By Lana Sweeten-Shults
GCU News Bureau
Amy Leach knows firsthand what COVID has demanded of Grand Canyon University’s nursing students, who were facing one of the most daunting challenges of their academic careers in the most stressful of times: conquering the National Council Licensure Examination (NCLEX) during a global pandemic.
She has worked with students who took their practice exams remotely while their brother was in the next room on Zoom for his classes, their mom was at the dining room table working from home, and there was no way to find a quiet space at a coffee shop to take those exams, since so many businesses were closed during the pandemic.
Leach’s job: to breathe with those students, pivot with them and help them succeed in passing the formidable test all nursing graduates must take before they can work in the field.
“It’s still going on now,” said Leach, the College of Nursing and Health Care Professions’ NCLEX Success Manager, of the stresses surrounding the exam. “I’m finding that students want more. Some of them are meeting with me four, five, six, seven times. … I’m kind of that anchor, I think, to help guide them through that process.”
She is one of many anchors in the college, whose prelicensure nursing students – those seeking to become registered nurses -- achieved a 96.17% first-time pass rate on the NCLEX in 2020, finishing the year strong despite the barriers COVID presented.
That first-time pass rate is among the highest in Arizona and exceeds the state average of 91.44% for the year and the national average of 86.58%.
That kind of academic achievement also shows the dedication of GCU’s faculty, not only to help students succeed, but to keep moving nurses through the pipeline as the nation continues to face a national nursing shortage and as those in the profession worry how the pandemic might amplify that shortage.
GCU continues to contribute the largest number of NCLEX test-takers in the state to combat that shortfall. Of the 313 tests delivered to the University’s prelicensure nursing students in 2020, 301 met the threshold to earn their license on the first attempt.
“We have been able to really identify and support our faculty and students in whatever it takes to be successful,” the college’s Dean, Dr. Lisa Smith, said of those stellar first-time past rate numbers during COVID.
When the state first started to go into lockdown in March 2020, the college had just two weeks to transition a fully on-ground program to a virtual one. But switching from in-person classes to online classes was the easy part.
What would be the most imposing challenge would be trying to find a way to replace the hands-on experiences that are so vital in training future nurses and helping them pass the NCLEX. At the core of their education is not just traditional classroom work but simulations of real-world medical scenarios in the college's immersive simulation lab along with clinical placements, when students work alongside nurses and other industry professionals at health care facilities.
“How do you take hands-on patient care, in addition to working with a mannequin, and all of a sudden, putting it on a computer screen?” Smith asked.
What the nursing faculty did during virtual learning at the end of spring and during the summer was gather recordings the college already had in its library, since students’ immersive simulation lab exercises are always recorded. Faculty walked students through those recorded scenarios, with students commenting on what was done correctly and what wasn’t.
Then there were clinical placements to figure out.
“The hospitals said, ‘No. We can’t take any students because we’re in critical mass,’” Smith said.
So in the spring, the college contracted with a vendor. NurseThink vClinical online clinical simulations were offered for free during COVID to help students finish the last few weeks of the semester. The simulations re-create being in a real emergency room, for example, complete with ER noises and pop-ups that might say, “A patient is complaining of this, what do you do?”
For the summer, the college offered half of the curriculum it normally would virtually, including partnering with ATI for virtual clinicals, and asked students to take the other half of their coursework during the fall. The hope was that hospitals would reopen. By the time fall rolled around, some clinical placements were being offered, but many students still had to fulfill their clinical hours virtually.
“It has been a very large initiative by Dr. Smith, along with our Assistant Dean, Heather Ziemianski,” to place students at hospitals, said Trina Staton, Associate Dean of the Prelicensure Bachelor of Science in Nursing program. “We are tracking, I’d say, probably the best in Arizona in regard to the amount of face-to-face clinical time that we are getting for our students.”
Smith added, “I had to be very assertive in the fall and in the beginning of the spring semester, reaching out to our health care partners, saying, ‘Please, let us in. We’re prepared. We’ll do whatever it takes. We’ll serve you. We’ll do things that we’ve not done before if it helps you and not be a burden.'
“We have about 30 health care partners, and I contacted every single one of them and just kept pushing and pushing, and it has paid off.”
It has improved a bit for the spring 2021 semester. “We’re still not at 100%, but we’re at a much better place clinical-wise than we were in the fall,” Smith said.
Beyond immersive simulations and clinical placements, another challenge was that the three-day, face-to-face NCLEX review course offered at the end of the semester was not offered in the spring and summer of 2020 because of COVID.
“This is a HUGE thing,” Smith said. “This is how we prepare them (nursing students).”
The company offered an online version, but the faculty wanted to bolster students even more. They invited students who missed the live review to take it when it was offered in the fall.
Leach, who normally speaks face-to-face with students in the classroom as the NCLEX Success Manager, transitioned to the virtual world, too. She created prerecorded webinars that students watched, and then she made appearances in Zoom classes for questions.
The college also has made Leach’s “bandwidth bigger,” she said, by adding two nursing instructors – Richard Busby and Ann Campbell – as success coaches for the college’s Level 4 nursing students. Leach has mentored them in coaching students through the Level 4 semester and readying them for the HESI exit exams, which are predictor exams for the NCLEX.
Leach works with students who are at risk of not passing the NCLEX. She also works with the college’s students once they graduate with their Bachelor of Science in Nursing degrees, staying with them until they pass the exam.
This support has been especially important during COVID since NCLEX testing sites were shut down for a time. Even after they reopened, social distance protocols meant fewer students could take the test.
“Research has shown that the students that are ready to test, the sooner they test after graduation, the greater their chances of passing,” Smith said. “She (Leach) really reached out to those students, really trying to keep them highly engaged in study while they were waiting to test.”
All those efforts paid off in the end.
“To produce that number of professional nurses in our program, at that level of excellence, in the midst of a pandemic that forced us to adjust our curriculum and simulations, is an incredible achievement,” GCU President Brian Mueller said. “It’s a testament to our faculty and nursing leadership and, most importantly, to our students who achieved that level of success during an incredibly stressful time while dealing with everything related to COVID-19. I couldn’t be more proud of our nursing graduates who are now on the front lines of this pandemic and helping fill the nationwide nursing shortage.”
It’s something the college wouldn’t have been able to do, Smith added, without the support of Mueller, Provost Dr. Hank Radda and the University’s other leaders.
Now faculty members are embracing their current cohort of students, the ones affected the longest by the COVID changes, and continuing to be vigilant about their success.
Smith said, “We’re going to do, again, whatever we need to, to really wrap our arms around these students this year to make sure that they can be successful.”
GCU senior writer Lana Sweeten-Shults can be reached at [email protected] or at 602-639-7901.
GCU Today: No hospital, no problem: Nursing students go virtual
GCU Today: Residency changes unmasked in face of COVID-19