Abstract
Introduction
Worldwide, COVID-19 affected nursing students’ and faculty's mental and physical health. The final clinical placement for fourth-year nursing students during the third wave of COVID-19 in Toronto, Canada, included direct patient care without vaccination eligibility. Students’ experiences during the pandemic and faculty exposure to teaching and supporting them provide unique reflective opportunities.
Objective
To examine the lived experiences of nursing students and faculty during the third wave of the COVID-19 pandemic.
Methods
The study used a qualitative phenomenological design with thematic analysis. A voluntary response sample of 80 participants shared their narratives of working and teaching during January to May 2021. An optional interview guide offered open-ended questions requiring reflection. The study was conducted in a nursing school in Toronto, Canada during fourth-year baccalaureate students final clinical placement settings.
Results
A total of 77 fourth-year baccalaureate nursing students and three faculty members participated. Thematic analysis of nursing student narratives identified four main themes: (i) fear and anxiety of COVID-19 during clinical practice; (ii) impact on students’ learning environments; (iii) intrinsic and extrinsic factors that enabled students to persevere; and (iv) how to deal with future pandemics. Thematic analysis of faculty narratives identified three main themes: (i) the importance of preparatory work; (ii) psychological and physical manifestations of supporting students; and (iii) the resilience of students and faculty.
Conclusion
Future disease outbreaks and other large-scale health events will require nurse educators to understand and plan strategies for both themselves and students practicing in high-risk clinical settings. Nursing schools should rethink all fourth-year students’ experiences, perceptions, and feelings to minimize their susceptibility to physical and psychological distress.
Introduction/Background/Literature Review
Infectious diseases have existed for thousands of years, but only in the last few hundred years have the impacts of yellow fever, cholera, and influenza epidemics been documented (Veenema, 2019). What impact do outbreaks of diseases have on healthcare workers, specifically nurses? Did we learn from the last severe acute respiratory syndrome (SARS) epidemic in Toronto, Canada, in 2003? Has anything changed since 2003 to 2022 regarding epidemic or pandemic nursing?
In 2003, nurses caring for SARS patients feared coming to work and observed inadequate infection control measures (Veenema, 2019). SARS nurses faced a poorly equipped healthcare system that could not respond to the crisis (Rankin, 2006). Emergency room and intensive care nurses faced the greatest challenges because personal protective equipment (PPE) was not used, and the disease went undetected for weeks (B. Orazietti, personal communication, June 7, 2022). In an already underfunded, understaffed provincial health care system, there was a lack of communication regarding outbreak management (Rankin, 2006). The SARS epidemic in the Toronto Greater Area (GTA) claimed 44 lives and infected 79 nurses. Rankin (2006) describes how this epidemic strained nurses deeply, causing fear, isolation, and abandonment by employers. Despite the SARS epidemic, healthcare workers (HCWs) were resilient (Maunder et al., 2006). However, despite this trait, the study notes that a substantial number of HCWs were negatively affected by SARS. Ironically, this 2006 study concluded that epidemic/pandemic planning should focus on adequate staff support to bolster HCW resilience to encounter future outbreaks (Maunder et al., 2006).
With COVID-19, history repeats itself, although much more severely this time. At the time of this study, the pandemic was in its third wave (January 2021), and the virus had mutated into several variants and was rapidly spreading. Globally, there were 96,267,473 COVID-19-infected people, with 2,082,745 deaths, according to the World Health Organization (2021). Nevertheless, the COVID-19 pandemic seemed like an identical threat to the nursing profession as SARS. Nurses feared contracting the disease, illness, and death for oneself, family, and friends (B. Orazietti, personal communication, June 7, 2022). Several studies found that nursing COVID-19 patients was more demanding than nursing SARS patients due to severity of symptoms and included higher nurse mortality, leading to posttraumatic stress disorder (PTSD) and more severe mental health problems (Havaei et al., 2021; Khanlou & Orazietti, 2020; Stelnicki et al., 2020). The emotional toll was more severe, due to the longevity of the pandemic, distressing media coverage, mutations of the virus, lack of nurses and doctors and burnout (B. Orazietti, personal communication, June 7, 2022). A phenomenological study (Rathnayake et al., 2021) examined nurses’ perspectives on caring for COVID-19 patients and found that nurses’ psychological and physical distress were common, attributed to witnessing patients’ suffering, guilt over limited care, work-related factors, discomfort while wearing PPE, stigma, and discrimination.
Considering the COVID-19 pandemic within the academic context is important. Reviewing literature on COVID-19 and its impact on nursing students and education revealed varying perspectives. According to Oducado and Estoque (2021), nursing students found online learning very stressful during the COVID-19 pandemic. Faculty reported that students’ academic performances were negatively impacted by the pandemic. Michel et al. (2021) found that students perceived the pandemic caused substantial difficulties in their lives, such as financial issues, increased family duties, relocation, and a shortage of public transportation. Personal and academic lives of the students were negatively affected by loneliness and separation from their peers. Only one study by Dewart et al. (2020) examined the unique requirements and concerns of nurse educators teaching clinical courses and nursing students working in direct patient care.
The purpose of this research study is to provide readers with an understanding of the lived experiences of nursing faculty teaching clinical courses and nursing students working in Canadian clinical placement settings during the third wave of the COVID-19 pandemic. As a result of this research, nursing programs will have strategies to educate and support clinical faculty and students in clinical practice for future disease outbreaks and other large-scale health events.
Methods
Design
A qualitative phenomenological design using thematic analysis was used in accordance with Braun and Clarke's (2006) phenomenological methodological pattern. This design was aimed at understanding nursing students working and faculty teaching during clinical placements in the third wave of COVID-19 by exploring views from those who have experienced it.
NURS 4527 9.0 – Integrated Nursing Science Practicum (NURS 4527) students were invited to participate in the project through an online announcement via the university's online learning management system (eClass). The principal investigator invited nursing faculty teaching NURS 4527 to participate via personal email. Participants were required to sign and upload a consent form to a secure eClass dropbox before participating. Participants received an information sheet about the study's aim and design, along with optional sample questions. Faculty members reflected on their experiences teaching a practicum course during a pandemic while students reflected on their clinical placement experiences. Nursing students’ and faculty members’ experiences were captured through self-video and self-written reflections. A secure assignment folder on eClass was used to store narratives. Due to COVID-19 restrictions, no in-person interviews or focus groups were conducted.
Research Question
What are the lived experiences of nursing faculty teaching clinical courses and nursing students working in clinical placement settings during the third wave of the COVID-19 pandemic?
Sample and Setting
The study was conducted during the 2020/21 winter semester at a nursing school in Toronto, Canada (January to May 2021). The sample consisted of 77 fourth-year baccalaureate nursing students and three faculty members supervising nursing students in their final clinical placement during the third wave of the COVID-19 pandemic. Nursing students were situated in 50 different practice settings across Canada including acute care hospitals, rehabilitation centers, long-term care (LTC) facilities, public health centers, home care agencies, and the Canadian Red Cross Society.
Inclusion/Exclusion Criteria
Fourth year nursing students enrolled in NURS 4527 and faculty members teaching NURS 4527 (with internet access) were included in the study.
Institutional Review Board Approval
Authorization from the University Research and Ethics Department was received in May 2021 (Certificate Number: e2021–124). To avoid ethical dilemmas between nursing faculty and students, such as perceived student coercion, nursing students were only asked to participate once the semester was complete, and grades assigned and uploaded. The narrative collection process required informed consent from all participants.
Data Analysis
The six steps of thematic analysis based on the Braun and Clarke (2006) phenomenological approach were used to identify relevant themes. The thematic analysis was carried out manually. Researchers first transcribed the digital and audio files and noted initial ideas. Following, initial codes were generated, which included coding interesting data features. Collating the codes into potential themes involved sorting the different codes into potential themes and subthemes. Themes and subthemes were next reviewed, and a thematic map of the analysis was generated. Lastly, an ongoing analysis to refine the specifics of each theme, clear definitions and names were developed. Student participant validation was not feasible as personal narratives were transcribed one year post graduation and student emails were no longer functional. Faculty participant validation was completed.
Results
Sample Characteristics
This study collected no sociodemographic characteristics, as participants were solely asked to anonymously reflect on their experiences during the COVID-19 pandemic. The available demographic characteristics are students aged 22–30 and fourth-year baccalaureate nursing students working in various clinical settings across Canada. The class itself was heavily female-gendered. The final sample included 80 participants comprising 77 nursing students and three faculty members. Four themes from student narratives and three from faculty narratives were determined through thematic analysis highlighting the negative and positive aspects of nursing students and faculty's lives during the pandemic.
Research Question Results
Nursing Student Narratives
Theme 1: Fear and Anxiety of COVID-19 During Clinical Practice
Students reported mixed attitudes and emotions in response to their practicums, however, 98% of students reported feeling anxiety and concern. One student stated, “Understanding this pandemic's difficulties never truly impacted me until I was on the front lines facing uncertainty, terror, and fear.” Student's anxiety was compounded by fears related to their inability to complete their program and subsequently delaying their graduation. A student describes, “With our lives shifting significantly and school turning to online, the fear crept up inside of me whether I will be able to finish my school, how placements would work, what does this mean for me in the future.” While students appreciated the opportunity to continue their clinical placements, they were concerned about how the restrictions would affect the quality of their learning. Students reported anxieties about transmitting COVID-19 to their patients and family members, especially elderly people, and chronically ill patients. A student explains, “The lingering thoughts of potentially being exposed to this deadly virus, bringing something home to my family was highly heartbreaking to think about.” Many students had to take time off during the term as they experienced symptoms, felt unwell or were exposed to COVID-19. One student was so unwell with COVID-19 that they were “hospitalized in Intensive Care and on 100% oxygen.” Another student reported contracting the virus and experienced health challenges when returning to the practice environment, involving fatigue.
The shortage in PPE legitimately heightened nursing students’ fears, and the expectation to provide their own PPE further exacerbated their stress. A student states, At times especially during day shifts, there would be moments where there would be a limited supply of gowns. This caused stress within the unit staff and me because we were limited on our ability to care for the patients and in case of an emergency.
I didn’t realize how much COVID-19 scared me until I entered my final consolidation in a long-term care home as a nursing student. I wasn’t scared about my health; I had a massive fear that I would be the one to bring it into the LTC home and be the cause of an outbreak.
Another cause of anxiety was the uncertainties involved with rapidly evolving pandemic guidelines. When the COVID-19 vaccine was available, many students were eager to receive it as soon as they met the eligibility criteria. A student explains, During the term in placement, I had the opportunity to receive my vaccination which helped me feel safer and comfortable going in to work for each shift knowing I am putting my part to help reduce the spread of the virus and protecting not only my family, friends, myself as well as my patients.
The extra demands of the placement during a global pandemic while striving to keep up with their coursework led many to report feeling burnt out. One student describes, “This semester was a personal challenge. It was marked by getting up at 0430 to feed/pump, get my baby ready for the day, work a long day, and come home and be present while doing tests, quizzes and studying throughout.” Despite all, students reported feeling obligated to continue their placement as a “sense of responsibility to the profession.”
Theme 2: Impact on Students’ Learning Environments
Nursing students reported steep learning curves switching from virtual to in-person placements during the pandemic. The university switched students’ practicum sessions to virtual sessions when the COVID-19 pandemic was declared (S. Peniston, personal communication, January 13, 2023). Students valued the virtual simulation and found that it provided practical experience but reported challenges in developing the “soft skills” in a simulated environment.
Students’ sense of isolation was another consistent theme. Physical distance made it challenging for students to meet and form study groups, which helped students maximize their learning by engaging with peers before the pandemic. A student explains, “One of the biggest challenges was probably the sense of isolation. Not only was the school semester interrupted but study support groups were separated.”
Numerous challenges affected students’ coursework and clinical practicum in clinical placement settings. Students reported feeling “stifled” by the lack of practical learning opportunities. Several practices, such as interdepartmental rotations to experience a variety of clinical skills, were restricted to limit unnecessary exposures. Although students understood infection prevention and control (IPAC) precautions and rationales, their clinical experience was limited. Under-resourced/understaffed units and rapidly evolving placement environments also challenged nursing students. A student explains, “My mental health was affected at times when the workload was overwhelming or when experiencing death related to a patient diagnosis of COVID.” Another student describes, “After completing my placement, I experienced firsthand how hard nurses and healthcare professionals are working to overcome this pandemic. The toll it takes on nurses emotionally, physically, and mentally truly impacts their ability to care for patients.”
Communication and therapeutic relationships between students and clients were also challenged due to PPE requirements (mask/shield) and “forced” limited contact with patients. To maintain isolation precautions, students had to adapt how they developed and fostered therapeutic relationships. Nursing core values of compassion and empathy were reinforced while caring for patients during the pandemic, a valuable experience for many students. A student explains, Seeing people in such a vulnerable state and having to go through difficult moments in their life alone was hard for me to witness. I did my best to accompany them during meals or spark a conversation while providing care, to improve their overall wellbeing even in the slightest.
Despite the above challenges, a significant portion (83%) reported that these learning environments accelerated their growth and promoted the development of necessary practice skills such as “flexibility and adaptability.” Students reported advancing their knowledge and exercising innovative strategies in IPAC practices. One student explains, “It was a good reminder of the risk while working in a COVID-19 ICU and the importance of rigorous hand hygiene, and careful donning and doffing.”
Nursing students gained an understanding of the impact of social determinants of health (SDoH) on population health during the COVID-19 pandemic. They observed how the pandemic further exacerbated existing health and social issues and identified emerging trends in population. A student describes, “As a student working during the COVID-19 pandemic, I do believe there were certain SDoH that should be considered in care for clients such as housing, food security, social inclusion and income.” Students grasped the understanding of social, political, and global factors that impact health and access to care. Lack of access to primary care, including mental health and substance use services, was identified as affecting and exacerbating disparities in health outcomes. One student identified that “delayed access to primary care services resulted in an increased demand for secondary and tertiary levels of care.” Many students identified that they gained significant insight into the nuances involved in health care delivery, including health promotion, policy and public health issues, and direct clinical care. One student explains, “Having done IP [integrated practicum] during a pandemic added an additional layer of education. I learned how hospitals dealt with crises.” Additionally, students emphasized the importance of patients’ families and caregivers, and the absence of their presence at the bedside caused by visitor restrictions. Many students reported feeling morally obligated to spend extra time with their patients and assisted patients to maintain virtual contact with family members. A student describes, “Since visitors were not allowed in the hospital, I often set up facetime for patients and their family. I think this tool is underutilized throughout hospitals.” In addition to social isolation and its detrimental effects during illness, family members had limited opportunities as advocates and caregivers. A student notes, “The one thing that stood out to me was that these people are going through these challenging times alone. They cannot have a family member at their side when they are the sickest and the loneliness.”
Theme 3: Intrinsic and Extrinsic Factors That Influenced Perseverance
Nursing students reported resilience and perseverance as critical skills and intrinsic factors that allowed them to succeed. One student narrative cites the following: Overall, my experience as a nursing student who got to work through a global pandemic has taught me how to demonstrate courage, compassion, and humility. Courage to be resilient and be there for my patient even when I feel frustrated, compassion to appreciate my co-workers and the needs of my patients, and humility to recognize opportunities to learn.
I was proud to finish placement with a fulltime job to return to at the facility, wonderful relationships that I’ve formed during, and knowing that I’ve accomplished something that many haven’t worked through a pandemic.
Theme 4: How to Deal with Future Pandemics?
In response to future pandemic planning, students proposed several solutions at the university and national levels. Participants reported that they would have appreciated more active faculty check-ins. To prevent future pandemics, they recommended focusing on primary prevention practices and SDOH. There was a consensus that LTC settings needed to be restructured for safe patient care and staff work environments. Students felt that nurses’ voices were rarely heard in the media and that nurses should participate in decision-making.
Faculty Narratives
Theme 1: Importance of Preparatory Work
One faculty member noted that “preparing students for an integrated practicum during a global pandemic was a significant and remarkable undertaking that required deliberate planning and meticulous preparation.” Preparation for NURS 4527 began six months earlier than usual as it was clear to faculty and nursing program administrators that this “student cohort would have challenging requirements due to the unique circumstances of the pandemic.” Aside from discussing rapidly changing course delivery methods, the meetings in advance discussed how to support students, establish guidelines for their unique practicum situations, and outline algorithms and processes for potential scenarios.
Theme 2: Psychological and Physical Manifestations of Supporting Students
Faculty reported feeling “worried about students contracting the COVID-19 virus” and the short- and long-term consequences on students physical and mental health, as little was known about the virus. Faculty expressed guilt about not practicing direct care but sending students into the clinical environment and the risks associated with it. They feared for students’ health and safety and felt overwhelmed. As a result, faculty members experienced significant “moral distress” because they believed they were sending students into a “war zone without armor.” Further, faculty were overwhelmed by the magnitude and burden of the repercussions of students contracting COVID-19 beyond academics, including missing work, affecting their livelihood, and infecting their families. Due to the increased need to provide emotional support to students, faculty felt burnt out. One faculty explains, “I spent double or triple the number of hours required to teach and support students compared to previous semesters.” Feelings of uncertainty and frustration over the changing policies and plans at the school, practicum, and Ministry of Health levels were also reported by faculty as they tried to address the student's uncertainty related to these changes. A faculty member describes, “I was coping with rapid changes on a daily basis; struggled to keep on top of the rapid changes.” Moreover, the requirement to quickly transition to virtual teaching increased faculty's workload and they struggled to cope with the rapid changes. This led to burnout, fatigue and heightened stress levels manifesting physically as “headaches and neck pains.”
Theme 3: Resilience of Students and Faculty
Despite the highly challenging circumstances, faculty members observed that this cohort of students was uniquely resilient, adapting to changes and supporting one another. Faculty reported “a sense of pride for their students’ successful completion” of the semester, with many students landing job offers in their placements. One faculty narrative cites the following: About 3 months after the placement was over, I received a card from a student with her picture in nursing scrubs with a hospital badge, smiling. So just looking at her finding meaning through the experiences she has gone through, that made me happy.
By far the biggest accomplishment was having all our students complete the term successfully and move towards graduation day. Another accomplishment is how our core team of 3 Course Directors…became so close, as we leaned on each other for support over the term. We have truly bonded for life as friends forever no matter what. We had each other's backs and always made time to listen to each other's struggles with each student situation.
These same factors were highlighted by faculty as critical recommendations for future pandemics: preparation in advance, establishing a core team with clear guidelines for communication and decision-making algorithms, and finally, supporting each other through the process.
Discussion
In this study, nursing students and faculty described their experiences in a final practicum course during the third wave of the COVID-19 pandemic. According to the authors, the study is the first to examine the overall nursing student and faculty experience during clinical placements in Canada.
Nursing students were at risk from COVID-19 impacts, not just on their physical health, but also psychological well-being. Vaccination concerns regarding availability, eligibility, short- and long-term health impacts, stigma of being labeled as anti-vaccine, and rapid changes in pandemic guidelines, increased students’ anxiety in this study. Similarly, Grande et al. (2022) cite nursing students’ increasing anxiety about COVID-19, their immune system weakness, and doubts or skepticism about the vaccine. Anxiety was attributed to contracting COVID-19 and transmitting the virus to family members. Nursing student narratives explained the inherent personal risk felt by students working in high-risk environments, sometimes with PPE shortages. Anxiety was attributed to concerns about completing their program and delaying graduation. Several students indicated that the unexpected developments during the pandemic added to their already high stress levels as fourth-year nursing students. In the literature, similar studies have described the COVID-19 pandemic as intensifying the demands of student academic and personal life commitments (Aslan & Pekince, 2021; De Gagne et al., 2021; Grande et al., 2022; Mendez-Pinto et al., 2022). According to Cengiz et al. (2022), nursing students were exposed to stress, anxiety, and uncertainty during the pandemic, expressed withdrawal and loss of hope, displayed obsessive behaviors, were depressed, and had difficulty sleeping. Kuru Alici and Ozturk Copur (2022), Mendez-Pinto et al. (2022), and Usher Am et al. (2022) found moderate to high rates of reported mental health concerns in nursing students, including anxiety and depressive symptoms. Usher Am et al. (2022) reported signs of PTSD in 49.4% of nursing students, while Mendez-Pinto et al. (2022) found a significant prevalence of PTSD in 26.7% of nursing students. The high PTSD rates in these studies are concerning. Nursing students must be aware of the possibility of post-pandemic PTSD in the short term and in the future when additional significant healthcare events or pressures occur.
Further exacerbating their psychological challenges are feelings of isolation from other nursing students. Solitude was also identified by Kokturk Dalcali et al. (2021) as a risk factor for mental distress. To assist nursing students during future pandemics and other health emergencies, university counseling centers should consider offering distance counseling within the constraints of these emergencies (Cengiz et al., 2022). Online support groups can also be offered by university counseling centers for students to share common concerns and receive social support (Cengiz et al., 2022). Nurse educators should recognize the multidimensionality of psychological and emotional well-being in nursing students and provide appropriate support, including concrete plans in the curriculum to reduce these challenges (Grande et al., 2022). According to Kuru Alici and Ozturk Copur (2022), nursing students should be taught coping skills such as meditation and stress management techniques to reduce anxiety and fear.
Nursing student narratives highlighted the pandemic's impact on learning. When clinical placements were available, practical learning opportunities were restricted due to IPAC precautionary measures due to COVID-19 restrictions. In times of reduced clinical placements, students were taught through online simulations. According to Kuru Alici and Ozturk Copur (2022), 84.2% of nursing students reported anxiety due to remote teaching during the pandemic. The abrupt transition from face-to-face to online learning, where additional adjustments were required, proved stressful for nursing students, according to Grande et al. (2022). In nursing student narratives, additional challenges were encountered during the pandemic transition. Under-resourced units and student role ambiguity coupled with a lack of previous “hands-on” clinical placements and skill development heightened students’ anxiety. Cengiz et al. (2022) found similar difficulties for students adapting to online learning, lacking clinical placements that provide skill acquisition, and adjusting to rapid educational change. Usher Am et al. (2022) highlights the importance of recognizing risks to student confidence and harmful mental health outcomes post-pandemic. In their explanation, students who lack solid clinical decision-making skills may risk losing their registration status and careers. In post-graduation practice settings, students may make near-misses or clinical errors. Merino-Godoy et al. (2022) recommend healthcare and nursing education institutions establish a transition program. Furthermore, Godbold et al. (2022) recommend a partnership approach with nurse educators and practice colleagues to ensure successful transitions from student nurse to qualified nurse post pandemic.
Sociodemographic variables were not considered in this study. However, similar studies have found interesting sociodemographic correlations in understanding the psychological impact of COVID-19 among nursing students. According to Mendez-Pinto et al. (2022), being female, smoking, and feeling fear and stress had significant psychological effects. Furthermore, females, cohabiting with friends rather than family, and feeling stressed were linked to depression. According to Kokturk Dalcali et al. (2021), living with family reduced anxiety levels. Student nurses aged 18–20 and female students reported increased stress levels during the pandemic in studies conducted by Kuru Alici and Ozturk Copur (2022). Further, watching the news, worrying about infection risks, and curfews contributed to stress. Kuru Alici and Ozturk Copur (2022) found that nursing students’ anxiety levels were significantly related to where they lived. Urban nursing students had higher anxiety levels than rural nursing students. Additionally, anxiety was significantly associated with COVID-19-positive family members. As expected, students with pre-existing physical and mental health challenges found it difficult to cope with the increased stress levels due to the pandemic. Similarly, Usher Am et al. (2022) found that participants with a pre-existing mental disorder suffered from more profound psychological effects.
Despite psychological and physical challenges during the COVID-19 pandemic, nursing students continued their placements. Several students cited a sense of responsibility for the nursing profession and learning environments that accelerated their development as final-year nursing students. Student narratives emphasize the importance of nurse-patient therapeutic relationships during restricted family visitation, PPE requirements (face masks), and limited close contact with patients. Others observed the pandemic helped them better understand SDoH including access to care and overall health outcomes. The pandemic provided deeper insight into health care delivery, health promotion, policy, and public health issues. There is limited literature analyzing nursing students’ positive attitudes toward COVID-19. Bahcecioglu Turan et al. (2022) examined nursing students’ attitudes toward the nursing profession during the COVID-19 pandemic. Researchers found that despite the pandemic, nursing students maintained a positive attitude. Further positive attitudes should be assessed in follow-up studies with newly enrolled nurses.
An encouraging theme in this study was resilience among undergraduate nursing students. Positive extrinsic factors included a positive orientation, consistent faculty communication, supportive preceptors, social networks, and strict agency protocols. Nursing passion, self-care, and a sense of purpose were intrinsic factors. Moreover, students reported feeling confident, accomplished, and proud. Despite facing multiple difficulties during the pandemic, Munn et al. (2022) found nursing students demonstrated average grit and resilience. The study found that students did not learn these coping skills at university. According to the authors, educators need to incorporate grit and resilience constructs in coursework as well as identify effective strategies to develop these characteristics during nursing programs to be able to replicate these strategies effectively in the healthcare field.
A final theme from nursing student narratives offered advice on coping with pandemics. Half of the students reported that more faculty check-ins would be helpful. Nursing students identified primary prevention, addressing SDOH, and long-term facility restructuring as ways to reduce the population impact of future pandemics. No comparable studies showcased students’ recommendation on future pandemic planning. Nursing student narratives suggested being organized in the struggle against problems, addressing unions and associations, and being politically aware as remedies. Moreover, they emphasized the need for nurses to advocate for public health and educate the public. According to Catiker (2022), the pandemic affected senior nursing students’ perceptions of the nursing profession's political power and visibility.
Faculty narratives cite personal psychological and physical distress in supporting nursing students in clinical placement during the COVID-19 pandemic. Fear was driven by concerns about unvaccinated nursing students contracting COVID-19 amidst the unknown sequelae of the virus. Some expressed guilt and moral distress about sending students to high-risk settings while faculty remained away from direct patient care. Faculty reported burnout as students needed significantly more emotional support than in other years. A rapid transition to online learning and the constant changes in university and public health guidelines led to higher work demands. A study by Sacco and Kelly (2021) describing nursing faculty experiences during the COVID-19 pandemic parallels our study regarding faculty concerns. The authors cite faculty frustration with university- or administrative-related issues such as rapidly changing policies and plans and noted that a lot of support from the university administration was needed. In addition, Sacco and Kelly (2021) found faculty shared feelings of guilt related to not practicing in direct care and concern for students’ safety working in high-risk clinical placements. Like our study, faculty felt genuine commitment and cited positive teaching experiences during the pandemic. In a study by Sessions et al. (2022), nurse educators’ experiences during the COVID-19 crisis were categorized into three themes: (i) uncertainty within pandemic ambiguity, (ii) prioritizing pedagogy, and (iii) professional commitment. Of note, faculty cited priority for student success and a solid professional commitment as motivators despite the adversity they faced during the pandemic. In our study, faculty narratives commented on their own resilience and highlighted that collegial bonds and supportive senior leadership within the nursing school strengthened their resilience. Similarly, Bejster et al. (2021), Sacco and Kelly (2021), and Sessions et al. (2022) cite faculty resilience and adaptive skills as essential skills used to persevere during the pandemic and highlight the importance of establishing a collaborative culture and adapting to meet emerging student needs. According to Sessions et al. (2022), faculty stress responses to COVID-19 might still need to be fully realized and Sacco and Kelly (2021) recommend future studies.
Lastly, faculty narratives recommend preparatory work to pre-plan for pandemic challenges. Pre-planning suggestions included discussions on how to support students, establishing guidelines for students’ unique practicum circumstances, and developing algorithms and processes for decision-making for potential scenarios during the pandemic. Similarly, Leaver et al. (2022) cite the importance of pre-planning within nursing programs to ensure students and faculty are prepared to address future emergencies and pandemics.
Strengths and Limitations
This study has limitations. First, the sample was small, with only 77 fourth-year baccalaureate nursing students and an underrepresented faculty sample of only three participants. The small number of faculty members leads to high subjectivity. Second, the study was conducted in a single nursing institution. Third, no sociodemographic variables were collected as the researchers were only interested in participants’ lived experiences through their anonymous narratives. Fourth, student participant validation was not feasible due to manuscript writing delays. Lastly, a mixed methods study design with specific instruments such as the COVID-19 anxiety scale, the COVID-19 anxiety syndrome scale, or the short health anxiety inventory to collect data could improve the validity of the data.
Conclusions/Implications for Practice
Globally, the COVID-19 pandemic affected every nursing program, nurse, and nursing student. Future disease outbreaks and other large-scale health events require nurse educators to understand the psychological and physical impacts placed on students involved in high-risk clinical settings. A key consideration is frequent check-ins with nursing students during clinical placements and incorporating concrete plans into nursing student curriculums to address psychological and emotional well-being reduction. It is important for students to learn how to deal with challenges under anxiety-provoking circumstances, including how to take advantage of counseling services at their universities. Furthermore, developing a nursing curriculum that promotes grit and resilience is essential. Preparing student nurses for future pandemics and other health emergencies requires an understanding of socio-political issues. To better prepare students for health-related emergency situations and pandemics, nursing education institutions need to create transition programs. Faculty narratives cite physical and psychological manifestations, such as fear and guilt, in supporting nursing students in clinical placement during the pandemic. Planning in advance, establishing a core team with clear guidelines for communication and decision-making algorithms, and supporting each other are faculty-specific recommendations for future planning. The post-pandemic effects of nursing students and faculty must be considered in future studies.
Footnotes
Acknowledgments
We want to thank the nursing students and faculty at the School of Nursing, York University, Toronto, Canada, who participated in the study.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical Approval
York University Research and Ethics Department authorized this study. Institutional approval was obtained in May 2021 (Certificate Number: e2021–124).
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was financially supported by the Faculty of Health Junior Faculty Funds/Minor Research Grant, York University, Toronto, Canada
