Telenursing Community Partnership Solved Clinical Placement Dilemma

In her final semester at Dominican, nursing student Melissa Barroso ’20 was a much appreciated voice on the other end of the telephone for Ruth, a retired nurse who now lives in the West Marin County town of Point Reyes Station.

Ordinarily, the two would have met in person. For the past six years, Dominican’s Dr. Ellen Christiansen and her Community Health nursing students have performed in-person home visits in collaboration with Laura Sherman and Susan Deixler, care managers at West Marin Senior Services.

The Community Health program has grown into a successful, locally-based collaboration that has served more than 150 older adults in West Marin and elsewhere throughout Marin County. Ruth, now in her 90s and legally blind, is one of the WMSS’s many elderly clients.

Last semester, thanks to fast action by Christiansen and colleagues in the Department of Nursing, the in-person program transformed into a telenursing option designed to provide direct patient care experiences for Dominican’s senior nursing students. This was a win-win move — one that ensured dozens of senior nursing students would gain the clinical hours necessary for graduation this spring.

The transformation also was testament to Dominican’s strong community ties, says Dr. Andrea Boyle, Chair of the Department of Nursing.

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“Forming long-term and trusting partnerships with community organizations is something that Dominican does very well,” Boyle says. “When we suggested the telenursing program we received an immediate yes!”

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In March, Dominican received approval from the California Board of Registered Nursing (BRN) for the telenursing clinical placement option. This came as obstacles to completing clinical education hours risked delaying graduation for thousands of nursing students in California. Many hospitals and other healthcare facilities where students complete their clinical rotations suspended their programs for students as the facilities respond to the COVID-19 pandemic.

“This telenursing program was an excellent solution that not only benefits one of our community partners, but also will enable our students to graduate and enter the workforce at a time when they are desperately needed,” says Dr. Ruth Ramsey, Dean of the School of Health and Natural Sciences.

About 30 senior nursing students were paired with about 50 elderly WMSS clients under the supervision of WMSS staff and Dominican faculty preceptors.

The Dominican students interacted with elderly and at-risk clients through a series of telephone or online sessions addressing nursing, health, and social well-being issues. The clinical placement was part of a four-unit Leadership and Management preceptorship course and enabled participating senior nursing students to complete from 10-20 course clinical hours.

For Melissa, nursing was an early calling. In a recent thank-you letter to the Board of the Mother Mary Raymond Scholarship program, Melissa noted that the main driving factor for attending Dominican to study nursing was her mother, Michelle Barroso (Santiago) ’97.

“I too wanted to love and care for others in the manner she did, which is why I chose this hands-on profession,” Melissa wrote in a note of thanks after being awarded the Legacy Scholarship.

Melissa’s mother was a labor and delivery nurse at El Camino Hospital. She sadly passed away from cancer more than a year ago.

“Growing up and having the privilege of listening to her work stories, seeing her receive letters and gifts from the patients whose lives she touched, and watching her interact so lovingly with her coworkers inspired me,” Melissa says.

Dr. Boyle says that the WMSS program provides students with hands-on experience delivering compassionate care during clinical phone interactions with this group of vulnerable and at-risk elders.

“Compassionate care is an essential part of nursing — and one that often is overlooked as students prepare to enter the workplace,” Boyle says. “This program will give the students a wonderful reminder of the importance of compassion and caring in nursing.”

Each student was provided with the name of a WMSS client and was responsible for making initial phone contact with their client for an introduction and to determine a telephone or online contact schedule to meet client needs. Throughout the course students took a full medical history, compiled a complete medication list, and completed both a thorough functional assessment and a home safety checklist.

Students also researched medical topics on behalf of their clients in order to provide evidence-based information that the client can discuss with a primary care provider. The course instructors held video conferences with their clinical groups so that students could present and discuss their cases and the clinical group could contribute ideas for the ongoing care plan.

WMSS’s Sherman said the telenursing program provided a critical new service to semi-rural and rural seniors who are sheltering in place and experiencing increased isolation and heightened concern at this time.

“The telenursing program quelled many seniors' fears and conveyed peace of mind,” she says. Once it was announced, the demand was strong. “I received client phone messages ... ‘When is the student nurse calling me? I'm ready!’”

The telenursing program also quelled many students’ fears of being able to graduate on time. Within days of Dominican offering the telenursing option, the University received a heartfelt ‘thank you.’

“I thank you all from the bottom of my heart for forging this path for all of us to graduate on time, and with meaningful work,” wrote nursing student Meredith Weber. “In an unprecedented time, you all managed to turn one stress point into relief.”

Meredith noted that with two young children, running a busy household and completing school left her with few spare moments in the day.

 “While some programs are canceling, ours is shining as an example of how to get creative, leverage the good name/reputation we have built in the community, and keep us safe,” Meredith says.

While the shift to telenursing is essential this semester, Boyle believes it is a delivery method that the department will embrace in coming years.

 “We will need to continue — and expand — telehealth, it is meeting a demand that will not be going away any time soon.”