Introduction

As the vaccines became readily available, healthcare staff skilled in intramuscular injections (IM) were needed to assist with vaccinations. Several clinics were set up throughout Galveston County to administer the vaccine, including UTMB Health’s Employee Health Department, Ambulatory Care Division, Student Health Department, and the Galveston County vaccination hubs. A call for assistance came into the nursing school and the adult health II course coordinator identified this as a unique clinical experience for students. The course coordinator collaborated with faculty, staff, and students to allocate clinical time to the vaccination efforts. Nursing students who were in the second semester were identified as the ideal cohort to participate in this experience because they had been validated on the Intramuscular injection (IM) skill.

The COVID-19 pandemic has recently been the most significant global health issue-facing healthcare [1]. The pandemic challenged schools of nursing to continue producing qualified graduate nurses while onsite classrooms and skills labs were closed to in-person offerings. In addition, clinical sites discontinued face-to-face student experiences. Nursing education was forced to move to a virtual environment to teach theoretical concepts and clinical skills [6]. Each state’s Board of Registered Nursing determines clinical requirements for nursing schools. The Texas Board of Nursing stated, “Programs may use up to 50% simulation activities in each clinical course” [2]. Nursing faculty were required to develop alternate experiences to meet the clinical objectives of each course.

Operation Warp Speed (OWS), in partnership with the Department of Health and Human Services, the Department of Defense, and the private sector, quickly developed a COVID vaccine that was safe and effective for public administration under a Food and Drug Administration (FDA) emergency use authorization by the end of 2020 [3]. OWS also was charged with producing and administering 300 million doses of the vaccine by the middle of 2021 [3]. Additional issues were identified, specifically allocation, prioritization of who should receive the first doses, and physical deployment of the vaccine [4]. The US Government created vaccine delivery plans to deliver mass quantities to individual states. However, as the vaccine distribution began, some counties faced disorganization issues, inadequate staffing, and sub-optimal management of the administration sites, mainly as small clinics evolved into significant hubs for vaccine administration to meet the overwhelming demand [5].

Purpose

This project aimed to evaluate students’ perspectives on utilizing COVID-19 vaccination clinics for clinical experience in the Adult Health II course.

Methods

The site’s Institutional Review Board (IRB) approved the project as a quality improvement project. Participation in the survey was voluntary, and students were notified immediately that their responses would be used for publication. The secondsemester nursing students who participated in the vaccination clinic (132 students) were sent an anonymous Qualtrics link to the five-question survey. The students utilized a 5-point Likert scale (Strongly Agree to Strongly Disagree) to answer the question, “The opportunity to participate in the COVID-19 vaccination was a beneficial clinical experience”. A yes or no response was used to answer, “In your opinion, did the COVID-19 vaccination clinic meet the clinical objectives for the course?” and “If given the opportunity, would you volunteer your time to the COVID-19 vaccination clinic?” Free text questions were used to evaluate what the students learned and the challenges they encountered during the vaccination clinic. Demographic data were not collected for the survey. All questions except “If given the opportunity, would you volunteer your time to the COVID-19 vaccination clinic?” required responses from the students. Qualtrics provided an analysis of the objective questions asked in the survey. Qualitative analysis was conducted by thoroughly reviewing each student’s comment and identifying themes.

Results

The survey yielded responses from 82 students. One aim of the survey was to determine if students found the COVID-19 vaccination clinic to be a beneficial clinical experience. Most students (65; 79.27%) strongly agreed, and 16 (19.51%) agreed it was a beneficial clinical experience. Seventy-nine students (96.34%) thought that the experience met the clinical objectives of the course. Seventy-seven students (95.06%) stated they would volunteer their time at the COVID-19 vaccination clinics if available.

A qualitative review of the students’ comments regarding what was learned through the COVID-19 vaccination clinic revealed three primary themes. The first was improving their IM injection skills. A student stated, “Before doing the vaccination clinic, I was not extremely confident in my ability to do injections since I only had the opportunity to do very few insulin injections during other clinical rotations.” Another student provided, “That day I did 150-200 injections and now feel confident and able. It was nice to be able to have the opportunity to get so much practice!”

The second theme was developing therapeutic communication skills. One student identified the importance of therapeutic communication to ease individuals’ anxiety about receiving the vaccine. Another student stated, “I practiced how to communicate and calm patients while providing effective patient education in a short time frame.”

The third theme was patient education. Students had many opportunities to educate patients about the vaccine and its side effects. Per a student, “I learned how to prepare the vaccine, and I was able to educate the patients on what vaccine they were getting. My clinical skills have improved a lot by attending the vaccine clinic.” Additionally, students enjoyed working with an inter professional team at the vaccination clinics. They also enjoyed working in the community and believed it would positively affect the community.

Students did report some challenges while working in the vaccination clinics. They felt overwhelmed by the number of individuals coming through the community vaccination clinic hubs. One student noted, “Time management was a challenge. There were many patients, and we had to work quickly to stay on track.” Students also struggled with appropriately documenting the vaccine in the electronic health record but were able to quickly learn to document. Lastly, due to the size of the community vaccination clinics, students were sometimes challenged with identifying the community lead.

Discussion

Utilizing COVID-19 vaccination clinics as a replacement for clinical immersion proved to be a worthwhile experience for nursing students. Students had the opportunity to improve IM injection skills, which are often unavailable in an acute care setting. It also pushed them to utilize therapeutic communication skills. Faculty also recognize the need to utilize clinical experiences like the vaccination clinic to thread population health throughout the nursing curriculum. Based on the survey results, it is essential for faculty to “think outside the box” and offer various clinical experiences that will allow nursing students to develop technical and professional skills.

References

1. Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, et al. (2020) Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep 69: 759-765.
2. Texas Board of Nursing (2020) Managing clinical experiences during the COVID 19 pandemic.
3. Slaoi M, Hepburn M (2020) Developing safe and effective covid vaccines-Operation Warp Speed’s strategy and approach. N Eng J Med 383: 1701-1703.
4. Wouters OJ, Shadlen KC, Salcher-Konrad M, Pollard AJ, Larsen HJ, et al. (2021) Challenges in ensuring global access to COVID-19 vaccines: Production, affordability, allocation, and deployment. Lancet.
5. Carr E (2021) COVID-19 vaccines: Preparing for vaccination in the context of clinical oncology care. Clin J Oncol Nurs 25: 76-84.
6. Hargreaves L, Zickgraf P, Paniagua N, Evans TL, Radesi L (2021) COVID-19 Pandemic Impact on Nursing Student Education: Telenursing with Virtual Clinical Experiences. SAGE Open Nurs 7: