October 2, 2020

Nursing Students Say School's Outdated Attendance Policy on COVID Tests Puts Them At Risk

Nurse checking on patient in busy hospital room

When Rachel Smith,* 25, a nursing student in her last semester of school, first came down with a cough, she brushed it off as a head cold. 

As her symptoms persisted and worsened, however, Smith started to wonder if she could have contracted COVID-19. One-by-one, she checked off all the COVID boxes: 

  • brain fog 
  • body aches 
  • loss of taste and smell
  • headache
  • fever 
  • fatigue so deep that she began slurring her words

The real deal-breaker, however, is when a coworker whom she had ridden home with, tested positive for the virus only one day after they had worked together. 

Now, along with certain exposure and the fact that she was already experiencing her own symptoms, Smith was faced with a dilemma: 

  1. Should she get tested and risk being kicked out of her nursing program?
  2. Skip testing and potentially infect others?

Unclear Policies on COVID-19 

Smith struggled with an almost impossible situation brought on by unclear policies and procedures by her nursing school. Even more troublesome, Smith is not alone - nursing students across the country are facing the exact same struggle. 

The school--like many--had a strict attendance policy that punished any student who missed more than one clinical day. A COVID-19 diagnosis meant a two-week quarantine, and thus, missing all school and in-person clinicals. 

Although the school’s attendance policy was clear, what the school failed to do was set any sort of policy on what would happen if a student did test positive. Instead, they said each case would be “individualized,” Smith relates. 

Unrealistic Attendance Policies in a Pandemic

A fellow nursing student who had tested positive was told she could not advance in the semester, as she would be missing clinical days that could not be made up. This student, already a semester behind because of the shut-down in the spring, was forced to delay her graduation by another whole semester. All because she had tested positive for a virus she could not control and informed the school of her diagnosis. 

After word got around about what happened to the student, fear settled into the remaining students. No clear policies and a student penalized created an unofficial “don’t ask, don’t tell” environment for the small-knit group of students. And Smith struggled with what she should do. 

Rapid Testing is Not Available in All Areas

Taking a test could mean forfeiting her chance to graduate in December, but not taking the test could mean potentially infecting the high-risk patients on the floor she was working with. And further complicating matters was the fact that rapid testing was not widely available in her area, meaning that a test taken on Tuesday, when she first exhibited symptoms, would not give her a result in time for her back-to-back clinicals on Thursday. 

In the end, Smith did what she felt was the only decision she could feel comfortable with and called several testing centers until she found one that would offer a rapid test. “I felt like it was my obligation to keep people safe and that I shouldn’t return to clinicals until I knew I didn’t have COVID-19,” Smith tells Nurse.org. 

Her result? Positive. 

More Students Speak Out

After Smith shared her positive diagnosis with her school, a rather remarkable thing happened: almost all of the other students in her clinical group admitted that they too, were experiencing symptoms. However, none of them had spoken up out of fear of being held back in the semester. 

Upon learning that other students were displaying symptoms, the school decided to suspend in-person clinicals and offer remote learning--and the decision turned out to be a timely one, as two additional students in her direct clinical group also went on to test positive. 

As Smith’s experience clearly exemplifies, when nursing schools fail to implement clear policies that guide their students exactly what to do if they are experiencing COVID-19 symptoms or if they have been exposed to someone with a positive test, everyone suffers. Smith struggled with feeling like the decision was left on her shoulders alone, weighing what she feared was a real threat to her patients with her own graduation. 

American Association of College of Nurses Guidelines on COVID-19 

Instead of leaving COVID-19 testing up to student’s discretion and electing to handle cases on an individual bases, nursing schools need to follow the clear guidelines set by the American Association of College of Nurses, which state that nursing schools should: 

  1. Actively encourage students, faculty, and staff who are sick or who have recently had close contact with a person with COVID-19 to stay home or in their living quarters.
  2. Develop policies that encourage sick individuals to stay at home without fear of reprisals and ensure students, faculty, and staff are aware of these policies. Offer virtual learning and telework options, if feasible. 
  3. Have students, faculty, and staff stay home when they have tested positive for or are showing symptoms of COVID-19. 
  4. Have students, faculty, and staff who have had recent close contact with a person with COVID-19 also stay home and monitor their health.

Moving Forward 

Today, Smith is still in her 2-week quarantine and recovering at home with her partner, who also tested positive. She tells Nurse.org that simply walking around her yard leaves her feeling winded and she is still struggling with brain fog. Although she is glad that she got tested and did what she feels was ultimately the right thing, she wishes that her school--what should be a model for leading public health decisions--had better supported her during a difficult time. 

“I wish our school would have had a plan in place to let us feel secure in knowing that if we got COVID, then we would still be able to graduate on time and it wouldn’t hold us back,” she notes. 

*Names have been changed to protect privacy

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