Of the 150 potential student participants, 26 students answered the anonymous survey for a return rate of approximately 17%. The sample included 26 third-year and fourth-year undergraduate student participants from the host university. Several of the participants (n = 17) chose to engage in an in-person clinical format during the Spring 2021 semester, whereas other participants (n = 9) chose virtual clinical format.
Research questions 1 and 2 were evaluated using a thematic analysis, where responses were reviewed by multiple authors for patterns throughout the data. Research questions 3 through 8 were reviewed using a descriptive analysis based on the format of the questions.
Results by Research Question
Q1: Please describe what led you to decision to engage in virtual clinical.
Participant’s answers varied in response and included themes such as fear of social isolation, and the impact of nonacademic commitments.
Exemplar quotes used to support student’s expression of fear of isolation include: “…campus wasn’t allowed to go places (social outings), it wasn’t a good option for me mentally.”
Another participant stated.
“…I had to decide if I wanted my mental health to decline from social isolation and not be able to work or attend in-person clinicals and not have the option to leave for work.”
Some students described the importance of having virtual clinical experiences during their final semester of their undergraduate education.
“Although it wasn’t hands on clinical, I still learned critical thinking skills and was able to enjoy what was left of my senior year rather than being upset and depressed like I was in the fall semester.”
Some students describe the nonacademic commitments they were able to pursue because they selected to engage in virtual clinical:
“Enabling access and participation in commitments and relationships out of …[the host university].”
“I didn’t think it would impact my career long-term.”
Q2: Please describe what led you to the choice to engage in an in-person clinical.
Many participants rationalized their choice to selecting an in-person clinical experience. Themes emerged regarding having trust in the traditional learning experience as well as many feared that the virtual environment would not be substantial to meet their learning and professional needs.
Some students described that they were comfortable with the traditional, in-person clinical experiences provided to them and thought that being in-person was the only way to adequately obtain those skills. Participants stated:
“I did not want to miss out on hands on experiences.”
“Online clinical could never replace the experience felt by in-person clinical.”
“I felt that in-person clinical was an invaluable experience. Being in-person has helped me learn skills such as confidence, flexibility, communication skills, etc. that cannot be learned virtually.”
Additionally, students thought that participating in in-person clinical settings would be the best opportunity to develop their nursing skills because they began applying for nursing positions and graduate schools. Exemplar quotes included:
“Afraid how it would look on future job or graduate school applications.”
“I knew that I needed it for my future.”
“Based on my own experiences of personal, virtual clinical experience from Fall 2020; there seems to be more busy work rather than learning.”
“Virtual simulations do not allow me to feel confident in my nursing skills.”
Q3: What do you see as the Pros and Cons of virtual clinical?
Students who selected a virtual clinical format were able to provide insights to their thoughts regarding the positive and negative aspect of engaging in a virtual clinical experience. Although there were some negative aspects highlighted, a majority of comments surrounded positive takeaways students perceived through participating in virtual clinical as showcased in Table 1
Table 1Pros and cons of virtual clinical
Q4: What do you see as the Pros and Cons of in-person clinical?
Students who selected to participate in an in-person clinical format were able to describe their thoughts about the pros and cons of selecting to be in-person for their clinical experiences. Although participants enjoyed the ability to develop their nursing skills and engage with faculty and peers, some students thought that social isolation and the risks of being in-person were drawbacks to their clinical experiences as described in Table 2
Table 2Pros and cons of in-person clinical
Q5: How do you feel about the decision to engage in virtual clinical now that the semester has started?
Several participants described their thoughts surrounding their decision to partake in a virtual clinical format while they were participating in their clinical experiences. Students provided a variety of personalized responses, with most of them providing positive responses about their decision, including:
“It was the right decision for me.”
“I don’t regret it.”
“Virtual clinical allowed me to improve my critical thinking.”
“Virtual clinical has enabled me to understand how diseases work and why certain treatments are beneficial. I can always re-learn or practice skills.”
Q6: How do you feel about the decision to engage in an in-person clinical now that the semester has started?
Many students detailed their decision of selecting an in-person clinical experience. Participants provided multiple mixed responses regarding their decision to participate in an in-person clinical experience, such as follows:
“I feel like I made the right decision.”
“I am glad I did it for the hands-on learning, but I would probably be at a better place mentally if I chose virtual.”
“I have had valuable in person clinical experiences, so I am happy with my decision.”
Q7: Do you have any major concerns about your choice? How can we improve this experience for you?
All participants had the opportunity to discuss any concerns regarding their decision to select an in-person or virtual clinical experience. Participants described concerns such as marketability, social experiences, development of nursing skills, and the impact their clinical choice has on mental health and wellness. Exemplar quotes include
“Biggest concern is that when applying for jobs people won’t perceive virtual clinical as well as in-person clinical.”
“My major concern is that I am missing out time with my friends.”
“I am concerned if I am still on track with my peers.”
“By staying remote I have missed out on skills I should have learned.”
“Severe COVID-19 restrictions have made my experience undesirable.”
“This has substantially and negatively impacted my mental health (in person).”
“There needs to be more open communication with students from administration and not just them telling us what we are and aren’t going to do.”
“I feel it was a good choice for me and I was given adequate resources to succeed virtually.”
“I just wished students were able to care for COVID-19 positive patients—we will have to in a few months in the real world.”