Q&A with IU South Bend Associate Dean of Nursing Barbara White
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With the continued effects of a national nursing shortage being felt across the county, Indiana University South Bend is investing in new technology to ensure its students are prepared for the demands and distractions of working a hospital rotation even before reaching their clinicals.
The regional campus’s new $10 million Dwyer Healthcare Simulation Center in Parkside Hall is expected to open next year. It’s one of the latest ways IUSB’s Vera Z. Dwyer College of Health Sciences is attempting to help meet the need of 4,300 nursing positions open across the state, according to the Indiana Hospital Association.
Inside INdiana Business talked to Barbara White, IUSB’s assistant dean of nursing, about the shortages and how the Dwyer college is innovating to meet the increasing demands of the health care industry.
What programs does IUSB offer in nursing?
We have three programs in nursing. One is a bachelor’s degree in nursing as a traditional degree, meaning that students graduate from high school, maybe they go out in the world, try another job, and then decide that they want to come into nursing, or maybe they go right into nursing right after high school. However that happens, it’s a traditional baccalaureate degree. It’s about four years to finish that degree and it prepares them to work as what we call a generalist nurse, so they are prepared to be a nurse in any setting after that generalist baccalaureate degree.
A second degree that we offer is what we call the RN to BSN. Another way to become a registered nurse is through an associate degree like at Ivy Tech or Southwestern Michigan (College), places like that. You can get an associate degree in nursing and some of those people choose to get their bachelor’s degree on top of it. So, they get licensed as a nurse, and come back to us and do approximately another 15 to 18 months of coursework to get their bachelor’s degree.
The research is very clear in nursing that the hospitals with a higher percentage of baccalaureate-prepared nurses have better patient outcomes than those with a lower percentage of baccalaureate-prepared outcomes. So, that RN to BSN program is really important for improving the outcomes of the patients in our community.
The third program that we have is a master’s in nursing and that is predominantly a family nurse practitioner program, but also has a track to become a nurse educator to teach in nursing, either in the hospital setting or the academic setting, and then a nursing administration track as well. So, it’s an advanced preparation for those kinds of specialty roles.
What is a nursing simulation center?
The nursing simulation center is critical for providing real life-like experiences for students before, or in addition to, experiences with real patients. What we’re able to do in simulation is let them make mistakes. We can’t let them do that in the clinical setting. We can let them take an order from a physician. They can’t do that in the clinical setting because they are unlicensed. We can let them make their own decisions without any guidance from us so that they can practice that decision-making, those clinical judgments we call them, so that they are ready for that responsibility upon graduation, because if they go through the years of the program and graduate and haven’t had any practice with that, then when they have to make that first life/death kind of decision, it can be very intimidating.
We learned this from the aviation industry, which uses simulation all the time. If you remember Sully who landed the plane on the Hudson and people said, “How did you know how to do that?” And, he’s like, “I’ve done this lots of times in simulation.” We hope that nurses have that same sense that when they are up against a really difficult, unusual kind of clinical situation that they can pull from their memory some simulation experience that might help them with their decision-making and knowing what to do to rescue that patient in that situation. That’s what we’re working for.
Tell me about the current nursing simulation center.
The simulation center we have now is just one room and in that room is a med cart and a supply cart and the patient—the mannequin—and the patient bed. And there’s a chair for the family member to sit, and one of the students acts as a family member.
There’s several problems with it. One problem is that everything is right there in one room, and that is not true in a hospital. In a hospital, the med room is down the hall and around the corner and the supply room is down a different hall and around a different corner. When nurses are practicing, when we are caring for patients, we know that we need to give them medication, so we go to the med room, we pull that medication, we check to make sure it’s the right medication. Then, we go back to the patient room.
During that trip to the med room and back from the med room, at least three or four people talk to us and distract us, and you can imagine how that leads to med error. So, when they’re in simulation, we want to imitate the real life as much as we can. And when, in our current, one-room facility, they only walk two steps over to the med cart, there’s no chance for them to get distracted.
In the new simulation center, the med room is going to be down the hall just like it is in a hospital. We’re going to have a camera in the med room, so we’ll be able to watch the students pull their meds and see the process they go to. Are they checking the chart? Are they checking the dose? Are they checking the time? Are they checking the patient’s name? Did they check that more than once to make sure it’s the right thing? And, they can do it all on their own in a more life-like kind of environment.
The second thing is that we have these mannequins—they’re robots is what they are—and we use a laptop computer to determine the respiratory rates and their heart rates. You can actually take their blood pressure. They blink. They’ve got pulses. And, that’s all controlled by a computer. Currently, the area that we as instructors use to control that is shared by the skills lab.
So we have students in the lab sharing space with the instructors who are controlling the simulation, and it’s very distracting for the students mostly, but also for the instructors. So, we will have designated control rooms that are not shared space with other learning environments and that’s going to be phenomenally better.
What else will the new simulation center bring?
For us, in this situation, size matters greatly because it’s going to give us so many more opportunities. Part of that is that we will have four simulation rooms, versus just one now, which means that we can set up one kind of patient in one room and a different kind of patient in another room. Currently, when we go from one simulation to another, we have to basically use the same mannequin in the same situation because it’s a big amount to set the patient up in a different way.
If we have four rooms, we’ll have great flexibility in the patient scenarios that we’re able to give students. In (pediatrics), we’re really excited about this because currently we only have one space, and if we’re going to use the baby, we need to use the baby for pretty much all the (pediatric) simulations. If we’re going to use the toddler mannequin, now we’re going to be able to have a baby in one room and a toddler in the other.
Secondly, is the extra space so that we will have a med room and a supply room. Thirdly, it’s going to have better technology for videoing, so when the students are doing their simulation, it will be all captured on video. Traditionally, how we do it is that half the students participate in the simulation and the other half watch the simulation. What is really interesting about that is that we have found by research that the people who watch the simulation learn the most. I think it’s partly because your nerves are so bad when you’re being videoed and watched that you’re so worried about doing the right thing in the simulation that it really almost diminishes your opportunity to learn from it.
If we have video capabilities such that we can capture that and replay it for people who have done the simulation, imagine what they could learn from watching themselves in that scenario. And then we’re going to have the opportunity to be able to discuss what happened in it, go back and maybe do it again, and video it again so that they will get the positive reinforcement of ‘I did it this way the first time,’ but we all know practice makes perfect. They’re not going to be perfect at the get-go, and we don’t expect them to be, but then for them to be able to grow in their skill over time is really going to be a benefit.
It sounds similar to sports. All the great athletes watch their plays back.
That’s exactly what it is. It is exactly that same thing. You see them with their iPads on the sidelines, watching things in between innings or in between plays or whatever. The quarterbacks are looking at it. That’s exactly what we’re going for.
Tell me more about the logistics. How is the new center being funded and what are your timelines for opening?
It’s under construction right now and the Vera Z. Dwyer Trust has donated a substantial amount of money for it. They’ve been very supportive of our nursing program and our Dwyer College of Health Sciences for a number of years now and so we are very grateful for that. We do have a piece of the pie that is not yet covered and so we have several fundraising efforts that we are trying to pick up those last few pieces.
The construction is supposed to be done Dec. 18. We do take Christmas break. We are on an academic schedule. Once it is done, we have some HVAC stuff that is coming in at the beginning of the year, and then we have to move all of our equipment and move in. We have to get the beds, the mannequins and all of that kind of stuff. We’re going to take the spring semester to move into the space, and we will begin using it as learning space in the fall semester. We also have to get inspected by the Indiana State Board of Nursing. They want to know that the space is adequate and meets the standards for nursing education before we are actually in the learning space.
Nursing is doing fundraising. We have a fund in honor of LuAnn Woodrick, who was a faculty member here for many years, and died tragically in a car accident in 2016. She was our first simulation nursing instructor. She brought simulation to IU South Bend. My dream is that our alumni will gather themselves by $50 bills and $100 bills to be able to, if we mobilize our over 2,000 alumni and friends and family, dedicate one of these rooms to LuAnn. She’s with us every moment. Whenever we do simulation, we think of her. She is honored in our current simulation space and so we want to continue to honor her and the strong roots that she gave us in simulation in the future.
This comes at a time when there’s national shortages across the nursing industry. What role does IU South Bend’s nursing program have to play in filling these gaps?
Nursing is struggling as a profession. We were pounded in the pandemic. Nursing takes great pride in being the No. 1 most trusted profession in the country and we’ve been that way for many, many, many years. However, during the pandemic, we really got smashed from political ideologies, from changes in policies, from an unknown virus that didn’t have much science behind it, flying with the best theoretical knowledge we possibly could under the circumstances, with a lot of fear, placing our families at risk, not knowing how much we were placing our families at risk, trying to protect the health of the nation and trying to protect our own health and the health of our families.
There was a lot of moral distress. We couldn’t give nursing care the way we wanted to. Nursing is very holistic in our approach. Families are always part of everything we do. To remove families from our nursing care caused moral distress. We are still recovering from that moral distress as a profession. Curiously, during the pandemic, there were a lot of nurses who left the profession. At the beginning, the largest number of people leaving the profession were those who were older, my age, 60 and older, who would have been retiring in the next four or five years and just said, “You know what? This is too much. I’m going to leave right now.”
But, currently, the people who are leaving the nursing profession more than anybody, are those who are 30 and younger. It’s the climate of nursing and their inability to do nursing the way they want to do nursing and to provide care in the way that they know they should be providing care, but don’t have the resources, don’t have the manpower to be able to do it. The money is short. Somebody in health care is making money. It isn’t acute care hospitals and it certainly isn’t nurses. There needs to be an equity check and figure out the distribution of resources in a way that helps nursing be more sustainable. It is not sustainable right now.
We understand at IU South Bend that baccalaureate-prepared nurses will be the leaders for bringing nursing out of this hole, so the people we are graduating, we invest a huge amount into them, realizing they are the future of health care in our community. If we’re going to come out of this, we’re going to come out of it on the shoulders of our graduates. So, every faculty member takes that very seriously.
Whatever we can do to make nursing education more realistic and to think ahead into what skills and thinking processes and communication skills they will need in the future, and start to work on that now so that they are in a position to be able to grow into and build their professional practice over time so that when they are 40-year nurses, as I am now, they can look back and say, “Wow, that’s where we started, but look at how far we’ve come.” That’s our goal.
That said, why should students choose to go into nursing today?
It is the most fulfilling profession you could ever ask for in the entire world. That’s why. It’s because we make such a difference. I teach in the last semester before graduation and I do in-class reflective writing. I periodically ask them questions that they write on, and one of the questions I asked a few weeks ago was “How did you make a difference as a nurse in the last week?” And, one student was so taken with it, she wrote about it but then she came up to my office later and told me a story.
She was talking about a patient that she took care of who needed pain management, and had some other diagnoses that made it tricky to get this patient the medications they needed because of some organ failure. She stayed on that patient for the entire shift and collaborated with the staff nurse who collaborated with the hospitalist to get that patient pain meds that he hadn’t had in 24 hours. He was learning to live with an amputation and he can’t learn to live with an amputation if his pain isn’t managed. On that day, she may have changed him from living in a long-term care facility to being able to be discharged to home because she managed his pain. That’s what brings us into work every day. That’s the work we do.
Anything else?
Our graduation rates are above 90% and our retention rates are also at 90% so the people who come into the nursing program, stay in the nursing program and graduate from the nursing program. And 90% of those who graduate from the program stay in basically our three county area. Most of them stay in the South Bend, Elkhart and Plymouth area. We feel that strongly we are directly feeding our health care community. We know that we are feeding Memorial and Elkhart and Goshen and St. Joe, that we are a feeder system for those health care agencies.
We are also a feeder for all of those other non-acute care facilities. We are also feeding the school systems with school nurses and outpatient infusion therapy and hospice. Some of our grads are in the health department. Some of our grads are community health workers in our community. They’re doing a wide variety of things.
The 10% of students who go outside of the area, we’re very proud of them, too, because they’re going down to Riley Children’s Hospital. They’re going out to Colorado. We have several who are in Boise, Idaho, doing phenomenal work in critical care units in Boise, Idaho. We have graduates all over and it’s cool that you are educated in the South Bend area and then go to these big metropolises, Chicago and places like that, and they come back and say we had a great education. We were well prepared for the transition into professional practice.
But, we also have a very tight nursing community in the South Bend area. I’m the assistant dean of nursing at IU South Bend. I had lunch yesterday with the dean of nursing from Saint Mary’s. I had lunch with the dean of nursing from Bethel a few months ago. We all talk to each other. We are very close and we are collaborative. We are feeding the community together. We are not doing this solo and we also have tight relationships with all of the area health care facilities. Without their generosity of opening their doors, our students couldn’t get the education that they’re getting, so we closely work with Beacon and St. Joe and Goshen Health, along with a lot of those other outpatient clinics and South Bend Clinic and places like that to help educate our students and we’re very grateful for those relationships.