1. Section Editor(s): Howard, Elisabeth D. PhD, CNM, FACNM

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Each year, in May, we celebrate Florence Nightingale's birthday during Nurses' week and celebrate her life and contributions to the nursing profession. It is timely to reflect on her legacy and the significant role of nurses in the COVID-19 pandemic.1 Despite the negative effects of the pandemic, interest and enrollment in both medical and nursing programs have gone up.2 Although this increased interest in the profession is exciting, there is a concerning lack of both outpatient and inpatient clinical sites to support increased enrollment.2,3 This column is a reflection on this trend and the task before us in reimagining and ensuring adequate clinical sites for the future of nursing and advanced practice.


Nursing ethics are founded on the work of Emmanuel Levinas,4 which describes the ethic of belonging and our shared humanity with patients and one another. The coronavirus1 pandemic increased the visibility and the face of healthcare workers, specifically drawing attention to the challenges and rewards of patient care and of being a nurse. This window into the human and relationship-centered world of nursing care did not steer people away; it inspired an interest in nursing as a meaningful career. In addition, COVID-191 clinical care displayed the intense creativity involved in human-centered care.


Historically, despite great darkness, postpandemic times enjoyed an influx of creativity and collaboration across disciplines. For example, the Black Plague5 was followed by the Renaissance, a time of unparalleled partnership between artists and scientists. It was a time of innovation, of reimagining the world, examining perspective, beauty, and rebirth. COVID clinical care is abundant with such ingenious inventions in the form of nurse-led solutions.


Nurses are natural problem solvers and resourceful architects of the environment. They are at the forefront of developing person-centered and care-inspired clinical solutions. These examples span the gamut from trouble shooting mask design6 to designing low-cost, protective face shields6 to virtual rounding tools6 to the development of a hospital-prone team to effectively care for COVID patients.6 Nurses often have the can-do vision of hope and resolution.


This vision and creativity may now shift to the pressing need for clinical sites to accommodate the surge of interest in nursing.2 Nursing schools in the United States turned away more than 80 000 qualified applicants from baccalaureate and graduate nursing programs prior to the pandemic due to insufficient number of faculty, clinical sites, and preceptors despite a continued projected shortage of nurses.2,3 As we near postpandemic times, these shortage projections are even higher.2,3


It is time to consider and remove external, internal, and systemic barriers to clinical experiences for nursing and advanced practice students. Potential clinical sites can be abundant, not scarce if we collaborate on the possibilities and consider innovations in the expansion of clinical education. We must address the obstacles to incorporating nursing students in our own work environments. Partnerships with schools of nursing, transition to practice programs, residencies, fellowships, mentorship, preceptorship, simulations, and ongoing professional development opportunities are vital.3 In the clinical setting, finding opportunities to build relationships, collaborating, and problem-solving, all work toward a culture of belonging, inclusion, and equity.


The ongoing internal work for the nursing profession and hospital systems includes an organizational and personal commitment to the creation of an inclusive learning environment in the workplace. This consists of a mindset that embraces lifelong learning and to acknowledge and understand barriers such as implicit bias. In the workplace, finding opportunities to build relationships in teams, to interact in positive ways to identify solutions, all work toward the development of a culture of belonging and inclusion. Nurses are key to this community building within hospital systems as well as in the outpatient and community settings. It is part of an ethic of belonging and inclusivity that are the basis for human-centered nursing care.


The growing interest in nursing is evident in the influx of applications. Supporting this increase will take an institutional and personal commitment to innovate ways to include more nursing students into added clinical and simulation experiences. The pandemic offered the world an inside look into the profound humanity and creativity in the work of nursing care. The surge of interest in this great profession can be ignited through connection and engagement in fostering a community of diversity, equity, and inclusion; building a workforce that collectively ascends to consistently deliver culturally responsive, equitable care. Growing the possibilities for clinical sites both in and out of the hospital will support this.


In these recent dark times, nurses transformed lives through their care, elevating individuals and families, thereby lighting a path to health, wholeness, and equity. In the spirit of our founder of nursing, Florence Nightingale-the lady with the lamp, and in the recent words of American poet and activist, Amanda Gorman, "For there is always light, if only we are brave enough to see it, only brave enough to be it."7 Let's go forward in 2023, the 203rd anniversary of Florence Nightingale's birthday, with the courage to see, connect, and gather at the table where everyone is welcome to have a seat. Let's apply this to the clinical setting and find ways to take this opportunity to nurture and grow the next generation of nurses.


-Elisabeth D. Howard, PhD, CNM, FACNM


Clinician Educator


Watson Caring Science Senior Scholar


Professor of Obstetrics and Gynecology


Warren Alpert Medical School


Brown University


Providence, Rhode Island




1. Centers for Disease Control and Prevention. Isolation and precautions for people with COVID-19. Accessed February 1, 2023. [Context Link]


2. American Association of Colleges of Nursing. Nursing shortage. Accessed February 1, 2023. [Context Link]


3. American Association of Colleges of Nursing. Data spotlight: the impact of insufficient clinical sites on baccalaureate program admissions. Accessed February 1, 2023. [Context Link]


4. A&E Television Networks, LLC. History Channel. Accessed February 1, 2023. [Context Link]


5. Levinas E. Totality and Infinity: An Essay on Exteriority. Pittsburgh, PA: Duquesne University Press; 1969. [Context Link]


6. Johnson & Jonson Nursing. 5 Nurses making waves in healthcare innovation. Accessed February 1, 2023. [Context Link]


7. The Hill We Climb, by Amanda Gorman. Accessed February 1, 2023. [Context Link]