Enhancing Infection Control and Student Learning: A Collaborative Strategy Using Nursing Students During COVID-19
Abstract
Background
Coronavirus disease 2019 resulted in restrictions in didactic and clinical rotations while sites denied entry or limited numbers of nursing student placements to decrease impact staff nurse workload. Pandemic incidences of hospital-acquired infections, central line–associated bloodstream infections (CLABSIs), and catheter-associated urinary tract infections (CAUTIs) increased, underscoring the importance of increasing workforce-ready nurses.
Method
To increase the number of nursing students permitted into the hospital, hospital and school administrators devised the nurse assist program (NAP), which is a collaborative approach developed to address increased staff workloads and personnel shortages and facilitate student return to clinical settings. Student nurses supported infection-control practices and addressed hospital-acquired infection bundle compliance issues in real-time to reduce patient harm.
Results
When nursing schools struggled to access clinical sites, area hospitals sought to implement the NAP and requested students for placement.
Conclusion
Following NAP implementation, CAUTI and CLABSI were shown to decrease. [J Nurs Educ. 2025;64(1):60–62.]
Introduction
The entry of coronavirus disease 2019 (COVID-19) onto the health care landscape fundamentally altered how student nurse clinical rotations occurred on a large-scale basis at healthcare and educational institutions nationwide, with limited numbers of nursing students able to receive required clinical training and experience for nursing degrees. However, increases in central-line associated bloodstream infections (CLABSIs), and catheter associated urinary tract infections (CAUTIs) correspondingly high- lighted a greater need for fully qualified nurses (McMullen et al., 2020).
Method
A 900-bed academic, level I trauma and stroke medical center collaborated with a school of nursing to provide bedside support to nurses during the COVID-19 pandemic. Before project implementation, discussion between hospital nursing leaders and school of nursing administrators addressed plans for implementation and benefits for both hospital and school. To increase the number of nursing students permitted into the hospital, hospital and school administrators devised the nurse assist program (NAP), which is a collaborative approach developed to address increased staff workloads and personnel shortages and to facilitate student return to clinical settings. Student nurses assisted with infection control practices (ICP) helping offset nurse workload and improving patient safety.
During a period when nursing schools struggled to access clinical sites, the adjacent partnered nursing school was able to increase enrollment by 25% (American Association of Colleges of Nursing, 2022). Additionally, area hospitals sought to implement NAP and requested students for placement. Following NAP implementation, in-hospital CAUTI and CLABSI rates decreased while national rates continued to rise. Baccalaureate nursing degree requirements for nursing school accreditation include didactic and clinical experience occurring concurrently and must meet specified clinical hour requirements. For more than a decade, lack of available clinical placements has been cited as a key problem for schools of nursing to increase enrollment (American Association of Colleges of Nursing, 2022). Schools find it more and more difficult to locate clinical sites willing to accept placement of student nurses (American Association of Colleges of Nursing, 2022).
At pandemic onset, nursing staff shortages resulted in meetings between hospital administrators and nursing school clinical staff to determine how to increase student clinical experience while increasing the number of nursing students permitted in the hospital to augment staff workloads (American Nurses Association, 2021). NAP was a pandemic initiative designed to facilitate student return to clinical settings, address increased staff workloads, and augment personnel shortages (Buerhaus, 2021). As a result of this collaboration between the hospital and nursing school during the COVID-19 pandemic, infection rates were significantly lower than national averages and resulted in increased nursing student clinical placement in area hospitals and generated high student confidence scores in quality and safety initiatives, as well as optimized patient health outcomes. The success of the NAP continues, as it is currently ongoing and serves as a creative educational template for learning clinical skills and other quality and safety initiatives.
Design
A total of 62 nursing students rotated through medical/surgical and intensive care units throughout the hospital. The nursing students, who had not previously been exposed to quality and safety initiatives, along with 26 nursing faculty received 2 hours of education provided during the first week of the quarter. Education initiatives consisted of a classroom presentation on evidence-based practice measures in conjunction with hands-on training for central line and urinary catheter maintenance and infection prevention bundles. The classroom presentation, which included a lecture using Microsoft PowerPoint from Infection Preventionists (IPs) from the Department of Clinical Epidemiology and Infection Prevention along with central line dressing change demonstration from the vascular access team educator.
The IPs conducted training and demonstration on completion of the CAUTI and CLABSI maintenance and infection prevention bundle audit tools. The CLABSI audit tool was designed to collect and track the following compliance information: central line type; location; dressing type; intravenous tubing changes; alcohol caps placement on unaccessed ports; if dressing is clean, dry, and intact; and if dressing is dated. Students were trained to identify deficits and perform interventions during completion of the CLABSI audit tool.
The CAUTI audit tool was designed to collect and track the following compliance information: catheter is secure, catheter is free of kinks, if catheter has any dependent loops, closed system is maintained, bag is below the bladder, bag is not touching the floor, and bag is less than three-quarters full. The audit tool also tracked interventions performed by the students. Students received instruction that audit tool completion and interventions could only be undertaken while under direct supervision from nursing faculty or clinical instructors. Students were also taught to report their presence on a unit to the charge nurse before entering patient rooms or engaging in any audit activities.
Implementation
The project was piloted on 15 inpatient units. Clinical instructors and nursing faculty supervised nursing students during assessment using the CAUTI and CLABSI audit tools. If an audit tool criteria deficit was identified, corrective interventions were executed by students with clinical instructor or nursing faculty supervision. Findings and interventions completed were communicated to staff and unit charge nurses. Incidences of CAUTI and CLABSI were tracked during implementation. Data were collected on findings and interventions from students, clinical instructors, and nursing faculty following project completion.
The NAP director communicated with IPs each week regarding units and days designated for nurse assist participation and rotation. Upon arrival, the clinical instructor received a list of patients with urinary catheters and central lines. During the student nurses' 12-hour shifts, the clinical instructor took student pairs or groups of three to assigned units to conduct catheter and line assessments. Students performed interventions as needed with the time allotted. Weekly, participating students performed the audit process two to three times per quarter for four consecutive quarters. The quality department director held bi-weekly meetings with the IP and nursing faculty to discuss program efficacy and set goals for continued success of the program.
Results
Sixty-two nursing students participated in NAP and completed 219 CAUTI and 267 CLABSI bundle audits. Interventions done on noncompliant CAUTI and CLABSI bundles in Figure A (available in the online version of this article). CAUTI rates decreased by 86%, and CLABSI rates decreased by 50% compared to the previous year. Rates also remained below the national value–based purchasing benchmark for hospitals. The postimplementation survey of students showed 98% felt that they would utilize catheter and central line education in the future (Figure B; available in the online version of this article). Sixty percent of nursing students strongly agreed to feeling confident assessing urinary catheters, while 42% agreed to feeling confident in assessing central lines (Figure C; available in the online version of this article). Ninety-two percent of participating faculty felt the program helped nursing students understand the importance of CAUTI and CLABSI prevention, while 80% of faculty felt the program increased student confidence in central line/Foley catheter assessment and intervention.
Implications for Nursing Education
Nursing students gained clinical experience working collaboratively with bedside nurses to reduce infections and were exposed to quality and safety initiatives using infection prevention care bundles. Nursing students reported high confidence levels in assessment skills relating to urinary and central line catheters while feeling that they would continue to utilize this knowledge. Although NAP was initiated as a response to the COVID-19 pandemic, the hospital and nursing school continue to sustain this program due to its success within the institution. The NAP can be used as a clinical education template for nursing students to learn other clinical skills and quality and safety initiatives. The use of NAP facilitated the return of nursing students to their previous clinical location site and led to an increase of clinical placements, as other facilities began requesting nursing students. Although results were statistically significant, one study limitation was availability of faculty to accommodate a high volume of in-hospital central lines and urinary catheters.
Conclusion
The NAP added to a decrease in CLABSIs and CAUTIs while providing an opportunity for clinical hands-on experience and training in central line and urinary catheter cares within the hospital setting. Program participation facilitated student return to clinical settings and mobilized additional resources to relieve nurse workload. The NAP provides a proactive learning environment for nursing students, reporting high confidence scores while supporting long-term, evidence-based infection prevention. Additionally, program measures afforded opportunities for collaboration, growth, and training efficacy in partnership with nursing education. The NAP is ongoing and continues to serve the hospital and nursing school while serving as an educational template for future nursing education.
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