Nursing Students' Experiences of How a Sudden Change in the Work Environment due to the COVID‐19 Pandemic Influences the Clinical Learning Environment: A Qualitative Study

ABSTRACT

Aim

To explore nursing students' experience of how the COVID‐19 pandemic influenced the learning environment in clinical setting and how they responded to the change.

Design

Qualitative descriptive interview study.

Methods

Eleven third‐year baccalaureate nursing students from a University College in Northern Denmark participated in individual semi‐structured interviews conducted in the spring 2021. Data analysis was guided by Braun and Clarke's thematic analysis.

Results

Two themes were generated: ‘A compromised learning environment’ and ‘Adjusting to circumstances and making things work’.

Conclusion

Students perceived that their learning became secondary and was influenced negatively. Some students' focus shifted from an attention to learning opportunities to managing daily patient care and became hesitant to pose questions that were relevant to their learning. Students faced a dilemma between helping with daily tasks and prioritising their learning needs. Some students adjusted to the circumstances by taking the lead. Others reacted more passively and prioritised helping nurses in managing the daily workload.

Implications for the Profession and Patient Care

The study highlights that changes in the work environment impact students. Institutions must ensure that students feel a sense of belonging and prioritise time with clinical supervisors for questions and reflection, avoiding situations where practical tasks take priority over learning. Since students manage changes differently, they require tailored support.

Impact

The study addressed changes in the clinical learning environment caused by the COVID‐19 pandemic. The changes within the environment influenced the students learning negatively. The findings are of relevance to lecturers, supervisors, and academic decision‐makers within nursing education and may guide the planning of clinical placements to better accommodate individual learning needs.

Reporting Method

The study adheres to the COREQ guidelines.

No Patient or Public Involvement

This study did not include patient or public involvement in its design, conduct, or reporting.

Summary.

• What does this paper contribute to the wider global clinical community?

  • ○
    Insight into how nursing students experience how a sudden change in work environment influences their learning environment.
  • ○
    Insight into the different ways nursing students manage sudden changes in work environment.
  • ○
    Reflective questions that may guide future development of policy documents and nursing curricula that aim at educating nurses in an ever‐changing health care system.

1. Introduction

The learning environment within the clinical setting changed suddenly and, for some students, drastically during the COVID‐19 pandemic (Boman et al. 2022; Jones et al. 2024; Ulenaers et al. 2021). Infection prevention and lockdowns during this period compelled schools of nursing and universities to rethink how they taught and trained the science of nursing (Heilferty et al. 2021; Park and Seo 2022). Virtual learning spaces were hastily implemented, replacing lectures, simulation lab teaching, and, in some instances, clinical placements (Swift et al. 2020; Michel et al. 2021). For safety reasons, some nursing students were prohibited from attending their clinical placements, while others ‘continued as usual’. The Northern Region of Denmark was one of the regions that maintained students within their clinical placements throughout the second wave of the pandemic, with students learning the usual curriculum within the clinical placements. The students were not deployed to support healthcare professionals, as seen in other countries (Barisone et al. 2022; Casafont et al. 2021).

The learning environment within a clinical setting is central to nursing students' learning trajectories. Nursing education, in close collaboration with clinical partners, has the obligation to plan and structure clinical placements that support nursing students' learning. The planning must consider how students are best supported in the healthcare environment, with its constant change due to organisational restructuring, changes in the number of staff and staff composition, moves to new hospital settings and lockdowns due to pandemics. This study uses the unusual situation of the COVID‐19 lockdown to explore nursing students' experiences of how a sudden change in the clinical work environment influences their learning and how they respond to the change.

2. Background

The clinical learning environment is complex, consisting of physical and psychosocial interactions, as well as organisational, cultural, teaching and learning components (Flott et al. 2015). The learning environment within a clinical setting is of utmost importance for nursing students' opportunities to learn, as it influences their learning outcomes and student satisfaction with the nursing profession (Flott et al. 2015). Several studies underline that work (Bryan et al. 2022; Michel et al. 2021) and the learning environment changed in clinical practice during the pandemic (Beisland et al. 2021; Eweida et al. 2020; Ulenaers et al. 2021), a change that influenced the students' learning trajectory (Boman et al. 2022).

There are several international studies on how nursing students coped with virtual lectures, instructions and online simulation during the pandemic (Griscti et al. 2024; Shorey et al. 2022). A systematic review by Shorey et al. (2022) indicated that undergraduate nursing students' experiences and opinions were mixed and extended, from perceiving online education as convenient, flexible and supporting significant academic achievement to experiences of feeling isolated, diminished academic achievements and poorer clinical readiness. Other studies have explored the emotional and psychological influence the pandemic had on nursing students placed within clinical placements (Aslan and Pekince 2021; Beisland et al. 2021; Eweida et al. 2020; Kochuvilayil et al. 2021). However, there are only a few studies on nursing students' experiences of their learning environment within clinical placements during the pandemic (Boman et al. 2022; Russo et al. 2023; Ulenaers et al. 2021). The available studies reported that students' time spent within clinical placement was characterised by discrepancies between learning objectives and learning opportunities, which caused uncertainty, anxiety and a feeling of being insufficiently supported (Boman et al. 2022; Ulenaers et al. 2021). However, despite facing several difficulties and challenges in their internship during COVID‐19, the students indicated gaining additional knowledge and skills beyond the formal learning outcomes and successfully evolved towards becoming health professionals (Boman et al. 2022; Russo et al. 2023).

Although pandemics such as the COVID‐19 are uncommon, situations that change learning environments within clinical settings are common. The current international situation with a nursing shortage resulting in clinical environments with fewer colleagues with a nursing background will ultimately change the work and learning environment (Buchan and Catton 2023). There will be fewer nurses to learn from and seek guidance from, and the nursing tasks and working practices will change over time, with other professionals assisting or taking over tasks previously undertaken by nurses. Another common change situation is the construction and relocation of newly built hospitals, including moving from multiple‐bedroom hospitals to single‐bedroom hospitals (Maben et al. 2015). This relocation process involves changes to the physical and social environments and influences the learning environment (Maben et al. 2015). In the future, nursing students will have to manoeuvre in ever‐changing work environments, and healthcare and educational systems should consider how to prepare students and nurses for these evolving environments.

In this study, we took advantage of the opportunity the pandemic presented regarding sudden change in the work and learning environment to explore nursing students' perceptions of how it influenced their learning within clinical placements and how they managed these changes. The insight into students' experiences and perspectives is of relevance for lecturers, supervisors and decision‐makers within the education setting when planning and structuring the nursing curriculum.

3. The Study

3.1. Aim

This study aimed to explore nursing students' experiences of how the COVID‐19 pandemic influenced the learning environment in the clinical setting and how they responded to the change.

4. Materials and Methods

4.1. Design and Theoretical Framework

The study employed a qualitative descriptive design, using semi‐structured individual interviews (Merriam and Tisdell 2016) to explore nursing students' experiences of how the pandemic influenced their learning environment and how they responded to the changes. The study draws on interpretive description methodology (Thompson Burdine et al. 2021; Thorne 2016), which lies within the social‐constructivist paradigm. This paradigm acknowledges that experiences are socially constructed and influenced by the setting. The qualitative approach enabled insight into the nursing students' experiences and perspectives (Merriam and Tisdell 2016). Furthermore, the methodology acknowledges the experiences and perspectives that the researchers bring into the data collection, analysis and interpretation of the findings. Due to the sparse literature on nursing students' experiences during the pandemic within clinical placement, an inductive approach was taken for the data collection and analysis. The reporting of the study followed the ‘Consolidated criteria for reporting qualitative research’ (COREQ) (Tong et al. 2007).

4.2. Setting

The study was undertaken at the school of nursing of a university college in the Northern Region of Denmark and Aalborg University Hospital, Denmark. The nursing programme comprised 90 clinical ECTS and 120 theoretical ECTS, had a duration of three and a half years, and led to a bachelor's degree. The students spent the 90 clinical ECTS in clinical practice.

The nursing students included in the study had all undertaken their 6th‐semester clinical placement at an acute care university hospital in Denmark during the second pandemic lockdown in the fall of 2020. The students' clinical placement extended over 5 months, during which they worked 8‐h shifts 4 days a week. The students were appointed a clinical supervisor who was employed by and worked as a registered nurse at the hospital. The clinical supervisors all held a diploma in supervision (10 ECTS) and were allocated a certain percentage of their working hours to supervision. The clinical supervisors were responsible for coordinating the students' clinical placement period as well as ensuring a supportive learning environment. Apart from the supervisors' delegated responsibility, all nurses employed at the university hospital had a contractual obligation to supervise nursing students. The interviews were conducted from May to June 2021, 4 months after the students finalised their 6th semester and final clinical placement.

4.3. Sampling and Participants

Eleven nursing students from two campuses attending the 7th semester of the bachelor's degree nursing programme at the school of nursing of Northern region of Denmark were purposefully sampled. The inclusion criteria were nursing students who had attended their 6th semester of clinical placement at Aalborg University Hospital. Following managerial approval from the educational institution, the first author sent an informative recruitment email to all nursing students attending their 7th semester at the school of nursing. Thirteen students responded positively. One student was subsequently excluded due to her clinical placement in a general practitioner's office; another student could not set aside time for the interview. The participants were between 20 and 25 years old and female. They had undertaken their clinical placement in the non‐pandemic wards of an acute care hospital setting at the University Hospital in Aalborg. The allocation of students between wards is listed in Table 1.

TABLE 1.

Allocation of students in wards.

Informant	Clinical placement
1	Medical ward
2	Surgical ward
3	Acute care
4	Intensive care
5	Medical outpatient unit
6	Medical ward
7	Medical ward
8	Intensive care
9	Intensive care
10	Medical ward
11	Paediatric ward

4.4. Data Collection

To gain insight into nursing students' experiences of how the pandemic influenced the learning environment and how they responded to the change, data were collected using semi‐structured interviews based on Brinkmann and Kvale's (2009) method for conducting individual qualitative interviews. The interview guide was developed based on the literature on students' experiences with the pandemic, as well as the literature on learning and clinical learning environments. The interview guide was structured around three topics: experiences of the clinical placement, learning in a changed work environment in clinical placement, and experiences from the pandemic to draw on in the future (Table 2).

TABLE 2.

Questions guiding the interview.

Topic	Central questions
Topic 1: Experiences of the clinical placement	Can you tell me about your experiences from your clinical placement? Try to think back on the first few weeks in clinical practice Did the national lockdown influence the ward you were allocated to? If so, how? Tell me about how you experienced the atmosphere at the hospital/your ward Did the atmosphere influence your learning in clinical practice? If so, how?
Topic 2: Learning in a changed work environment in clinical placement	What did you expect to learn in your final clinical placement as nursing student? Was your learning influenced by the lockdown? If so, how? Did you experience having to work more independently during the pandemic compared to previous clinical placements? If so, how?
Topic 3: Experiences from the pandemic to draw on in the future	Are there experiences from your clinical placement, that are specific to the pandemic, that you can draw on in the future? If so, can describe them?

Five face‐to‐face interviews were conducted on campus in an undisturbed room, and six interviews took place via the video conferencing tool Microsoft Teams. The interviews lasted between 25 and 40 min and were conducted by the two authors, Tanja Thomassen (senior lecturer, master of science (MSc) in public health, RN) and Siri Lygum Voldbjerg (associate professor, PhD, RN). The interviews were audio‐recorded and transcribed verbatim by the first author. Recordings were subsequently deleted.

4.5. Data Analysis

Data were analysed using the six phases of thematic analysis described by Braun and Clarke (2022). In Phase 1, all interviews were listened to and transcribed. For an overview of the dataset, NVivo was used to process the transcripts, coding and analysis (Jackson and Bazeley 2019). The transcriptions were read and re‐read several times. Reflective notes were made to initiate the coding process in Phase 2. Open coding was used, and the data were organised into meaningful themes based on elements that influenced the nursing students' learning environments and how they responded to change. The identified themes included supervisor, fellow students, the discourse in the ward related to the pandemic, contextual changes due to the pandemic (restrictions, protective equipment, distance and staff), independence, and taking the lead in own learning. In Phase 3, connections between the coding were found, and themes were identified. The coding was discussed in the research group and synthesised into two main themes with several subthemes. Ultimately, the analysis was reported in a thematic structure (Table 3).

TABLE 3.

Themes.

Aim: To explore nursing students' experience of how the COVID‐19 pandemic influenced the learning environment in clinical setting and how they responded to the change
Theme	Subtheme	Citations
A compromised learning environment	Learning as secondary	Well, I think the nurses have been very busy. There have been times when I was in doubt about something, and I would really have liked to ask for advice. However, I didn't really want to go to the nurses because they were so busy. At other times, I was sort of stationed as ‘the person who walks the hallway’ and did all the basic patient care because they were just too busy to do it themselves. (Informant 3) There were fewer resources, so that had an impact on my learning. Where should they place me? There weren't many people at work. Who had time for one like me, who needs to have everything explained? (Informant 4) I often found that the nurses were extremely busy. In some situations, there was definitely a learning aspect. But more often, I believe it was simply due to a shortage of nurses on duty, which is why I was asked to step in. (Informant 11)
	Missing clinical supervisors' supervision	I was left alone to care for an intensive care patient, who fortunately was not particularly acute. I had other nurses around me, but that feeling of suddenly being alone with such a responsibility, it wasn't much fun. The feeling of safety that the clinical supervisor created and having someone to reflect with was gone. (Informant 8) Well, I think that some of the daily supervisors are good, but it is far from all of them. You can kind of feel that… it sounds a bit harsh to say this, but it sometimes feels like they don't really want you with them. That you are a bit of a burden they have to drag along with them. You can feel the pressure, and the stress related to having a student. One you must explain everything to. That makes you hold back a little with the questions, because you don't want to put further pressure on them. You don't want them to perceive you as a burden. You want to keep a good relationship with the person. So, you end up keeping a low profile and stay in the background. (Informant 9) I think it's such a shame that we don't get more time with our clinical supervisors, because they've received specific training for a reason. They understand how to support us, they know what our education involves, what we need to take away from our placements, and what we should focus on. They're also better at explaining their actions—saying things like, ‘I'm doing this because…’ As students, we're often so busy that we forget to ask, ‘Why are you actually doing that?’ (Informant 9)
	Excluded for learning opportunities	Well, that is what they said. I should no longer be in contact with the covid patients. So that put a limit to what I could get involved in. (Informant 4) … we usually have morning meetings at the ward, where all healthcare professionals meet and discuss the plan for the patient—is there anything we need to pay attention to today? I was excluded from that. I wasn't allowed to participate because I was unnecessary staff, so I wasn't there. (Informant 7) It gave a good insight into what they actually do in an outpatient clinic rather than an operating ward. Normally you would have the opportunity (the student) to visit the ambulatory 1 day, the bed ward the other and the recovery the third. But we were not allowed to ‘swap’ between wards…. It would have been good to see where the patients go and where they come from. (Informant 2) My experience was that I often didn't get the chance to ask the questions I wanted to. Sometimes it felt like I was just told, ‘just pick up the phone’ and then I had to handle calls from GPs and similar tasks. Of course, that also offered some learning opportunities, but it felt quite uncertain at times. (Informant 5)
Adjustning to circumstances an making things work	Taking the lead	… I had to reflect on my own competencies in relation to what I felt comfortable with. It was my responsibility to assess what I can do and what I'm allowed to do, as a student. (Informant 6) I realised that I am responsible for my own learning and that requires that I take initiative to how I can meet my goals for learning. (Informant 4) We clearly had to start standing on our own feet a bit more, and we found ourselves in that position because our supervisors also had to take care of their responsibilities. (Informant 7)
	Going with the flow	I think that there were several practical skills that I would have liked to have learnt. Including administering medication, hanging up liquids and to learn how to place a peripheral venous catheter. I think there are a lot of practical skills I didn't get to practice enough or didn't do at all. (Informant 5) We have to make things work. If that means that there isn't time for reflection with us, well that's how the world as a nurse looks like. … I like to be part of the daily work and the challenges. (Informant 10)

4.6. Ethical Considerations

The study was carried out in accordance with the Code of Ethics of the World Medical Association (2013) and registered on the University College North Denmark research database under ID number 20900393. The informants received oral and written information about the study and were informed that they could withdraw from the project at any time without further explanation. All informants signed a consent form.

4.7. Rigour and Reflexivity

To ensure rigour, different strategies inspired by Lincoln and Guba (1985) were considered. The study's credibility was enhanced by selecting informants who had first‐hand experience with the phenomenon of interest. At the end of each interview, the participants were given the opportunity to elaborate on matters they thought were important to the overall aim. Furthermore, the study's credibility and confirmability were strengthened by illustrating the findings with citations from the dataset. To ensure dependability, the first three transcribed interviews were coded independently by the two researchers. Differences were discussed until consensus was reached before the rest of the interviews were coded. The remaining transcripts were then divided between the two researchers and coded. Following the coding, the two researchers met several times to generate subthemes and themes through a reflexive process that challenged the analysis and interpretation through reflexive questions. The second author did not have previous contact with the participants and could therefore challenge the first author's eventual preunderstanding, which may influence the analysis of data from any student. With regard to the transferability of the study, we have provided a detailed description of participants, setting, the process of data collection and the analysis.

5. Findings

Two overall themes were generated from the analysis. The first theme, ‘A compromised learning environment’, describes the students' perceptions of the clinical learning environment and how it influenced their learning. The second theme, ‘Adjusting to circumstances and making things work’, describes how they responded to changes within the learning environment.

5.1. A Compromised Learning Environment

Due to the COVID‐19 pandemic, the students' learning needs were compromised from several perspectives. They perceived that their learning became secondary, that they missed out on valuable time with their clinical supervisors, and that they were excluded from learning opportunities.

5.1.1. Learning as Secondary

Due to the relocation of nurses to pandemic wards and nurses being sent home because of pandemic restrictions, the students experienced a cutback in nurses at work. The cutback resulted in nursing students perceiving that their learning needs became secondary and, in some situations, were altogether set aside. As one student noted, the usual weekly reflective sessions were cancelled:

Patient flow was lower, and some nurses were relocated to pandemic wards, and there wasn't the same amount of time to ask questions and learn. Many of the weekly reflective sessions with our supervisors were cancelled. (Informant 5)

The students' restricted access to nurses and shortened time allocated for reflection led to fewer opportunities for the students' enquiries, questions, and reflections, matters pertinent to their learning process and training. Another student reported that a lack of staff resulted in her not being seen as part of the team of nurses:

There were fewer resources, so that had an impact on my learning. Where should they place me? There weren't many people at work. Who had time for one like me, who needs to have everything explained? (Informant 4)

Not being seen as part of the nursing team left the students with a feeling of being superfluous and a burden to the team of nurses. The students reported that the focus of clinical supervisors and nurses shifted from learning opportunities to managing daily patient care. According to one nursing student:

Interviewer: Do you think that the atmosphere throughout this reorganisation has affected your learning?

Informant: Yes, it has because the focus suddenly shifted to how do we get the job done (caring for patients) instead of how I can get the most (learning) out of the few weeks I have left (within clinical placement). (Informant 7)

The nursing students felt that their colleagues' attention to how they as students could be part of the nursing team while considering their learning needs became secondary and, in some instances, vanished altogether. The feeling of being used as a substitute for the lack of nursing staff was further supported by a student who expressed that she was asked to do tasks that did not have a learning perspective targeted at her learning objectives. It became a question of managing a ward that was too busy:

Well, I think the nurses have been very busy. There have been times when I was in doubt about something, and I would really have liked to ask for advice. However, I didn't really want to go to the nurses because they were so busy. At other times, I was sort of stationed as ‘the person who walks the hallway’ and did all the fundamental patient care because they were just too busy to do it themselves. (Informant 3)

Perceiving the nurses being busy made the students hesitant to pose questions that were relevant to their learning. Furthermore, they found themselves in a dilemma between contributing to daily work routines, in which the primary focus was on getting care done and keeping the ward together, and their own need to have a primary focus on their learning needs.

Interviewer: Has it affected your learning?

Informant: Yes, because the focus suddenly shifted to how we manage the workaday together rather than how I can get the most out of my time as a student. (Informant 3)

Another student reiterated some of the skills she did not learn due to a limited focus on what the student needed to experience and practice to reach the learning objectives:

I think that there were several practical skills that I would have liked to learn, including administering medication, hanging up liquids, and placing a peripheral venous catheter. I think there are a lot of practical skills I didn't get to practice enough or didn't do at all. (Informant 5)

Being part of a learning environment where learning was perceived as secondary influenced their learning. The students were often left alone with patients, resulting in limited opportunities for practicing practical skills and critical reflection. The students expected to be acknowledged as someone needing attention, support, and time rather than simply seen as a welcome part of the daily workforce.

5.1.2. Missing Clinical Supervisors' Supervision

Having a clinical supervisor around was valued by the nursing students. They considered being in close contact with and having access to the clinical supervisor central to their learning. However, access to and the relationship between students and clinical supervisors was challenged during the pandemic, as the interviewed students reported having limited contact with their clinical supervisors. According to the reflection of a student whose clinical supervisor was sent home due to COVID‐19 symptoms:

I was left alone to care for an intensive care patient, who fortunately was not particularly acute. I had other nurses around me, but that feeling of suddenly being alone with such a responsibility wasn't much fun. The feeling of safety that the clinical supervisor created and having someone to reflect with was gone. (Informant 8)

Having a supervisor within reach created a feeling of a safe environment where the nursing students felt that they were in good hands and that there was someone to help, supervise, and reflect with if needed. The relationship with the clinical supervisor and the opportunity to spare were seen as central to their learning. It seemed more legitimate to draw on the clinical supervisor in relation to the learning aspect than other nurses and colleagues.

With the clinical supervisors' limited or lack of opportunity to be present in the ward with the students, they had to depend on other nurses for help and guidance. However, they reported that getting the other nurses' attention and supervision was also challenging:

It was more difficult to reach a nurse when I had questions about something I had done—especially if it was a procedure I had only done once before and needed help or supervision. (Informant 6)

Another nurse reported not always experiencing a sympathetic attitude from the nurses regarding supervision:

Well, I think that some of the daily supervisors are good, but that was not all of them. You can kind of feel that … it sounds a bit harsh to say this, but it sometimes feels like they don't really want you with them. That you are a bit of a burden they have to drag along with them. You can feel the pressure and stress related to having a student, someone you must explain everything to. That makes you hold back a little with the questions, because you don't want to put further pressure on them. You don't want them to perceive you as a burden. You want to keep a good relationship with the person. So, you end up keeping a low profile and staying in the background. (Informant 9)

The students' perceptions of the nurses' reluctancy regarding help and guidance made them feel like a nuisance. The students' experiences of the nurses' stress and work pressure challenged the learning environment. The students prioritised keeping a good relationship with the nurses, refrained from asking for help to avoid disturbing them, and, thereby, set their learning needs aside.

One supervisor had resigned, so I sometimes had to go with other nurses, and that just meant that I had to start all over again each time. They also had a hard time giving me the responsibility…. I had expected that I would have become more independent and that I, for example, would know much more about administering medication. (Informant 8)

Not having a stable team of supervisors had a negative impact on the students' learning and feelings of achieving independence in terms of carrying out specific nursing tasks. This independence was important for them to achieve, as it was their last clinical semester in the education.

5.1.3. Excluded From Learning Opportunities

Due to the pandemic, there was a restriction regarding how many healthcare professionals could be in direct contact with patients with a COVID‐19 diagnosis. This often resulted in nursing students being excluded from care situations. As one student reported:

Well, that is what they said. I should no longer be in contact with COVID patients. So that put a limit on what I could get involved in. (Informant 4)

Being excluded from care situations restricted their opportunities to learn from actual caring situations with patients. Furthermore, students experienced being excluded from cross‐professional meetings concerning patient care and treatment. As one student highlighted:

… we usually have morning meetings at the ward, where all healthcare professionals meet and discuss the plan for the patient. Is there anything we need to pay attention to today? I was excluded from that. I wasn't allowed to participate because I was ‘unnecessary staff’, so I wasn't there. (Informant 7)

The exclusion from patients and meetings left the students with a feeling of not being part of the healthcare professional team and as part of the wards' daily planning and work routines. The students experienced being excluded from valuable learning situations.

Learning opportunities from cross‐professional collaboration were furthermore challenged by restrictions regarding moving between wards, resulting in students not being able to follow the patient's trajectory across different wards. As one student indicated:

It gave a good insight into what they actually do in an outpatient clinic rather than in an operating ward. Normally, you would have the opportunity (as the student) to visit the ambulatory one day, the bed ward on the next day, and the recovery on another day. But we were not allowed to ‘swap’ between wards…. It would have been good to see where the patients go and where they come from. (Informant 2)

The COVID‐19 restrictions resulted in limited mobility, as the students were not able to follow their patients. It gave them less insight into patients' care trajectories and what was needed and relevant to patients in establishing, for example, continuity of care.

5.2. Adjusting to Circumstances and ‘Making Things Work’

The nursing students were quite accepting of the changed work and learning environment. They adjusted to their circumstances and made it work. However, they had different ways of managing the challenges they encountered. Some students took the lead in their own learning. Others had a more passive and awaiting approach to the influence of the changed learning environments on their learning.

5.2.1. Taking the Lead

Some nursing students reacted to the changes within the learning environment by taking responsibility for their own learning. They accepted the circumstances, but at the same time, they were attentive as to how the changes influenced their learning and that it required alternate action from their side. As one student said:

… I had to reflect on my own competencies in relation to what I felt comfortable with. It was my responsibility to assess what I could do and what I was allowed to do as a student. (Informant 6)

The uncertainty of the situation impelled some students to become aware of their own boundaries concerning skills and competencies. Furthermore, there was a reflection regarding their responsibility for their own learning and being explicit when in need of help. The notion of feeling responsible was also highlighted by another student:

I realised that I am responsible for my own learning, and that requires that I take initiative in how I can meet my learning objectives. (Informant 4)

Some students became aware of their own role and responsibility for their own learning process, a responsibility that required initiative from their side in order to obtain the required learning objectives.

5.2.2. Going With the Flow

Other nursing students had a more awaiting and accepting approach to the changes in the learning environment and the challenges this brought on. Their focus was on helping the nurses with patient care:

We have to make things work. If that means that there isn't time for reflection with us, well, that is what the world as a nurse looks like. … I like to be part of the daily work and the challenges. (Informant 10)

These students had a more adaptive and pending approach at the expense of their learning. They prioritised giving a helping hand to the nurses in managing the daily workload and took it as a positive experience. Another student prioritised helping the nurses caring for the patients rather than claiming her need to learn and practice administering medicine.

… The staff had been sent home, and there was a shortage of nurses on the ward, which made it difficult for me to focus on my own patients. So, it was easier for me to provide nursing care for the patients, while someone else handled the administration of medicine. (Informant 3)

Yet another student accepted that the situation of the pandemic could have serious consequences, as she might not meet the educational requirements and could ultimately fail the semester:

I took it one day at a time. Worst case, I'd have to postpone my exam. If I failed, I'd just try again. That was the mindset I had. (Informant 7)

The students were aware that the situation in some instances had a negative influence on their learning. However, they were very accepting of the situation and seemed to go with the flow without being critically reflective as to how they themselves could contribute to achieving their learning objectives.

6. Discussion

The findings of this study highlight how nursing students' experiences of the physical and psychosocial interactions, as well as organisational, cultural, teaching and learning components, within the learning environment were affected by a change in work environment due to the pandemic. A restriction or change in one component led to a change in one or several other components, and the change influenced the students' learning on several levels. Furthermore, the study reveals that nursing students reacted either by taking the lead or by being passive regarding their own learning in a suddenly changing learning environment.

Regarding the organisational component, this study shows that the nursing students experienced a cutback in nurses due to the relocation of nurses to other wards and nurses on sick leave, which influenced their learning. The students experienced limited access to clinical supervisors and other nurse colleagues, which restricted their opportunities to seek guidance, question others' practice, and critically reflect with more experienced colleagues. Students' limited support and contact with clinical colleagues, academic staff, and peers during the pandemic has previously been reported by Romero‐Blanco et al. (2020) in their study on Spanish nursing students' experiences. Supervisors and mentors are critical to students' professional development in clinical practice (Mikkonen et al. 2020); they are a prerequisite to establishing a culture characterised by a spirit of clinical enquiry, which is central to developing critical thinking and reflective practice. The pandemic‐imposed limited opportunity for enquiry, which is imperative for nurses' learning and development (Patel and Metersky 2022), exemplifies how the cultural component of the learning environment was affected by a change in the organisational component. Learning and developing the skills necessary for critical reflection was one of the components that the students highlighted as limited or not present at all due to the pandemic.

Furthermore, the cutback in nurses resulted in nurses losing the awareness of and time for supervising and including the students in daily care situations, resulting in the component of teaching being de‐prioritised and, in some situations, excluded. With a minimal focus on teaching and supervision, some students felt superfluous and were not part of the team of nurses. Studies have emphasised that being part of a team and feeling a sense of belonging within clinical placement improves students' confidence and motivation to learn (Levett‐Jones et al. 2009). Liljedahl et al. (2016) indicated that belonging to the workplace is a prerequisite for learning.

A change in the physical component within the learning environment became apparent with the implementation of restrictions on the number of people allowed per room. The restriction resulted in students being asked not to take part in meetings and/or not to enter patients' rooms, ultimately excluding them from learning opportunities. Furthermore, the students' exclusion from meetings and activities within the patients' rooms affected the learning environment component regarding psychosocial interactions. The exclusion restricted their opportunities to work with their supervisors and learn from actual patient care situations. The findings from this study underline that the students perceived that due to limited contact with supervisors and staff, they did not get to learn and develop the practical and technical skills that were required. Furthermore, being left out of meetings and not being able to follow patients from one department to another gave them less insight into patients' care trajectory and into what was needed to establish person‐centred care with a focus on continuity. A review by Inocian et al. (2022) underlines that working alongside professional nurses and being involved in patient care has a positive impact on students' development of caring behaviours through role modelling and patient interaction, ultimately leading to the promotion of safe patient care.

Being in an environment with sudden and ongoing changes that influenced the learning environment generated different reactions among the nursing students. Some took the lead in their own learning trajectory, while others had a more passive approach and went with the flow without consideration for their learning. This diverse reaction to change was highlighted in a study by Boman et al. (2022), who showed that students reacted to the chaotic situation of the pandemic in different ways. Some took the opportunity for their own initiatives and planned for a better learning process, whereas others became overwhelmed by the sudden responsibility for their own learning, felt they were left alone, and ultimately found it difficult to learn. Boman et al. (2022) When supervising and supporting nursing students, it is imperative for clinical supervisors to be attentive to the fact that students react quite differently to sudden changes in the work environment and therefore provide different kinds of support and encouragement.

6.1. Strengths and Limitations of the Study

The lockdown posed a few challenges to the study regarding the face‐to‐face interviews of the students. Six of the interviews were conducted using an online video conferencing tool. This may have created a relational distance between the researcher and the informant and challenged the researcher's task to put the informant at ease and create a room of trust where the informant could express thoughts and reflections. During the analysis of the videoconferencing calls, special attention was drawn to the informants' engagement in the interviews. The informants seemed to accept the premise of the video conferencing tool, and their engagement did not seem to be affected. The evaluation of both verbal and non‐verbal communication suggested that the interviewees were at ease and eager to share their experiences with the researcher.

The students were interviewed 4 months after completing their 6th‐semester clinical placement. In fall 2020 and spring 2021, there were quite a few uncertainties regarding the rules for conducting research during a national lockdown that was repealed in May 2021. Therefore, it took a while to obtain approval for the project protocol from the university's research committee. Having students reflect on their clinical placement 4 months after completing the placement may have influenced their recollection. However, the students did not seem to have difficulty describing and reflecting on their experiences. Furthermore, their experiences are similar to other nursing students' experiences in other international studies (Aslan and Pekince 2021; Beisland et al. 2021; Eweida et al. 2020; Kochuvilayil et al. 2021), underlining that the reflections are trustworthy and mirror their experiences at the time of their placement.

The data could have been enriched by observational data of the student practice within the hospital. However, due to the uncertainty about the risk of COVID‐19, it was not an option to conduct field observations. Data saturation was not sought, as the study aimed for a heterogeneous sample of nursing students representing different experiences. However, it is uncertain whether the data represented the full range of students. Students were affected by the uncertainty due to the pandemic, and some students may not have had the opportunity to participate in the interviews. Therefore, their experiences may not be represented in this study.

6.2. Implications for Clinical and Educational Practice

Due to changes in the nursing workforce and hospital environments, nursing students will have to navigate ever‐changing work environments. It is, therefore, imperative that healthcare and educational institutions collaborate on how to prepare and support students and nurses for these evolving environments that ultimately influence their opportunity to learn. First, they must acknowledge that students are affected by changes in working and learning environments. Second, they should create an environment in which students feel they belong, are in contact with their clinical supervisors, and have the time and space for questions and critical reflections. Third, educators must prevent dilemmas in which students feel impelled to prioritise helping with tasks rather than the opportunity to learn. Fourth, educational institutions and hospitals must acknowledge that students have different ways of managing changes in the learning environment and, therefore, provide differentiated support.

7. Conclusion

Hospitals and educational institutions were not prepared for a pandemic with such far‐reaching consequences. This study offers insight into how nursing students perceived how the pandemic changed the clinical learning environment and how they responded to these changes. The study outlines how the pandemic created an environment in which learning was perceived as secondary to patient care, with some situations not prioritising learning at all or having limited staff, absent clinical supervisors, and alternate rules regarding students' presence at meetings and patient situations. All of these changes negatively influenced the students' learning opportunities. The study calls for reflections and actions on how to prepare students, educational institutions, and hospitals for a future that withholds changes in the work and learning environment due to pandemics, alternate hospital settings, and staff composition. Through close collaboration, hospitals and educational institutions could address the following questions in developing a policy: How do we ensure that students feel they belong to the ward? How do we establish a culture in which students' questions and reflections are welcome? How do we make sure the students are part of valuable learning opportunities? How do we support students in being people with learning needs? How do we acknowledge and respect that students have different needs for support in responding to sudden change?

Although conducted under the COVID‐19 pandemic, the findings remain relevant in today's dynamic clinical settings and are critical to the future development of nursing curricula that aim to educate nurses in an ever‐changing and evolving healthcare system. Students need to be within clinical learning environments that acknowledge that a learning environment consists of different components that must be supported at several levels. Such a learning environment acknowledges students' need to belong and learn and does not put them in the dilemma of needing to prioritise helping nurses manage the daily workload rather than taking the opportunity to learn.

Disclosure

Study registration: The study is registered at the University College of Northern Denmark Research Database under id‐number 20900393.

Conflicts of Interest

The authors declare no conflicts of interest.

Thomassen, T. , and Voldbjerg S. L.. 2026. “Nursing Students' Experiences of How a Sudden Change in the Work Environment due to the COVID‐19 Pandemic Influences the Clinical Learning Environment: A Qualitative Study.” Journal of Advanced Nursing 82, no. 5: 5218–5228. 10.1111/jan.70171.

Data Availability Statement

Data available on request from the authors.