Baccalaureate nursing students’ experiences of how the COVID-19 pandemic influenced learning – a mixed method study

In March 2020, the impact of the COVID-19 pandemic enforced the reconfiguration of educational programs globally. Online distance learning, digital seminars, and supervision became the new normal [1‐4]. For students in need of practical learning and training as a part of their curriculum, restrictions and alterations in practical placements and limited access to simulation training at campuses became the new normal and threatened the viability of students’ education [2, 5‐7]. Both students and professors had to adapt to the new situation [8].

Nursing students may be particularly vulnerable during a pandemic, since practical and clinical training is an important part of their study where they might meet patients with COVID-19 or unclear infection status. In clinical placements, they become part of the health care system and are exposed to stressful factors, such as fear of being infected and spreading the virus to patients [9‐12]. Caring for critically ill COVID patients may be challenging and may cause anxiety and stress among nursing students [13‐15]. Recent studies have shown that the COVID-19 pandemic has caused a variety of challenges to nursing students globally such as uncertainty, stress, problems with concentration and learning efficiency, and fear of infection. Students were also concerned about their grades, passing their exams, the final graduation [2, 11, 13, 14, 16‐18], and their career ahead [11]. In addition, previous studies have identified loneliness, mental health problems, and sleeplessness among nursing students [11, 13, 15]. However, Swift et al. [17] also found that nursing students in the UK expressed a sense of being a part of history, learning new things, and stepping up to a challenge that will be personally fulfilling as well as professionally worthwhile.

Most nursing programs are traditionally conducted in a face-to-face learning environment and emphasize the importance of a sociocultural perspective on learning [19]. Students are regarded as active participants and co-constructors of learning, where learning is essentially a social term rather than individual in nature and where interaction constitutes the learning process [20]. A reduced or even absent possibility for interaction due to pandemic restrictions, and use of alternative platforms such as learning management systems and web conferencing, has changed the nursing students’ learning situation [1, 2].

At the current stage of the COVID-19 pandemic, most Norwegian nursing students as well as the general population are vaccinated. While statistics indicate that Norwegian society has handled the pandemic rather well, a new wave of coronavirus has arrived, and nurses and other health care providers have experienced a work overload and are exhausted [21, 22]. Most inhabitants trust the governmental rules and recommendations, the transmission rate has been relatively low, there have been few hospital admissions and few deaths, and the rate of vaccinated people is high compared with other countries [21]. Despite this, Norwegian baccalaureate nursing students have been affected by restrictions depending on local and temporal variations in the transmission rate. Practical training, which is normally 50% of the three-year baccalaureate nursing program (a total of 180 European Credit Transfer System points), has proceeded with modifications [23]. During the second wave of the pandemic (January–February 2021), a national survey including five Norwegian universities showed that nursing students’ academic concerns and satisfaction with the educational curriculum were significantly influenced by the pandemic, with the level of satisfaction being lower than pre-pandemic values [23]. The national survey data for baccalaureate nursing students’ experiences of the learning situation exist for the five Norwegian universities, and revealed some differences between the universities, most likely due to variation in the number of COVID-19 cases and restrictions in the regions [23]. However, in-depth knowledge alongside survey data seems to be lacking. The aim of this study therefore is; to describe and explore how the COVID-19 pandemic influenced baccalaureate nursing students’ experiences of learning and their social life as a student.

The aim of this study was to explore how the COVID-19 pandemic influenced baccalaureate nursing students’ experiences of learning. The general picture that emerges from our analysis is the importance of social interactions for learning [20]. The students were worried about not reaching learning outcomes and had worries and challenges in clinical placement. However, they experienced more normal days in clinical placement and a feeling of being a part of the history.

The nursing students experienced a fear of not reaching learning outcomes both in theoretical classes and clinical practice because of all the adaptations and restrictions imposed due to the COVID-19 pandemic. These findings are in line with previous studies where nursing students had problems with concentration and learning efficiency, fear of COVID-19, their grades, final graduation, and future career [11, 14, 18]. Looking closer into the numbers in the national survey [23], more students in the present university reported satisfaction with the university’s handling of the situation and were less concerned about the quality of the education compared with other universities. Such findings were most likely associated with the relatively low transmission rate during the pandemic and local restrictions in the university region [21], along with nearly normal maintenance of clinical practice, which was not seen in the other universities [5]. Despite this, our students experienced fear of not reaching their learning outcomes, experienced stress, missed their peers and friends, and experienced fear of COVID.

The fear of COVID and its concomitant restrictions hampered the possibilities and advantages that social interactions bring to learning [20]. A recent study from Sweden [30] showed that while some of the nursing students preferred digital learning and use of digital tools, the majority said that digital learning reduced their opportunities for social interaction and felt that this reflected negatively on their learning process. Moreover, students reported that the reduced social interaction had a negative effect on their mental health [30]. In most nursing education, learning is regarded as a social experience rather than an isolated one, and social interaction is a significant element in the learning process [20]. Reduced social interaction affects both the learning process and the students’ mental health. The results from our study showed that first-year students were more vulnerable than second- and third-year students. They felt lonely and some of them had few fellow students. The pandemic forced the professors to start with digital teaching instead of traditional campus-based teaching, and most of the professors were not prepared for this. A longer preparation time might have resulted in the development of learning activities that better supported social interaction, such as digital groups and discussion [8]. Although the students in our study were able to attend clinical practice, they were worried about not reaching expected learning outcomes and not being able to fulfill the number of days required in clinical studies.

Both the quantitative and qualitative data show that first-year students are more vulnerable than second- and third-year students. This might be because first-year students have not yet been able to meet each other face-to-face, are not used to being tertiary students, and are strongly affected by the uncertainty of the future. Already at the beginning of the nursing program, they were worried about not being able to complete their education and become a nurse. Living with such uncertainty and stress may have a negative impact on the learning process [14, 15, 18].

Despite the nursing students’ fear and struggles, they were also grateful for the experience of being a part of a historical tradition. Some studies show that the status of nursing has risen during the pandemic [31]. Our findings are in line with those of Swift et al. [17] who showed that where students successfully stepped up to a learning challenge, they found it both personally fulfilling and professionally worthwhile. Such experiences were mostly related to the students’ clinical placement, where several students in our study told stories about how they had become “a positive difference” for the patients and in the ward.

The COVID-19 pandemic influenced nursing students’ learning significantly. Most of the students were concerned about the quality of their education and were worried about excessive absence from practical placements due to COVID infection or quarantine. The students missed their face-to-face contact with their peers and professors, which underlined the importance of social interaction for learning. Despite challenges in clinical practice, the students appreciated the experience of being a part of history. The challenges of the students’ experiences must be incorporated into the university’s curriculum and teaching.