Nursing in the time of COVID-19

On the "U Rising" podcast, President Ruth V. Watkins engages in insightful conversations with students, staff, faculty, alumni and community stakeholders who are at the center of the state's flagship research university. President Watkins also connects with other leaders to give listeners a fresh take on top issues and innovations in higher education in Utah and across the country. You can subscribe to U Rising via iTunes, Spotify, Stitcher and other podcast streaming services.

The nursing profession is changing the landscape of health care and many of us are more aware of the vital role nurses play in patient care as they serve on the front lines of of the coronavirus pandemic. This also happens to be the

International Year of the Nurse and Midwife, a fitting time to recognize our nurses and midwives. In this episode, Marla De Jong, dean of the College of Nursing, and Tracey Nixon, chief nursing officer at the University of Utah Health, share insights into the profession today. Marla also shares how you can join the “Thank a Nurse, Fund the Future” initiative that is supporting our student nurses. Recorded on Thursday, Oct. 1, 2020. Thanks to Brooke Adams and Dave White for technical assistance. Music by Taylor Hartley.

President Ruth Watkins: Welcome to the U Rising Podcast, where you get to meet some of the wonderful people who are helping us achieve great things at the University of Utah. My name is Ruth Watkins. I'm the president of the U and my guests today are Marla De Jong, dean of the College of Nursing and Lewis Perry Presidential Endowed Chair, and also Tracey Nixon, chief nursing officer at the University of Utah Health. So, welcome to both of you, Marla, Tracey, so good to have you.

Marla De Jong: Thank you for having us.

Tracey Nixon: Yes. Thank you very much. We're excited to be here.

President Watkins: Well, we were visiting a minute ago about how very important nursing is to the world today and truly always. It's a delight to have a few minutes to visit with you about that. Now you both are new to leadership roles at the University of Utah, and I think listeners would love to hear what those roles are. And maybe just a little bit about your story at the University of Utah. So, Marla, why don't you start?

Marla De Jong: Thank you. I have been at the U since November of 2017, initially serving as chair of the Acute and Chronic Care Division within the College of Nursing. And I began as dean mid-August. And in that role, I provide strategic vision and operational leadership for the college's academic and scholarly programs. I create an environment and community to support the college's faculty, staff and students, ensure that we provide high quality academic programs, support our research mission, advance the scholarship of our faculty, and serve as the college’s public voice, promoting initiatives across Utah and the region and articulating our contributions to nursing, health care and health policy.

President Watkins: So, we know that deans matter in terms of leadership. It's a very important role. Congratulations on your selection as our new dean and also for such a remarkable College of Nursing that we have at the University of Utah. I think listeners, hopefully, know how strong our College of Nursing is, but today's the day for them to find out if they haven't heard before. Tracey, tell us a little bit about your new leadership role.

Tracey Nixon: Well, I have been with University Health Hospitals and Clinics since 2005. I started as a clinical nurse in our medical ICU and have held a variety of leadership roles since that time. I actually am at the one-year mark in my current role as the chief nursing officer, that includes my interim appointment that started back on October 1st of last year. So, I am one year into this role. My responsibilities as the chief nursing officer for Hospitals and Clinics involve several aspects, so I'm responsible for all nursing clinical operations across our enterprise. That includes both inpatient ambulatory across all of our hospitals, ambulatory health centers, clinics. So anywhere that nursing care is delivered. I'm also responsible for our nursing practice and our scope of practice within the health system and ensuring that we have the workforce, the training, the education, and the skills to deliver a patient high quality, reliable, safe care.

President Watkins: And I would want to give a shout out of congratulations to you as well. One of the things I was just walking around the campus and I see all of our banners about our top 10 health quality rankings, and I have a little feeling that nurses play a pretty critical role in us getting a ranking like that.

Tracey Nixon: Yes. Yes.

President Watkins: Tracey, Marla, you both play a role there. I'm guessing that the profession of nursing has changed over the years. I think listeners would be interested in knowing a bit about your view of how the field is changing, has changed, and then maybe what the future is in terms of nursing. And perhaps Tracey, you should go first and then Marla can talk about how we prepare nurses for those kinds of new changing roles.

Tracey Nixon: Yeah, well I think the field of nursing has changed dramatically and will continue to change as we go forward. I think some of the most obvious things as I reflect back on where nursing was and where we are today are, right, you can start with the funny, right? We used to work caps and gowns and stockings. We have progressed to scrubs. Most nurses, if you talked to them, if they started in caps and gowns, they're very thrilled about that change.

But I even think one of the significant changes from that time includes, right, we moved from being viewed as, I think, more assistants, right, to positions in our early healthcare profession years, to we are truly clinical experts. We are integral parts of the healthcare team. We have our own practice that is very specific to nursing, to the care we provide. So, a dramatic shift in that way.

In addition, our practice is way beyond the acute care hospital, right? So, from education, forensic nursing, nursing informatics, and we continue to see the role of the nurse grow and expand as we try to better take care of our communities and meet the needs the health care needs of our communities across the country. So, it's an exciting time for us. It continues to be an exciting time. There's much, much more we can do, I think, as we go forward.

President Watkins: Well, very good. And Marla, maybe pick up a little bit on that. I think the thought of kind of interdisciplinary team members with nurses front and center I would imagine has implications for how we prepare people in this profession and then certainly all the way through doctor of nursing practice as well.

Marla De Jong: Exactly. I think one of the profound differences and advancements is that nurses are really changing the landscape of health care in our local communities, in our state, in our nation. And what I mean by that is we're confronting major public health care issues like mental health, like air quality, like healthy aging, like climate change and the impact that those things have on health. And so when we think about that from an educational perspective, our curriculum has evolved beyond educating nurses for hospital-based practice, to expanded roles in primary care where nurses are incredibly important members of the primary health care team, promoting health, delivering care, managing chronic diseases and coordinating care among those interdisciplinary members of the health care team.

And as you mentioned, Dr. Watkins, the different programs that we offer now in nursing have evolved. Nationwide, in the last seven years, we have doubled the number of employed nurses with a doctoral degree. And so, we have nurses with the knowledge and the competencies to advance patient care, to produce the science that we need to answer these clinical questions and to be leaders within health care, within health policy and to practice independently in those advanced practice nursing roles.

The other thing that I think we're paying more attention to are our topics like social determinants of health and providing effective, efficient, equitable and accessible health care and creating this culture of health whereby we're improving the health of individuals and families and communities and working very hard to reduce health disparities. So, I think it's that focus on health, the access to care, the overall quality of care, and we are making a tremendous difference.

Another thing that I think we've seen change over time is nurses are more involved on boards and commissions in non-health care settings and bringing the importance of health to our communities. We're applying our entrepreneurial skills and thinking about what are the solutions that we need to be innovative and solve some of these health care problems.

And I hope that we're doing a little bit better job of taking care of ourselves, attending to our own personal wellness, strengthening our own resiliency and striving for better work life balance than perhaps we've had in the past.

President Watkins: What's exciting and appealing about what you're saying is the role that nurses can and do play in prevention as well as restoration of health. And I love the mantra of more health less medicine, and population health in general. So, it's exciting to see the way you're talking about nurses as leaders, as participating in public health guidance, and all the things that can help people live healthy lives. It's exciting to see the role of nurses moving in that direction as well.

Now this year, what a year. What a year I would imagine for nurses. Let's talk a little bit about the pandemic and the stress, I think, and the challenges for nurses on the front lines, as well as the pandemic moment and how that may have impacted how we prepare nurses for the future. So maybe we start with you again, Tracey. We see very poignant stories of the roles that nurses have played during this period. I have to believe that has been very difficult.

Tracey Nixon: Yeah. I certainly think that it has been more than any of us probably understood when we stepped into our careers, that we would be nursing through a pandemic of this magnitude. What I can say is I am so incredibly proud and impressed by the nursing profession, through all of this. I mean, as a nurse, I always have been, but for me personally, this highlights the commitment and the passion they have for those that they serve. It has been incredibly challenging for all of us. But in the early days of trying to understand what it was going to mean for us here locally in Utah, right, lots of examples as we watched New York go through their experience. So, trying to translate that to us, lots of conflicting information to manage.

So just the pace of change that we were trying to navigate in those early times, trying to help our staff be prepared, our nurses be prepared, trying to secure the PPE, manage the fears that staff had through all of that, asking them to do things they have never done before, cross training, taking nurses from an ambulatory setting and training them to be ICU-extended nurses. So really the demand to be an incredibly flexible and nimble workforce. And again, right, without hesitation people just picked up and did what they needed to do to take care of our patients. They've had to be incredibly innovative. We just have not taken care of patients in the way our patients need us to right now.

Our ICU patients, COVID positive ICU patients that are proned. So yes, proning in a medical ICU is not a completely uncommon practice. But it is very, very rare. And now we have patients proned for the majority of their stay while ventilated and on all sorts of support. So how do we care for a patient that's prone? It's certainly beyond our normal nursing ratios and, right, so how do we manage that? And we're asking them to do that in full personal protective equipment. So PAPRs, which creates challenges in just movement and how long you can stay in all of that personal protective equipment.

So, they have been incredible but trying to focus on how we take care of them during all of this, with the physical demands, the emotional demands, they are caring for patients who are isolated. I think this is probably the thing I have heard the very most, and that proves to be one of the most challenging thing for all of our health care workers, but to care for patients who are incredibly ill and dying and they're alone for that, the emotional burden and pain, I think for both the patient, but the staff. Having to connect with their loved ones using FaceTime to say their last farewells, right? But the emotional impact to our staff has been, I think, one of the hardest parts of this and how do we help them through that? How do we help them heal and recover and continue to do the work because they have more patients, right, that day and the next shift and the shift after that. So, I think that has been incredibly challenging for them.

And then how, I think, how do they stay safe and do they feel safe? So, do they feel safe at work, but also do they feel safe to go home? Right? So, there is, especially early on, lots of fear about how the disease transmission worked exactly, lots of conflicting information. So how do we help our staff be safe at work? How do we help them be safe when they go home so they can continue to take care and be part of their own families and lives?

So, it has been, I think, incredibly challenging, but again, amazing workforce, committed professionals, and really has highlighted, I think, certainly the nursing profession and their commitment to what they do, but also the amazing teamwork. So it is, right, it is not just nurses. It is just this amazing team that has come together to make this happen that has been incredible to be part of and to, right, watch what an amazing health system we have.

President Watkins: Yeah. I'd like to really express my gratitude to your nursing team and to you for your leadership. It is really a remarkable time. And I know that our patients and their families and our community sees the work that you all do and expresses appreciation for it. So, wow. I mean, this is...the pandemic moment has brought a lot of change to us all. And you maybe at the front of that, and you too, probably, Marla, because I'm sure that the pandemic is changing the way we're thinking about preparing the workforce and probably has created a lot of new teaching moments in nursing. So, tell listeners a little bit about that.

Marla De Jong: Yes. And I too just want to say to Tracey, very powerful, heartfelt words. And nurse to nurse, I know where you're coming from, and I appreciate everyone on the front lines within our health care systems, wherever that may be.

Certainly, the experience is somewhat different for us on the academic side. We, too, are being flexible and innovative. And so, in March, like the rest of the university, our highly qualified faculty and the staff who support them began delivering our courses online, either synchronously or asynchronously. We leveraged a virtual simulation and tele-health to teach clinical skills when we could.

So for instance, our psych mental health nurse practitioner students and their preceptors used secure technology to care for patients in ways that were actually similar to in-person clinic appointments because our goal was to remain open. Our goal was to educate students. Our goal was to give students the very best possible experience so that they could graduate on time so that, Tracey, you could hire them. And so, that was important to us and not all nursing schools in the country have been able to do that. And so, we will continue on in that manner.

But you might imagine that for some of our students, it wasn't quite as easy. For example, our baccalaureate students who normally complete so many hours of clinical training in inpatient settings were not able to do that, but I'm thankful for our forward-thinking faculty who produced online demonstrations to teach clinical skills. Our college purchased off-the-shelf software by which we could do virtual simulations that allowed students to assess a virtual patient, to select nursing interventions and re-evaluate their patient based on feedback from that virtual patient and a virtual preceptor.

And then our faculty met with students in small groups to help work through those scenarios and to learn what they could in a virtual fashion. This semester we are delighted to be back in clinical settings and we're grateful to be part of the U's academic health care system and for our partners like Intermountain Healthcare System and the VA who have welcomed our students, so that now they have that full spectrum experiential learning opportunity. Of course, we ensure that our students are safe by providing them with the personal protective equipment that they need. And then looking forward, we're thinking about ways that we can even expand upon virtual reality as an exciting tool to use for teaching repetitive tasks, training and staging even more complex patient scenarios in a virtual manner.

We also, from a research perspective, are busy conducting new studies that are COVID-related. Our interdisciplinary researchers have submitted nine grant applications regarding COVID topics alone. And although many of them are still under review, three are funded and underway and like Tracey's clinicians, through it all and in the midst of the snow storm, the pandemic, the earthquake, the hurricane force winds, our nurses and nurse practitioners and nurse midwives continued to provide high-quality, high-value patient care in hospitals and clinics and community settings, throughout the juvenile justice system here in Utah, and even in patient homes. And so, doing our best to adapt and make sure that we are still meeting the needs of our patients.

President Watkins: We thank you for your creativity, the hard work and innovation of your colleagues. And I think it is interesting to try to imagine the pandemic has been extraordinarily difficult for so many and yet the capacity of digital learning and the digital experience, there are good things that we are taking from this. And I would imagine that for nurses, the opportunity to repeat virtual procedures until they learn them well, could be very, very handy and really powerful as a learning tool. So, we thank you for your efforts to think through those questions and imagine how we come through this stronger, better and continuing to prepare the nurses the state and Intermountain West and the world really needs.

I understand the WHO designated 2020 as the International Year of the Nurse and the Midwife. It seems so very fitting in the moment we're in. Tell me a little bit about how that celebration happens, how nurses are recognized and given well, well deserved recognition, I would say.

Tracey Nixon: Marla, do you want to lead?

Marla De Jong: So, I'll start by saying that the International Year of the Nurse and Midwife was declared prior to COVID and it was designated that way to recognize the vital role that nurses have in promoting health, preventing disease, providing care and transforming health care around the world. It also honors the 200th anniversary of Florence Nightingale's birth, and it highlights the challenging conditions, though, that worldwide nurses often face in their profession and brings attention to the risks associated with the nursing shortage and advocates for the investments in nursing worldwide, in terms of our nursing workforce and our midwifery workforce. The effort was really to highlight the contributions that nurses make and to exude confidence that, in the future, we will continue to make those contributions, but we need to recruit many, many more nurses in the short term.

President Watkins: Tracey, can we do anything to celebrate our nurses?

Tracey Nixon: We typically celebrate Nurses Week. It occurs in May for us. We have an Honors for Nursing Program the College of Nursing leads for us. So, unfortunately, in May, we had just shut down our hospital and all of our business and all of our traditional means for celebrating were kind of brought to a screeching halt. And those continue, right? Many of the restrictions about how we would typically celebrate, gathering sizes, the sharing of food, some of the things that are very, right, near and dear to the nurse's heart and how we celebrate is, right, through the sharing of food and the gathering. And so, we haven't been able to do those.

We have focused a lot at the hospital around local recognition and local acknowledgement and being very present with our teams as we go through. We did some of the announcements and some of the letters that we send out and ways of typically expressing gratitude but trying to do it more on a personal and one on one basis with our different teams across our health system. We focused a lot on the health care heroes, really trying to emphasize and show support for our staff that way, but also trying to meet nurses really where they were at that time. There was still a great deal of fear, lots of stress. We were rapidly changing in those early months and so trying to be super sensitive to that. And there were lots of people around our area we're losing their jobs and lots of stress on their personal lives. So, trying to be sensitive and balance that and be thoughtful about how we go and recognize. So, meeting our nurses, wherever they were in the spaces they were to just provide more personal recognition and gratitude in lieu of our typical events that we plan.

I think that there was... it felt weird for us. Nurses Week is usually, as Marla will tell you, kind of a big deal for us, right? We were all about celebrating ourselves for the entire week. It just did not didn't resonate and hit home with us in light of everything that was going on within our own organization and our community, but across the country. It was challenging. So, we tried to balance that and strike a happy medium and, right, have more personal, one-on-one recognition with our teams as we went through.

President Watkins: That makes perfect sense. And I would say, as we move through the pandemic, the University of Utah owes you nurses a whole lot, and we will plan a very big celebratory event as we see us clear through the pandemic. So, I think the world will have a celebratory event, but I know we will want to highlight the role nurses have played. And on that note, I hear we have an initiative called “Thank a Nurse, Fund the Future.” Tell listeners about that.

Marla De Jong: Yes. So, as I alluded to earlier, the World Health Organization estimates that there will be a worldwide shortfall of 9 million nurses and midwives by the year 2030 unless we have some sort of radical action that reverses that. And so, the College of Nursing is doing our part to educate nurses, but our students are experiencing financial burdens due to the climate of COVID and other personal reasons.

So, we are within the College of Nursing providing emergency funds. We call it the Ripple Scholarship due to the far-reaching effects of providing financial relief to our students. And the need within our college has never been greater. Pre-COVID, we typically awarded scholarships to six or 12 students per semester. This past spring, we awarded scholarships to 47 students for nearly $88,000. And already this fall, we have awarded 17 scholarships for over $25,000. And so, to raise money, we've launched UStarter crowdfunding, and we're grateful to our BSN student Carol and her husband Jeff Stowell, who pledged to match $25,000 in donations after hearing and witnessing firsthand the immediate need within our student body.

So, if you are interested in donating, your dollar will be matched one-to-one. And if you would like more information, I encourage you to visit

President Watkins:

So, listeners who among us has not had our lives improved by a nurse, touched in one way or another, our own or our family members? Be a part of it. Thank you, Marla, Tracey, for your leadership, your support of health and patient care and education of future nurses. Listeners, thank you for joining us today for the U Rising Podcast and I hope you'll join us for the next edition. Thank you all.