WEBVTT 00:00:05.610 --> 00:00:06.600 position:50% align:middle My name is Brendan Martin. 00:00:06.600 --> 00:00:08.720 position:50% align:middle For those of you who do not know me, my name is Brendan Martin. 00:00:08.720 --> 00:00:10.860 position:50% align:middle I'm the Director of Research here at NCSBN. 00:00:10.860 --> 00:00:15.180 position:50% align:middle And I'm here today to discuss the results of actually two studies. 00:00:15.180 --> 00:00:21.340 position:50% align:middle But this morning, one of our COVID-19 studies entitled Assessing the Impact of the COVID-19 Pandemic 00:00:21.340 --> 00:00:26.520 position:50% align:middle on Nursing Education: A National Study of Prelicensure RN Programs. 00:00:26.520 --> 00:00:32.860 position:50% align:middle Before I dive into some of the results though, I would be remiss if I didn't mention that this is once 00:00:32.860 --> 00:00:37.690 position:50% align:middle again an excellent example of interdepartmental collaboration here at NCSBN. 00:00:37.690 --> 00:00:42.020 position:50% align:middle Not only did the research team put in a considerable amount of time and effort on this particular study, 00:00:42.020 --> 00:00:47.710 position:50% align:middle but we're also indebted to the voice that I actually hear next door doing her introduction for Richard, 00:00:47.710 --> 00:00:53.360 position:50% align:middle Nancy Spector and her group within nursing education, for their support over what seemed like a very long 00:00:53.360 --> 00:00:57.830 position:50% align:middle two-year period, if we can kind of all mentally project back to 2020 to 2022. 00:00:57.830 --> 00:01:01.126 position:50% align:middle But, without further ado, let's just kind of jump right in. 00:01:01.126 --> 00:01:05.946 position:50% align:middle So, for today's presentation, I want to cover a few main points. 00:01:05.946 --> 00:01:11.006 position:50% align:middle Whether or not you've had the opportunity to review the set of results just yet, this may come as news to you. 00:01:11.006 --> 00:01:16.186 position:50% align:middle But, the final publication for this took the form of an over 60-page supplement to the "Journal 00:01:16.186 --> 00:01:17.776 position:50% align:middle of Nursing Regulation." 00:01:17.776 --> 00:01:21.906 position:50% align:middle So, the point of this presentation is to really help with the heavy lift of reviewing that 00:01:21.906 --> 00:01:23.826 position:50% align:middle volume of information. 00:01:23.826 --> 00:01:29.706 position:50% align:middle In particular, to provide you a bit of background on the overall results and then kind of how they dovetail 00:01:29.706 --> 00:01:32.496 position:50% align:middle with other industry research on this topic. 00:01:32.496 --> 00:01:37.976 position:50% align:middle To begin, I'm going to provide a bit of background on why we wanted to pursue a longitudinal examination 00:01:37.976 --> 00:01:42.156 position:50% align:middle of prelicensure nursing education in the first place and really generally speaking, 00:01:42.156 --> 00:01:44.496 position:50% align:middle what we hoped to achieve. 00:01:44.496 --> 00:01:50.126 position:50% align:middle I'm then going to get into the methods so that you are clear on how we went about defining our sample, 00:01:50.126 --> 00:01:55.506 position:50% align:middle ultimately, the mechanisms that we chose to collect the data, and then how we analyze the responses, 00:01:55.506 --> 00:02:00.894 position:50% align:middle before I'll get into the meat of the presentation in which I will cover really the broad strokes of the 00:02:00.894 --> 00:02:05.054 position:50% align:middle results themselves, and again how they kind of intersect with other related research. 00:02:05.054 --> 00:02:10.874 position:50% align:middle And then, I will absolutely endeavor to leave about probably 5 to 10 minutes for any questions or comments 00:02:10.874 --> 00:02:11.884 position:50% align:middle that you may have. 00:02:11.884 --> 00:02:16.154 position:50% align:middle Of course, if something occurs to you following today's event or the event in general, 00:02:16.154 --> 00:02:19.874 position:50% align:middle please feel free to reach out to me directly. 00:02:19.874 --> 00:02:24.654 position:50% align:middle So, this is an unfortunate way to start any presentation because I'm going to ask you to all kind 00:02:24.654 --> 00:02:27.214 position:50% align:middle of go backwards mentally to early 2020. 00:02:27.214 --> 00:02:30.189 position:50% align:middle So, deep apologies for that. 00:02:30.189 --> 00:02:33.439 position:50% align:middle But, the context for what we were trying to achieve with this study, I think, 00:02:33.439 --> 00:02:38.219 position:50% align:middle is only understandable within what we were trying to achieve as a research group as a whole, 00:02:38.219 --> 00:02:43.869 position:50% align:middle beginning shortly after the official declaration of the COVID-19 pandemic in the United States. 00:02:43.869 --> 00:02:50.519 position:50% align:middle So, typically our research agenda includes anywhere between 30 to 40 active research studies. 00:02:50.519 --> 00:02:56.749 position:50% align:middle We had an active research agenda up until about mid-March 2020, and then like everything else, 00:02:56.749 --> 00:02:58.199 position:50% align:middle we kind of put that to the side. 00:02:58.199 --> 00:03:03.855 position:50% align:middle And what we decided to do was we decided to gather, as a research group, virtually, of course, 00:03:03.855 --> 00:03:09.795 position:50% align:middle to really plan a targeted and yet expansive research agenda focused specifically on the impact of the 00:03:09.795 --> 00:03:13.925 position:50% align:middle COVID-19 pandemic on pretty much every level of nursing. 00:03:13.925 --> 00:03:20.175 position:50% align:middle So, what came out of this conversation were about 10 applied research studies of different scopes, 00:03:20.175 --> 00:03:22.005 position:50% align:middle designs and timelines. 00:03:22.005 --> 00:03:27.135 position:50% align:middle Topics generally ranged from prelicensure nursing education, no surprise there, 00:03:27.135 --> 00:03:31.462 position:50% align:middle to early career and APRN practice and really a plethora of workforce trends. 00:03:31.462 --> 00:03:37.072 position:50% align:middle But again, if you take nothing else from kind of this context slide, the goal was as best as possible, right, 00:03:37.072 --> 00:03:41.202 position:50% align:middle and there's what you want to achieve and what you can achieve with research, but as best as possible, 00:03:41.202 --> 00:03:47.682 position:50% align:middle we wanted to capture the full impact of the pandemic on really every level of nursing. 00:03:47.682 --> 00:03:53.992 position:50% align:middle I do think I can kind of spin this slide as a positive intro to this presentation in that I am able to say 00:03:53.992 --> 00:04:01.634 position:50% align:middle that we are glad to report that in April of 2023, we published all of our COVID research studies as a 00:04:01.634 --> 00:04:05.994 position:50% align:middle supplement to the "Journal of Nursing Regulation" and all of those results are free for download. 00:04:05.994 --> 00:04:10.464 position:50% align:middle So, if you have not perused those yet, I would highly encourage you to download as many as you 00:04:10.464 --> 00:04:17.154 position:50% align:middle can stuff into your briefcase just for a little light reading on your flight home. 00:04:17.154 --> 00:04:19.474 position:50% align:middle So, one of the principle, you might be asking yourself why am I 00:04:19.474 --> 00:04:22.784 position:50% align:middle about to say this, because that's the talk next door so I we missed our moment here. 00:04:22.784 --> 00:04:28.114 position:50% align:middle But, one of the principle and most critical studies assessing the impact of the pandemic on the nursing 00:04:28.114 --> 00:04:33.037 position:50% align:middle profession was the 2022 National Nursing Workforce Survey. 00:04:33.037 --> 00:04:38.307 position:50% align:middle So, that was led by my colleague, Richard Smiley, and we would argue that the 2022 report really 00:04:38.307 --> 00:04:43.427 position:50% align:middle represents the largest, most comprehensive and robust examination or assessment 00:04:43.427 --> 00:04:48.187 position:50% align:middle of the nursing workforce in the United States since the onset of the pandemic in March 2020. 00:04:48.187 --> 00:04:54.517 position:50% align:middle However, if you think back to what I said in terms of our early April kind of 2020 planning session, 00:04:54.517 --> 00:05:01.029 position:50% align:middle we anticipated, as a research group, as NCSBN, and through coordination with our state partners, 00:05:01.029 --> 00:05:06.439 position:50% align:middle that the impact of the pandemic would not ultimately be limited to just the current nursing workforce. 00:05:06.439 --> 00:05:10.099 position:50% align:middle So, in parallel to that study, one of the studies that we engaged in was a 00:05:10.099 --> 00:05:14.549 position:50% align:middle longitudinal assessment to prelicensure nursing programs around the United States. 00:05:14.549 --> 00:05:17.339 position:50% align:middle And that's what we're here to discuss today. 00:05:17.339 --> 00:05:19.829 position:50% align:middle So, it's kind of a mouthful. 00:05:19.829 --> 00:05:21.749 position:50% align:middle This was in the abstract. 00:05:21.749 --> 00:05:24.039 position:50% align:middle This was in the paper itself. 00:05:24.039 --> 00:05:27.669 position:50% align:middle But, we really were quite ambitious with what we were trying to achieve here. 00:05:27.669 --> 00:05:33.427 position:50% align:middle We recognized that this was potentially a very unique moment in time and to have a historical record of what 00:05:33.427 --> 00:05:38.157 position:50% align:middle was taking place during that and how it impacted current nursing education and possibly future nursing 00:05:38.157 --> 00:05:40.097 position:50% align:middle education was absolutely imperative. 00:05:40.097 --> 00:05:44.487 position:50% align:middle So, the primary objective for this study was to assess the institutional, academic and demographic 00:05:44.487 --> 00:05:49.477 position:50% align:middle characteristics of prelicensure nursing students' academic, initial post graduation, 00:05:49.477 --> 00:05:51.387 position:50% align:middle and early career outcomes. 00:05:51.387 --> 00:05:55.337 position:50% align:middle So, nothing if not ambitious. 00:05:55.337 --> 00:05:56.917 position:50% align:middle Who comprised our sample? 00:05:56.917 --> 00:06:00.238 position:50% align:middle I always like to say I couldn't have asked a better question if I had planted it. 00:06:00.238 --> 00:06:01.268 position:50% align:middle It's a really great question. 00:06:01.268 --> 00:06:06.928 position:50% align:middle This cross-sectional study utilized a four-phase longitudinal design to assess the academic learning 00:06:06.928 --> 00:06:11.968 position:50% align:middle standardized examination outcomes and early career outcomes for prelicensure nursing students who were 00:06:11.968 --> 00:06:14.138 position:50% align:middle entering the core of their nursing curriculum. 00:06:14.138 --> 00:06:22.388 position:50% align:middle So, these were oftentimes kind of rising juniors in full 2020 and with an anticipated graduation timeline 00:06:22.388 --> 00:06:23.468 position:50% align:middle in the spring of 2022. 00:06:23.468 --> 00:06:29.518 position:50% align:middle When considering the full arc of the research and on the next slide I'm going to give you kind of a timeline 00:06:29.518 --> 00:06:34.169 position:50% align:middle so you have a greater sense of what were the activities in which we were engaging, when we were in the field, 00:06:34.169 --> 00:06:37.019 position:50% align:middle what were we looking to capture and when, etc. 00:06:37.019 --> 00:06:42.579 position:50% align:middle But, when considering the entire arc of the research, from July 2020 to December 2022, 00:06:42.579 --> 00:06:49.099 position:50% align:middle we really ended up conducting a two and a half year-long study of 51 prelicensure programs, 00:06:49.099 --> 00:06:52.299 position:50% align:middle including over 1,100 participants across 27 states. 00:06:52.299 --> 00:07:00.369 position:50% align:middle As a result, this mixed method study was able to leverage over 4,000 course base observations, 00:07:00.369 --> 00:07:04.949 position:50% align:middle supplemented by hundreds and hundreds of early career observations, and then also the rich personal 00:07:04.949 --> 00:07:08.729 position:50% align:middle narratives that emerged out of targeted focus groups. 00:07:08.729 --> 00:07:12.849 position:50% align:middle Before I move on, this isn't really kind of part of my kind of talking points here, 00:07:12.849 --> 00:07:17.979 position:50% align:middle but I think it's a critical thing to call out because I think Linda did an excellent job in the keynote 00:07:17.979 --> 00:07:23.349 position:50% align:middle about how we, as researchers, need to think about very complex challenges and issues 00:07:23.349 --> 00:07:25.809 position:50% align:middle and how we approach them from a research perspective. 00:07:25.809 --> 00:07:30.764 position:50% align:middle When we entered into this study, it was not on our radar to include focus groups. 00:07:30.764 --> 00:07:32.384 position:50% align:middle This was not a mixed method study. 00:07:32.384 --> 00:07:34.824 position:50% align:middle We are all kind of quantitatively oriented. 00:07:34.824 --> 00:07:39.344 position:50% align:middle We all thought to ourselves these fixed items, as long as we use a number of instruments, 00:07:39.344 --> 00:07:41.704 position:50% align:middle we're really going to be able to capture it. 00:07:41.704 --> 00:07:46.614 position:50% align:middle But, about one year into our two-year data collection window, what we realized in our discussions with the 00:07:46.614 --> 00:07:50.434 position:50% align:middle program representatives, the faculty, the administrators, the students, 00:07:50.434 --> 00:07:53.934 position:50% align:middle is that we were starting to see kind of leaks in the pipe. 00:07:53.934 --> 00:07:58.884 position:50% align:middle We were starting to recognize that there was important context that we possibly weren't capturing that would 00:07:58.884 --> 00:08:04.271 position:50% align:middle be really important for interpreting our end kind of stage quantitative results. 00:08:04.271 --> 00:08:07.021 position:50% align:middle So, what we did is what you should do as a researcher. 00:08:07.021 --> 00:08:12.001 position:50% align:middle We called an audible and we ended up tacking on targeted focus groups at the end of our study, 00:08:12.001 --> 00:08:18.501 position:50% align:middle and ultimately making this a mixed methods research study. 00:08:18.501 --> 00:08:22.121 position:50% align:middle So, this is the general timeframe for this study displayed in front of you. 00:08:22.121 --> 00:08:29.551 position:50% align:middle In July 2020, we conducted email-based outreach to administrators and faculty at prelicensure RN programs 00:08:29.551 --> 00:08:31.147 position:50% align:middle all around the country. 00:08:31.147 --> 00:08:34.597 position:50% align:middle In total, our kind of our initial goal with this was to get a lay of the land. 00:08:34.597 --> 00:08:39.437 position:50% align:middle How are things changing with kind of, like, the rapid progression and expansion of the pandemic, 00:08:39.437 --> 00:08:43.187 position:50% align:middle and then to also kind of set the stage for our future study. 00:08:43.187 --> 00:08:50.227 position:50% align:middle So, what we got in response to this was about between 550 and 600 program administrators and faculty 00:08:50.227 --> 00:08:55.967 position:50% align:middle responded to us with absolutely critical information for how their planned delivery of educational materials 00:08:55.967 --> 00:08:59.037 position:50% align:middle and services had changed in light of the pandemic. 00:08:59.037 --> 00:09:04.005 position:50% align:middle As I mentioned that we also used this as a recruiting kind of springboard or platform into our formal 00:09:04.005 --> 00:09:07.745 position:50% align:middle longitudinal data tracking, which then kicked off in August 2020. 00:09:07.745 --> 00:09:13.245 position:50% align:middle This period of within program data collection then carried through the end of May, 00:09:13.245 --> 00:09:15.825 position:50% align:middle as you can see from the diagram in front of you. 00:09:15.825 --> 00:09:20.735 position:50% align:middle This served as a major inflection point in kind of the data collection process for this study, 00:09:20.735 --> 00:09:25.225 position:50% align:middle because at this stage, we pivoted away from student and faculty and kind 00:09:25.225 --> 00:09:29.675 position:50% align:middle of within program data collection to early career data tracking. 00:09:29.675 --> 00:09:34.755 position:50% align:middle There are kind of two pivotal moments here that aren't necessarily, like, super highlighted with the red dots. 00:09:34.755 --> 00:09:36.355 position:50% align:middle But, you can see one in August in 2022. 00:09:36.355 --> 00:09:41.955 position:50% align:middle So, what we wanted to do with the new nurse graduates is we wanted to track them six months into their 00:09:41.955 --> 00:09:43.895 position:50% align:middle early career practice. 00:09:43.895 --> 00:09:47.015 position:50% align:middle So, we had two intervals for data collection for those new nurse graduates, one at three months, 00:09:47.015 --> 00:09:52.785 position:50% align:middle or August 2022, and then another in November 2022, or about six months following graduation. 00:09:52.785 --> 00:09:56.355 position:50% align:middle In parallel as you can see, kind of sandwiched in there, 00:09:56.355 --> 00:10:00.653 position:50% align:middle we also conducted our focus groups from June 2022 to August 2022. 00:10:00.653 --> 00:10:04.413 position:50% align:middle And I'll get into some of the specifics on the focus groups in a second. 00:10:04.413 --> 00:10:10.043 position:50% align:middle But, what you can kind of see in terms of bookending of this, it was really July 2020 where we started 00:10:10.043 --> 00:10:15.963 position:50% align:middle to initiate some of our kind of proactive data collection efforts to December 2022, 00:10:15.963 --> 00:10:21.663 position:50% align:middle when really all phases of the formal data collection period closed. 00:10:21.663 --> 00:10:26.273 position:50% align:middle Regarding the study methodology, we used a combination of real-time student and faculty 00:10:26.273 --> 00:10:32.382 position:50% align:middle self-report data as relayed to us via email-based surveys, using Qualtrics. 00:10:32.382 --> 00:10:35.842 position:50% align:middle We used a combination of in-house and externally validated instruments. 00:10:35.842 --> 00:10:40.082 position:50% align:middle All I mean by in-house are kind of custom survey elements or instruments that we generated. 00:10:40.082 --> 00:10:47.152 position:50% align:middle The explicit purpose of those custom survey instruments was really just to track and collect baseline 00:10:47.152 --> 00:10:53.652 position:50% align:middle demographic practice, academic information, really at the point of intake for the study. 00:10:53.652 --> 00:10:58.232 position:50% align:middle So, if you were consenting to participate in the study, we just wanted to learn a little bit more about you. 00:10:58.232 --> 00:11:02.274 position:50% align:middle When we got into the actual program outcomes, the faculty outcomes, the student outcomes, etc., 00:11:02.274 --> 00:11:06.704 position:50% align:middle we relied uniquely on externally validated instruments. 00:11:06.704 --> 00:11:10.294 position:50% align:middle In addition to that, we also collected within program and end of program 00:11:10.294 --> 00:11:12.874 position:50% align:middle standardized examination scores, so end of program kind of being the 00:11:12.874 --> 00:11:14.564 position:50% align:middle NCLEX score obviously. 00:11:14.564 --> 00:11:19.394 position:50% align:middle We were able to collect that information because it was facilitated by the individual program, 00:11:19.394 --> 00:11:22.124 position:50% align:middle kind of research site coordinator. 00:11:22.124 --> 00:11:26.464 position:50% align:middle So, each of the participating programs had a faculty or an administrator designated as the primary point 00:11:26.464 --> 00:11:31.247 position:50% align:middle of contact for us as the study went forward. 00:11:31.247 --> 00:11:34.807 position:50% align:middle The quantitative survey findings were then supplemented with focus groups. 00:11:34.807 --> 00:11:38.957 position:50% align:middle So, the focus group sampling method was very much purposeful. 00:11:38.957 --> 00:11:43.257 position:50% align:middle So, we were interested in understanding how what we had learned quantitatively kind of translated into kind 00:11:43.257 --> 00:11:44.777 position:50% align:middle of a more general space. 00:11:44.777 --> 00:11:52.867 position:50% align:middle So, we initially sampled from the folks who had consented to participate in prior stages of the study. 00:11:52.867 --> 00:11:57.987 position:50% align:middle Individuals who participated in our study were separated into one of three distinct groups. 00:11:57.987 --> 00:12:00.929 position:50% align:middle So, either the profile as students, administrators or faculty. 00:12:00.929 --> 00:12:06.179 position:50% align:middle In the event that somebody wore two hats in the study and that did come up, 00:12:06.179 --> 00:12:10.459 position:50% align:middle oftentimes took the form of a faculty member who had administrative responsibilities or an administrator who 00:12:10.459 --> 00:12:14.389 position:50% align:middle had faculty responsibilities, we simply asked the respondent to really kind 00:12:14.389 --> 00:12:18.049 position:50% align:middle of reflect on where the majority of their time and kind of resources were spent, 00:12:18.049 --> 00:12:20.689 position:50% align:middle and then to self-select based on that information. 00:12:20.689 --> 00:12:24.499 position:50% align:middle And then, I'm not going to get too much into this, although this is where we all get really excited 00:12:24.499 --> 00:12:28.379 position:50% align:middle within the research group, various statistical methods were deployed from general 00:12:28.379 --> 00:12:32.099 position:50% align:middle descriptive to kind of various non-parametric models for some of the simpler, 00:12:32.099 --> 00:12:34.779 position:50% align:middle kind of higher order comparisons. 00:12:34.779 --> 00:12:37.689 position:50% align:middle And then, this did span all the way to Generalized Estimating Equation models, 00:12:37.689 --> 00:12:41.059 position:50% align:middle where we were trying to account for, like, some of the longitudinal nature of the data, 00:12:41.059 --> 00:12:44.639 position:50% align:middle and then detailed textual analysis with our guy over here, Charlie. 00:12:44.639 --> 00:12:49.029 position:50% align:middle And then, what we wanted to do with that is we really wanted to assess student, 00:12:49.029 --> 00:12:55.259 position:50% align:middle faculty and institution level data kind of at large for all the data points that we were collecting. 00:12:55.259 --> 00:12:58.889 position:50% align:middle So, like our workforce study, we would argue that this study stands as one of the 00:12:58.889 --> 00:13:02.764 position:50% align:middle most comprehensive and rigorous assessments of prelicensure nursing education in the United States 00:13:02.764 --> 00:13:04.784 position:50% align:middle since the onset of the pandemic. 00:13:04.784 --> 00:13:09.004 position:50% align:middle And more importantly, the reason why I have this slide here is because 00:13:09.004 --> 00:13:12.494 position:50% align:middle as I've mentioned, and I will mention it again, I don't think you can mention it too many times, 00:13:12.494 --> 00:13:16.944 position:50% align:middle these results are freely downloadable from the "Journal of Nursing Regulation" website. 00:13:16.944 --> 00:13:19.384 position:50% align:middle So, I'm going to go over a number of tables in today's presentation. 00:13:19.384 --> 00:13:21.054 position:50% align:middle This is but a snapshot. 00:13:21.054 --> 00:13:24.144 position:50% align:middle Imagine how many tables and figures that you can fit into 60 pages. 00:13:24.144 --> 00:13:27.964 position:50% align:middle The world is your oyster as a researcher here. 00:13:27.964 --> 00:13:29.714 position:50% align:middle So, let's get into the results. 00:13:29.714 --> 00:13:33.600 position:50% align:middle What were we able to find, at least kind of broad strokes a little bit. 00:13:33.600 --> 00:13:36.330 position:50% align:middle So, overall, I don't think that this will come as a surprise to you. 00:13:36.330 --> 00:13:40.470 position:50% align:middle The COVID-19 pandemic affected prelicensure nursing education. 00:13:40.470 --> 00:13:46.740 position:50% align:middle Over 80% of the programs that participated in our summer 2022 baseline planned to incorporate some level 00:13:46.740 --> 00:13:50.590 position:50% align:middle of clinical simulation in their delivery in fall 2020. 00:13:50.590 --> 00:13:56.620 position:50% align:middle And while that might sound like a lot, we think it's important context to really think 00:13:56.620 --> 00:13:58.860 position:50% align:middle about this in terms of the raw numbers. 00:13:58.860 --> 00:14:03.375 position:50% align:middle So, when we looked at the data, what we found was that the number of programs that 00:14:03.375 --> 00:14:10.755 position:50% align:middle offered no clinical simulation pre and post-pandemic onset, that number fell from 130 programs in fall 2019, 00:14:10.755 --> 00:14:15.165 position:50% align:middle and this is within our set, right, it's not necessarily across the entire landscape 00:14:15.165 --> 00:14:22.445 position:50% align:middle but within our set, that number fell from 113 in fall 2019 to 11 in fall 2020. 00:14:22.445 --> 00:14:28.865 position:50% align:middle So, a near wholesale shift in the way programs were thinking about clinical education. 00:14:28.865 --> 00:14:32.548 position:50% align:middle On this slide in front of you, you can see how the mean usage of face-to-face 00:14:32.548 --> 00:14:36.258 position:50% align:middle high-fidelity simulation and virtual clinical simulation changed term over term 00:14:36.258 --> 00:14:37.748 position:50% align:middle over the two-year period. 00:14:37.748 --> 00:14:39.338 position:50% align:middle Two things to kind of call out here. 00:14:39.338 --> 00:14:45.678 position:50% align:middle One is that those proportions kind of term to term stack or are additive and they sum up to a higher kind 00:14:45.678 --> 00:14:47.278 position:50% align:middle of academic year figure. 00:14:47.278 --> 00:14:49.038 position:50% align:middle So, you can kind of see how that translates. 00:14:49.038 --> 00:14:52.848 position:50% align:middle It's not to suggest only 17% was clinical simulation. 00:14:52.848 --> 00:14:55.788 position:50% align:middle Those stats, so it was about 40% in the first year. 00:14:55.788 --> 00:14:57.128 position:50% align:middle And that leads me to my second point. 00:14:57.128 --> 00:15:00.742 position:50% align:middle I think that this kind of dovetails a little bit with our own experience of the pandemic, 00:15:00.742 --> 00:15:04.242 position:50% align:middle in that there was an acute inflection point in the first academic year. 00:15:04.242 --> 00:15:08.562 position:50% align:middle And you can see even when things were still, you know, somewhat not under control, 00:15:08.562 --> 00:15:13.022 position:50% align:middle they did start to wane when we got into the second year of tracking. 00:15:13.022 --> 00:15:19.032 position:50% align:middle A consistent trend that emerged from this study were the superior outcomes documented by both students and 00:15:19.032 --> 00:15:25.982 position:50% align:middle faculty alike, for high-fidelity face-to-face simulation and in-person clinicals vis-à-vis 00:15:25.982 --> 00:15:28.422 position:50% align:middle virtual clinical simulation. 00:15:28.422 --> 00:15:33.102 position:50% align:middle So, these results manifested time and time again across a variety of covariates. 00:15:33.102 --> 00:15:38.992 position:50% align:middle So, this was program setting, student SCS, the timing of student's clinical rotations just 00:15:38.992 --> 00:15:40.502 position:50% align:middle to name a few. 00:15:40.502 --> 00:15:45.562 position:50% align:middle Some important context for this, and this is kind of where I think I've kind of learned 00:15:45.562 --> 00:15:49.452 position:50% align:middle more about this topic and kind of presenting these findings, I've tried to incorporate this, you know, 00:15:49.452 --> 00:15:52.162 position:50% align:middle as I go as kind of a living, breathing document. 00:15:52.162 --> 00:15:56.322 position:50% align:middle One of the ways in which I started to understand people were interpreting some of our results is that virtual 00:15:56.322 --> 00:15:58.352 position:50% align:middle clinical simulation was bad. 00:15:58.352 --> 00:16:02.827 position:50% align:middle So, I am here to stand in front of you to tell you that is not what our results mean. 00:16:02.827 --> 00:16:09.107 position:50% align:middle What we found when we were reviewing our data points is that the sheer range, like, 00:16:09.107 --> 00:16:15.697 position:50% align:middle the variability of what someone defines as virtual clinical simulation, how they adapt it, 00:16:15.697 --> 00:16:18.627 position:50% align:middle to what proportion they adapt it, what tools they are using, 00:16:18.627 --> 00:16:22.077 position:50% align:middle what they are asking students to do, what they are asking faculty to do, 00:16:22.077 --> 00:16:26.817 position:50% align:middle ranged so considerably, even in this broad-based of a survey, 00:16:26.817 --> 00:16:30.243 position:50% align:middle that what we would argue is that virtual clinical simulation just simply, 00:16:30.243 --> 00:16:34.593 position:50% align:middle it's not a space that has reached a certain level of maturation yet, where we can really distinguish 00:16:34.593 --> 00:16:37.633 position:50% align:middle between what is a good method and what is a bad method. 00:16:37.633 --> 00:16:40.563 position:50% align:middle So, if nothing else, don't walk away from this thinking all virtual clinical 00:16:40.563 --> 00:16:41.833 position:50% align:middle simulation is bad. 00:16:41.833 --> 00:16:43.823 position:50% align:middle It's just it hasn't arrived yet. 00:16:43.823 --> 00:16:47.353 position:50% align:middle We're not at a point where we can start to zero in on even what's testable. 00:16:47.353 --> 00:16:51.613 position:50% align:middle When you think back to the National Simulation Study, we weren't asking is simulation okay. 00:16:51.613 --> 00:16:54.513 position:50% align:middle We were asking at what levels is simulation okay. 00:16:54.513 --> 00:16:58.293 position:50% align:middle Virtual clinical simulation isn't even at the point of is it okay yet. 00:16:58.293 --> 00:17:01.606 position:50% align:middle There are pockets, but we need to learn more. 00:17:01.606 --> 00:17:05.776 position:50% align:middle And then, further on kind of a positive note, we certainly didn't set out with this expectation. 00:17:05.776 --> 00:17:07.516 position:50% align:middle This wasn't one of our driving objectives. 00:17:07.516 --> 00:17:12.296 position:50% align:middle But, what we were able to do in this study is really largely confirm and replicate the results of the 00:17:12.296 --> 00:17:13.516 position:50% align:middle National Simulation Study. 00:17:13.516 --> 00:17:18.266 position:50% align:middle So, what we were able to document was that good adherence to face-to-face high-fidelity 00:17:18.266 --> 00:17:23.446 position:50% align:middle simulation really, broadly speaking, produced consistently strong student outcomes and 00:17:23.446 --> 00:17:30.251 position:50% align:middle oftentimes in our study, comparable to in-person clinicals. 00:17:30.251 --> 00:17:31.661 position:50% align:middle There you go. 00:17:31.661 --> 00:17:35.381 position:50% align:middle So, on the next few slides, I actually think this is a big enough screen where I 00:17:35.381 --> 00:17:38.761 position:50% align:middle don't need to do that thing that I hate, where somebody says, you know, "You can barely see it. 00:17:38.761 --> 00:17:39.441 position:50% align:middle But don't worry about it." 00:17:39.441 --> 00:17:40.891 position:50% align:middle Why did you put it on the slide then? 00:17:40.891 --> 00:17:46.291 position:50% align:middle So, like, I think you can read this slide, but what I really want to be careful here is to kind 00:17:46.291 --> 00:17:48.101 position:50% align:middle of balance your expectations. 00:17:48.101 --> 00:17:52.551 position:50% align:middle So, I'm not going to dwell on any one of these topics too much, right. 00:17:52.551 --> 00:17:56.211 position:50% align:middle We're time limited this morning and as I have said multiple, multiple times, 00:17:56.211 --> 00:17:57.571 position:50% align:middle all of this is freely downloadable. 00:17:57.571 --> 00:18:02.380 position:50% align:middle You can really dig into the details as much as you want on your flight home, in the next three minutes, 00:18:02.380 --> 00:18:03.460 position:50% align:middle however you want to download it. 00:18:03.460 --> 00:18:09.570 position:50% align:middle But, what I want to give you a sense of visually, right, and this is what tables and graphs and figures 00:18:09.570 --> 00:18:12.980 position:50% align:middle should do, it should help reinforce a message. 00:18:12.980 --> 00:18:17.820 position:50% align:middle How consistent our findings were across our externally validated instruments, 00:18:17.820 --> 00:18:21.250 position:50% align:middle our standardized outcomes and our early career measures. 00:18:21.250 --> 00:18:23.600 position:50% align:middle So, what you see here are the CLECS 2.0 results. 00:18:23.600 --> 00:18:28.180 position:50% align:middle So, this is looking at students' self-reported assessment of lineal learning. 00:18:28.180 --> 00:18:30.909 position:50% align:middle So, this is one of our externally validated instruments. 00:18:30.909 --> 00:18:35.139 position:50% align:middle And what you can see here for the bit highlighted, so I tried to zero in your attention, 00:18:35.139 --> 00:18:41.499 position:50% align:middle is the drop-off in virtual simulation and then the comparable rates for face-to-face high-fidelity 00:18:41.499 --> 00:18:47.749 position:50% align:middle simulation and in-person clinical placement, or sorry, in-person clinicals. 00:18:47.749 --> 00:18:51.209 position:50% align:middle These are similar trends you can see kind of the header what we're looking at. 00:18:51.209 --> 00:18:54.389 position:50% align:middle Thee are for the faculty CCEI results. 00:18:54.389 --> 00:19:00.721 position:50% align:middle So, these are the faculty assessment of students' clinical learning. 00:19:00.721 --> 00:19:03.951 position:50% align:middle Same thing but looking at standardized examination scores. 00:19:03.951 --> 00:19:07.291 position:50% align:middle So, you can see the first column here are in-program scores and NCLEX scores. 00:19:07.291 --> 00:19:12.951 position:50% align:middle So the in-program scores would be like HESI, Kaplan, ATI, etc. 00:19:12.951 --> 00:19:16.101 position:50% align:middle NCLEX, I hope that doesn't need any explanation. 00:19:16.101 --> 00:19:21.221 position:50% align:middle And then finally, the NCLEX results. 00:19:21.221 --> 00:19:25.621 position:50% align:middle Here is kind of the companion to the earlier graph that we were looking at when we were thinking 00:19:25.621 --> 00:19:26.601 position:50% align:middle about clinical learning. 00:19:26.601 --> 00:19:30.461 position:50% align:middle So, what we found, and this wasn't necessarily again, one of our driving goals. 00:19:30.461 --> 00:19:36.932 position:50% align:middle This actually kind of caught me off of guard, but in retrospect, I kind of think to myself that's 00:19:36.932 --> 00:19:41.592 position:50% align:middle pretty silly, because maybe this represented the lower hanging fruit between the two instructional formats. 00:19:41.592 --> 00:19:47.252 position:50% align:middle But, online delivery of lecture content, that shift to kind of online platforms was even more 00:19:47.252 --> 00:19:51.092 position:50% align:middle dramatic within our sample compared to the clinical learning environments. 00:19:51.092 --> 00:19:56.472 position:50% align:middle So, across the prelicensure nursing education landscape as documented in our study with our sample, 00:19:56.472 --> 00:20:03.194 position:50% align:middle there was a 60% increase in the planned delivery of didactic or lecture content in online spaces 00:20:03.194 --> 00:20:05.634 position:50% align:middle between fall 2019 and fall 2020. 00:20:05.634 --> 00:20:09.654 position:50% align:middle And this, like, you thought the clinical number were, you know, kind of maybe crazy. 00:20:09.654 --> 00:20:12.174 position:50% align:middle I saw some kind of nodding heads and, oh, yeah, look at that. 00:20:12.174 --> 00:20:20.034 position:50% align:middle For the programs that offered no online delivery of lecture content in fall 2019, that number was 167. 00:20:20.034 --> 00:20:25.904 position:50% align:middle It was almost 50% of the initial sample that responded to the baseline survey. 00:20:25.904 --> 00:20:30.641 position:50% align:middle That number fell to 21 in fall 2020. 00:20:30.641 --> 00:20:38.651 position:50% align:middle So, in one year, there were 140 to 150 programs that had not even as recently as their prior academic fall 00:20:38.651 --> 00:20:43.971 position:50% align:middle term had not considered moving any portion of their didactic training to an online delivery platform, 00:20:43.971 --> 00:20:47.271 position:50% align:middle were now migrating their content online. 00:20:47.271 --> 00:20:52.891 position:50% align:middle So, this near wholesale shift to online delivery of lecture content inevitably impacted students' academic 00:20:52.891 --> 00:20:54.951 position:50% align:middle learning and engagement outcomes as well. 00:20:54.951 --> 00:21:02.285 position:50% align:middle What we were able to find was that in-person and hybrid learning environments oftentimes produced consistently 00:21:02.285 --> 00:21:08.375 position:50% align:middle better academic learning outcomes on the parts of students and faculty compared to their peers that were 00:21:08.375 --> 00:21:12.325 position:50% align:middle learning in kind of almost uniquely online learning environments. 00:21:12.325 --> 00:21:16.665 position:50% align:middle In addition, we saw higher levels of engagement compared to those both in-person 00:21:16.665 --> 00:21:18.015 position:50% align:middle and hybrid environments. 00:21:18.015 --> 00:21:21.325 position:50% align:middle So again, hybrid environments, that kind of more quality control measures 00:21:21.325 --> 00:21:24.135 position:50% align:middle where there's, you know, a portion of this and a portion of that. 00:21:24.135 --> 00:21:28.515 position:50% align:middle Even in this instance, those were consistently producing more stronger student 00:21:28.515 --> 00:21:30.793 position:50% align:middle results across array of outcomes. 00:21:30.793 --> 00:21:37.313 position:50% align:middle And then, interestingly, how the lecture content was migrated online actually 00:21:37.313 --> 00:21:43.173 position:50% align:middle was one of the few kind of drivers in our study that affected consistently standardized examination 00:21:43.173 --> 00:21:44.263 position:50% align:middle scores as well. 00:21:44.263 --> 00:21:50.643 position:50% align:middle So, for programs that reported a larger online presence, what we found consistently was those were 00:21:50.643 --> 00:21:53.153 position:50% align:middle associated with lower NCLEX RN scores. 00:21:53.153 --> 00:21:56.913 position:50% align:middle Now, the context for that is they were still above the national average. 00:21:56.913 --> 00:22:00.478 position:50% align:middle So, this was a strong performing set, but where we did see movement, 00:22:00.478 --> 00:22:05.188 position:50% align:middle we felt it was important within context to spell that out. 00:22:05.188 --> 00:22:07.248 position:50% align:middle Again, one little caveat here. 00:22:07.248 --> 00:22:11.288 position:50% align:middle This is not to suggest that all online learning is bad. 00:22:11.288 --> 00:22:15.818 position:50% align:middle Rather what we found was it really mattered, the quality of the instructional materials, 00:22:15.818 --> 00:22:18.808 position:50% align:middle the support for the faculty, the training for the faculty, 00:22:18.808 --> 00:22:23.798 position:50% align:middle the quality of the platforms that they were using and then ultimately the proportion of the content that they 00:22:23.798 --> 00:22:27.048 position:50% align:middle were migrating online, that's what mattered. 00:22:27.048 --> 00:22:31.367 position:50% align:middle So, if you do all those things intentionally, well-funded, good training, it probably could work. 00:22:31.367 --> 00:22:34.277 position:50% align:middle There are probably examples of that even in our sample. 00:22:34.277 --> 00:22:40.007 position:50% align:middle But, what we saw was that there was such a range, such variability in our data set that isolating 00:22:40.007 --> 00:22:43.197 position:50% align:middle particular methods was near impossible. 00:22:43.197 --> 00:22:46.457 position:50% align:middle So, similar to the clinical results, let's see how are we doing here. 00:22:46.457 --> 00:22:47.707 position:50% align:middle So, about five minutes. 00:22:47.707 --> 00:22:51.237 position:50% align:middle So, similar to the clinical results, these are the CAP Perceived Learning Scale, 00:22:51.237 --> 00:22:56.987 position:50% align:middle looking at the delivery method for the didactic courses, so you can see online, in-person, hybrid. 00:22:56.987 --> 00:23:01.457 position:50% align:middle These are the second results, looking at student engagement. 00:23:01.457 --> 00:23:03.437 position:50% align:middle Some standardized examination scores. 00:23:03.437 --> 00:23:07.227 position:50% align:middle So, you can see we've kind of isolated the proportion of initial online lecture content, 00:23:07.227 --> 00:23:10.517 position:50% align:middle so that's fall 2020 primarily that was migrated online. 00:23:10.517 --> 00:23:17.266 position:50% align:middle You can see it was so great, right, going back to, like, the order of magnitude, the cut point was 61%. 00:23:17.266 --> 00:23:18.457 position:50% align:middle So, that was the median. 00:23:18.457 --> 00:23:23.977 position:50% align:middle Sixty-one percent of the content for these programs was getting migrated online. 00:23:23.977 --> 00:23:27.667 position:50% align:middle And then, finally a few more standardized examination results. 00:23:27.667 --> 00:23:32.646 position:50% align:middle Our research in this area further documents declines in the self-reported clinical preparedness of prelicensure 00:23:32.646 --> 00:23:38.256 position:50% align:middle RN students and similar drop-offs in the practice proficiency of early career professionals. 00:23:38.256 --> 00:23:44.386 position:50% align:middle And again, specifically tied to shifts to more remote and virtual kind of delivery methods. 00:23:44.386 --> 00:23:46.326 position:50% align:middle So, here are the clinical results. 00:23:46.326 --> 00:23:50.056 position:50% align:middle So, this is looking at clinical preparedness and practice proficiency associated 00:23:50.056 --> 00:23:51.526 position:50% align:middle with the clinical characteristics. 00:23:51.526 --> 00:23:54.396 position:50% align:middle So, how much of the clinical learning was shifted. 00:23:54.396 --> 00:23:58.276 position:50% align:middle And then again, associated with didactic characteristics. 00:23:58.276 --> 00:24:02.037 position:50% align:middle I'm not going to get into too much detail because I do not want to leave a minute here at least. 00:24:02.037 --> 00:24:03.907 position:50% align:middle So, we looked at AACN data. 00:24:03.907 --> 00:24:09.107 position:50% align:middle They documented same period of time for the first time in 20 years, drop-offs in enrollment, 00:24:09.107 --> 00:24:15.517 position:50% align:middle drop-offs in applications to baccalaureate programs, entry-level BSN, RN to BSN, you name it. 00:24:15.517 --> 00:24:19.537 position:50% align:middle So, one of the reasons why we wanted to highlight this information is because we felt as though it underscored 00:24:19.537 --> 00:24:25.207 position:50% align:middle the fact that really what we're looking at is a very broad-based effect of the pandemic on nursing education 00:24:25.207 --> 00:24:30.444 position:50% align:middle and likely something that we'll kind of start to see how long that tail is over time. 00:24:30.444 --> 00:24:33.344 position:50% align:middle Similarly, there's been research out there that really attests to, I think, 00:24:33.344 --> 00:24:36.884 position:50% align:middle the fact that issues of exhaustion, burnout, stress are not limited to the 00:24:36.884 --> 00:24:38.324 position:50% align:middle frontline healthcare workforce. 00:24:38.324 --> 00:24:39.644 position:50% align:middle There's multiple ways to think about it. 00:24:39.644 --> 00:24:42.924 position:50% align:middle We always think of it kind of in terms of inpatient context. 00:24:42.924 --> 00:24:45.044 position:50% align:middle But, it's everybody, right. 00:24:45.044 --> 00:24:48.854 position:50% align:middle And so, from a constellation of all this research, we're starting to see kind of the stars aligned 00:24:48.854 --> 00:24:51.524 position:50% align:middle in an industry battered from all sides. 00:24:51.524 --> 00:24:53.174 position:50% align:middle So, what are the key takeaways? 00:24:53.174 --> 00:24:57.604 position:50% align:middle You know, this one, I think hopefully, I don't need to say this, but, you know, 00:24:57.604 --> 00:25:01.076 position:50% align:middle what we were able to document is that there was a real impact of the COVID-19 pandemic 00:25:01.076 --> 00:25:02.986 position:50% align:middle on prelicensure nursing education. 00:25:02.986 --> 00:25:06.426 position:50% align:middle I don't think that comes as a big surprise to anyone. 00:25:06.426 --> 00:25:09.446 position:50% align:middle So more informative, perhaps, if I can get it to come up, 00:25:09.446 --> 00:25:15.406 position:50% align:middle more informative perhaps are the findings related to programs' really significant reliance on online 00:25:15.406 --> 00:25:19.316 position:50% align:middle delivery of lecture content and virtual clinical simulation in particular, 00:25:19.316 --> 00:25:22.406 position:50% align:middle and the corresponding deleterious effect on student outcomes. 00:25:22.406 --> 00:25:25.766 position:50% align:middle If you remember, there was a bit of a silver lining here in that we were able to replicate the 00:25:25.766 --> 00:25:27.336 position:50% align:middle National Simulation Study. 00:25:27.336 --> 00:25:33.070 position:50% align:middle So, when programs were, even at high thresholds, relying on face-to-face high-fidelity simulation, 00:25:33.070 --> 00:25:38.290 position:50% align:middle they were producing consistently strong student outcomes comparable to in-person clinicals and 00:25:38.290 --> 00:25:39.570 position:50% align:middle at times, exceeding. 00:25:39.570 --> 00:25:46.480 position:50% align:middle Now, not statistically significant, like, exceeding, but you know, they were doing a good job with that. 00:25:46.480 --> 00:25:50.920 position:50% align:middle But then, most importantly, what we feel as though that the study really underscore 00:25:50.920 --> 00:25:55.740 position:50% align:middle is that today's new nurse graduates likely feel as though in particular for that kind of acute phase 00:25:55.740 --> 00:26:00.879 position:50% align:middle of the pandemic, likely feel as though that they are in a more precarious position than potentially they 00:26:00.879 --> 00:26:02.029 position:50% align:middle ever have been. 00:26:02.029 --> 00:26:06.649 position:50% align:middle And so, we would argue, as NCSBN, that there's a real demand for our practice partners 00:26:06.649 --> 00:26:10.969 position:50% align:middle to work with these new nurse graduates and to kind of respond to their needs to facilitate their transition 00:26:10.969 --> 00:26:15.429 position:50% align:middle to early career practice and develop kind of a salience in this new and kind 00:26:15.429 --> 00:26:17.859 position:50% align:middle of transformed healthcare landscape. 00:26:17.859 --> 00:26:21.959 position:50% align:middle Further, we would also argue, and I think the literature is pretty well documented 00:26:21.959 --> 00:26:25.539 position:50% align:middle on this, there needs to be efforts to adjust [inaudible 00:26:24.571] in nursing education, 00:26:25.539 --> 00:26:30.638 position:50% align:middle in particular how it relates to emergency and public health emergency education and training. 00:26:30.638 --> 00:26:38.888 position:50% align:middle And finally, I do think more needs to be done in terms of understanding when and what thresholds we should use 00:26:38.888 --> 00:26:45.458 position:50% align:middle kind of some of these educational tools, these technological tools at our disposal to really 00:26:45.458 --> 00:26:48.938 position:50% align:middle facilitate experiential learning on the part of the students, not just in the clinical environment, 00:26:48.938 --> 00:26:52.848 position:50% align:middle but even online through didactic and lecture content. 00:26:52.848 --> 00:26:54.648 position:50% align:middle So, I am going to, look at that. 00:26:54.648 --> 00:26:56.408 position:50% align:middle I saved you a minute. 00:26:56.408 --> 00:27:00.496 position:50% align:middle So, I did not do a good job of saving time at the end. 00:27:00.496 --> 00:27:05.186 position:50% align:middle So, what I will do is if you have questions, please, I am here the entire conference. 00:27:05.186 --> 00:27:06.006 position:50% align:middle Catch my ear. 00:27:06.006 --> 00:27:07.236 position:50% align:middle Ask me any questions you have. 00:27:07.236 --> 00:27:08.556 position:50% align:middle Follow up with me. 00:27:08.556 --> 00:27:12.066 position:50% align:middle My email, I can make my email widely available to anyone who needs it. 00:27:12.066 --> 00:27:13.546 position:50% align:middle But, thank you for your time and attention. 00:27:13.546 --> 00:27:15.988 position:50% align:middle I hope you found the presentation interesting.