Linda Driscoll Powers shifted her career at the age of 35 to pursue nursing, sacrificing a lot for herself and her family.
The nursing student at the University of Colorado College of Nursing in Denver was a high school dropout who worked through her 20s and 30s to build a business, all while juggling being a young mother. For the soon-to-be-graduate, completing her nursing degree would mean she could walk in a graduation ceremony for the first time.
"I have never walked for anything in my life," she told The Independent.
Ms Powers' passion for mental health encouraged her to leave her desk job and pursue nursing with the goal to graduate in May 2020.
But the growing Covid-19 pandemic has forced CU to suspend clinical rotations and cancel the graduation ceremony, leaving some students, including Ms Powers, wondering if they will even graduate on time.
"It feels devastating," she said. "This degree is a really big deal for me and my family. We've all made a lot of sacrifices during this nursing school journey."
CU is working on creative alternatives for its 172 upcoming graduates to help them complete their clinical hours and avoid delays in graduation.
Creative alternatives for clinicals, such as telehealth and simulations, are up for consideration, but it is dependent on what the Colorado Board of Registered Nursing approves - Dr Fara Bowler, Senior Director of Experiential Learning Team and Dr Tammy Spencer, Interim Assistant Dean of Undergraduate Program, and Leli Pedrom Interim Assistant Dean of Undergraduate Program, told The Independent.
"We are doing everything we can to creatively make up clinical hours - from simulation to telehealth opportunities," the administrators said. "Our ability to make up any missed clinical hours is, in part, dependent on the current rules and regulations related to licensing and accrediting bodies."
The school says about 67 per cent of its class is on track to graduate on time because students like Ms Powers have just 29 hours to complete. But for the other 33 per cent, their graduation could be delayed as simulations and telehealth options "may not be an appropriate substitution for all clinical experiences" to complete the 144 hours they have left.
"We are working on making up the clinical hours for the remaining 33 per cent," the school added. "However, clinicals are not just a substitution of any type of activity; the curriculum and program outcomes are tied to specific clinical competencies depending on the specific area of nursing, from medical surgical to pediatrics to obstetrics to community health nursing.
"Our goal is that the entire class graduates on schedule."
Lina Stanchev, who initially planned to graduate from CU's nursing school in May 2020, is one student who has 144 clinical hours left to complete.
"It's feasible, but now that they're postponing everything I'm pretty certain that I won't be able to graduate by May," she said.
As the pandemic evolves, Ms Stanchev felt unless the school made a decision "imminently" about how she could complete her necessary clinical hours, graduating in May would be impossible.
"I think it is the uncertainty of it all that has been more stressful than anything," she said, "and not having any clear guidelines of what's to be expected."
But, ultimately, Ms Stanchev understood why it was necessary for her section of the class to face requirements of in-person clinical rotations.
"A reduction in those clinical hours would be great, but at the same time there has to be some sort of requirement where we show proof we've brushed up on our clinical skills and nursing judgement," she said. "That will make us more prepared for the workforce."
California nursing students are now asking Governor Gavin Newsom and the state's Board of Registered Nursing to alter guidelines for their graduation class to prevent delayed graduations.
CU has also asked the Colorado Board of Registered Nursing to decrease the number of clinical hours required "due to the lack of clinical placements in this Covid-19 crisis."
"We have not had confirmation from the state Board of Nursing that this request will be granted," Dr Spencer said.
The Independent contacted California and Colorado's Board of Registered Nursing to ask if altering graduation requirements is under consideration. A spokesperson for California's board declined to comment but said more information would be released "in the coming days".
Large universities in other parts of the US are also cancelling clinical rotations for an extended period of time.
The University of Missouri cancelled clinicals for nursing students through 31 March. The University of Arkansas Medical Sciences asked its students to immediately leave their clinical rotations amid the Covid-19 pandemic, according to Kaiser Health News, with no set return date. The University of Pennsylvania School of Nursing has also cancelled in-person clinical rotations until further notice.
Postponing or cancelling clinicals across the country encouraged the National League of Nursing (NLN) and the National Council of State Boards of Nursing (NCSBN) to ask nursing schools and state boards to "offer the greatest possible flexibility to students nearing graduation" during the pandemic.
"While the COVID-19 outbreak has forced many educational institutions to send their students home or provide them with online learning, it remains imperative that nursing educators also find ways to help their students graduate on time this spring," a statement read.
Dr Beverly Malone, CEO of NLN, told The Independent it was time for nursing schools to think innovatively for clinical rotations.
"These are unusual times and we need to do some unusual things," she said. "It's not like we can kind of lean back and say, 'This is how we do our programs.' We need to think about how we can make it possible for our students to get the education they need and move onto the next level."
"At the same time, we need to make sure they're protected and they're learning their objectives," Dr Malone added.
Simulations was one alternative NLN recommended for nursing schools to rely on.
"We have a percentage of at least 10 per cent simulation that we recommend for everyone, but we know it can go up to about 50 per cent," Dr Malone said. "And that means you wouldn't have to go into a hospital or into a clinical area to get quite a bit of that clinical experience."
Flexibility in these programs to graduate students on time is imperative, in part, because a nursing shortage is anticipated by 2030.
The US Department of Labours' Bureau of Labour Statistics anticipates nursing to be among the top healthcare professions seeing job growth with the workforce growing as much as 12 per cent by 2028. To accommodate this growth, more than 200,000 Registered Nurses (RNs) need to enter the workforce each year.
In 2019, 78,394 students graduated from nursing programs, according to the American Association of Critical-Care Nurses.
"(Delaying graduations) would expand the nursing shortage," Dr Malone said. "There are two major issues that fuel the shortage: not enough faculty and not enough clinical placements.
"Our job is to make sure the supply continues with the demand, and when I say supply I am talking about our nursing colleagues," she added. "We've got to make sure that the supply of nurses continues."
Altering the graduation requirements remains up to each state board or the governors of each state.
But for students like Ms Powers and Ms Stanchev, they just want a decision so they can plan to graduate and practice within their industry.
"Nurses are needed more than ever," Ms Powers said. "We need to be pushed through."