Nursing Students Step up Amid Pandemic by Vaccinating Community

When the spring semester began in late January, it seemed as if the stars had finally aligned for Cal State San Marcos to send its nursing students back into the community for their badly needed clinical rotations.

Some were scheduled to be stationed in the Valley Center-Pauma Unified School District, providing health screenings and education to children of all ages. Others were bound for a food pantry in Fallbrook. Still others were slotted to go to Rachel’s Women’s Center, a homeless shelter in downtown San Diego.

COVID-19, however, was not done wreaking havoc on the usual operations of the School of Nursing at CSUSM. For various reasons stemming from the pandemic, the planned community health rotations barely got off the ground.

So the leaders of the nursing school did something that they have become all too accustomed to during this once-in-a-century health crisis – they adjusted on the fly to ensure that CSUSM nursing students are continuing to receive the best possible preparation for their careers despite the restrictions imposed by the coronavirus.

Only days before the semester started, nursing lecturer Madelyn Lewis got an email from a colleague at Palomar Health informing her that the company, in concert with the County of San Diego, would be opening a drive-through vaccination site at its former hospital in downtown Escondido and was seeking CSUSM nursing students to help administer the shots. By early February, Lewis had completely shuffled the schedules of dozens of students, who were now assigned the valuable and life-affirming task of helping vulnerable community members begin to escape from the year-long darkness of the pandemic.

“Since all this started, the one thing I kept saying is, ‘We have to be part of the solution,’ ” said Lewis, a retired county public health nurse who has been teaching at CSUSM for about a decade, in the area of community health. “As a former public health nurse, there’s nothing more important that we should be doing than vaccines and testing. What else is there, really? We’re doing what public health needs us to do, and because of the gravity of the situation, the students are thrilled to be helping.”

That certainly looked to be the case on a Thursday in mid-March, when about 10 students from the Accelerated Bachelor of Science in Nursing (ABSN) program joined Lewis in the parking garage of the old Escondido hospital for an eight-hour shift of giving vaccines to people in cars as they navigated the drive-through location.

It was the seventh week of Lewis cobbling together groups of students to work at the site three days a week, and they had the process down to a science. The students moved quickly and efficiently as the cars snaked through the garage in pods of several each, with each vaccinator assigned a number position on either the inside or outside lane.

The setting was drab, to be sure, but lights had been strung up to brighten the atmosphere, and that was matched by the mood of the clients after they received their shots. Many of them hollered out their windows or honked their horns as they exited out of sheer elation.

“I just feel so proud. At the end of the shift, no matter if it’s a good day or a bad day, I know that we’re doing the work that people are dying to have done – literally dying,” said Joseph de Silva, who will be graduating with the rest of his ABSN cohort in May. “Our knees are hurting, our backs are aching, but we all have smiles on our faces when it’s done. Hopefully, we can vaccinate as many people as possible so life can return to normal.”

When Di Pham entered the ABSN program in January 2019, she never could have imagined what she would be doing just over two years later, before she even obtained her nursing license.

“I think this is a career-defining moment for all of us, and to have that so early on in our experience is so neat,” Pham said during a break from vaccinations last month. “Whatever path we choose to go on, this will be remembered in history for a long time, and we get to be a part of it. We’re lucky to have the opportunity.”

Two days before de Silva, Pham and classmates vaccinated hundreds of community members at Palomar Health, four other students in their cohort were engaged in the same vital task on CSUSM’s campus, in The Sports Center as part of the vaccine site that was then run by the county and now is being managed by Sharp HealthCare. The contrast from the scene at Palomar couldn’t have been starker – this was a walk-in clinic in a well-lit, cavernous space – but the ebullient vibes in the air felt comfortingly familiar.

Evan Swarth, an ABSN student originally from Washington, D.C., was in his seventh week of working one shift a week at The Sports Center, and he estimated that he had administered more than 300 shots during that time. On this day, Swarth was paired at a table with fellow nursing student Austin Reese, who was new to the CSUSM site after spending the previous few weeks at St. Paul’s PACE, a senior care center in Chula Vista. Swarth was greeting and asking questions of the clients while Reese was handling vaccine paperwork and database duties.

“This has been the coolest experience for me so far because so much of health care can be kind of depressing,” Swarth said. “Patients in the hospital might not even want their nurse to be in the room, and certainly don’t want a nurse near them with a needle. But when they’re coming to us here, they’re so excited and looking forward to the experience. That’s really special to see, and also we can feel how grateful and appreciative they are.”

Swarth recounted the case of a 97-year-old woman who, in his words, “traipsed and boogied” from the entrance of The Sports Center all the way to the table where Swarth was to give her the vaccine.

“And she even invited me over to a little dancing party later,” he said. “That was my favorite one.”

Rosemary Gaines, the nursing lecturer who supervises the students at the campus site every Tuesday and Wednesday, said those types of interpersonal interactions with clients are invaluable for the professional development of the nursing students. The act of giving injections is the easy part, a basic skill that’s learned early in nursing school. It’s the so-called “soft skills” that are being put to the test.

“We try to make this like the real world because they’re almost in it,” Gaines said. “They don’t just meet the client. We do a lot more than just, ‘Here’s your Pfizer injection.’ We talk to them, get to know them, because they’ve been very socially isolated.” 

The Sports Center and Palomar Health had been the only area locations where CSUSM nursing students are administering vaccines, but recently a third site even closer to home entered the mix. Last late month, CSUSM was approved to receive its first doses of the Moderna vaccine, and soon after the university opened a clinic exclusively to vaccinate members of the campus community. The clinic now has been operating for three weeks, and nursing students have been tasked with giving out those hundreds of shots as well. One of those students, Dominique Agosta-Westley, gave a shot to Deborah Kristan, the interim dean of the College of Education, Health and Human Services (in which the School of Nursing resides), on March 24, the first day the clinic was open. 

It’s all quite a change from where the School of Nursing found itself at this time last year, when its students and faculty absorbed perhaps the biggest impact from the abrupt shutdown of campus and nearly all facets of society. It wasn’t just that their ground classes became remote classes. Almost overnight, all of the meticulously arranged clinical placements around the region dried up, imperiling the students’ graduation dates and immediate job prospects. 

“As spring turned to summer, we had to go about finding new sites, literally from scratch, in the middle of a pandemic, finding places that would take students under whatever circumstances,” Lewis said.  

As the course coordinator for community health nursing, most of that burden fell on Lewis’ shoulders. She pieced together a few new partners – Rachel’s Women’s Center, St. Paul’s PACE in Chula Vista, La Posada de Guadalupe men’s shelter in Carlsbad – and when the county opened up the COVID-19 testing center at CSUSM to nursing students last fall, that created a wealth of opportunities.  

Meanwhile, on campus, nursing faculty were similarly being resourceful to ensure that students still were receiving the education they needed. While lectures remained virtual, last summer the School of Nursing began running a socially distanced skills lab in University Hall to provide students practice with the types of core competencies that they ordinarily would be honing in a hospital or clinic.  

And more recently, the nursing school has compensated for the absence of traditional preceptorships in hospitals by offering virtual reality simulations. When students come to the lab on their assigned day, they participate in face-to-face, manikin-based simulations. Then they head to Inspiration Studios in Kellogg Library to participate in VR simulation experiences. The sessions are overseen by professors, with technological help from Blake Schilling, the coordinator of Inspiration Studios. 

“The goal of the VR experience for our students is to strengthen their clinical reasoning skills by mimicking real-world patient care and the problems and risks they encounter there,” said Sheri Biro, simulation lead faculty. “It helps them to develop skills and build confidence to prepare them for clinical practice.” 

Most CSUSM nursing students will admit that they would have preferred to get the complete clinical experience that the pandemic has denied them over the past year. But the wide-reaching improvisation and adaptability of the School of Nursing leadership and faculty served the students well, allowing them to receive a high level of career training under historically adverse circumstances. 

“The most valuable part of this experience for me has been the overall reminder of why I decided to become a nurse, which is to serve and help the community,” Swarth said. “And what better way to do that than to be part of this surreal experience that we’ve never seen before in the history of our time.” 

Media Contact

Brian Hiro, Communications Specialist

bhiro@csusm.edu | Office: 760-750-7306