Preparing nursing students for pandemics and other crises through Global Initiatives

Intensive care unit nurse Caroline Wright, a 2018 graduate of the Medical University of South Carolina College of Nursing’s accelerated bachelor of science in nursing program, temporarily left her job at MUSC Health to work in a COVID-19 unit at New York’s Long Island Jewish Medical Center. It’s been an eye-opener. 

“This is nursing unlike anything I learned in school or learned working.” Wright said. 

She’s had to reuse protective gowns and masks. And difficult decisions have to be made on a routine basis. “These patients are so sick. It’s like triaging, in a sense. Just discerning how you’re going to prioritize care. It’s rewarding, but it has also been the hardest and most harrowing time of my career.”

As Wright can tell you, nursing in a pandemic requires not only compassion and nursing knowledge, but also creativity, flexibility, teamwork and the ability to think critically and make decisions quickly. 

The College of Nursing recognized the need for students to hone those skills, aware that a global health crisis might be on the horizon. Nurses need to be able to respond to crises and provide care when resources are scarce. 

 

So the College of Nursing secured two philanthropic gifts, the Falk-Griffin Global Initiatives Endowment and the Mary Swain Global Initiatives Endowment, to fund student global health experiences. Students will learn about clinical care in countries where needs are high and resources are limited.

Suparna Qanungo, Ph.D., associate professor and director of the College of Nursing’s Global Health Initiatives Program, piloted the program in India in 2015. The experience changed students’ perspectives dramatically. 

For example, when her students entered a cancer center and saw what she described as tons of people waiting in line, they were overwhelmed by the need for care and services. “They were like, ‘My gosh, this many patients here? How are they going to be seen in a day?’”

 

The students found out by watching the Indian doctors and nurses, who made sure every patient was taken care of.  “The physicians were so calm and the patients were happy,” Qanungo said. “The students learned how, in an adverse situation with a lot of patients waiting, you can still deliver the quality of care you need.” 

When it came time for the nursing students to observe a surgical procedure, they didn’t get the protective gear they had learned about and were expecting. “All we got for gowning up was a green gown that was sterilized. It was reusable. And we had no covered shoes. That was the strangest one. And a few reusable gloves. Most of the PPE, personal protective equipment, was reusable. Our students, I still remember, were a little hesitant.”

An Indian doctor reassured them. “We are used to working with limited resources, and this is how we do it,” he told them.

In addition to spending time with doctors and nurses, the MUSC students worked in what Qanungo described as underserved areas where they learned how to treat patients with limited supplies and get creative with what they had.

The Global Initiatives program will build on what she learned from that experience. While Qanungo chose India for her first foray because she grew up there and was familiar with it, the program will include visits to other countries as well. 

COVID-19 is a stark reminder of how important these kinds of experiences can be, Qanungo said. “There are a lot of parallels between what they learn in other countries and what some nurses are facing now in the U.S. during the novel coronavirus pandemic.”

Cathy Durham can attest to that. She has a doctorate of nursing practice degree and is director of the College of Nursing’s DNP Program. She’s also a U.S. Navy Reserve captain. Durham was deployed to New York City in mid-March as the number of COVID-19 cases soared. She’s supervising more than 130 nurse reservists.

“Most of our team here has deployed to Iraq or Afghanistan or Haiti or Djibouti. When you’re in environments that are medically austere, you often have to go without significant technology.  You may not have all the bells and whistles or the newest medications but you still have to respond,” she said.

She said the College of Nursing’s Global Initiatives program will give students a taste of that. 

 

“Students having that opportunity in a somewhat controlled environment will absolutely help them in providing care, and if we were ever confronted with a pandemic again, being able to triage really quickly and be able to respond calmly will be essential. There is no other experience that will provide you with that.”

Wright, the MUSC Health nurse at Long Island Jewish Medical Center, said crisis care can be challenging, and occasionally, amazing.

“I had a mother who had just given birth. She was COVID-19 positive, and the baby was positive. The mother was on a ventilator. They put her on ECMO (extracorporeal membrane oxygenation). They put her on continuous dialysis. She was going downhill fast,” Wright said.

“I didn’t really see her after that. I just figured – you don’t really ask when you don’t see a patient, because you don’t want to hear what happened. But as I was leaving the hospital after a long shift one day, I heard all this commotion in the lobby. I looked over, and that same patient was being wheeled out of the hospital with her baby in her arms. That moment right there – I needed that. It made it all worth it, really and truly.” 

Wright decided to sign up for another four weeks on the pandemic’s front line.