News: CJ Exclusives

State regulators relaxing some rules to let nurses, doctors graduate, go to work

Nurse Jennifer Witting stands beside telemedicine equipment at the Aspirus Keweenaw Hospital in Laurium, MI on June 20, 2012. The Aspirus Health Foundation, Inc. received two Distance Learning and Telemedicine (DLT) grants through the U.S. Department of Agriculture’s (USDA) Rural Development (RD) DLT Program. (USDA photo)
Nurse Jennifer Witting stands beside telemedicine equipment at the Aspirus Keweenaw Hospital in Laurium, MI on June 20, 2012. The Aspirus Health Foundation, Inc. received two Distance Learning and Telemedicine (DLT) grants through the U.S. Department of Agriculture’s (USDA) Rural Development (RD) DLT Program. (USDA photo)

State regulators are helping nursing and medical students graduate and enter the workforce. 

The coronavirus froze students’ clinical hours, partly shuttered testing, and threatened to block hundreds of students from graduating and treating patients — just when the state most needs them. 

The N.C. Board of Nursing has waived regulations and stepped back as a regulator to let nursing students graduate on time. The board could continue to lower regulatory barriers, depending on lawmakers and the virus, said David Kalbacker, spokesman for the nursing board.

The N.C. Medical Board postponed certain examinations to ensure hundreds of applicants don’t get sidelined from the workforce, said medical board spokeswoman Jean Brinkley.

“We’re looking for those barriers and getting rid of them,” Brinkley said. “In a pandemic, we are looking at a situation where it literally might be all hands on deck.”

The spread of the virus canceled most students’ clinical hours. With shortages of protective gear, many hospitals and clinics froze student’s clinical rotations. Colleges scrambled to move clinical experience online so students could meet regulatory thresholds.

“All of the students are at different places. Clinical rotations are as individual as the student is individual,” said Dr. Lori Byrd, N.C. Community Colleges Health Sciences Program associate director. “It’s been a whirlwind, but the thing that’s been the best for me was seeing the instructors and the students rise to the challenge.”

Teachers moved to virtual simulations for nursing students, said Louise Fleming, assistant dean of the UNC Chapel Hill School of Nursing. Almost half of her students completed the 120 hour focused care experience required by the N.C. Board of Nursing before the college shut down dorms and clinical training. 

But the pandemic has stretched community colleges, which have struggled for years with less funding and lower teacher salaries.

“This is not business as usual,” said Kim Gold, N.C. Community Colleges chief academic officer. “It’s a steep learning curve, and it’s a fast learning curve. Those colleges are being creative and doing the best they can. They have limited resources, but they are being creative.”

Some rural schools are providing internet in their parking lots to help students who don’t have internet access, said Byrd.

“Rural areas in N.C. traditionally struggle with having access to high speed internet — and then you close the McDonald’s,” Byrd said. “This is their way to a better life. Going through school, they have to make whatever concessions they can.” 

Students’ ability to become certified was also threatened. Some testing locations briefly closed, and teachers feared the coronavirus would slow testing. 

Regulators responded. Nurse anesthetists, nurse midwives, and clinical nurse specialists can practice without finishing their certification exams during the emergency. Similar waivers for nurse practitioners are pending.

“We don’t want to put barriers between people and the workforce,” Kalbacker said. “They know their students, and we certainly don’t want to be a hindrance to more personnel getting out into the trenches and clinics and hospitals where they need to be.”

Other action is more informal. Kalbacker says the board will give colleges some discretion on the number of clinical hours nursing students need to graduate and care for patients.

“If they feel that these students are competent, that they can grasp what they need to do, we’re not going to sit there and count every hour,” Kalbacker said. “I can see how it’s a little dicey for program directors, but I think that’s a decision they can come to with their graduates.”

Both boards temporarily waived criminal background checks, after the virus affected fingerprinting services.

“We’re going back to something that was done 30 years ago,” Byrd said. “It’s how I started. It does work out. It’s not what they want, it’s not optimal, but this is an individual situation. And we have to adapt.”

This isn’t the end of the nursing board’s work to break down barriers, as it studies executive orders from states such as Maine and Louisiana. Louisiana temporarily suspended physician supervision on nurse practitioners, says Kalbacker. 

Some lawmakers questioned whether regulators would act to help nurse practitioners volunteer at the second meeting of the House Select Committee on COVID-19 Health Care Working Group. Nurse practitioners can’t volunteer to help with the coronavirus without a physician supervisor in N.C.

“Nurses should be regulated by nurses, and they should collaborate,” Kalbacker said. “I think we’re getting closer, and this crisis may push it even closer to regulation by nurses solely. But it may be a bridge too far in this environment.”

The push to waive physician supervision will depend on the N.C. Medical Board, unless Cooper intervenes, says Jordan Roberts, John Locke Foundation health care policy analyst. The board defended physician supervision in March. 

“The board doesn’t have anything that it’s ready to talk about, but it is continuing to look at other opportunities to maximize the supply of healthcare,” Brinkley said. “There’s already quite a bit of flexibility in N.C.’s supervision law. Never say never, but that’s a point.”