With reduced clinical hours, online simulations, and COVID outbreak risks, nursing students find themselves in a concerning spot. Image: Pexels/Stock
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Nursing students have faced many changes and been thrust into many situations that they normally would not, due to COVID-19.

Many science and health science students have had more dynamic experiences during online schooling, with in-person labs being held on campus even at the height of the pandemic and clinical placements being continued.

This has given them a rare access to the centre of a public health crisis through their academics. These students have a unique perspective on student life and education during COVID-19. 

Nursing students have experienced this intensely, as they have many required clinical placements starting in second-year, including through practicums such as Care of Adults Experiencing Illness (NSG3305) and Complex Nursing Care (NSG4430). These placements would traditionally take place on-site, in places such as nursing homes and hospitals, for hands-on learning and practical application. 

Online learning experience during COVID-19

Coreena Ethridge is a fourth-year nursing student who has completed multiple clinical placements, including at the Civic and General hospitals, during COVID-19. 

“The unit I was in this past semester was on a COVID-19 outbreak. That means we had to get tested weekly out of our own time and expense. I worked as a PSW [personal support worker] for the last two years and have worked on COVID-19 wards and with positive patients,” she detailed.

“Due to social distancing and policies for COVID-19, our labs were reduced to 75 per cent online, and clinical was reduced to 50 per cent online. We typically have 96 hours of lab, which was moved to online, except for 12 hours of in-person labs to complete our skills tests. We are supposed to have 192 hours of in-person clinical experience per semester, which was reduced to 96 hours, [with the rest of the hours made up] via online simulations,” Ethridge continued. 

“Clinical practice allows us to gain confidence and work towards becoming component and safe nurses. We can work alongside nurses, have our own patients, and perform nursing skills.  Losing half of our hours has created so much fear and anxiety among nursing students, we all have fears of not knowing what to do in certain situations or how to react.  There is so much frustration with the fact that we are paying full tuition for half the number of hours we [are supposed to] receive.” 

Jay Steep is a second-year nursing student whose university education started online and has continued with minimal in-person courses during COVID-19. Their clinical placements are upcoming, but have not yet begun. 

“The professors have been excellent for the most part as far as adapting the courses [online], and they’re always very helpful and kind,” Steep said.“From what I’ve heard, students during normal times are able to establish a sort of rapport with the professors, use them for references, or just get to know them. With online learning, we don’t have that.”

Third-year nursing student Victoria Losier spent almost a year of university fully online after March 2020, before starting to attend in-person labs and clinical sessions in the winter of 2021. 

Speaking about her experience learning in an online environment, Losier stated, “I’ve found it hard to learn virtually compared to in-person. Especially given that there are no health science study groups for any of the third-year nursing classes, compared to the previous two years where we had access to in-person, then virtual study groups for the classes.”

The socialization aspect in online classes (or lack thereof), has been a concern for students and faculty alike. This is especially true for students like Steep, in second year, who started their university education online and have not had the in-person experience.

“We also don’t know our peers. There’s only so much that can be done through a Whatsapp group chat, and we are going into clinicals in two weeks without having ever met the people we are going into clinicals with,” Steep said. “Without having in-person classes, I haven’t been able to connect with other students, or with the professors.”

Online education itself carries many uncertainties, including the legitimacy of evaluations. In terms of online examinations — the issue that has troubled many professors and faced every student — Steep perceives them as detrimental to learning as a nursing student. 

“For me, the biggest thing that I have noticed is the effect of open-book exams. There is an entire cohort of nursing students who don’t properly know their anatomy, or their pathophysiology, myself included,” said Steep, although he conceded that “part of the issue is on the onus of the students for not studying as if the exams were closed-book.”

Losier agrees. “The biggest things for me are the reduced lab hours in Fall 2020 and reduced clinical hours in Winter and Fall 2021, which I feel took away our cohort’s ability to learn the basics needed to become competent nurses. I feel our cohort missed out on important lab and clinical time due to hospitals putting capacity limits on students, which has impacted our ability to practice confidently,” she says. 

As a third-year student, Losier has experienced clinical placements, both in person and with virtual supplements. 

“I have had three placements so far. My experience has felt very rushed in the placements due to reduced in person hours, we supplemented in person clinical with virtual patient simulations. The virtual patient simulations did not seem very helpful to me, though our instructors would often try to make the most of them,” Losier explained. 

Nervous for the future

The uncertainty caused by the fluctuating health mandates — most recently, the University of Ottawa’s early January decision to move classes online through the end of the month — is causing confusion for students. 

When asked about their expectations for nursing experience and clinical placements, Steep concisely expressed that it has been stressful no matter who you ask. 

For nursing students, this is yet another point of concern for their experience and education. 

Ethridge is worried about retaining skills learned in online labs, saying, “There have been countless times the past two years where I was in clinical practice and I was expected to do a certain skill that I “learned” in a lab online. I was very nervous to do the skills because I had never done it before(…) Several times for my own comfort, I have opted to just watch the skills be performed because I had not had a chance to practice the skill in person.”

Losier reflects on the faculty’s approach to experience and education during the pandemic, saying, “It’s been interesting for me to experience the reduced lab and clinical hours while also receiving emails from the faculty of nursing that encourage us to get healthcare related jobs (such as PSW, public health positions, and patient care aides). It always feels hypocritical to tell us it’s too dangerous to have in-person labs or in-person classes, but on the flip side being asked to step up and work in front line health care to support the community and gain experience. It seems the most helpful thing that we can do as students is get a solid education so that we will be safe professionals instead of supplementing our partial education with nursing type jobs.”

Steep is similarly worried about staying optimistic through the uncertainty of their clinical placements.

“With staff stretched further and less nurses available, the placements are less functional. While the hospitals and the university try to keep placements standard, with the lack of staff, there aren’t always the resources. Plus, we are all on last-minute notice, where our clinical placements may be cancelled due to the instructor having COVID,” Steep explained.

“I’m concerned about what the experience will be. I think a lot of us are trying to hold onto our optimism going into this first clinical, but I think we all know that it’s going to be rough. And while nursing is never a glorious profession, this experience is going to be so far on the other end of the spectrum that we will never have seen it coming.”

In comparison to many other students, Ethridge has experience with clinicals during the pandemic which have shaped her experiences.

“I feel most nursing students will agree that we are all scared that we won’t be prepared for when we graduate. Most of us still feel like we know nothing…COVID-19 has heightened this fear due to the lost hours and experience.”

“I have mostly good experience in clinical but with all the restrictions, I only wish we had more time so that I can gain more confidence. The biggest thing that allows nurses to feel confident in the bedside is having experience behind them. Theory can only teach a nurse so much. It is the hours spent at the bedside caring for our patients and working with other HCP that allows us to become confident and competent nurses,” she said.

Current outlook on the nursing field

Nursing, a field that is not for the faint of heart, has been more publicized and recognized of late due to the pandemic. This has, according to Steep, damaged students’ outlooks for their futures in the field.

“I am now trying to apply for care home jobs and am being turned down because I don’t have clinical or academic references,” Steep explained. 

Losier emphasized, “I think a lot of students are experiencing burnout from the high expectations of nursing school, personal complications, and nursing type jobs without any ability to decompress. I think a lot of us have this sense of dread, graduating into a health care system that depends so heavily on the overworking of nursing staff that has become incredibly clear during this pandemic.”

Additionally, the view of nursing as a whole, and especially as a career, has been dampened by the pandemic.

“I think we all have also lost our optimism on going into nursing a lot faster than normal. Everyone who signs up for the program should know that nursing is not an easy field, and that it takes a lot from you. However, watching what has been going on in the past few years, with how nurses have been treated and compensated and abused during the pandemic, there is a common sentiment that we are making a huge mistake by taking our lives in this direction that previous years don’t seem to have gotten at least until they started really working in care settings,” Steep stated. 

Ethridge agrees. “Thousands of nurses are leaving the profession because they are exhausted. In four months, I will be entering a profession that is understaffed and screaming for help. I still want to be a nurse and I love my program, but I am already burnt out and I haven’t graduated yet. This stress from the pandemic that has been placed on the nursing profession, is felt by the nursing students across the nation. Nursing students are the next generation of our profession, and we are all entering this profession scared and frustrated.”

However, Losier concluded on a hopeful note. “Though nursing is a very difficult profession and many of us are struggling in the program, I have so much hope for progress towards a better future in nursing. I think this sentiment is shared by so many of my fellow students and it’s why we keep pushing through the obstacles.”

Future nurses at the U of O have experienced the COVID-19 pandemic much differently than many other students, combining online classes with only occasional in-person labs and clinical placements. While online classes and education can be beneficial for many — by teaching independence while also allowing flexibility and mobility —  they can also severely inhibit socialization and practical application. 

Nursing students, in a program and field in which on-site learning and application are necessary, are suffering from the lack of needed in-person training and placements due to the fluctuating public health mandates. The lack of consistency and the harsh exposure to the COVID-19 health crisis has caused a decrease in students’ faith and optimism in nursing and their futures within the field.