Before nurses graduate from college, they usually have to spend months treating real patients to get clinical experience before they start working.
But over the past few years, the pandemic has prevented a lot of that from happening.
At Southwestern Vermont Medical Center in Bennington, a new program has been started to support new nurses as they navigate their way through the sometimes challenging first year.
On a recent afternoon about a dozen nurses filtered in and sat around a circle of desks. A few cracked open their lunch to eat during class.
Transition-To-Practice program director Alison Camarda started the class by asking the nurses to write down something positive that happened recently.
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“The last time we were all together it was pretty heavy in this room,” Camarda said. “And I thought it might be nice before we dig into heavy things to have some things that are a little brighter.”
Things have been pretty heavy inside Vermont’s hospitals.
A nursing shortage is putting pressure on everyone, while the ongoing pandemic and everything that it brings to healthcare is forcing constant changes to how hospitals operate.
The monthly class here is one part of a year-long residency program that was started recently at the hospital in Bennington.
Along with having a more experienced nurse work with new hires out on the floor, the monthly class allows the new nurses to talk about everything from mastering new technical skills to concentrating on their own mental health.
There are about 200 hospitals across the country that have started an accredited program like this, and SVMC is the first in Vermont to offer it to its new nurses.
Katherine Doucette says when she started working at the hospital last year, she leaned heavily on the extra support, especially after her college courses were changed during the pandemic.
“For me I was really excited. I was supposed to do this giant capstone in the ED right before graduation. And then COVID happened,” she said. “So I didn’t get to do that, like, final piece right before COVID. So I was a little bit nervous about, you know, actually being the nurse.”
Before the pandemic, the training nurses would spend time in a hospital, but that was shut down due to COVID protocol.
And when things were at their worse, even their hands-on class time at college was moved online.
So nurses that are coming out of school now missed out on a lot of training.
"I think one thing, you know, that’s definitely impacted by COVID, is that pre-COVID, you could like, sit down and talk to people. They could see your face, and see your facial expressions, and now, I feel like it’s a little bit more difficult."- Katherin Doucette, SVMC nurse
And then they had to start working on the front lines of the biggest public health crisis in a century.
Doucette says there’s been a lot of adjusting.
“I think one thing, you know, that’s definitely impacted by COVID, is that pre-COVID, you could like, sit down and talk to people,” she said. “They could see your face, and see your facial expressions, and now, I feel like it’s a little bit more difficult to kind of like, not build a connection with people but almost like, build a connection with people. You can’t see their face. They can’t see your face. So that’s definitely — the person-to-person interaction is definitely different than what I expected when I started nursing school.”
Brittany Priggen wasn't able to do any training inside a hospital before she graduated.
So she went from reading about this new virus during an online college course, to treating some of the first COVID-19 patients in Vermont.
“I'm in my public health course, reading about 'We've got three cases of COVID in the United States,'” Priggen said. "'Here's our first cases.' Well, now here's what SVMC looks like. At some points I had four to five patients that were all COVID positive, and learning how to manage all of that.”
Priggen said the residency program was a big help during her first year, and today she supervises two new nurses.
And as the pandemic rages on, she's passing on that idea that balance, and mental health, have to be a part of the initiation period.
“New grad nurses have this expectation of 'This is how it's going to be,'” Priggen said. “There are hard days. There are emotionally hard days. Believe me, I came in through a pandemic. And I went home crying a lot by the end of the night, you know, but I hung in there. Taking care of myself, outside of work but also inside of work. Reflecting on the job, in the moment, even outside of the job, kept me going, still to this day.”
Even before the pandemic there was a high turnover rate among first-year nurses.
A 2014 study found that one in five leave the profession after one year.
And the pandemic has only worsened that number, with a survey last year finding that COVID-19 was causing a dramatic increase in the number of all nurses leaving the profession.
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“Certainly COVID has made the profession of nursing a lot more difficult. It’s made it more difficult to be a nurse,” said Pamela Duchene, chief nursing officer at Southwestern Vermont. “You have to constantly think about the personal protective equipment. You have to think about where you are. What you’re doing. Whether or not your exposing yourself, and then therefore your family and the ones you care about also to the virus.”
“We’re gonna see, in a few years, the impact of the pandemic on our retention, overall, as a profession. For the nurses that have started their careers during the last two years, I’m not sure that we’re going to know, right now, what the downstream effects of that are going to be.”- Alison Camarda, director of Transition-To-Practice program
Sam Irion grew up in nearby Arlington. His dad was an EMT and he says he wanted to be an emergency department nurse for as long as he can remember.
And even though he started nursing school with some experience under his belt, the loss of hands-on experience made the transition difficult.
“By having online clinical, we were able to meet the expectations of our program, but we may not have been able to get as rich of an experience as you could being in the hospital and being hands on with patients, and seeing real experiences,” Irion said. “So that made me nervous coming into a hospital setting as a nurse, because, you know, I didn’t have as much clinical experience as most other people who are working in the role that I’ll be working in.”
“There really isn’t anything that one-for-one replaces that direct experience, caring for patients, in the hospital environment,” said Camarda, director of the residency program. “And so that, I think, has also contributed to a little bit of uncertainty with how the nurses entering the profession during the pandemic are going to cope with that transition.”
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Camarda said she’s giving the experienced nurses some extra training, to make sure they understand what the younger nurses are going through.
And all of this is playing out during a pandemic that forces changes to how the hospital operates on a monthly basis.
Camarda said it might be a while before anyone understands what this all means for the nursing profession.
“We’re gonna see, in a few years, the impact of the pandemic on our retention, overall, as a profession," Camarda said. "For the nurses that have started their careers during the last two years, I’m not sure that we’re going to know, right now, what the downstream effects of that are going to be.”
Have questions, comments or tips? Send us a message or get in touch with reporter Howard Weiss-Tisman @hweisstisman.
