By Christina Cavazos

When the COVID-19 pandemic hit the United States, Lynn Phillips knew she had to act quickly if her nursing students were going to graduate on time.

Amid the pandemic, Phillips believed it was crucially important to graduate nurses who could help create healthier communities. Phillips is a Registered Nurse with a Ph.D. in nursing education, and currently serves as an associate professor and director of the Simulation Learning Center at the Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences at UCCS.

In March, clinical rotations halted at hospitals across the country as medical centers imposed restrictions aimed at reducing the spread of COVID-19.

So Phillips and her team turned to simulation, creating scenarios that allowed students to practice clinical reasoning and make decisions in a virtual setting.

“I would definitely say we learned to think outside the box,” she said.

Phillips has been a nurse for 36 years and is certified as a pulmonary clinical nurse specialist.

“I have a passion for helping people with breathing problems, but equally competing is my passion for education,” said Phillips, who has taught nursing for the past 19 years at UCCS.

She’s been working with the Simulation Learning Center since 2007. At the center, simulation realistically portrays encounters with patients in a safe setting. Students care for manikins and actors portraying patients.

When the pandemic hit this spring and the college began to rely more heavily on simulation, the program allowed Phillips’ students to complete clinical requirements so they could graduate or advance grade levels.

Phillips spoke with the Business Journal about the program and how it adapted amid COVID-19, so that more than 100 students could successfully graduate this spring and summer.

Tell us about the Simulation Center.

The Simulation Center was funded and built in 2012. It allows students to learn through simulation experiences. If you’ve ever seen iPads on Segways, that’s how students visit the Simulation Center. That’s part of how we’re able to run in this COVID-19 world.

At the Simulation Center, we have three different kinds of simulation. We have manikins that are pretty high-functioning. In a pre-COVID world, students would work with manikins and they would respond just like a person would. We also have a group of trained actors who can portray the symptoms that a person with a particular illness would have. Our students visit them — and our students can be anywhere in the world and they can roll into a room, review the symptoms, consult, obtain the diagnosis, and write prescriptions. We have that experience available for the instructor to review and make comments and critiques. Then, the third type of simulation is when standardized patients are visited in person by our on-site students.

It was quite the challenge for us when two of our three simulation modalities were no longer available.

So instead of coming in person, they learned about Webex (a company that allows for virtual meetings through videoconferencing). The actors learned how to act and portray these illnesses from the shoulders up. We delivered them patient gowns and things like oxygen tubing and casts to show broken arms. In some cases, we even delivered computers so they would have webcams. They learned to portray these things from home. Then, we invited them into Webex rooms with our students and faculty, and students were able to have live interactions with patients digitally.

So how did you bring it all together?

We had five days — spring break in March — to pull everything together. We have an amazing team here, and we were so thankful for our patients who stepped up. We didn’t have enough standardized patients, so we had to ask volunteers to step in.

On our team, I’m the director. We also have a simulation technology technician, Tim Russom, who was instrumental in choosing the platforms that we ran with. All of us had to learn how to run those platforms. We also have a simulation nurse educator, Greg Maruzzella, who in many cases had to write all the material. We had to write it all with the faculty and create it from scratch.

How many students were impacted by these simulation experiences?

So, we have two senior cohorts — 77 that graduated in May and another 35 that will graduate in two weeks. They were the most affected. We wanted them to be able to graduate and join the workforce.

But we wanted to keep the pipeline going, too. If we had stopped clinical learning for sophomore and junior students, they wouldn’t be able to progress. So we actually provided simulation to all levels of students so they all stayed on track in their learning.

The total number of students who participated in scenarios was 466. That’s just in the seven weeks that we ran remote. We ran a total of 984 encounters. An encounter is when a student meets a patient and takes care of them. Some students ran multiple encounters.

Altogether they were able to complete 1,968 clinical hours across all disciplines in those seven weeks.

In a pre-COVID world, how much of a student’s time in clinicals was ordinarily spent in simulated experiences compared to in-person, hospital clinical rotations?

In our program, simulation is about 20 percent. That other 80 percent is in not just hospitals, but it’s in mental health settings, day cares, home visits, and of course there’s a good chunk of hospital experience.

You mentioned clinical experiences in mental health settings. For the simulated experiences this spring, did you delve outside of physical illnesses and simulate other types of scenarios, like mental health?

Yes, we did. And those — the mental health scenarios — are some of our most difficult scenarios. We simulated an experience with intimate partner violence, where students had to interview the person who was abused and offer a safety plan for that person.

Nursing education is not only about treating the patient, but about developing a plan of care for the patient. Our students normally spend time educating a patient of their choice. We had to create all of those patients, too, with their histories and diagnoses and then students had to develop treatment for them.

How did your students respond to the simulated experiences overall?

The primary response was ‘Thank you for helping us.’ They were worried they wouldn’t graduate. It’s not quite the same, but they were able to graduate. We also have clinical faculty who evaluate our students and their learning. Our faculty said they think this cohort of students graduating has a better understanding of why they’re doing things. Hospitals can be very busy and you can get caught up in things like paperwork and taking temperatures over and over. This experience took away all the busyness of the hospital setting and made them focus on what’s going on. That’s really what nursing is about: determining what is the problem and what’s needed to fix it. They were able to spend their hours learning about why things happened and what they should do. I think the cohort is going to be really strong in clinical knowledge.

What have you learned as an educator from this experience?

I learned to think out of the box. In simulation, we already think out of the box. We already have to be creative to work in simulation, but this pushed us further.

Pediatrics was the hardest because we can program our pediatric manikins to do whatever we want, but we can’t program children, and we can’t ask children to portray roles. So, we had to be creative with pictures and stories. We created a pediatric triage, like a nurse health line, and had patients call in as different mothers and fathers with different problems. Then students had to sort through what to tell them.

I’ve also learned about relying on your team and leveraging technology. We have a lot of technology that we’re very fortunate to have and we’re learning new ways to leverage it.

What are your thoughts on the class of students graduating right now? How do you think they will impact the community?

We are graduating strong nurses right now. The nurses that we graduate need to be eloquent in describing to the public what they do and what their value to society is, as well as working with patients and saving their lives.

My passion is things like, our students get focused on ‘I want to work in the emergency room.’ This cohort got to train on things like how to do COVID contact tracing. We worked with the public health department, and their eyes were opened to ‘This is nursing. This is not just saving lives, it’s saving communities. And this is how to make healthy communities.’ We’re teaching students that nursing is not a task. It is service to our communities and it is about making our communities healthier. I love that part when the light bulb goes off, and I love the part when they walk into simulation and it’s so real to them. We’re able to teach empathy. We’re creating the realism, where students can learn not just the science but the art.

These students in the middle of their entire lives being changed were just eager to push forward. They overcame all sorts of barriers to continue their education. I just admire them. They are going to be great nurses.