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Remote learning for nurses: how to keep staff training on track

When COVID-19 forced us to embrace virtual clinical education, we achieved more than a quick fix

Harnessing technology and understanding factors that influence learning is key

Learning carried out remotely became necessary as COVID-19 took hold Picture: iStock

When the COVID-19 pandemic hit the United States in March, not only did it require an emergency response from essential personnel and redeployment of staff to help in clinical areas, but all routine and established training had to be redesigned to ensure the safety of education staff and participants.

Like many other healthcare organisations worldwide, at Northwell Health Solutions in New York we had to work remotely, redesigning all our existing training so that it could be delivered virtually.

We were unsure whether remote learning would engage participants

Face-to-face training sessions were considered more personable by many and assumed to be

Harnessing technology and understanding factors that influence learning is key

Learning carried out remotely became necessary as COVID-19 took hold Picture: iStock

When the COVID-19 pandemic hit the United States in March, not only did it require an emergency response from essential personnel and redeployment of staff to help in clinical areas, but all routine and established training had to be redesigned to ensure the safety of education staff and participants.

Like many other healthcare organisations worldwide, at Northwell Health Solutions in New York we had to work remotely, redesigning all our existing training so that it could be delivered virtually.

We were unsure whether remote learning would engage participants

Face-to-face training sessions were considered more personable by many and assumed to be more effective, so concerns were initially raised about this new approach. How would we engage participants? How would we ensure they are paying attention? And would the training be as meaningful when conducted virtually?

The education team trains both clinical and non-clinical staff, who coordinate care for complex patients to keep them well and stable in the community to avoid unnecessary hospital admissions.

The areas covered by staff training include patient-centred care, teamwork and collaboration, social determinants of health, motivational interviewing, chronic disease management, end of life care and cultural competence.

Due to COVID-19, we also held virtual training sessions on infection control and the use of personal protective equipment (PPE), covering best practice for staff who had to make home visits and the donning and doffing of PPE, which was demonstrated using a video.

How we adapted our educational resources to the virtual learning environment

Before the pandemic, in-person training for nursing and non-nursing staff took place in a central location and was well attended and received. Each topic was presented in an interactive way with the help of videos, case studies and group activities, and questions were posed throughout the sessions, which were evaluated at the end via a survey.

Most of the content for the virtual sessions was taken from previous in-person training sessions, with all interactive activities revised to accommodate the virtual environment. Questions that would be posed by a group facilitator were built into interactive presentation software Mentimeter, which also enabled the use of videos, case studies, games, and the building a word cloud from participants’ responses.

‘Feedback showed participants’ level of engagement and interaction during virtual training sessions was the same as during in-person trainings, and satisfaction levels remained high’

We also had to think about issues such as group size, length of presentation, technology used by the participants and strategies to keep people engaged.

Size of the virtual training group

In-person training sessions were limited to 30 people due to the size of the training room. Although virtual training sessions are not limited to a specific number of attendees, limiting the number of participants can be helpful for training that requires the most interaction. The virtual motivational interviewing class, for example, was limited to 15 participants. We learned it was easier to start small and increase the number of people over time, with most training sessions accommodating 20-28 people.

Length of the presentation

All virtual presentations lasted between two and two and a half hours to keep the attention of the participants. This worked well, with most participants evaluating the sessions as ‘just the right length’. Two participants said they really enjoyed topics such as cultural competence and patient-centred care, and wished the sessions were longer.

Participants reported high satisfaction levels for their online training sessions Picture: iStock

Technology being used by participants

The sessions took place using Microsoft (MS) Teams so participants needed a computer and, ideally, a smartphone. Attendees were given different options – log in through a computer and use a smartphone for interactive activities; call in and log in through a smart phone; or use a computer only. Participants received an invitation and reminder email a day before each training session and were asked to log in ten minutes before training to test the technology. A designated facilitator was there to trouble-shoot; if someone had trouble logging in, for example, the facilitator could assist without interrupting the presentation if it had already started.

Keeping participants engaged

Mentimeter software was used to incorporate live polling by posing different types of questions – multiple choice, open ended, true/false – and elicit reactions. For those unable to use Mentimeter, the MS teams chat option was available. We incorporated interactive activities, such as case studies and games, and facilitators posed questions and comments intermittently. Participants were able to pose questions or comments by speaking up, using chat in MS Teams or through Mentimeter. Facilitators reviewed sign-in sheets before each training to understand the audience and ensure examples given ‘spoke’ to participants.

Between March 25 and September 25, we held 70 virtual training sessions for groups of 15-25 participants. A total of 895 people attended the trainings, with an evaluation survey showing they were rated ‘excellent’ by 90% of participants.

An effective way to deliver training

Overall, switching from in-person to virtual training proved to be an effective and safe method of delivery. Feedback showed participants’ level of engagement and interaction during virtual training sessions was the same as during in-person trainings, and satisfaction levels remained high.

As well as enabling us to train a larger numbers of participants, holding training sessions virtually saved participants’ time and cut costs because they no longer had to travel to a central location.

Overcoming difficulties with technology and keeping people engaged

But it wasn’t without its challenges, which included issues with technology, the increased likelihood of multi-tasking by participants during sessions, and the availability of facilitators to troubleshoot and monitor chats.

To address this, we had debrief sessions after each training to discuss what worked and what didn’t and what could be improved for the future. We designated one team member to assist with any technological issues, and a separate team member was assigned to monitor chat during each training session, which worked well.

We floated the idea of requiring participants to be on camera while in training to ensure they were not multi-tasking, but we have not implemented this yet; as adult learners, we trust participants to be responsible for their own learning and to want to get the most out of the sessions.

5 tips for making online learning more effective

  • Plan your session well, including practising beforehand and testing your equipment
  • Keep it interactive – include videos, pose questions and challenge your audience
  • Be ready for the unexpected – technical issues will happen so it’s important to have a plan B.
  • Evaluate each session using a post-session survey and/or team debrief, and look for ways to improve
  • Have fun! This is a great opportunity to be creative and learn new skills

What we thought was a temporary staff education fix could become a long-term training solution

When we initially implemented our virtual training sessions, we thought they would be a temporary fix and we would be back to ‘normal’ in a few months. The impact of COVID-19 in New York was severe earlier in the year; during the worst three weeks of the pandemic – March 22 to April 11 – New York City averaged around 33,000 new cases and 2,500 deaths each week.

Between August 16 and September 12, this had dropped to around 1,650 new COVID cases per week, with 30 deaths. Although cases are going up across the US, we are stable at this time in New York. I believe this is largely due to the protective measures that have been strictly enforced since March, such as mask wearing, social distancing, and the closing of many businesses with slow and measured reopening.

By holding virtual training sessions, we were able to continue staff engagement throughout the pandemic, as well as educating and supporting them. We have also started offering virtual professional development classes, such as time and stress management; these included tips for remote working, conflict resolution, preceptorship and communicating for results.

We were leaning toward a mix of virtual and face-to-face sessions until recently, but as we prepare for a resurgence of COVID-19, we will continue with virtual training for as long as we need to.


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