually simulated environments. 00:15:54.136 --> 00:15:59.786 position:50% align:middle These results manifested time and time again across an array of the factors that we were tracking. 00:15:59.786 --> 00:16:08.000 position:50% align:middle So, program setting, program type, student SES, the timing of students' clinical rotations, etc., etc. 00:16:08.000 --> 00:16:11.850 position:50% align:middle So one of the things that struck us with these results, it's kind of twofold as it relates 00:16:11.850 --> 00:16:13.480 position:50% align:middle to clinical simulation. 00:16:13.480 --> 00:16:21.200 position:50% align:middle One is this study effectively constituted an incredibly large geographically, racially, 00:16:21.200 --> 00:16:28.480 position:50% align:middle and ethnically diverse natural experiment that effectively, really in a one-to-one fashion replicated 00:16:28.480 --> 00:16:30.640 position:50% align:middle the results of our national simulation study from 2014. 00:16:30.640 --> 00:16:36.610 position:50% align:middle So what we saw was when there was good adherence to rigorous evidence-based guidelines 00:16:36.610 --> 00:16:41.850 position:50% align:middle regarding high-fidelity face-to-face simulation, the student outcomes were just as strong, 00:16:41.850 --> 00:16:45.850 position:50% align:middle they were just as consistent, and they were just as replicable as their peers 00:16:45.850 --> 00:16:47.920 position:50% align:middle in in-person clinicals. 00:16:47.920 --> 00:16:53.500 position:50% align:middle The same cannot be said of virtual simulated environments, even in as large of a sample as we were 00:16:53.500 --> 00:16:55.060 position:50% align:middle able to capture. 00:16:55.060 --> 00:16:58.820 position:50% align:middle And again, this is credit to these pre-licensure RN programs all around the country, 00:16:58.820 --> 00:17:00.610 position:50% align:middle really volunteering of their time. 00:17:00.610 --> 00:17:02.460 position:50% align:middle What extra time did any of us have in fall 2020? 00:17:02.460 --> 00:17:08.340 position:50% align:middle But because of their contributions to this study, we were able to recognize that it wasn't necessarily 00:17:08.340 --> 00:17:14.000 position:50% align:middle even just the application of virtual simulation, but it was the range and the definition of what 00:17:14.000 --> 00:17:23.260 position:50% align:middle constituted virtual simulation that ultimately resulted in poorer student outcomes time and time again. 00:17:23.260 --> 00:17:25.850 position:50% align:middle So, what I'm about to do, I feel a little bit like Oprah, right? 00:17:25.850 --> 00:17:27.200 position:50% align:middle So, we're in Chicago. 00:17:27.200 --> 00:17:31.060 position:50% align:middle So, what I'm going to do in these next few slides is you get a table and you get a table and you 00:17:31.060 --> 00:17:32.140 position:50% align:middle get a table. 00:17:32.140 --> 00:17:34.480 position:50% align:middle But I think you can take my word for it. 00:17:34.480 --> 00:17:35.750 position:50% align:middle I hope you take my word for it. 00:17:35.750 --> 00:17:39.210 position:50% align:middle You can certainly download the report, you can peruse it at your own leisure. 00:17:39.210 --> 00:17:44.580 position:50% align:middle But what I wanted to do is to kind of give you just a visual reference for how consistent these 00:17:44.580 --> 00:17:45.570 position:50% align:middle results are, right? 00:17:45.570 --> 00:17:47.050 position:50% align:middle You don't even need to take my word for it. 00:17:47.050 --> 00:17:48.450 position:50% align:middle I'll show you some pictures. 00:17:48.450 --> 00:17:53.810 position:50% align:middle So, what I've done is I've just kind of taken screenshots of the tables from the resulting 00:17:53.810 --> 00:17:57.920 position:50% align:middle publication for this study, and what I've highlighted for you on these slides 00:17:57.920 --> 00:18:00.140 position:50% align:middle singularly are course modality. 00:18:00.140 --> 00:18:03.310 position:50% align:middle So, the delivery format for the instructional material. 00:18:03.310 --> 00:18:07.050 position:50% align:middle So, these results that you see in front of you are relate to the CLECS 2.0. 00:18:07.050 --> 00:18:10.840 position:50% align:middle So, these are students self-rating of their clinical experiences. 00:18:10.840 --> 00:18:15.530 position:50% align:middle For those familiar with the CLECS, the 2.0 part of this is because it captures 00:18:15.530 --> 00:18:16.690 position:50% align:middle all three modalities. 00:18:16.690 --> 00:18:23.690 position:50% align:middle So, the CLECS originally only kind of captured that face-to-face simulation and the in-person clinical, 00:18:23.690 --> 00:18:28.780 position:50% align:middle the 2.0 part allowed us to capture also the virtual simulation. 00:18:28.780 --> 00:18:31.770 position:50% align:middle Here, again, you see the faculty CCEI results. 00:18:31.770 --> 00:18:34.440 position:50% align:middle And again, if you're thinking to yourself, "Why is he going through these so quickly?" 00:18:34.440 --> 00:18:37.040 position:50% align:middle It's because you can download it. 00:18:37.040 --> 00:18:43.080 position:50% align:middle Standardized examination results, and then the NCLEX results. 00:18:43.080 --> 00:18:46.640 position:50% align:middle So again, across all of our measures, and, you know, you might be thinking to yourself, 00:18:46.640 --> 00:18:47.870 position:50% align:middle "Where's the early career stuff?" 00:18:47.870 --> 00:18:52.240 position:50% align:middle We're coming to that? 00:18:52.240 --> 00:18:53.940 position:50% align:middle So, shifts to online. 00:18:53.940 --> 00:18:59.420 position:50% align:middle So, kind of to date I focused on...or up to this point, I focused on clinical simulation. 00:18:59.420 --> 00:19:03.430 position:50% align:middle Shifts to online delivery of lecture content were even more pronounced. 00:19:03.430 --> 00:19:07.570 position:50% align:middle And I have to say, this caught me a little off guard, and I think in retrospect, it shouldn't, right? 00:19:07.570 --> 00:19:12.300 position:50% align:middle Because these kind of represented some of the lower-hanging fruit opportunities to transfer what you 00:19:12.300 --> 00:19:14.240 position:50% align:middle did in a classroom online. 00:19:14.240 --> 00:19:22.560 position:50% align:middle But what we saw was a 60% increase in the plan use of online lecture delivery from fall 2019 to fall 2020. 00:19:22.560 --> 00:19:24.020 position:50% align:middle So what does that mean? 00:19:24.020 --> 00:19:25.580 position:50% align:middle Again, in hard numbers, right? 00:19:25.580 --> 00:19:32.430 position:50% align:middle One hundred sixty-seven programs who responded to our baseline survey in the summer of 2020 indicated that 00:19:32.430 --> 00:19:36.607 position:50% align:middle they offered no online lecture content in fall 2019. 00:19:36.607 --> 00:19:40.980 position:50% align:middle That number fell to 21 in fall 2020. 00:19:40.980 --> 00:19:47.340 position:50% align:middle So, I don't think it's an overstatement to say this near wholesale shift to online delivery of lecture 00:19:47.340 --> 00:19:52.160 position:50% align:middle content inevitably impacted students' learning and engagement outcomes as well. 00:19:52.160 --> 00:19:58.910 position:50% align:middle What we saw time and time again is that in-person and hybrid learning consistently surpassed those instances 00:19:58.910 --> 00:20:02.290 position:50% align:middle where those folks were in online-only environments. 00:20:02.290 --> 00:20:07.420 position:50% align:middle Similarly, students who enrolled in in-person and hybrid courses also reported significantly and 00:20:07.420 --> 00:20:11.900 position:50% align:middle consistently higher levels of engagement, vis-a-vis their peers who are 00:20:11.900 --> 00:20:14.240 position:50% align:middle in online-only environments. 00:20:14.240 --> 00:20:20.170 position:50% align:middle And, interestingly, this is one of the things that I don't want to overstate too much because our program 00:20:20.170 --> 00:20:24.520 position:50% align:middle set was very strong in terms of their performance on standardized examination scores. 00:20:24.520 --> 00:20:30.110 position:50% align:middle But it was really this transition from the classroom to an online space for lecture content, 00:20:30.110 --> 00:20:36.340 position:50% align:middle so the didactic content where we really did see some of the slippage in the standardized test outcomes. 00:20:36.340 --> 00:20:41.260 position:50% align:middle So, students who were enrolled specifically in kind of online lecture-content-only programs, 00:20:41.260 --> 00:20:47.580 position:50% align:middle so programs that had shifted a larger proportion of their content online also experienced greater decreases 00:20:47.580 --> 00:20:51.800 position:50% align:middle in their NCLEX RN results, vis-a-vis those who would rely more on either hybrid 00:20:51.800 --> 00:20:54.480 position:50% align:middle or in-person delivery. 00:20:54.480 --> 00:20:56.180 position:50% align:middle So, again, a few tables. 00:20:56.180 --> 00:20:59.260 position:50% align:middle So, this is the cap perceived learning scale. 00:20:59.260 --> 00:21:03.460 position:50% align:middle So, this is specific to kind of that lecture setting. 00:21:03.460 --> 00:21:04.880 position:50% align:middle These are the second results. 00:21:04.880 --> 00:21:08.340 position:50% align:middle So, whenever we kind of talk about student engagement, this instrument, again, 00:21:08.340 --> 00:21:13.070 position:50% align:middle an externally validated instrument was really narrowed in on that particular topic. 00:21:13.070 --> 00:21:21.140 position:50% align:middle Some standardized examination results, and then a few more standardized examination results. 00:21:21.140 --> 00:21:24.120 position:50% align:middle But our research in this area, and I think that this is where we start to see some 00:21:24.120 --> 00:21:28.980 position:50% align:middle real intersection with the workforce work also documented significant declines in the clinical 00:21:28.980 --> 00:21:34.780 position:50% align:middle preparedness of new nurse graduates and drop-offs in the clinical proficiency and diagnostic proficiency 00:21:34.780 --> 00:21:36.620 position:50% align:middle of early career nurses. 00:21:36.620 --> 00:21:41.830 position:50% align:middle And this was largely driven, once again, by shifts to more remote and virtually simulated 00:21:41.830 --> 00:21:44.520 position:50% align:middle educational models required by the pandemic. 00:21:44.520 --> 00:21:46.420 position:50% align:middle So, this isn't casting aspersions, right? 00:21:46.420 --> 00:21:49.740 position:50% align:middle We did the best that we could in the time that we were allotted. 00:21:49.740 --> 00:21:56.310 position:50% align:middle But what this tells us is that kind of rapid transition not only had initial deleterious effects for the 00:21:56.310 --> 00:22:00.070 position:50% align:middle pre-licensure students in their program, but that kind of carried forward to their 00:22:00.070 --> 00:22:01.280 position:50% align:middle early career experience. 00:22:01.280 --> 00:22:07.310 position:50% align:middle And when we're able to highlight, for instance, the delivery format or the delivery method, 00:22:07.310 --> 00:22:10.640 position:50% align:middle that is because with this large of a sample, these many observations, 00:22:10.640 --> 00:22:14.620 position:50% align:middle we were able to take all those possible confounders, maybe not the unobserved ones, 00:22:14.620 --> 00:22:18.620 position:50% align:middle but the ones that we were certainly tracking anytime in which we saw an independent association 00:22:18.620 --> 00:22:20.250 position:50% align:middle with another characteristic. 00:22:20.250 --> 00:22:24.260 position:50% align:middle We were able to look simultaneously at, well, let's say we control for student SES, 00:22:24.260 --> 00:22:28.980 position:50% align:middle let's say we control for institution type, let's say we control for institutional setting. 00:22:28.980 --> 00:22:32.220 position:50% align:middle In those more rigorous, kind of multi-variable settings, 00:22:32.220 --> 00:22:39.140 position:50% align:middle those other possible predictors of these outcomes ultimately fell away. 00:22:39.140 --> 00:22:43.730 position:50% align:middle And what we were left with was a very durable, a very consistent, and a very strong relationship 00:22:43.730 --> 00:22:49.150 position:50% align:middle with delivery format, specifically, and an array of outcomes. 00:22:49.150 --> 00:22:53.470 position:50% align:middle So, this table before you presents the early career outcomes, assessing clinical preparedness, 00:22:53.470 --> 00:22:59.970 position:50% align:middle and practice efficiency associated with clinical characteristics, and then again, 00:22:59.970 --> 00:23:04.400 position:50% align:middle with some of the didactic or lecture characteristics. 00:23:04.400 --> 00:23:08.420 position:50% align:middle So, with these last few slides, one of the things that I like to do with these 00:23:08.420 --> 00:23:11.380 position:50% align:middle opportunities because I feel like this is the point of counseling together, 00:23:11.380 --> 00:23:15.800 position:50% align:middle this is the point of networking nationally, is to give you a sense also of where our results kind 00:23:15.800 --> 00:23:17.910 position:50% align:middle of fall within the existing body of evidence, right? 00:23:17.910 --> 00:23:23.200 position:50% align:middle There's a conversation that is going on exterior to all walls, and we want to understand how do the results 00:23:23.200 --> 00:23:27.340 position:50% align:middle that we're contributing, you know, either resonate with or potentially contrast with some 00:23:27.340 --> 00:23:28.740 position:50% align:middle of the data that is out there. 00:23:28.740 --> 00:23:36.210 position:50% align:middle What we found is with our partners with AACN, is that they have reported during this particular point 00:23:36.210 --> 00:23:43.430 position:50% align:middle in time and fairly disconcertingly, drop-offs in both enrollment to baccalaureate programs, 00:23:43.430 --> 00:23:50.630 position:50% align:middle as well as prospective student interests in these programs, represented in terms of applications. 00:23:50.630 --> 00:23:55.840 position:50% align:middle And so, while outside the scope of our research agenda, one of the reasons why I want to draw your attention 00:23:55.840 --> 00:24:01.120 position:50% align:middle to this particular finding is because I think it underscores how wide-ranging the impact that the 00:24:01.120 --> 00:24:02.190 position:50% align:middle pandemic has been. 00:24:02.190 --> 00:24:08.980 position:50% align:middle And I think it also highlights how durable some of these effects are going to be as we kind of project 00:24:08.980 --> 00:24:09.710 position:50% align:middle forward a little bit. 00:24:09.710 --> 00:24:13.620 position:50% align:middle I know that that's a big part of the conversation with the workforce, also with this study. 00:24:13.620 --> 00:24:17.140 position:50% align:middle You know, when we look towards the horizon a little bit, this represents really the Vanguard, 00:24:17.140 --> 00:24:19.590 position:50% align:middle prospective student interest in nursing program. 00:24:19.590 --> 00:24:27.060 position:50% align:middle And that ultimately has an effect on the overall workforce eventually. 00:24:27.060 --> 00:24:32.710 position:50% align:middle And then, similarly, a recent AACN publication really attesting to the 00:24:32.710 --> 00:24:39.570 position:50% align:middle faculty burnout and the fact that exhaustion and stress are not limited to the frontline healthcare workforce. 00:24:39.570 --> 00:24:46.320 position:50% align:middle So, again, really, a constellation of rigorous studies showing evidence of a kind of an industry effectively 00:24:46.320 --> 00:24:51.240 position:50% align:middle battered from all sides over the past two to three years. 00:24:51.240 --> 00:24:54.202 position:50% align:middle So, what are the key takeaways for this study? 00:24:54.202 --> 00:24:59.750 position:50% align:middle The effects of the pandemic on pre-licensure nursing education are clear. 00:24:59.750 --> 00:25:02.210 position:50% align:middle They're widespread, they're multiple. 00:25:02.210 --> 00:25:06.260 position:50% align:middle I do think that this falls squarely into the category of duh. 00:25:06.260 --> 00:25:11.960 position:50% align:middle If you've been tracking even popular media, we recognize that the pandemic had a significant effect 00:25:11.960 --> 00:25:14.210 position:50% align:middle on education, not just nursing. 00:25:14.210 --> 00:25:21.830 position:50% align:middle So, perhaps more informative are the findings related to programs' significant reliance on virtual simulation 00:25:21.830 --> 00:25:29.030 position:50% align:middle and online lecture delivery and the deleterious effects on student outcomes long-term, durable, 00:25:29.030 --> 00:25:32.080 position:50% align:middle in multiple settings. 00:25:32.080 --> 00:25:39.360 position:50% align:middle By contrast, I will revisit the fact that our study effectively functioned as a natural experiment that 00:25:39.360 --> 00:25:46.050 position:50% align:middle showed and confirmed that good adherence to that face-to-face, high-fidelity simulation did produce 00:25:46.050 --> 00:25:51.200 position:50% align:middle consistently strong and replicable student outcomes. 00:25:51.200 --> 00:25:55.800 position:50% align:middle But most importantly, we feel our study underscores that today's new nurses 00:25:55.800 --> 00:26:00.000 position:50% align:middle likely feel as though they are in a more precarious position than, potentially, they ever have. 00:26:00.000 --> 00:26:07.220 position:50% align:middle So, we would argue that an urgent demand exists for practice partners to respond to the needs of these new 00:26:07.220 --> 00:26:13.220 position:50% align:middle nurse graduates to facilitate transitions to practice that really develop a sense of salience in this 00:26:13.220 --> 00:26:17.000 position:50% align:middle arguably transformed healthcare landscape. 00:26:17.000 --> 00:26:24.230 position:50% align:middle Furthermore, there really need to be efforts to address gaps that were revealed as a result of the pandemic 00:26:24.230 --> 00:26:26.390 position:50% align:middle in kind of the educational curricula. 00:26:26.390 --> 00:26:30.860 position:50% align:middle So, for instance, particularly as it relates to disaster and public health emergency 00:26:30.860 --> 00:26:32.910 position:50% align:middle education and training. 00:26:32.910 --> 00:26:35.540 position:50% align:middle And then, finally, I don't think that this will come as any surprise. 00:26:35.540 --> 00:26:41.920 position:50% align:middle The use of educational technology to facilitate students' experiential learning really needs 00:26:41.920 --> 00:26:43.100 position:50% align:middle to be revisited. 00:26:43.100 --> 00:26:48.860 position:50% align:middle So, with that virtual clinical simulation space, there needs to be more research on this topic. 00:26:48.860 --> 00:26:53.120 position:50% align:middle There needs to be rigorous evidence-based guidelines for when to use it, what constitutes 00:26:53.120 --> 00:27:00.850 position:50% align:middle virtual simulation, and what produces consistently strong and replicable student outcomes. 00:27:00.850 --> 00:27:06.820 position:50% align:middle So, I could go on and on about this, but obviously, we do have very important news here coming shortly. 00:27:06.820 --> 00:27:08.510 position:50% align:middle So, I am going to stop here. 00:27:08.510 --> 00:27:11.460 position:50% align:middle I'm going to open the floor to any questions that you might have. 00:27:11.460 --> 00:27:16.220 position:50% align:middle One of the things that I will hasten to mention is that you might come up with questions on your flight home, 00:27:16.220 --> 00:27:17.210 position:50% align:middle on your drive home. 00:27:17.210 --> 00:27:20.260 position:50% align:middle You might come up with questions within 10 minutes of this session ending. 00:27:20.260 --> 00:27:22.560 position:50% align:middle We are always happy to collaborate. 00:27:22.560 --> 00:27:24.030 position:50% align:middle We want to coordinate with you. 00:27:24.030 --> 00:27:28.400 position:50% align:middle We think that there's real power in doing this all together, not just as, like, a nursing community, 00:27:28.400 --> 00:27:30.300 position:50% align:middle but also an inter-professional community. 00:27:30.300 --> 00:27:34.280 position:50% align:middle So, should you have questions following this session, it just doesn't occur to you right now, please, 00:27:34.280 --> 00:27:35.580 position:50% align:middle feel free to follow up with us. 00:27:35.580 --> 00:27:37.780 position:50% align:middle I have to say, it used to be that my door is always open. 00:27:37.780 --> 00:27:40.340 position:50% align:middle Now, I also say, "My virtual door is always open." 00:27:40.340 --> 00:27:41.830 position:50% align:middle But we love that collaboration. 00:27:41.830 --> 00:27:43.040 position:50% align:middle It energizes us. 00:27:43.040 --> 00:27:44.030 position:50% align:middle So please do not hesitate. 00:27:44.030 --> 00:27:47.890 position:50% align:middle But with that, I will say thank you for your time, and I will open the floor to any questions that 00:27:47.890 --> 00:27:49.270 position:50% align:middle you might have. 00:27:49.270 --> 00:27:50.370 position:50% align:middle I see podium number four. 00:27:50.370 --> 00:27:51.820 position:50% align:middle - [Medi] Hi, Brendan. 00:27:51.820 --> 00:27:52.580 position:50% align:middle Good morning. 00:27:52.580 --> 00:27:53.350 position:50% align:middle - Hey, good morning, 00:27:53.350 --> 00:27:57.160 position:50% align:middle - Medi Barnelli [SP] from Washington, DC aka, the District. 00:27:57.160 --> 00:28:01.420 position:50% align:middle I'm excited to hear your information this morning, and I have a question, 00:28:01.420 --> 00:28:06.650 position:50% align:middle with all the information you shared regarding these new nurses and the barriers that they've had to overcome, 00:28:06.650 --> 00:28:10.710 position:50% align:middle as well as the educators, two thoughts come to mind. 00:28:10.710 --> 00:28:18.620 position:50% align:middle One, what are your thoughts as it relates to how acute care individuals, educators can help to facilitate that 00:28:18.620 --> 00:28:23.840 position:50% align:middle gap that has been experienced from the academic setting now they're into the clinical practice area? 00:28:23.840 --> 00:28:29.800 position:50% align:middle Two, there's a lot of conversations about, in many organizations specifically, mine as well. 00:28:29.800 --> 00:28:35.480 position:50% align:middle We're looking at care delivery models and how these new nurses are going to be able to easily adapt 00:28:35.480 --> 00:28:37.460 position:50% align:middle to different care models. 00:28:37.460 --> 00:28:41.870 position:50% align:middle For example, one nurse, and not speaking specifically of ratios. 00:28:41.870 --> 00:28:46.260 position:50% align:middle I know that's a whole another topic and a whole another animal, but a conversation as it relates 00:28:46.260 --> 00:28:53.350 position:50% align:middle to team nursing, conversations regarding if you have lead technicians and the individuals these new nurses 00:28:53.350 --> 00:28:57.540 position:50% align:middle that don't quite understand or comprehend what these new care delivery models are. 00:28:57.540 --> 00:28:59.330 position:50% align:middle I know that's kind of a loaded question. 00:28:59.330 --> 00:29:02.250 position:50% align:middle - Well, you took the words out of my mouth. 00:29:02.250 --> 00:29:07.990 position:50% align:middle So, I think one of the things that we are careful to do, I am trained as a statistician, right? 00:29:07.990 --> 00:29:09.270 position:50% align:middle So, I have a lane. 00:29:09.270 --> 00:29:14.380 position:50% align:middle We try to do a good job of documenting, what are the realities, right? 00:29:14.380 --> 00:29:19.000 position:50% align:middle And then, we leave it to, you know, the subject matter experts, the stakeholders, right? 00:29:19.000 --> 00:29:24.330 position:50% align:middle To really try to address what are the realities and kind of come up with those policy solutions. 00:29:24.330 --> 00:29:28.130 position:50% align:middle But I think what you're getting at there, and we would absolutely state this publicly, 00:29:28.130 --> 00:29:31.880 position:50% align:middle is that this is really an all-ideas-to-the-table, all-hands-on-deck approach. 00:29:31.880 --> 00:29:37.900 position:50% align:middle That's how this has to be because as Richard attested to, we're dealing with a plethora of issues 00:29:37.900 --> 00:29:39.220 position:50% align:middle within the current workforce. 00:29:39.220 --> 00:29:42.620 position:50% align:middle Now, we're getting into, essentially, the pipeline for the workforce. 00:29:42.620 --> 00:29:46.110 position:50% align:middle And then when you look at the AACN data, we're also talking about prospective student interest 00:29:46.110 --> 00:29:47.960 position:50% align:middle in the profession at all, right? 00:29:47.960 --> 00:29:53.500 position:50% align:middle And so, this is going to require everybody coming together and to thinking of comprehensive solutions. 00:29:53.500 --> 00:29:55.260 position:50% align:middle It's not silos, right? 00:29:55.260 --> 00:29:59.620 position:50% align:middle Everybody has to understand that maybe there are gaps in how we're educating students, 00:29:59.620 --> 00:30:03.340 position:50% align:middle but there's also gaps in how we're onboarding new nurse graduates. 00:30:03.340 --> 00:30:06.520 position:50% align:middle And then, there's gaps in terms of, potentially, you know, some of the mental healthcare 00:30:06.520 --> 00:30:07.940 position:50% align:middle for current practitioners. 00:30:07.940 --> 00:30:10.000 position:50% align:middle There's also gaps in the retention policies. 00:30:10.000 --> 00:30:13.710 position:50% align:middle There's potentially gaps in trying to bring those folks back off of the sidelines. 00:30:13.710 --> 00:30:17.060 position:50% align:middle And so, I think it is not only a nursing phenomena, as Hank talked about. 00:30:17.060 --> 00:30:22.960 position:50% align:middle It's a kind of an inter-professional healthcare phenomena, but as it relates specifically to nursing. 00:30:22.960 --> 00:30:24.060 position:50% align:middle I think it's an all-hands-on-deck. 00:30:24.060 --> 00:30:25.840 position:50% align:middle I hope that's not a frustrating answer. 00:30:25.840 --> 00:30:27.450 position:50% align:middle It's a loaded question with a frustrating answer. 00:30:27.450 --> 00:30:28.430 position:50% align:middle How about that? 00:30:28.430 --> 00:30:28.960 position:50% align:middle - Thank you so much. 00:30:28.960 --> 00:30:32.580 position:50% align:middle - But, you know, I think it is one of those things where if this was simple, right, 00:30:32.580 --> 00:30:35.220 position:50% align:middle and if it was straightforward, we wouldn't be here trying to talk about it. 00:30:35.220 --> 00:30:38.680 position:50% align:middle And I think you're spot on in your assessment that this is really going to take everybody working 00:30:38.680 --> 00:30:39.560 position:50% align:middle together in concert. 00:30:39.560 --> 00:30:40.360 position:50% align:middle - Thank you. 00:30:40.360 --> 00:30:41.020 position:50% align:middle - Yeah. 00:30:41.020 --> 00:30:43.360 position:50% align:middle I see number three. 00:30:43.360 --> 00:30:44.590 position:50% align:middle - [Jessica] Good morning. 00:30:44.590 --> 00:30:46.780 position:50% align:middle Jessica Lannan, Michigan. 00:30:46.780 --> 00:30:50.340 position:50% align:middle First of all, thank you for all of the hard work you've put into this. 00:30:50.340 --> 00:30:57.910 position:50% align:middle We've been able to find the studies online, but wondering if it would be possible for us to get 00:30:57.910 --> 00:31:03.530 position:50% align:middle an electronic copy of your PowerPoints to take back to our stakeholders for both presentations. 00:31:03.530 --> 00:31:04.580 position:50% align:middle - Yeah, absolutely. 00:31:04.580 --> 00:31:05.490 position:50% align:middle Not a problem. 00:31:05.490 --> 00:31:10.520 position:50% align:middle Either this will be made available, as I mentioned, as a resource following the close of this meeting. 00:31:10.520 --> 00:31:14.110 position:50% align:middle If not, if it's difficult to find, again, feel free to reach out to me. 00:31:14.110 --> 00:31:15.790 position:50% align:middle I have no hesitation saying this. 00:31:15.790 --> 00:31:19.630 position:50% align:middle My email is bmartin@ncsbn.org. 00:31:19.630 --> 00:31:20.960 position:50% align:middle Please reach out to me directly. 00:31:20.960 --> 00:31:24.350 position:50% align:middle If you cannot find it, I will make sure that you get copies of both reports. 00:31:24.350 --> 00:31:27.200 position:50% align:middle But I will hasten to mention, they are free for download on the website. 00:31:27.200 --> 00:31:28.980 position:50% align:middle Oh, and the presentation. 00:31:28.980 --> 00:31:29.750 position:50% align:middle - So, the PowerPoints. 00:31:29.750 --> 00:31:29.970 position:50% align:middle - Yes. 00:31:29.970 --> 00:31:30.230 position:50% align:middle The presentations, yes. 00:31:30.230 --> 00:31:31.000 position:50% align:middle - PowerPoints, not the reports. 00:31:31.000 --> 00:31:31.120 position:50% align:middle Okay. 00:31:31.120 --> 00:31:31.390 position:50% align:middle - There you go. 00:31:31.390 --> 00:31:31.990 position:50% align:middle - Thank you very much. 00:31:31.990 --> 00:31:35.680 position:50% align:middle - Yes, you're welcome. 00:31:35.680 --> 00:31:36.200 position:50% align:middle Number six. 00:31:36.200 --> 00:31:39.230 position:50% align:middle - [Gerianne] Gerianne Babbo, Washington State Board of Nursing. 00:31:39.230 --> 00:31:44.240 position:50% align:middle First of all, thank you so much for this work that you did and that your team has done. 00:31:44.240 --> 00:31:51.120 position:50% align:middle My question is, when you looked at the high-quality, high-fidelity simulation, did you look at ratios? 00:31:51.120 --> 00:31:53.390 position:50% align:middle Was it done at one-to-one or one-to-two? 00:31:53.390 --> 00:31:58.710 position:50% align:middle And then, my second question is, did you look at the percentage of simulation? 00:31:58.710 --> 00:31:59.330 position:50% align:middle Was it... 00:31:59.330 --> 00:31:59.930 position:50% align:middle - Yes. 00:31:59.930 --> 00:32:00.580 position:50% align:middle - ...40, 50, 60? 00:32:00.580 --> 00:32:02.800 position:50% align:middle And did that make any difference? 00:32:02.800 --> 00:32:03.440 position:50% align:middle Thank you so much. 00:32:03.440 --> 00:32:03.810 position:50% align:middle - Yes. 00:32:03.810 --> 00:32:05.760 position:50% align:middle So, yes, no, thank you for those good questions. 00:32:05.760 --> 00:32:10.290 position:50% align:middle So, in the first regard, we did not look at the ratios specifically. 00:32:10.290 --> 00:32:16.620 position:50% align:middle Because one of the things that we were cognizant of upfront is trying to do this type of a study, 00:32:16.620 --> 00:32:22.330 position:50% align:middle in particular, when everything was so new, everything was so scary at the onset of the pandemic, 00:32:22.330 --> 00:32:25.400 position:50% align:middle we basically just asked programs to do what they were doing. 00:32:25.400 --> 00:32:28.460 position:50% align:middle This was, in its core form, a natural experiment. 00:32:28.460 --> 00:32:33.090 position:50% align:middle And so, I know that there are thoughts as to, like, the appropriate ratio and whatnot. 00:32:33.090 --> 00:32:34.560 position:50% align:middle We did not look at that specifically. 00:32:34.560 --> 00:32:40.070 position:50% align:middle But what we did look at is we did look at the proportion of utilization, both point in time, 00:32:40.070 --> 00:32:43.880 position:50% align:middle and then at the kind of the start of every single term. 00:32:43.880 --> 00:32:50.560 position:50% align:middle What we did is we asked participating faculty to, once again, tell us what are the proportion that you 00:32:50.560 --> 00:32:56.200 position:50% align:middle plan to use of high fidelity face-to-face virtual simulation, in-person clinical instruction. 00:32:56.200 --> 00:32:57.770 position:50% align:middle Also, for the lecture content. 00:32:57.770 --> 00:33:01.190 position:50% align:middle And the explicit reason for that was because we anticipated upfront, obviously, 00:33:01.190 --> 00:33:02.860 position:50% align:middle that this wasn't a static thing. 00:33:02.860 --> 00:33:07.080 position:50% align:middle We couldn't track it in July 2020, and then carry it forward and anticipate that we were 00:33:07.080 --> 00:33:08.510 position:50% align:middle still going to remain accurate. 00:33:08.510 --> 00:33:12.910 position:50% align:middle So, we have both point-in-time understandings, which was one of those graphs. 00:33:12.910 --> 00:33:17.860 position:50% align:middle But we also have a sense of how that kind of trended over time in terms of the proportional usage. 00:33:17.860 --> 00:33:22.850 position:50% align:middle And that's one of the reasons why we can confidently state that these results really replicated the national 00:33:22.850 --> 00:33:30.050 position:50% align:middle simulation study, because we knew were you employing it more than the recommended 50% high fidelity. 00:33:30.050 --> 00:33:35.110 position:50% align:middle And in many of these instances, almost in all of these instances, programs were not. 00:33:35.110 --> 00:33:40.460 position:50% align:middle And for that reason, the high fidelity face-to-face, those strong and consistent student outcomes really 00:33:40.460 --> 00:33:41.620 position:50% align:middle were borne out in the data. 00:33:41.620 --> 00:33:45.650 position:50% align:middle There were almost no significant differences between face-to-face, high-fidelity simulation 00:33:45.650 --> 00:33:47.010 position:50% align:middle and in-person clinicals. 00:33:47.010 --> 00:33:52.000 position:50% align:middle Where we did see the differences was with the virtual, given the lack of evidence-based criteria. 00:33:52.000 --> 00:33:53.700 position:50% align:middle And then, I see eight, I believe. 00:33:53.700 --> 00:33:54.990 position:50% align:middle - [Jose] Hi, again. 00:33:54.990 --> 00:33:56.570 position:50% align:middle Jose from Florida. 00:33:56.570 --> 00:34:03.310 position:50% align:middle I truly am very impressed with the extent and scope of the study that you all did, 00:34:03.310 --> 00:34:06.070 position:50% align:middle and I'm glad that it's published already. 00:34:06.070 --> 00:34:11.860 position:50% align:middle And we are all in support as we are part of the education committee also for the Board 00:34:11.860 --> 00:34:13.550 position:50% align:middle of Nursing in Florida. 00:34:13.550 --> 00:34:21.340 position:50% align:middle But my comment is on the gap that you highlighted just now with the first speaker. 00:34:21.340 --> 00:34:31.230 position:50% align:middle I do think that there's a lot of qualitative power skills component as what our NASA speaker 00:34:31.230 --> 00:34:33.490 position:50% align:middle from last year implicated. 00:34:33.490 --> 00:34:41.600 position:50% align:middle They're not soft skills, but power skills on how the program utilizes their 00:34:41.600 --> 00:34:49.820 position:50% align:middle staff in establishing those relationships with their students ensuring their success in the program. 00:34:49.820 --> 00:34:55.610 position:50% align:middle And I do think that that qualitative piece truly makes a difference. 00:34:55.610 --> 00:34:59.690 position:50% align:middle We have started with the Florida Board of Nursing, and I'm going to address this also with the president's 00:34:59.690 --> 00:35:02.190 position:50% align:middle meeting this afternoon. 00:35:02.190 --> 00:35:05.850 position:50% align:middle Put it in the agenda, is that we have started the success stories. 00:35:05.850 --> 00:35:12.920 position:50% align:middle We have invited program directors who are consistently successful having successful pass rates as the first 00:35:12.920 --> 00:35:16.330 position:50% align:middle metric with NCLEX-RN or NCLEX-PN. 00:35:16.330 --> 00:35:23.220 position:50% align:middle And they are presenting that to the board and to the public as we are giving them the opportunity 00:35:23.220 --> 00:35:24.170 position:50% align:middle to give that. 00:35:24.170 --> 00:35:26.220 position:50% align:middle Also, we ask them to give... 00:35:26.220 --> 00:35:31.600 position:50% align:middle Another metric is their evidence-based component so that they can give us, like, 00:35:31.600 --> 00:35:37.930 position:50% align:middle what guides you in this qualitative piece so that it can support you with the success of your program. 00:35:37.930 --> 00:35:39.190 position:50% align:middle Truly commendable with your study. 00:35:39.190 --> 00:35:39.610 position:50% align:middle Thank you. 00:35:39.610 --> 00:35:43.060 position:50% align:middle - Thank you for those comments. 00:35:43.060 --> 00:35:44.310 position:50% align:middle Three, I think. 00:35:44.310 --> 00:35:46.670 position:50% align:middle - [Suzanne] Hello, Suzanne from New York. 00:35:46.670 --> 00:35:49.630 position:50% align:middle Thank you very much for this very helpful study. 00:35:49.630 --> 00:35:56.430 position:50% align:middle My question relates to population groups because In New York, there are particular challenges 00:35:56.430 --> 00:36:03.640 position:50% align:middle with offering in-person patient care experiences for pediatric populations. 00:36:03.640 --> 00:36:11.450 position:50% align:middle Did your study kind of investigate the impact or the effectiveness of simulation on preparation for practice 00:36:11.450 --> 00:36:13.540 position:50% align:middle for these particular population groups? 00:36:13.540 --> 00:36:13.900 position:50% align:middle Thank you. 00:36:13.900 --> 00:36:18.590 position:50% align:middle - So , if I misinterpret the question, reel me back in, but you are touching on something. 00:36:18.590 --> 00:36:22.090 position:50% align:middle So, as I alluded to earlier, this is a 60-plus page supplement. 00:36:22.090 --> 00:36:22.230 position:50% align:middle - Yes. 00:36:22.230 --> 00:36:25.190 position:50% align:middle - So, had to distill it into 20 minutes effectively. 00:36:25.190 --> 00:36:29.850 position:50% align:middle We looked at an array of issues, I think, related to your questions. 00:36:29.850 --> 00:36:35.590 position:50% align:middle So, one of the things that we looked at and we asked about specifically was the effect of the difficulty 00:36:35.590 --> 00:36:41.820 position:50% align:middle of finding in-person clinical placements.We also asked about the certification and training of faculty, 00:36:41.820 --> 00:36:46.550 position:50% align:middle whether there were any upfront resources that the program was able to put forward to try to train folks 00:36:46.550 --> 00:36:48.450 position:50% align:middle for some of these transitions. 00:36:48.450 --> 00:36:52.100 position:50% align:middle And what we found time and time again, I don't think that this is going to surprise you, 00:36:52.100 --> 00:36:57.030 position:50% align:middle is that the programs that experienced the greatest difficulty of finding in-person clinicals and then kind 00:36:57.030 --> 00:36:59.970 position:50% align:middle of the intersection with the ones who weren't able to offer those resources, 00:36:59.970 --> 00:37:04.370 position:50% align:middle who didn't necessarily have the faculty trained to maybe allow for some of these, you know, 00:37:04.370 --> 00:37:05.930 position:50% align:middle extended modalities, etc. 00:37:05.930 --> 00:37:11.540 position:50% align:middle Those were where we did see some of the most consistent drop offs in student scoring. 00:37:11.540 --> 00:37:12.720 position:50% align:middle - Okay. 00:37:12.720 --> 00:37:18.670 position:50% align:middle And so, are there any studies underway to kind of analyze how effective this type of education 00:37:18.670 --> 00:37:22.590 position:50% align:middle like face-to-face simulation is for these particular populations? 00:37:22.590 --> 00:37:26.210 position:50% align:middle - Well, and this is where I will make a plug for my colleague, Dr. Nancy Spector. 00:37:26.210 --> 00:37:29.570 position:50% align:middle So, this is another booth, there's multiple booths. 00:37:29.570 --> 00:37:34.330 position:50% align:middle So, for the annual report data, we are absolutely trying to encourage jurisdictions 00:37:34.330 --> 00:37:36.890 position:50% align:middle to sign onto the annual report project. 00:37:36.890 --> 00:37:40.510 position:50% align:middle And the idea is there, we have a standardized instrument in which we collect 00:37:40.510 --> 00:37:45.540 position:50% align:middle this information time and time again with enough frequency that we can start to get at some of those 00:37:45.540 --> 00:37:47.900 position:50% align:middle criteria that you're thinking about on a more consistent basis. 00:37:47.900 --> 00:37:54.390 position:50% align:middle So, within research, this was a core focus of ours, but we don't necessarily spearhead 00:37:54.390 --> 00:37:57.460 position:50% align:middle education-specific studies often. 00:37:57.460 --> 00:38:01.400 position:50% align:middle Nancy's group does look at that topic very specifically and very durably. 00:38:01.400 --> 00:38:05.630 position:50% align:middle And so, I would encourage those jurisdictions who are not yet participating to stop by the booth and to kind 00:38:05.630 --> 00:38:10.900 position:50% align:middle of get some of that educational material and see about, really, the power that would be derived from that. 00:38:10.900 --> 00:38:14.170 position:50% align:middle And so, I think that that's kind of the answer to your question in a way. 00:38:14.170 --> 00:38:18.670 position:50% align:middle We, as NCSBN, continue to focus on this issue and will continue to focus on this issue. 00:38:18.670 --> 00:38:19.660 position:50% align:middle - Thank you very much. 00:38:19.660 --> 00:38:21.920 position:50% align:middle - You're welcome. 00:38:21.920 --> 00:38:23.740 position:50% align:middle Seven, looks like. 00:38:23.740 --> 00:38:28.170 position:50% align:middle - [Charity] Hi, my name is Charity Cooper from Illinois. 00:38:28.170 --> 00:38:37.600 position:50% align:middle We have struggled in our state with some programs, and our excellent education committee has looked 00:38:37.600 --> 00:38:42.430 position:50% align:middle at them and they have had consistently low pass rates. 00:38:42.430 --> 00:38:47.150 position:50% align:middle And during the pandemic, this worsened as well. 00:38:47.150 --> 00:39:03.670 position:50% align:middle I'm wondering if you looked at any things that we might do to help encourage those programs to better perform. 00:39:03.670 --> 00:39:14.470 position:50% align:middle And if you noticed any...if you had in your study any proprietorial programs, for-profit programs, 00:39:14.470 --> 00:39:20.380 position:50% align:middle and if you teased out any differences in those programs. 00:39:20.380 --> 00:39:22.180 position:50% align:middle - So, I can answer two questions. 00:39:22.180 --> 00:39:24.860 position:50% align:middle One, I feel like I should hand the baton to Nancy here. 00:39:24.860 --> 00:39:29.120 position:50% align:middle So, that is specifically the purpose and the goal of the annual report data. 00:39:29.120 --> 00:39:34.050 position:50% align:middle So, we aren't able to necessarily dig into that first component. 00:39:34.050 --> 00:39:39.520 position:50% align:middle But that is absolutely the point of the annual report database, to look at those indicators that can help you 00:39:39.520 --> 00:39:43.290 position:50% align:middle be proactive in your outreach to these programs to get them back on track. 00:39:43.290 --> 00:39:46.080 position:50% align:middle Because, ultimately, we view the NCLEX as kind of a lagging indicator. 00:39:46.080 --> 00:39:48.220 position:50% align:middle This goes back to our 2020 presentation. 00:39:48.220 --> 00:39:53.770 position:50% align:middle You know, there are other criteria and characteristics associated with the program that would maybe be more 00:39:53.770 --> 00:39:58.510 position:50% align:middle early indicators that you could get ahead of this and maybe start to collaborate with the program 00:39:58.510 --> 00:40:03.980 position:50% align:middle representatives to get them back in good shape before you start to feed things like a drop off in the NCLEX. 00:40:03.980 --> 00:40:06.620 position:50% align:middle So, again, I would make a plug for the annual report data. 00:40:06.620 --> 00:40:11.250 position:50% align:middle The second piece of your question, the answer is yes, and then no. 00:40:11.250 --> 00:40:15.040 position:50% align:middle So, a very, very small proportion of the programs who opted to participate. 00:40:15.040 --> 00:40:17.080 position:50% align:middle So, this was a voluntary opt-in survey. 00:40:17.080 --> 00:40:21.680 position:50% align:middle We wanted this to be as large as humanly possible, but just given the circumstances on the ground, 00:40:21.680 --> 00:40:23.600 position:50% align:middle you know, it narrowed pretty quickly. 00:40:23.600 --> 00:40:28.970 position:50% align:middle So, we did have some proprietary institutions in our sample, but they constituted such a small proportion 00:40:28.970 --> 00:40:29.670 position:50% align:middle of the programs. 00:40:29.670 --> 00:40:33.891 position:50% align:middle And then, I would layer on top of that, such a small proportion of the enrolled students 00:40:33.891 --> 00:40:34.888 position:50% align:middle in the study. 00:40:34.888 --> 00:40:39.980 position:50% align:middle I think it's actually less than 20 in the study of over 700 students, right? 00:40:39.980 --> 00:40:44.070 position:50% align:middle That their effect and their pull on the data was very, very minimal, if any. 00:40:44.070 --> 00:40:47.670 position:50% align:middle And then on top of that, the ability for us to then isolate them 00:40:47.670 --> 00:40:49.030 position:50% align:middle is very limited. 00:40:49.030 --> 00:40:51.560 position:50% align:middle But we did have some. 00:40:51.560 --> 00:40:51.710 position:50% align:middle Yes. 00:40:51.710 --> 00:40:52.810 position:50% align:middle Two, please. 00:40:52.810 --> 00:40:53.160 position:50% align:middle Loretta. 00:40:53.160 --> 00:40:54.750 position:50% align:middle - [Loretta] Thank you. 00:40:54.750 --> 00:40:59.770 position:50% align:middle So, this has, like, sparked, like, fireworks going off in my brain with all 00:40:59.770 --> 00:41:00.740 position:50% align:middle of this going on. 00:41:00.740 --> 00:41:07.820 position:50% align:middle So, a couple years ago, we started to focus in California on growing our 00:41:07.820 --> 00:41:10.310 position:50% align:middle education student base. 00:41:10.310 --> 00:41:14.820 position:50% align:middle We have about 30,000 nursing students enrolled at any point within California. 00:41:14.820 --> 00:41:22.110 position:50% align:middle And in our role at the Board of Registered Nursing in California, we actually approve every single enrollment 00:41:22.110 --> 00:41:24.320 position:50% align:middle change for every single school. 00:41:24.320 --> 00:41:27.770 position:50% align:middle And so, two years ago, during the pandemic, we noticed that we were low, 00:41:27.770 --> 00:41:35.090 position:50% align:middle and so we increased enrollments by schools coming forward a thousand students, and then, the next year, 00:41:35.090 --> 00:41:37.040 position:50% align:middle another thousand students. 00:41:37.040 --> 00:41:42.140 position:50% align:middle What we saw with these studies coming out, and some of the comments have been echoed here where 00:41:42.140 --> 00:41:43.570 position:50% align:middle they're like, "This is frightening. 00:41:43.570 --> 00:41:44.740 position:50% align:middle We have this huge shortage. 00:41:44.740 --> 00:41:45.860 position:50% align:middle What are we going to do?" 00:41:45.860 --> 00:41:54.370 position:50% align:middle Is we saw a huge spike in increase in new RN programs and growing current RN programs, 00:41:54.370 --> 00:41:56.800 position:50% align:middle and there's a lot of money behind it. 00:41:56.800 --> 00:42:07.230 position:50% align:middle And so, we then had 11 enrollment request in the first 2 months of this year equaling almost about a thousand 00:42:07.230 --> 00:42:09.980 position:50% align:middle new students, which is what we had the last two years. 00:42:09.980 --> 00:42:15.090 position:50% align:middle And that happened just at the one board meeting, and we do about four or five board meetings a year. 00:42:15.090 --> 00:42:18.610 position:50% align:middle So, our board actually was, like, "We have to stop. 00:42:18.610 --> 00:42:20.070 position:50% align:middle We have to stop and take a look at this. 00:42:20.070 --> 00:42:23.700 position:50% align:middle How is this impacting the schools that are already approved? 00:42:23.700 --> 00:42:25.420 position:50% align:middle What's happening with their growth? 00:42:25.420 --> 00:42:26.860 position:50% align:middle How is it affecting the community? 00:42:26.860 --> 00:42:28.990 position:50% align:middle How is it affecting the nurses at the hospital?" 00:42:28.990 --> 00:42:34.540 position:50% align:middle And a big thing that struck home with me yesterday is when the presentation from the World 00:42:34.540 --> 00:42:43.380 position:50% align:middle Health Organization, the gentleman said, the gender role where you have the healthcare 00:42:43.380 --> 00:42:46.200 position:50% align:middle as being primarily female. 00:42:46.200 --> 00:42:52.980 position:50% align:middle Well, what we're seeing in California is the spike in for-profit colleges and universities. 00:42:52.980 --> 00:43:02.250 position:50% align:middle And we have a very large university there that has over 3,000 students enrolled annually, 00:43:02.250 --> 00:43:08.500 position:50% align:middle which is about 10,000 students at any given time just in their program alone. 00:43:08.500 --> 00:43:15.740 position:50% align:middle And that's means when we have 30,000 students at any time in our state, they're a third of our RNs. 00:43:15.740 --> 00:43:22.520 position:50% align:middle And that means a third of our RNs are coming out having to pay $150,000 back on student tuition. 00:43:22.520 --> 00:43:29.970 position:50% align:middle And so, to me, if we're looking at gender inequality, you're also looking at that debt that is being handed 00:43:29.970 --> 00:43:33.460 position:50% align:middle over unequitable as well. 00:43:33.460 --> 00:43:39.850 position:50% align:middle And so, how do you manage the, oh, no, we all need to come back together and collaborate 00:43:39.850 --> 00:43:45.070 position:50% align:middle on this to fix this workforce issue with what are we going to do? 00:43:45.070 --> 00:43:49.630 position:50% align:middle What are the unintended consequences of that when we have rapid growth in our programs? 00:43:49.630 --> 00:43:53.650 position:50% align:middle We have people that are stepping up to help out. 00:43:53.650 --> 00:43:57.280 position:50% align:middle They're putting the boots on the ground, they're getting faculty, 00:43:57.280 --> 00:43:58.770 position:50% align:middle and they're getting clinical placements. 00:43:58.770 --> 00:44:02.450 position:50% align:middle They're putting people through because they're worried about this pipeline. 00:44:02.450 --> 00:44:10.640 position:50% align:middle But that pipeline can actually be negatively affecting a lot because you look at basic economy, 00:44:10.640 --> 00:44:13.390 position:50% align:middle they can't get into our public institutions. 00:44:13.390 --> 00:44:16.940 position:50% align:middle They're not growing the same way that our private institutions are. 00:44:16.940 --> 00:44:23.080 position:50% align:middle And the private institutions truly believe that they're serving because there's no openings in the public 00:44:23.080 --> 00:44:27.980 position:50% align:middle institutions because the private institutions are kind of outgrowing everybody else. 00:44:27.980 --> 00:44:32.090 position:50% align:middle - So, I don't know if this needs to be the last question. 00:44:32.090 --> 00:44:35.780 position:50% align:middle I know we're running up against time, but one of the things that I think you're touching 00:44:35.780 --> 00:44:39.100 position:50% align:middle upon is why this is such a multifaceted problem. 00:44:39.100 --> 00:44:39.280 position:50% align:middle - Mm-hmm. 00:44:39.280 --> 00:44:42.810 position:50% align:middle - And there is no simple low-lying solution to this. 00:44:42.810 --> 00:44:49.020 position:50% align:middle So, just growing enrollment for the sake of growing enrollment and trying to get in to expand our numbers 00:44:49.020 --> 00:44:54.270 position:50% align:middle at the front end of the funnel, kind of in a vacuum, like absent any consideration of the quality 00:44:54.270 --> 00:44:59.150 position:50% align:middle of that instruction, the debt burden, etc., what we're kind of doing in that process, I think, 00:44:59.150 --> 00:45:00.590 position:50% align:middle is misguided, obviously. 00:45:00.590 --> 00:45:06.430 position:50% align:middle I think that this needs to be an enrollment issue, which also has a, simultaneously, faculty issue, right? 00:45:06.430 --> 00:45:12.180 position:50% align:middle But there also need to be sufficient clinical spaces, there need to be sufficient clinical preceptors, right? 00:45:12.180 --> 00:45:17.680 position:50% align:middle There needs to be a mentally healthy workforce to onboard and mentor these new graduates. 00:45:17.680 --> 00:45:23.630 position:50% align:middle I think it is so multifaceted that to your very, very point, there is as there always are, right? 00:45:23.630 --> 00:45:29.970 position:50% align:middle There's leverage in some of these times of crisis for bad actors, and just because a program can facilitate 00:45:29.970 --> 00:45:34.610 position:50% align:middle growing enrollment doesn't necessarily mean that growing enrollment translates to policy solutions for a 00:45:34.610 --> 00:45:38.650 position:50% align:middle workforce that potentially has a dire projection, right? 00:45:38.650 --> 00:45:40.230 position:50% align:middle So, I think you're spot on. 00:45:40.230 --> 00:45:45.800 position:50% align:middle I think it does kind of come back though to the fact that everybody need this in concert, 00:45:45.800 --> 00:45:47.920 position:50% align:middle and I know the policy team is here somewhere. 00:45:47.920 --> 00:45:53.820 position:50% align:middle The policy team has talked in a number of jurisdictions about legislators singularly focused 00:45:53.820 --> 00:45:57.380 position:50% align:middle on growing enrollments, kind of absent any consideration of appropriate faculty 00:45:57.380 --> 00:45:58.990 position:50% align:middle or clinical training, right. 00:45:58.990 --> 00:46:00.580 position:50% align:middle That is not the solution. 00:46:00.580 --> 00:46:04.600 position:50% align:middle Nobody thinks that that is the solution outside of that kind of realm. 00:46:04.600 --> 00:46:09.210 position:50% align:middle And so, I think one of the things that you're speaking to yet again as others have spoken to is the fact that 00:46:09.210 --> 00:46:11.150 position:50% align:middle this really requires everybody working together. 00:46:11.150 --> 00:46:15.830 position:50% align:middle None of these things are silos, none of the possible policy solutions or long-term 00:46:15.830 --> 00:46:18.810 position:50% align:middle educational solutions are easy or low-hanging fruit. 00:46:18.810 --> 00:46:20.620 position:50% align:middle And so, that's a good point. 00:46:20.620 --> 00:46:26.360 position:50% align:middle - We actually had in our Sunset Builders last year, where our board was pretty much handicapped. 00:46:26.360 --> 00:46:30.590 position:50% align:middle They wrote into law saying exactly what we can look at. 00:46:30.590 --> 00:46:32.140 position:50% align:middle Do they have resources? 00:46:32.140 --> 00:46:33.620 position:50% align:middle Can they support it? 00:46:33.620 --> 00:46:39.430 position:50% align:middle And they specifically forbid our board to look at workforce and any other issues unless we 00:46:39.430 --> 00:46:41.370 position:50% align:middle wrote into regulations. 00:46:41.370 --> 00:46:49.780 position:50% align:middle And it's been a huge push in California to remove the board for approving these programs and having any say 00:46:49.780 --> 00:46:55.520 position:50% align:middle in enrollments and leave it up to accreditation and not leave it up to our board. 00:46:55.520 --> 00:46:59.680 position:50% align:middle And so, that has been huge handicapped that we've had to deal with this year, 00:46:59.680 --> 00:47:02.200 position:50% align:middle that we haven't had to deal with in the past. 00:47:02.200 --> 00:47:08.490 position:50% align:middle And it came from specific legislation and brought in by lobbyist coming in and saying, "Oh, the board is bad. 00:47:08.490 --> 00:47:09.100 position:50% align:middle This is bad. 00:47:09.100 --> 00:47:10.010 position:50% align:middle We have to do this." 00:47:10.010 --> 00:47:18.720 position:50% align:middle And so, I think it also goes back to what can we do from a regulatory standpoint to counter that and how do 00:47:18.720 --> 00:47:24.000 position:50% align:middle we go off of evidence versus, well, the need is here and they have the resources. 00:47:24.000 --> 00:47:26.380 position:50% align:middle So, let's just kind of put them all through. 00:47:26.380 --> 00:47:29.400 position:50% align:middle - Well, you'll find an ally in us for evidenced-based policy. 00:47:29.400 --> 00:47:31.440 position:50% align:middle So, I do think I'm getting the hook. 00:47:31.440 --> 00:47:34.530 position:50% align:middle There is one other individual at podium six, I will follow up with you. 00:47:34.530 --> 00:47:35.110 position:50% align:middle How about that? 00:47:35.110 --> 00:47:39.052 position:50% align:middle Directly, I'll come right back.Thank you so much.