Thursday, December 1, 2022

NHCS health science teachers speak out against deal with Novant

The New Hanover County Schools Tuesday meeting agenda contained a review of a of a memo of understanding with Novant Health NHRMC, passed by the board on Aug. 2. (PCD/ Amy Passaretti).

NEW HANOVER COUNTY — A deal to train high school nursing students in a hospital has sparked resignations and calls for the New Hanover County School Board of Education to intervene. 

The New Hanover County Schools Tuesday meeting agenda contained a review of a memo of understanding with Novant Health NHRMC, passed by the board on Aug. 2. Board member Judy Justice requested more information on the agreement after teachers raised concerns on how it would affect the nursing fundamentals course, taught at Hoggard, Laney and Ashley high schools. 

The MOU calls for students, who take the course to gain certification as a nurse aide, to complete some clinical hours in New Hanover Regional Medical Center. It shifts the setting of the training to an acute hospital; the program has been completed in long-term care facilities for decades.

Port City Daily talked to two health science teachers, both of whom wanted to remain anonymous due to fear of retaliation from NHCS and Novant Health. Throughout the article, they will be referred to as Allison and Wanda. 

Allison explained, in her 20 years experience, the common practice has been to train students in nursing homes, mainly because the patients are “stable.” 

“To bring a high school student into a nursing home setting is difficult enough and the students, they’re going from dealing with a mannequin in my lab to dealing with a real person,” Allison said. “They don’t have IVs, they don’t have any catheters in their body, there’s no tubes, there’s usually no oxygen — they are just an older person who needs medical assistance.”

NHRMC does not have a long-term care unit, therefore, students will be paired with a Novant charge nurse, or someone who manages a nurse department. That person will coordinate training on the hospital’s “lowest-acuity patients” — or individuals with less-intense conditions.

However, Allison said just being in a hospital means a patient will need more care than her students are prepared to handle.

“When I bring them to the nursing home the first time they get in front of a patient, they are absolutely terrified,” she said. “We have to take it very slow.”

She explained during the first few days students do simple tasks: Talk to patients, take temperatures.  

“By the time we leave, they’re giving showers, they are feeding, they’re changing linens, they’re doing everything,” she said.

The skills needed for nurse aide certification include measuring vital signs, dressing and undressing the resident, moving the resident in bed and providing mouth and denture care — only RNs are allowed to administer medicine or start IVs. 

The North Carolina Department of Public Instruction’s guidelines for the nursing fundamentals program are in-line with long-term care facilities. 

NCDPI requires 40 practicum hours to be completed in the career and technical education course. According to the 2022 memo, students would complete 10 of those hours at Novant. The school district’s FAQ document, included in Tuesday’s agenda, states: 

“CTE highly recommends the student attends clinicals at Novant Health NHRMC after completion of 30 clinical hours and their required skills check-off at a skilled nursing facility. (The required skills are assigned by NCDPI and are listed on a nurse aide training summary document provided by NCDPI: 40 hours are required).” 

The district attached the skills proficiency checklist in the agenda, which noted: “Student must demonstrate the ability to transfer NA I skill proficiency from the training lab to direct resident care in a long-term care setting.” 

Not only is student learning a concern among teachers, but they are also worried about how they will be protected under the district’s liability insurance. Wanda, a former health science teacher, said it was not clear if teachers would be covered as a RN, therefore putting their license at risk if a student, who must train under them, injured a patient. 

PCD asked the district if its insurance covered teachers in RN capacity; the communications team did not respond to the question but instead pointed to the MOU document and Tuesday’s meeting recording, which doesn’t clarify as much. 

“The hospital is way bigger than these nursing homes we go to and we can only have 10 students legally under our nursing license,” Wanda said. “But what if I’m in a room with a student and six rooms down, a nurse or CNA says, ‘Hey, you come here, I really need you to help me do this.’ And because these students are good people and want to help, they do it, and that patient gets hurt. Who’s to blame?”

According to Allison and Wanda, the MOU, and their opposition to it, has been in the works for nearly a year. They said they were never included in the decision to enter into the MOU with Novant. 

Both women said the NHCS superintendent at the time and Novant officials toured nursing fundamentals classrooms in the fall of 2021. Wanda detailed she was not notified of the visit nor the reason behind it. She said a couple weeks later is when health science teachers were told they would start training their students at the hospital.

When asked if Novant officials toured any campus last fall, New Hanover County Schools chose not to answer and Novant did not respond by press. 

Wanda said a coalition of teachers, including Allison, sent messages to the district attempting to set up a discussion to share their concerns with hospital training, only to be met with silence.  

Then, according to both women, a meeting was finally orchestrated. Wanda said the principals at each participating school discussed the plan via Zoom with Holly Reynolds, manager of Nursing Professional Development at New Hanover Regional Medical Center, in March. 

Wanda said they detailed their anxiety with shifting the program to a different setting, especially to a hospital mired in problems this year. Novant NHRMC came close to losing its Medicaid license over the summer, nurses are understaffed and must take on unsafe patient-to-staff ratios — all conditions that could cause more liability concerns. 

Wanda also said she was told during the meeting that classroom equipment was “already being funded by Novant,” which she took as an indication the district already made a decision to partner in training facilities. 

Both women confirmed they were told by district staff they would be written up for insubordination if they refused to train their students under their license at Novant. When it was clear they were going to be forced into the new program, the women decided to resign.

Teachers Margaret Gambino, who launched the nurse aide program at Ashley in 2003, and Ashley’s career development coordinator Emilie Pridgen, questioned the board of education’s MOU approval at Tuesday’s meeting. The women wanted to know why the current program — which has a 98% success rate — was now being changed with no consultation with the teachers.

“These programs are some of the most successful in our county and nothing was broken with them,” Pridgen said. “The rest of the teachers will leave if this plan stays in place. You will lose your health science programs.” 

“Do any of you know what it’s like to bring a teenager into a clinical setting?” Gambino asked the board. “When we questioned our license and liability, we were literally told ‘we all have a license to lose.’”

Prior to the public comment at Tuesday’s school board meeting, the board heard an explanation from Barbara Burt, who oversees the health science division at NCDPI. 

“There is no difference between the students completing their clinicals in the Nurse Aide I training program at a long-term care facility versus a hospital,” Burt said in the meeting.

Reynolds, who also spoke at the meeting, told the board students are placed in the hospital’s rehab facility, mostly made up of geriatric patients. She added Novant has been working with Brunswick County Schools’s nursing students for years.

At Cape Fear Community College, students completing the Nurse Aide I course do not complete their clinicals in a hospital setting. According to Sonya Johnson, CFCC’s vice president of marketing and community relations, the course is designed to assist individuals with “activities for daily living — care that would be required in a long-term residential or memory care facility.” It isn’t until the Nurse Aide II course, where students have completed their certification, that they are trained to work in acute care and complete their clinicals at NHRMC.

At Tuesday’s meeting, NHCS Chief Academic Officer Patrice Faison offered one perk to training students at Novant; the company will pay for CNA’s, or nurse aides, to become RNs. According to Wanda, the program Faison is most likely referring to requires a nurse aide to work for Novant for two years before the company will cover RN schooling. 

Contrary to the being iced out from the district, as Wanda and Allison described, Faison assured the board teacher’s concerns were being taken into consideration.

“We’ve heard our staff’s concerns,” Faison said. “Keep in mind, our students have to complete 40 hours of clinicals — we’re just asking right now that they get 10 [at Novant].”

Faison said the district’s plan is to hire an outside nurse for this spring to carry nursing fundamentals students to Novant, with NHCS teacher’s working collaboratively with the nurses at Novant. 

Per her understanding, Allison said the district plans to increase the amount of clinical hours to be completed at Novant every year until long-term care facilities are phased out — what she deems a “heartbreaking” result.

“When you go to these nursing homes for the last 20 years, you get really attached to those patients — they’re wonderful,” Allison said. “When I come with my nurse aides, they’re so excited to see them because we’ve become family to them. They are going to really miss us.”


Reach journalist Brenna Flanagan at brenna@localdailymedia.com 

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