The COVID-19 pandemic has had a profound impact on healthcare systems worldwide, causing significant challenges and disruptions to the delivery of healthcare services (World Health Organization, 2022; 2023). Among those who have been affected by the consequences of the pandemic are nursing students, who found themselves in an unprecedented situation, adapting to changes in their education and clinical placements while simultaneously facing the emotional and psychological challenges of an ongoing global health crisis (Swift et al, 2020). Understanding the experiences of nursing students during the pandemic and their subsequent perspectives on it is crucial for informing the development of appropriate support and educational strategies to address the needs of students and enhance their professional growth.
This study explored the emotional experiences, challenges and coping mechanisms of nursing students from a global perspective, drawing on the experiences of participants from the UK, Canada, Australia, and Gibraltar.
Background
The pandemic led to substantial changes in the delivery of nursing education and clinical placements for nursing students (Rosa et al, 2020). Numerous educational institutions transitioned to online learning, while clinical placements were disrupted or modified to meet the increased demand for healthcare services and to implement infection prevention measures (Dewart et al, 2020). These alterations placed extra stress on student nurses, requiring them to adapt to new learning methods and manage the emotional challenges of working in high-stress environments during a pandemic (Jackson et al, 2020; Hu et al, 2022).
Earlier studies have reported that student nurses frequently face anxiety, stress and uncertainty during their training. These emotional states could worsen due to the demands and challenges posed by a global health crisis (Labrague and De los Santos, 2020; Diaz et al, 2021; Fitzgerald and Konrad, 2021). Furthermore, the emotional and psychological impact of the pandemic on students had potential ramifications for their coping mechanisms, resilience and overall wellbeing (Savitsky et al, 2020; Susmarini et al, 2022). Therefore, there was a necessity to gain a deeper understanding of nursing students’ experiences and viewpoints during the pandemic. This understanding can help in the creation of suitable interventions and development of support strategies aimed at enhancing wellbeing and professional development for nursing students of the future.
Methodology and methods
The study used a qualitative research design to explore the hermeneutic phenomenology (lived experiences) of undergraduate nursing students during the pandemic. The aim was to include a diverse sample of students across a number of countries, different genders, age groups and years of education. Participants were recruited through a call to take part in the study disseminated via the Twitter (X) platform, widely used by the global nursing community, and through networks of colleagues working in higher education internationally, who supported recruitment by sharing the study with their student nurse groups. This was a self-selected sample of students, as respondents voluntarily chose to participate by responding to the call. To verify their eligibility, participants were required to provide a scanned copy of their university ID card, confirming their active enrolment in an undergraduate nursing programme at the time of the study.
The questions for the survey were developed through a comprehensive literature review and subsequently validated by a panel of experts in nursing education. The questionnaire aimed to retrospectively explore the lived experiences of nursing students by asking open-ended questions related to their education, placements and wellbeing throughout the pandemic.
Data saturation was key to ensuring comprehensive coverage of the topic under investigation. The point at which no new themes or insights emerged from the collected data marked the attainment of data saturation.
Data analysis was undertaken in several steps. Three researchers were involved in the coding and analysis of the data. Each researcher initially read through the responses to familiarise themselves with them. Preliminary codes for the student responses were then independently generated by each researcher. The team then met to discuss and agree on the emerging themes. Manual coding was employed as the chosen method. Multiple rounds of this were undertaken to refine the themes, allowing for an in-depth understanding of the raw data.
To confirm the accuracy of the data, member checking was employed. Participants were sent a summary of the findings related to their input, asking them to confirm or clarify their original responses, enhancing the robustness of the findings.
The analytical approach taken in this study was thematic analysis. This method allowed for the identification of recurrent patterns and themes within the participants’ narratives. The stages involved in this analysis were:
This approach aligned well with the hermeneutic circle, reinforcing the focus on lived experience that is central to the research.
Participants and sample
The study sought to explore the lived experiences of nursing students during the pandemic from a global perspective. To achieve this, a diverse and international sample was recruited using an online questionnaire disseminated via a Twitter (X) platform on social media. The study attracted 40 respondents across four countries – the UK, Canada, Australia and Gibraltar (a British Overseas Territory) – allowing for a broader understanding of emotional experiences, challenges, and coping strategies in the context of the pandemic. All 40 participants completed the study.
The demographic details of participants are shown in Table 1. The diverse sample in this study provided a unique opportunity to delve into the global student nurse perspective, examining their emotional experiences, challenges and coping mechanisms during the pandemic. This, in turn, helped identify the implications for their education and professional growth in the face of unprecedented circumstances.
| Characteristic | Number of students |
| Gender | |
|---|---|
| Female | 34 |
| Male | 5 |
| Non-binary | 1 |
| Age range (years) | |
| 18–20 | 3 |
| 21–30 | 26 |
| 31–40 | 8 |
| 41–50 | 2 |
| 51–60 | 1 |
| Education stage | |
| Year 1 | 5 |
| Year 2 | 7 |
| Year 3 | 20 |
| Year 4 | 8 |
| Country | |
| UK | 19 |
| Canada | 17 |
| Australia | 3 |
| Gibraltar | 1 |
Findings
The findings of this research were derived from the various subthemes identified within the participants’ narratives. Five key themes emerged:
The quotes provided below offer some insight into these themes, which are further discussed and interpreted in the discussion section of this article.
Theme 1. The impact of the pandemic on nursing education and support
Challenges of remote learning
The respondents’ narratives indicated that transition to remote learning posed significant challenges, particularly in terms of students acquiring hands-on experience in practical workshops. The inability to attend such face-to-face sessions left many students feeling that they had missed out on crucial learning opportunities.
‘University has changed a lot as we can't go in to our practical workshops to learn, which is where I learn the most! So I feel like I've missed out this semester.’
‘Our learning mode changed to online from face-to-face and it's really difficult to simulate practical lectures, which leads us to lacking practice.’
Communication and support from universities
The data indicated that communication from universities during the pandemic was inconsistent, with some students receiving ample information about lectures and assignments, while others thought that they had been left in the dark. The lack of clarity regarding placements added to uncertainty and stress for students.
‘In a time of uncertainty, there's been [a] lack of communication from our university and an expectation that things are communicated to people and then relayed to class, which gave me less confidence in the decisions made.’
‘I feel that communication has been varied, lots of information regarding lectures and assignments but poor communication regarding placement.’
Theme 2. The impact of the pandemic on nursing placements and student wellbeing
Fears and anxieties on placement
The participants quoted below reveal that nursing students on placement during the pandemic faced significant fears and anxieties, with concerns ranging from personal safety, lack of personal protective equipment (PPE) and exposure to SARS-CoV-2-positive patients. The challenging conditions in hospitals heightened the stress experienced by students.
‘Quite terrifying. Patients being brought into the emergency department without masks, coughing and fevers, later testing positive for COVID. Not being careful enough on the department due to the space in which we work.’
‘Very frightening. Hearing of people dying and not having enough PPE is a true reality check that this virus doesn't discriminate and kills people.’
Impact on learning opportunities
The following narratives indicate that the pandemic led to a reduction in learning opportunities for students on placement. Access to certain patients and conditions was limited due to COVID concerns, and many hospitals stopped taking students for placements, which has disrupted their learning experience.
‘I couldn't access some patients’ conditions I wanted to learn about because the patients were suspected COVID patients. I didn't get enough weeks to complete my placement.’
‘I only got 3/4 of my placements completed because hospitals were not taking students for placements.’
Theme 2. Communication and support on placement
The data showed that, during the pandemic, communication and support on placements varied greatly. Some students experienced lockdowns in nursing homes, while others faced confusion due to slow communication between the regulating bodies, the individual higher education institutions and the hospitals where they were due to have their placements. This lack of clear information further added to the challenges faced by the nursing students when on placement.
‘I found it very complex as I was on placement in a nursing home that went into lockdown. Communication was great though and I did feel supported, as much as could be expected.’
‘The government didn't really understand what was happening, or how to keep us all safe.’
‘It was very confusing at first, as [there seemed to be very slow liaison with the hospitals where we had] our placements regarding new ways of working, and the placements did not seem to know (at shop floor level) about the changes in practice supervisor roles, 80/20 splits, or even that we are still students and need to be assessed.’
Positive experiences and adaptability
The students’ experiences illustrated that, despite the challenges, some of them had positive placement experiences and they also demonstrated adaptability in adjusting to new roles and responsibilities. These students found their placements to be accommodating and supportive, even amid the uncertainties of the pandemic.
‘Placement has been great. While they have had very little communication from their end, they are accommodating and extremely helpful.’
‘Opted in as a band four staff member on an extended placement… I received a full day induction to my new role and placed in a ward and hospital with minimal coronavirus cases.’
Theme 3. The challenges and realities of caring for COVID-19 patients as a nursing student
Providing care with limited PPE
The narratives below suggest that the students faced challenges in providing care for COVID-19 patients due to limited personal protective equipment (PPE) being available. Despite the lack of optimal protection, they continued to care for patients in need on COVID-19 wards.
‘I was on placement in a COVID ward. PPE isn't fantastic, but has been available as needed.’
‘PPE was always available, but the use was inconsistent, people seemed to overuse it and that made it riskier.’
‘Staff were using so much PPE as they were so unclear about the dangers of this virus… at the time we were receiving daily death rates on the news. People were terrified. We were working hands on with the patients. This was a reality to the system.’
Adherence to safety protocols
The experiences described below showed that safety protocols were crucial for student nurses caring for COVID-19 patients. They adhered to measures such as barrier nursing, wearing PPE throughout shifts, and ensuring the safety of both patients and other staff.
‘I have looked after a patient who returned from acute trust post-coronavirus, and the patient was barrier nursed until they had 2 negative swabs.’
‘Every staff member also wears PPE at all times throughout a shift.’
‘Positive cases on placement, wore appropriate PPE, treated patients the same, just ensured safety was paramount.’
Witnessing rapid deterioration of patients
These participant data suggest that student nurses have witnessed the rapid deterioration of COVID-19 patients, particularly those with respiratory complications. These experiences have highlighted the severity of the virus and its impact on patients’ health.
‘Whilst on placement in a respiratory ward, I helped a patient who was in respiratory failure due to coronavirus. He deteriorated very quickly.’
‘The speed of deterioration in patients with COVID was rapid. I saw this everywhere, all around me, it was so scary. I don't think people can even contemplate the fear of being surrounded by dying people unless they work as healthcare professionals on the front line.’
Theme 4. The impact of the pandemic on nursing students’ education and placements
Changes in placements and assessments
The following narratives suggested that the pandemic led to changes in placements and assessments for student nurses, causing stress and uncertainty. Placements were cancelled, shortened or replaced, while the formats of exams were either altered or they were replaced with essays.
‘Placements kept getting cancelled and replaced, so added to stress and uncertainty.’
‘The placement I went on was shortened, so I will have to make it up next semester.’
‘Exam changed to an essay, and placements cancelled for our own safety.’
Incomplete clinical hours and competencies
The experiences outlined below indicate that, due to the pandemic, nursing students’ clinical hours were incomplete and they experienced delays in achieving the required competencies, which may impact their overall education and professional development.
‘We were told we were not allowed to go to clinical [placements] for the remainder of the semester and as a result have been marked incomplete due to the incomplete clinical hours.’
‘We are either going to be down on hours or not ticking off proficiencies when on placement.’
Adjusting to new expectations and responsibilities
The following quotes indicate that nursing students had to adjust to new expectations and responsibilities during the pandemic. They faced the reality of nursing on the front line while they were still learning, which can be overwhelming and challenging.
‘Placement feels very different – the university is supporting us really well, but there is a “just get on with it” attitude from some of the qualified staff.’
‘Placements treat us like we are nurses and forget we are still learning. The responsibility seems so real. We are nursing on the front line.’
Theme 5. Emotional impact of the pandemic on nursing students
Fear and anxiety
The narratives below suggest that nursing students experienced fear and anxiety during the pandemic, worrying about the unknown, the impact of the virus on the lives of patients and colleagues, and the possibility of bringing the virus home to their loved ones.
‘Fear of the unknown, sad for the death and pain that COVID has caused innocent and vulnerable people.’
‘I don't feel overly concerned for my own health as I feel I take proper precautions to protect myself, but I am very apprehensive and worried that I may bring it home to my parents while working in the hospital.’
Sadness and grief
The following responses illustrate that the pandemic had caused nursing students to feel sadness and grief as they witnessed the direct and indirect effects of the virus on countless lives.
‘I feel very emotional with regards to how many lives this virus has affected both indirectly and directly.’
‘It's an awfully sad virus, I have seen so many people die on my nursing journey, I grieve for all of them.’
Frustration and uncertainty
The experiences described below indicate that the pandemic has resulted in feelings of frustration and uncertainty for nursing students, as they navigated changes in their education and placements while considering the potential future consequences of the virus on healthcare systems and society.
‘I have feelings of uncertainty, worry and sometimes feelings of being really low.’
‘Uncertainty for what is to come, unsure of whether there will be a second spike in cases as restrictions start to lift.’
Anger and disappointment
These narratives illustrate that some nursing students experienced anger and disappointment at the political use of the virus and how this affected vulnerable groups, as well as the challenges faced by underpaid and undervalued essential workers.
‘I am absolutely furious, but the virus should neither be humanised nor demonised.’
‘I am livid about the way in which the virus is being used politically.’
Hope and confidence
The experiences described below reveal that, despite the challenges, some nursing students expressed hope and confidence in the ability of healthcare systems to manage the pandemic and reduce its impact.
‘I am confident that the NHS is doing the best [that] it can to reduce the spread and ensure patients beat the virus.’
‘I know we will get through this, and we will learn a lot of lessons because of it.’
‘I hope this will teach the world to do better, we need to prevent such viruses and work together.’
Discussion
The pandemic has had a profound impact on various aspects of the lives of nursing students, including their education, clinical placements, wellbeing and emotional experiences. The findings of this study revealed five key themes that highlight the multifaceted nature of the challenges that nursing students faced as the result of this global health crisis.
First, the impact of the pandemic on nursing education and support was evident, as many institutions transitioned to online learning to mitigate the risk of viral transmission (Dewart et al, 2020). This shift created challenges for nursing students, particularly those who struggled with self-directed learning and the lack of face-to-face interaction with their peers and educators (Swift et al, 2020). Moreover, the loss of practical lectures and limited access to resources due to the closure of libraries and other facilities further complicated their learning experience (Rosa et al, 2020).
Second, the pandemic significantly affected nursing placements and the wellbeing of student nurses. Clinical placements were disrupted or altered, causing stress and uncertainty among students as they faced cancellations, postponements and a lack of available placements (Jackson et al, 2020). These changes may have long-term implications for nursing students’ professional development, as many may have ended up graduating with fewer clinical hours and competencies than their pre-pandemic counterparts (Dewart et al, 2020).
The third theme – the challenges and realities of caring for COVID-19 patients as a nursing student – highlights the emotional burden faced by students during the pandemic. Many respondents reported feelings of fear, anxiety and stress related to their personal safety and the potential risk of spreading the virus to their families (Labrague and De los Santos, 2020). In addition, the students were exposed to the harsh realities of caring for critically ill patients, witnessing suffering and death caused by the virus, all of which may have lasting emotional and psychological effects (Savitsky et al, 2020).
The fourth theme – the impact of the pandemic on nursing students’ education and placements – further underscores the disruption caused by the pandemic. Students reported a lack of support from qualified staff in clinical placements and experienced a disconnect between the expectations set by their educational institutions and the realities of working on the front line during a pandemic. This dissonance may have further contributed to the stress and uncertainty experienced by the students.
The final theme – the emotional impact of the pandemic on students – emerged as a central motif in this study. Participants expressed a range of emotions, including fear, sadness, anger and frustration, in response to the various challenges posed by the pandemic (Labrague and De los Santos, 2020). These emotions will have had significant implications for the mental health and wellbeing of the nursing students, emphasising the need for targeted support and interventions to address their psychological needs during challenging times such as the period of the pandemic (Savitsky et al, 2020).
The findings of this study highlight both similarities and differences in the experiences of nursing students across the four countries (UK, Canada, Australia, and Gibraltar). Students commonly faced significant emotional and psychological challenges, including fear, anxiety and frustration, due to the uncertainty, high-risk environments and the realities of caring for COVID-19 patients. The shift to online learning and the modification or cancellation of clinical placements were reported globally, raising concerns about skill acquisition and meeting competency requirements. In all regions, there appeared to be a need for better communication, mentorship and emotional support from universities and placement providers during the pandemic.
However, differences emerged in access to PPE and adherence to safety protocols, with students in some countries reporting adequate resources, while those in others faced shortages and inconsistencies. Communication and support from institutions varied, with some offering clear guidance and others being perceived as inadequate, leading to feelings of isolation among students. Placement experiences also differed: while some students felt well supported and integrated into clinical teams, others faced reduced opportunities or were treated as fully qualified staff despite their student status.
These findings highlight the broadly similar challenges nursing students faced globally, while also recognising how local differences in healthcare systems, institutional responses and resource availability may have shaped individual experiences. This suggests the importance of developing shared international strategies to create more consistent and supportive approaches during future crises.
Future research
Future research should continue to explore the experiences of nursing students during public health crises such as pandemics, identifying additional areas for improvement and support. Longitudinal studies could provide insights into the long-term effects of such experiences on student nurses’ career trajectories and their professional development. Understanding the impact of such experiences would enable stakeholders to design interventions and policies that promote the growth and success of nursing students, to develop a strong and adaptable workforce within international healthcare systems capable of coping robustly in the face of future crises.
Recommendations for practice
Eight key recommendations emerged from the findings of this research, which centre on supporting nursing students during public health crises. They draw on the themes identified from the students’ responses
Comprehensive support systems
Establish robust support systems that include peer support, mentorship programmes and mental health services to reinforce the wellbeing and resilience of nursing students.
Enhanced remote learning
Improve online and remote learning strategies involving creative and engaging methods, mitigating the limitations imposed by the lack of in-person education during pandemics.
Safety in clinical placements
Prioritise the safety of students in clinical settings by ensuring the availability of adequate PPE, training in infection control measures, and clear communication about safety protocols.
Flexible nursing education
Cultivate flexibility and adaptability in curricula and teaching methods to help student nurses adapt to rapidly changing healthcare environments.
Open communication
Foster a culture of open communication and collaboration between students, educators and healthcare providers to facilitate optimal learning and practice.
Address emotional impact
Acknowledge and address the potential emotional toll of public health crises on nursing students, allocating resources to enable them to cope, including the provision of emotional support services.
Strengthen the global community
Continue to work towards reinforcing the global nursing community through networking opportunities, sharing best practices and collaborative research.
Recognition and support
Advocate for the full recognition of the contribution made by nursing students during health crises and ensure that they have access to the necessary resources and support for their education and wellbeing.
Putting the above recommendations into practice will enable nurse academics and clinical practice educators to adapt nursing education and healthcare systems to better support nursing students, enhancing both their professional development and overall wellbeing.
Conclusion
This study has highlighted the challenges and emotional experiences faced by nursing students across the world during the pandemic. The findings emphasise its impact on nursing education, placements and student wellbeing. Furthermore, it has illustrated the realities and difficulties of caring for COVID-19 patients as a student nurse. By exploring these aspects, this research offers valuable insights into the ways in which the pandemic has affected student nurses’ education and professional growth.
The findings from this study provide evidence-based recommendations for supporting student nurses during pandemics and other public health crises. These recommendations include implementing flexible learning approaches, enhancing communication and support systems, prioritising mental health and wellbeing, and encouraging peer support networks. By addressing these critical areas, educational institutions and healthcare organisations can better prepare and support student nurses in coping with the challenges presented by public health emergencies, ultimately ensuring the development of a resilient and competent nursing workforce.