the stress of nursing school

18 Effective Ways to Deal with Nursing School Stress

If you are a nursing student, you know how stressful it can be, especially if you are trying to balance school with other responsibilities. To be successful in nursing school, it is necessary to learn how to deal with nursing school stress. In this article, I will share some of my personal experiences with stress from nursing school and as a nursing instructor tell you 18 effective ways to deal with nursing school stress.

Is Nursing School Stressful?

Is it normal for students to be stressed in nursing school, 7 reasons why nursing school is so stressful, 1. transitioning to student life:, 2. financial responsibilities and school expense:, 3. you feel like you are on an emotional roller coaster., 4. failure to plan:, 5. lack of sleep:, 6. studying too much:, 7. feeling like you do not have a support system:, 7 ways nursing school stress can affect your performance and well being, 1. stress can lead to difficulty remembering and processing content., 2. stress can cause changes in your social skills., 3. stress may cause you to experience burnout syndrome., 4. unmanaged stress can lead to poor academic progress., 5. stress can lead to alterations in your immune system’s ability to resist illness., 6. stress, when left uncontrolled, can lead to health issues such as hypertension (high blood pressure)., 7. if stress remains unmanaged, it can affect your self-esteem., how to effectively deal with nursing school stress, 1. get organized nothing screams "stressed" like being disorganized in a program where success demands it., 2. form a study group with classmates., 3. make sure you have a support system outside of school., 4. ask for help, 5. utilize your instructors and academic advisors., 6. do not procrastinate., 7. find a nursing mentor., 8. get into the habit of doing an “after-class recap.”, 9. recognize your stressors., 10. learn to say, “no.”, 11. eat a well-balanced diet., 12. integrate exercise into your daily/weekly routine., 13. make sure you get plenty of rest., 14. take a bubble bath., 15. journal, 16. practice deep-breathing exercises., 17. take a day off from studying., 18. stay focused on the end goal., what are the best stress management resources for nursing students, facebook groups/pages, reddit communities, youtube videos/channels, is nursing school worth the stress, my final thoughts.

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Nursing School Stress: Effective Coping Strategies for Aspiring Healthcare Professionals

Stethoscopes and sleepless nights intertwine as aspiring nurses navigate the high-stakes gauntlet of medical education, where stress becomes both adversary and teacher on the path to healing others. The journey through nursing school is a demanding and transformative experience that challenges students mentally, emotionally, and physically. As future healthcare professionals, nursing students face a unique set of pressures that can significantly impact their well-being and academic performance.

Recent studies have shown that nursing students experience higher levels of stress compared to students in other academic programs. According to a survey conducted by the American Nurses Association, approximately 82% of nursing students report moderate to high levels of stress during their education. This alarming statistic underscores the critical need to address and manage stress in nursing education.

The importance of tackling nursing school stress cannot be overstated. Not only does it affect students’ academic performance and personal well-being, but it also has long-term implications for their future careers in healthcare. Is nursing stressful? The answer is undoubtedly yes, and learning to manage stress effectively during nursing school can set the foundation for a successful and fulfilling career in this demanding profession.

Common Sources of Nursing School Stress

Understanding the root causes of stress in nursing education is crucial for developing effective coping strategies. Here are some of the most common sources of stress for nursing students:

1. Academic pressures and rigorous coursework: Nursing programs are known for their intensive curriculum, covering a wide range of medical knowledge and practical skills. Students often find themselves grappling with complex subjects, frequent exams, and high academic expectations.

2. Clinical rotations and hands-on training: The transition from classroom learning to real-world patient care can be daunting. Nursing students must quickly adapt to hospital environments, interact with patients, and apply their knowledge in high-pressure situations.

3. Time management challenges: Balancing coursework, clinical rotations, study time, and personal life can be overwhelming. Many students struggle to find enough hours in the day to meet all their obligations.

4. Financial burdens and student loans: The cost of nursing education can be substantial, leading to financial stress and concerns about future debt. Many students work part-time jobs to make ends meet, further complicating their time management.

5. Work-life-study balance: Maintaining relationships, personal health, and extracurricular activities while pursuing a demanding degree can be challenging. Students often feel torn between their academic responsibilities and other aspects of their lives.

Recognizing the Signs of Nursing School Stress

Identifying the signs of stress is crucial for early intervention and management. Nursing students should be aware of the following indicators:

1. Physical symptoms: – Chronic fatigue and exhaustion – Frequent headaches or migraines – Sleep disturbances (insomnia or oversleeping) – Muscle tension and body aches – Weakened immune system leading to frequent illnesses

2. Emotional indicators: – Increased anxiety and worry – Irritability and mood swings – Feelings of overwhelm or hopelessness – Depression or persistent sadness – Emotional numbness or detachment

3. Cognitive effects: – Difficulty concentrating on studies or during clinical rotations – Memory problems and forgetfulness – Decreased problem-solving abilities – Racing thoughts or mental fog – Indecisiveness or second-guessing decisions

4. Behavioral changes: – Procrastination and avoidance of responsibilities – Social withdrawal from friends and family – Increased reliance on caffeine, alcohol, or other substances – Changes in eating habits (overeating or loss of appetite) – Neglecting self-care and personal hygiene

5. Academic performance decline: – Falling grades or difficulty maintaining previous academic standards – Missing deadlines or submitting incomplete assignments – Decreased participation in class discussions – Difficulty retaining new information – Increased test anxiety and poor exam performance

Recognizing these signs early can help nursing students take proactive steps to manage their stress and seek support when needed. Understanding stress overload nursing diagnosis can also provide valuable insights into identifying and addressing stress-related issues.

Effective Stress Management Techniques for Nursing Students

Developing a toolkit of stress management strategies is essential for nursing students to thrive in their academic and clinical environments. Here are some effective techniques to consider:

1. Time management and organizational strategies: – Use digital or physical planners to schedule study time, clinical rotations, and personal activities – Break large tasks into smaller, manageable chunks – Prioritize tasks based on importance and deadlines – Learn to say “no” to non-essential commitments – Utilize time-blocking techniques to maximize productivity

2. Study techniques and learning approaches: – Experiment with different study methods to find what works best (e.g., flashcards, mind maps, group study sessions) – Implement active recall and spaced repetition techniques for better retention – Use mnemonic devices and acronyms to memorize complex information – Take regular breaks during study sessions to maintain focus and prevent burnout – Seek out additional resources, such as online tutorials or study guides, to supplement coursework

3. Self-care practices: – Prioritize regular exercise, even if it’s just a short walk or yoga session – Maintain a balanced diet with nutritious meals and snacks – Establish good sleep hygiene habits, aiming for 7-9 hours of sleep per night – Practice relaxation techniques such as deep breathing or progressive muscle relaxation – Schedule regular “me time” for hobbies and activities you enjoy

4. Mindfulness and relaxation exercises: – Incorporate meditation or mindfulness practices into your daily routine – Try guided imagery or visualization techniques to reduce stress – Practice gratitude journaling to maintain a positive perspective – Use mindfulness apps or online resources for guided exercises – Explore relaxation techniques such as aromatherapy or listening to calming music

5. Building a support network: – Connect with fellow nursing students for mutual support and encouragement – Join study groups or form your own to share knowledge and experiences – Maintain open communication with family and friends about your challenges – Seek mentorship from experienced nurses or faculty members – Participate in nursing student organizations or support groups

Comprehensive stress management strategies for nurses can provide additional insights and techniques that nursing students can adapt to their current situation.

Institutional Support and Resources

Nursing schools and universities often provide various resources to support students’ mental health and academic success. It’s crucial for nursing students to be aware of and utilize these services:

1. Counseling services and mental health resources: – On-campus counseling centers offering individual or group therapy sessions – Teletherapy options for remote or busy students – Crisis hotlines and emergency mental health services – Stress management workshops and support groups – Access to mental health apps or online resources

2. Academic advising and tutoring programs: – Regular meetings with academic advisors to discuss progress and concerns – Peer tutoring programs for challenging subjects – Writing centers for assistance with papers and assignments – Supplemental instruction sessions for difficult courses – Study skills workshops and time management seminars

3. Peer mentoring and study groups: – Formal peer mentoring programs pairing experienced students with newcomers – Student-led study groups for specific courses or clinical specialties – Nursing student associations organizing academic and social events – Online forums or social media groups for sharing resources and advice – Collaborative projects and group assignments to foster teamwork

4. Stress management workshops and seminars: – Regular workshops on topics such as time management, test anxiety, and self-care – Mindfulness and meditation classes tailored for healthcare students – Stress-relief events during high-pressure periods (e.g., exam weeks) – Guest speakers and alumni sharing experiences and coping strategies – Wellness fairs promoting holistic health and stress management resources

5. Financial aid and scholarship opportunities: – Information sessions on financial aid options and loan management – Scholarship databases and application assistance – Work-study programs and on-campus employment opportunities – Financial literacy workshops and budgeting resources – Emergency financial assistance programs for unexpected hardships

How can schools help students with stress is an important question that nursing programs should continually address to support their students effectively.

Long-term Strategies for Coping with Nursing School Stress

Developing long-term coping strategies is essential for nursing students to maintain their well-being throughout their education and future careers. Consider the following approaches:

1. Developing resilience and coping mechanisms: – Practice reframing negative situations to find positive aspects or learning opportunities – Build a toolbox of coping strategies to draw from during challenging times – Seek out experiences that challenge you and help build confidence – Learn from setbacks and view them as opportunities for growth – Develop a strong sense of purpose and connection to your nursing goals

2. Cultivating a growth mindset: – Embrace challenges as opportunities to learn and improve – View mistakes as valuable learning experiences rather than failures – Focus on effort and progress rather than perfection – Seek feedback and use it constructively to enhance your skills – Celebrate small victories and milestones along your nursing journey

3. Maintaining work-life balance throughout your nursing career: – Set clear boundaries between work, study, and personal time – Prioritize self-care and make it a non-negotiable part of your routine – Learn to delegate tasks and ask for help when needed – Practice saying “no” to commitments that don’t align with your priorities – Regularly reassess and adjust your balance as your circumstances change

4. Continuing education and professional development: – Stay curious and open to learning new skills and knowledge – Attend conferences, workshops, and seminars in your areas of interest – Pursue additional certifications or specializations to enhance your career prospects – Engage in lifelong learning to stay current with evolving healthcare practices – Seek out mentorship opportunities to guide your professional growth

5. Advocacy for mental health awareness in healthcare education: – Speak openly about mental health challenges to reduce stigma – Participate in or organize mental health awareness events on campus – Advocate for improved mental health resources and support in nursing programs – Share your experiences and coping strategies with fellow students – Encourage a culture of self-care and mutual support among healthcare professionals

Effective nursing interventions for stress management can provide valuable insights for nursing students to apply both in their own lives and in their future practice.

In conclusion, managing stress in nursing school is a critical skill that can significantly impact both academic success and future career satisfaction. By recognizing the signs of stress, implementing effective coping strategies, and utilizing available resources, nursing students can navigate the challenges of their education with greater resilience and well-being.

It’s essential for aspiring nurses to prioritize their mental and physical health throughout their academic journey. Remember that seeking help is a sign of strength, not weakness. Comprehensive nursing care for patients with altered stress response begins with taking care of oneself.

As you progress through your nursing education, keep in mind that the stress management skills you develop now will serve you well throughout your career. The healthcare profession can be demanding, but with the right tools and mindset, you can thrive both as a student and as a future nurse.

Take action today by implementing some of the strategies discussed in this article, reaching out to your support network, and utilizing the resources available at your institution. Remember, you’re not alone in this journey, and with perseverance and self-care, you can overcome the challenges of nursing school and emerge as a compassionate, skilled healthcare professional ready to make a difference in the lives of others.

References:

1. American Nurses Association. (2021). Nurse Stress and Burnout Survey.

2. Labrague, L. J., McEnroe-Petitte, D. M., Gloe, D., Thomas, L., Papathanasiou, I. V., & Tsaras, K. (2017). A literature review on stress and coping strategies in nursing students. Journal of Mental Health, 26(5), 471-480.

3. Rathnayake, S., & Ekanayaka, J. (2016). Depression, anxiety, and stress among undergraduate nursing students in a public university in Sri Lanka. International Journal of Caring Sciences, 9(3), 1020-1032.

4. Reeve, K. L., Shumaker, C. J., Yearwood, E. L., Crowell, N. A., & Riley, J. B. (2013). Perceived stress and social support in undergraduate nursing students’ educational experiences. Nurse Education Today, 33(4), 419-424.

5. Stephens, T. M. (2013). Nursing student resilience: a concept clarification. Nursing Forum, 48(2), 125-133.

6. Turner, K., & McCarthy, V. L. (2017). Stress and anxiety among nursing students: A review of intervention strategies in literature between 2009 and 2015. Nurse Education in Practice, 22, 21-29.

7. World Health Organization. (2020). State of the World’s Nursing Report – 2020.

8. Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI Journal, 16, 1057-1072.

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8 Expert Tips to Survive Stress and Get Through Nursing School

By Will Erstad on 06/07/2021

It doesn’t take much imagination to understand why nursing school can be stressful. Pressure to invest in a quality degree program, achieve high grades and pass critical licensure exams are only the beginning—then there’s the looming trepidation that comes with working everyday with patients.

Needless to say, there is a lot weighing on the mind of a typical nursing student. There is no way to completely eliminate nursing school stress from your life—in some cases, it could even spur you on to do your best! But there are ways to help alleviate some of the pressure.

Who better to learn from than those who have made it through? We gathered nursing school advice and stress management tips from experienced nurses who handled the experience in stride. Read on to learn more about what can make nursing school stressful—and what you can do to manage it.

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What causes nursing school stress?

Nursing school has a reputation for being challenging. Most aspiring nurses don’t embark on their degree program assuming they’re going to skate by doing the bare minimum. The demanding workload is certainly part of the stress equation, but it’s not the only thing to consider.

Nursing school presents a mixture of complicated subject matter to learn, including memorizing unfamiliar medical vocabulary, performing hands-on clinical work, and demonstrating a high-level understanding of nursing ethics and patient care best practices—just to name a few. Traditional study tips can help, but the fact remains that nursing students have to master a wide array of topics.

On top of this, many nursing students dive so far into their studies, they feel as though they’re in a bubble. “Classes are intense, and workloads are heavy. This leaves very little time to socialize and have fun,” says Alaina Ross, registered nurse (RN) and expert contributor to Test Prep Insight . “This social isolation can compound any school-related stress you're feeling.”

8 Tips for surviving nursing school stress

You get the picture: Nursing school won’t always be a walk in the park. But that doesn’t mean you need to live with nursing school stress for the duration of your program! Use these “survival” tips from nurses to lighten the load of nursing school.

1. Develop a routine

Nursing school is a marathon, not a sprint. You’ll burn out quickly if you approach your studies without a plan.

“The most stressed-out nursing students I saw were the ones that tackled each day without a plan,” Ross says. “Having a set routine will help you stay focused and get through each day,” Ross says.

She recommends plotting out chunks of your day for different tasks, such as reviewing flashcards, completing homework or meeting with a study group. Don’t forget to include time for exercise, cooking a nourishing meal and relaxing!

2. Practice an after-class recap

Don’t wait until an exam is looming to start studying! Reviewing the most important material soon after your class is over can help you solidify what you’ve learned. This can help keep the list of things you need to extensively review and master much more manageable. Reviewing your notes shortly after a class is not only a great way to reinforce what you’ve just learned but also a way to identify gaps in your understanding so you can ask for clarification—without it being the night before a test.

3. Find a solid study group

Meeting with a study group offers a fresh way to review information beyond flipping through flashcards alone. A study group that meets weekly can compare notes, demonstrate skills and practice NCLEX-style questions that can be difficult to tackle on your own.

Having other students to lean on through nursing school is important for the social support as much as for actual studying! Dr. Jenna Liphart Rhoads, a nurse and educator at NurseTogether.com , shares that “making a friend in my nursing program who mirrored my outside life, study style and goals were the most helpful for getting through nursing school.”

A study group can solve two potentially stress-causing problems at once by providing both social and academic support. For nursing students who are short on time, that’s a win-win!

4. Mix exercise into your study sessions

When you feel your stress levels spiking, get moving! While exercise has long been a solid outlet to help relieve stress and anxiety, it can also boost your ability to retain the information you’re studying. Regular exercise can promote factors that promote mental acuity—like less stress-induced mental fog. 1

In the right circumstances, you may even be able to reap the benefits of exercise while studying. A long brisk walk with nursing school classmates where you discuss course materials or quiz each other with flashcards can be an excellent way to accomplish both.

Then again, getting active can also just be a way to push everything else on your plate aside—and that’s OK! Exercise can also provide a valuable break from nonstop studying. “Exercise helped me process the emotional situations that are a part of nursing school, take a mental break from studying and learning and keep my body healthy, which helped my mental health,” Liphart Rhoads says.

5. Eat well and nourish your body

While your health and sanity might be able to endure a short period of exhaustion, caffeine and on-the-fly meals, your performance will plummet as the months add up. “Never forget the mind-body connection,” says Sarah Johnson, RN and health ambassador at Family Assets .

Eating well is a crucial part of reducing stress, such as whole grains like oatmeal or quinoa that can release calming chemicals in the brain. 2 However, it can be particularly difficult to eat well during nursing school because high stress can cause people to overeat unhealthy comfort foods. 3 Start by making simple swaps, like reaching for carrots and hummus instead of potato chips during a study session.

Think of eating well as an investment in your nursing career. It will help you bring your best game, sustainably, throughout nursing school and beyond. “Treat your body well, and you will be better equipped psychologically to deal with the stress,” Johnson says.

6. Rely on your support system

Don’t get so absorbed in nursing school that you forget to connect with those who want to cheer you on along the way. Make time for regular catch-up conversations, share your struggles and successes, and accept help if it’s offered, such as ready-made meals or quizzing you before a big test.

“Leverage your network of family and friends to keep you positive and upbeat,” Ross says. “Call your parents on your commute to and from school, and catch up with friends over texts at lunch. These quick talks will help you stay positive and put a smile on your face.”

7. Ask for help

No one said you have to do nursing school all on your own. In addition to social support from friends and family, academic help is available right in the midst of your nursing school experience. Do not hesitate to reach out and ask for help—remember, no one involved with your nursing education wants you to fail.

Talk to your professors via email or during office hours if there are concepts you need help understanding. Ask a librarian if you’re struggling to find the right resource or need help conducting research. Ask a classmate to compare notes if you’re struggling to recall what you meant when you jotted something down.

There’s no bonus to going through nursing school in isolation. Keep an eye out for opportunities to ask for help from others!

8. Seek out peer support

Family and friends aren’t the only ones who can support you through nursing school. Getting official academic support can be just as much of a boost! A good nursing program will offer plenty of options for academic help if you know where to look.

For example, you can seek out help through the peer tutoring and peer mentoring programs at Rasmussen University. These academic support programs can match you with a student tutor or mentor who has is qualified to help you improve your study habits and work through any academic areas you need assistance with.

You can get through nursing school

Whether you’re still considering a career in nursing or you’re already halfway through your degree program, follow these stress management tips to help keep nursing school stress at bay. Still looking for more resources? Find some more nursing student resources here.

Of course, navigating nursing school is only the tip of the iceberg when it comes to potentially stressful situations you’ll encounter on the way to becoming a nurse. Another factor that may be looming large? The NCLEX® licensure exam awaiting you after graduation. Fortunately, we’ve got you covered—our article “ Nurses Share 13 NCLEX Exam Tips That Helped Them on Exam Day ” can help you get prepared.

1 “Healthbeat: Exercising Can Boost Your Memory and Thinking Skills” Harvard Health Publishing. February 15, 2021 [accessed May 2021] https://www.health.harvard.edu/mind-and-mood/exercise-can-boost-your-memory-and-thinking-skills 2 Dr. Craig Sawchuk “Coping with Anxiety: Can Diet Make a Difference?” Mayo Clinic. May 24, 2017 [accessed May 2021] https://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/expert-answers/coping-with-anxiety/faq-20057987 3 Harvard Health Publishing, “Harvard Mental Health Letter: Why Stress Causes People to Overeat” February 15, 2021 [accessed May 2021] https://www.health.harvard.edu/staying-healthy/why-stress-causes-people-to-overeat NCLEX is a registered trademark of the National Council of State Boards of Nursing, Inc. EDITOR’S NOTE: This article was originally published in January 2014. It has since been updated to reflect information relevant to 2021.

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Home Blog How to Reduce and Deal With Nursing School Stress

How to Reduce and Deal With Nursing School Stress

According to the Bureau of Labor Statistics , there will be over 3,400,000 nurses working within the United States by 2028. Of course, before becoming a registered nurse , these individuals will have to complete nursing school — a notoriously challenging program to complete. Resources like The 9 Circles of Nursing School Hell and How to Stay Motivated During Nursing School further underscore this point. Fortunately, there are ways to cope and emerge as a successful professional in the field. Keep reading for important tips to reduce nursing school stress.

Why Is Nursing School So Stressful?

It’s important to recognize that nursing school comes with a whole lot of work. School curriculum cover a wide range of subjects including physiology, chemistry, microbiology, statistics, sociology, math and more. It’s not uncommon for nursing students to pull all-nighters in attempts to get through all the material assigned.

Internships and certification hours add even more to the plate. These experiences will introduce nursing students to a world of injury, illness, trauma and suffering. This initial exposure may become overwhelming to first-time students.

Associate’s degree programs typically take around two years to complete while bachelor’s degree programs take four.

Still, how long nursing school lasts is just one part of the equation. Nursing students must be prepared to handle stress during the course of the journey.

How to Handle The Stress of Nursing School

How do nursing students cope with stress? The answer depends on who you ask. Check out our list below for some easy techniques to help minimize stress when in school.

Maintain a Schedule

Nursing school throws a lot at you, which means it’s important to remain organized. Minimize stress by setting a schedule. This will help manage your school work along with important everyday tasks. Start by looking at your school schedule. From there, you can figure out how many hours a day you need to designate to study time, personal time, and sleep!

Create a Study Group

Understand that you’re not in this alone. There is an entire school full of students out there able to relate to what you’re going through. Reach out to them for support. Unpack lecture topics as a group. Compare notes, quiz each other on important topics and prepare for exams in person. It’s also a great way to pepper in a little social time while studying!

Review Your Notes After Class

We know, the last thing you likely feel like doing after a long day of class is reviewing your notes. But setting apart some time each day to go over what you’ve learned could save you when it comes to preparing for tests. Cramming for exams is stressful. The more you can retain throughout the semester, the less time you have to pack into the days leading up to major assessments.

Reach Out to Your Professors

When attending a large nursing school, it’s easy to feel as though you’ve been swallowed up by the crowd. Remember, your professors are there to support you. Reach out to them outside of class to get better acquainted. Ask questions and don’t be afraid to rely on them as a resource.

Get Some Physical Exercise

It’s true; as a nursing student you will have an enormous amount of work to get through. Still, it’s important to practice self care throughout the program. Make sure you carve out enough time for some exercise every day. If you’re really strapped for time, take your study group on the road and discuss important topics while out for a walk! In the end, it will help you maintain your focus and get through study materials faster.

Find Time For Simple Pleasures

Of course, self care expands far beyond exercise! Before calling it a night, try to de-stress by squeezing in some time for something you love, whether it’s a good book, your favorite TV show, or simply getting into a hot bath. You don’t have to commit for an inordinate amount of time, just whatever you can afford!

You can also look into things that bring you joy without taking you away from your school work. Head to your favorite coffee shop to study and treat yourself to a special drink. Grab yourself a new piece or art to put up in the house. Maybe take home a new house plant to enjoy!

Maintain a Healthy Diet

There are two things that a good majority of nursing students lack: time and money. That combination can wreak havoc on a diet, with many students turning to cheap and ready-made meal alternatives.

Keep a Journal

Don’t let racing thoughts keep you up at night. Jot them down in a journal and dismiss them before bed. It may seem like a hard sell to the cynics out there, but journaling has been shown to decrease feelings of stress and anxiety. It will also provide an easy-to-reach location to store important notes and reminders.

Go Easy On Yourself

There will inevitably be moments where you don’t perform as well as you would hope. Forgive yourself. Remember, nursing school is a journey that cannot be completed without making a few small errors along the way. Think of these moments as teachable experiences. Try not to stress. Learn from it, and move on instead.

Begin Your Nursing Career With the New England Institute of Technology

How long is nursing school? It’s an important question to consider, especially considering the amount of stress it can introduce! The Associate Degree Program in Nursing at on of the best nursing school New England Institute of Technology can be completed in as little as 18 months.

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The program offers clinical and laboratory experiences as well as classroom learning to help you tend to diverse populations. Students will acquire clinical skills and high developed judgement skills throughout the program and be prepared for employment in a hospital, healthcare clinic, nursing home or outpatient facility.

Students will also develop high-tech and decision-making skills required to provide high quality care. They will have the opportunity to train in our fully equipped labs, stocked with the latest nursing simulation technologies.

We also offer a Registered Nurse to Bachelor of Science in Nursing (RN to BSN) program online to help working nurses further their positions. Recently, the program was ranked 25th in the U.S. in “Top 50 Best Value Online RN to BSN Programs 2017” by Value Colleges. We should also mention that our tuition rates fall below those of most other bridge programs across the country.

All classes are taught by faculty who are experienced professionals and clinicians who make sure the syllabus remains up-to-date and relevant to today’s dynamic healthcare environment.

Both nursing programs are accredited by the Accreditation Commission for Education in Nursing (ACEN). You can begin the application process for our associate and bachelor’s degree programs by filling out this form. You can also find out more information by calling us at 855-899-1497.

Stresses & Struggles of Nursing School

What are the stresses and struggles of nursing school ? What makes nursing school so hard? If you are reading this article, you have probably already heard from others how hard nursing is and that you have no life. Before I became a nursing student, that is all I heard from my friends and it scared me.

It’s no secret, nursing school has a reputation for being stressful and keeping you very busy. As a nursing student you will experience times where you are thinking “why in the world am I doing this….I should have done something else” and then other times you will say “I love this and can’t wait until I graduate and become a nurse”.

I definitely faced my own struggles and stresses. I remember during my 2 nd semester of nursing school that I almost changed my major to social work because I was so tired of the constant stress, but ended up hanging in there (thanks to my encouraging husband), which I’m very glad I didn’t give into the pressure of quitting.

In this article, I am going to talk to you about:

The most common struggles and stresses of nursing school
How do deal with the stresses and struggles of nursing school

Video of me talking about the Stresses and Struggles of Nursing School

The most common struggles & stresses in nursing school

Juggling so much at one time : Nursing school requires a lot of effort. Every week you will have either an exam, quiz, clinicals, and projects due. Then managing your everyday life which includes working, taking care of children, doing chores, family obligation etc., you can become very overwhelmed. This leads you to feel like you have no life!

Finding time to study & meet grade requirements : Sometimes you may have two or three tests in one week, along with completing clinical time at the hospital and going to classes. You may find it hard to find time to study and keep your grades up. It feels like you have so much to do in such little time.

Keeping Motivated : At times you will feel so tired and overwhelmed, and it is hard to keep motivated because all you want to do is sleep and not think about another exam or spending 12 hours at a clinical rotation. Motivation at times is hard to find!

Passing proficiency exams : Many programs require that in order to advance to the next semester, you complete proficiency exams like the ATIs or HESI. This is really stressful because not only do you have to complete all of your other classes, go to clinicals, complete projects, but you have to study for an exam that will determine if you advance to the next semester.

I remember having to pass the mid-curricular HESI and I already had a full load of classes and clinicals that I was trying to pass. By having to juggle all of these things at once, I was beyond stressed.

How to handle the stresses and struggles of nursing school

Almost everyone finds nursing school to be stressful and hard. If you don’t find it stressful or ever considering dropping out of it, you are a genius. My point to you is that it is NORMAL to experience stress and struggle in nursing school and remember that everyone else around you is going through the same ordeal.

Keep organized : Get a planner and use your time wisely. Make every day to be a productive day and use your time wisely. Always be planning at least a week ahead of time and start studying in advance.

Be prepared to make sacrifices : Prepare to dedicate yourself to the program and give it all you got. Let people and family know that right now some things are going to be a little different and you may not get to hang out or spend as much time as usual, but it is temporary. Then once you become a RN or LPN you will have time and money to hang out and do things, but right now you have to concentrate.

Take one day during the week where you do not think about anything nursing school related. On this day, do what you want to do. This will help relieve stress and prevent burnt out.

Evaluate your situation: If you haven’t started the program yet, evaluate if you are in a good time in your life to complete this journey. Make sure you don’t have family or job obligations that are going to add extra stress on you, because maybe in 2 or 3 year your life will be different and you may be ready for nursing school.

Consider part-time : If you find you are too busy right now or don’t think you can handle the stress, consider going part-time. You will have fewer classes at a time, so you can take your time.

Don’t strive for perfection, just pass : I learned early that earning straight A’s in nursing school was rare. People who tend to go into nursing have Type A perfectionists personalities (like me), but in nursing school be prepared for settle for a B or may be a C. Don’t kill yourself trying to get perfect grades because in the end you are a RN or LPN (there will be no A’s or B’s after your initials)

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How to Manage Stress as a Nurse

Stress may be one of the most overlooked issues that nurses and nursing students face. Yet, it is one of the most impactful as it can affect many aspects of work and personal life. Bedside nursing places high levels of emotional and physical demand on healthcare professionals.

Stress can affect the physical and mental health of nurses, which unfortunately can overflow into patient outcomes. It also undermines nursing retention and can hurt a healthcare organization’s finances.

Although not all stress is negative, even positive stress can have a negative effect on an individual. Since the mid-1950s, researchers and scientists have recognized that stress is an occupational hazard for nurses. Therefore, learning how to manage stress as a nurse is the key to enjoying a long and healthy career.

During the COVID-19 pandemic, nursing students made the transition to managing classes and clinicals online. Additionally, it became obvious there were pitfalls in the healthcare system that affected patient care and nurses’ physical and mental health. These challenges include understaffing, unsafe work conditions, financial losses for the provider, and under-resourced hospitals. As healthcare systems move forward, it is essential to mend these gaps to prevent poor patient outcomes.

Common Stressors in Nursing

A 2011 survey sponsored by the American Nurses Association discovered that combining and integrating person-focused strategies helps manage stress as a nurse at the individual level. Organization-focused strategies eliminated some conditions that helped reduce and prevent job stress.

Some of the common stressors for nurses include working during a nursing shortage . The current shortage is expected to intensify as the last of the baby boomer generation become senior adults. To compound this, nursing schools are struggling to meet the rising demand. Although the U.S. has periodically experienced shortages since the early 1900s, the current magnitude is more significant than ever before.

There are several reasons for the nursing shortage . For instance, as the baby boomer generation ages, it has also led to a large portion of the nursing workforce retiring.

Additional factors that lead to stress on nurses include extremely long shifts as compared to other professions. For example, hospitals have moved to nurses working 12-hour shifts, which gives nurses the option of working four days and having three days off. However, when overtime is required, nurses may be working 16-hour shifts multiple days in one week.

The nursing profession requires many high level nursing skills such as critical thinking, which increases mental strain daily. Working in an under-resourced and understaffed unit increases workplace tension and can lead to higher stress levels.

Nursing is an emotional labor of love. Nurses often must conceal their feelings of frustration, anger, or anxiety while on the job.

These are some of the common stressors that nurses experience daily. During the COVID-19 pandemic, an additional burden is placed on healthcare professionals and nursing students across the country. This only adds to the mental, emotional, and physical stress under which nurses must work.

COVID-19 Is Increasing Burnout and Stress in Nurses

COVID-19 has been responsible for an added burden of stress and burnout in nurses. According to one study from Wuhan, China, the pandemic added a psychological burden to frontline healthcare workers. This has also contributed to the post-pandemic nursing shortage .

The data confirmed past studies that reported negative adverse psychological reactions during the 2003 SARS outbreak. Healthcare workers feared infection, felt stigmatized, and reported reluctance to go to work. Additionally, they experienced anxiety, depression, and high levels of stress.

Not surprisingly, healthcare workers have the highest risk of contracting COVID-19. Thankfully, the infections had a low mortality rate. Experts counted 3,561 deaths of healthcare workers from March 2020 to March 2021; 32% (1,139) were nurses.

Popular Online RN-to-BSN Programs

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How to Cope and Manage Stress as a Nurse

It is crucial to cope with and manage your stress levels. Fortunately, proven strategies that reduce stress are not complex or complicated. They are simple, consistent practices you can incorporate into your everyday routine.

It’s important to remember that stress is a normal part of everyday life. However, chronic stress can increase your risk of heart attack, stroke, and Type 2 diabetes. Using the tips below, you can build a daily routine to help reduce your stress and protect your health, whether you’re a working nurse or a nursing student navigating online school.

Maintain a routine to alleviate anxiety.

People are creatures of habit. Developing a routine raises the potential you’ll successfully use strategies to promote your health and wellness. Routines keep you organized, structured, and can improve your health. This is especially important during stressful times. Even if you don’t typically thrive on a strict routine, it can give you a sense of control, improve your focus, and increase productivity.

A routine helps you to cope with change and stress like balancing work and school as a nurse . It takes approximately 21 days to form a new habit or routine. If you set a schedule and stick with it for three weeks, you’ll slowly see a reduction in anxiety and burnout.

Eat healthy to boost energy, mental performance, and sleep quality.

There is no denying it — life as a nurse is busy! Yet, there are ways to incorporate eating a healthy diet to support your physical and mental health. For example, refined carbohydrates, sugar, processed foods, and trans fats are all associated with depression. Consider these tips to eating healthy on a busy schedule.

Make a menu and a shopping list from the menu, so you have everything you need each week.
Swap canned or frozen vegetables for fresh.
Eat a nutrient-rich snack when you’re busy, so you don’t have to cook. Combine nuts, cheese, raw vegetables, dip, and fruit, depending on what you’re in the mood for.
Cook once and freeze the leftovers for an easy healthy meal with no preparation.
Prepare breakfast the night before so it’s “grab and go.”
Drink plenty of water to stay hydrated.
Pack your own snacks if you get hungry on long shifts.

Good sleep reduces anxiety and depression.

It would be best if you were spending one-third of your life asleep. That’s because sleep is essential to your health, especially getting better sleep as a night shift nurse . Research shows that sleep helps you relax, destress, and can reduce your risk of dementia . Symptoms of deprivation include slowed thinking, poor memory, lack of attention or focus , and inefficient decision-making.

Take care of your sleep environment and prebedtime habits to increase having a great night’s sleep. Your bedroom should be a place where you sleep (not work).

Don’t watch television or bring work to bed with you.
Keep your room cool and dark.
Use room darkening blinds and a sleep mask if needed. This helps your body produce melatonin and fall into a deep sleep.
Don’t eat before bed as it raises your energy level and may make it difficult to stay asleep.

Exercise regularly to lower stress, improve mood, and sleep quality.

Although you are likely walking miles on every shift, exercise outside of work has benefits of its own. Data show that regular exercise has a significant impact on your mental health. In fact, exercise is commonly recommended by therapists treating individuals for eating disorders, stress, anxiety, and depression. Exercise lowers your stress hormones, helps release endorphins, and improves your sleep quality.

Spend time in nature to lower stress hormones.

Spending time outdoors can help reduce your stress and anxiety levels. Research finds that just 20 minutes outside can help lower your stress hormones. If scheduling an outdoor walk seems like just one more thing to add to your list, consider how you might incorporate a walk into your daily errands.

Is there a park between the grocery store and your home where you could take a quick stroll before shopping? Do you get off work during daylight hours and could take a walk before heading to your car? Can you help your elderly neighbor by walking her dog occasionally?

Practice setting healthy boundaries.

Setting boundaries is essential to good mental health. It isn’t always easy, but the end result is well worth the effort. For example, you may find that it’s necessary to say “no” to one more overtime shift if you are feeling exhausted. While this may feel difficult when the hospital is understaffed, it is essential to effective patient care that you are alert and focused while on duty.

Having a healthy support system is essential to mental health.

A strong social support system in close friends and family has far-reaching benefits. Your network can play an important role during stressful times. On the other hand, isolation can cause more poor lifestyle choices and increase blood pressure. It also promotes a poor ability to cope with stress. Social support can mitigate vulnerabilities and improve resilience to stress.

As a busy nurse, it’s essential to maintain your social network. Schedule times to regularly check in with your close friends and family. While digital communication is a quick way to schedule a coffee or phone conversation, it is not a substitute for face-to-face interaction. If you don’t currently have a strong support network, consider looking for friends through volunteer opportunities , religious organizations like church or temple, taking a class, or joining a gym.

Connect with a therapist to form healthy coping mechanisms.

Improving your mental health has significant benefits for your physical health and your patients. One strategy is to form a relationship with a mental health specialist or counselor. They can help you identify specific stressors in your life you may have overlooked.

Choose a therapist who is familiar with cognitive behavioral therapy to learn tactics to lower your stress levels. This can help prevent nurse burnout . Burnout can lead to cardiovascular disease, obesity, insomnia, and depression.

Practice mindfulness to combat anxiety.

Mindfulness is a state in which you attend to the present. This means you don’t judge your thoughts or feelings as good or bad; you let your thoughts pass through you and focus on being present. It also infers that you are aware of your current surroundings and do not practice daydreaming.

Being mindful of the present can help combat depression and anxiety. These feelings are often rooted in concern over what might happen. Mindfulness practices include meditation, yoga, and body recognition. These are self-care for nurse practices that you can learn and use at nearly any time to help reduce stress, such as at work, on the drive home, or while taking care of family obligations.

Prioritizing self-care improves emotional health.

Self-care is not the same as self-indulgence. Instead, self-care means caring for yourself in a way that promotes health and wellness. This includes self-care products for nurses , strategies to improve your nutrition and diet, seeking medical care when needed, and building healthy lifestyle choices into your daily routine. You will experience the benefits of lowered stress and anxiety, greater energy, and a better outlook on life.

Self-care strategies include many of the tips on this list, such as:

Staying connected to friends and family
Eating a healthy diet
Spending time outdoors
Setting healthy boundaries

Connecting with loved ones relieves stress.

Being around loved ones releases a powerful hormone in your body called oxytocin, which aids in relaxation. Historically, scientists have found the hormone is released during childbirth, breastfeeding, and sex. But we now know that most forms of social bonding or positive physical contact can also trigger the release. Activities like petting an animal, moving in sync with a group, like at a concert, or even eating together can also trigger the release of oxytocin.

During one human couple study , researchers administered oxytocin intranasally before a conflict discussion. They found couples using oxytocin had more positive communication and lower levels of the stress hormone cortisol. Another study found that individuals who perceived support through hugging experienced reduced stress and less severe signs of illness. This is why it is essential to maintain relationships while in nursing school or at work.

Spending time with your pet can improve your mood.

Science has discovered the unconditional love of a pet can help reduce stress and improve heart health. Interactions help reduce levels of cortisol, blood pressure, and loneliness.

Pets can also boost your mood and increase feelings of support. Studies have also found that spending time with a pet can help release oxytocin, including petting your dog. If you don’t have a pet at home, consider volunteering at a local shelter to get your doggie therapy.

Breathing techniques regulate your nervous system.

Deep breathing helps your body relax and lowers your stress level. This is because deep breathing triggers your brain to send messages to lower your heart rate and blood pressure. Using deep breathing is a good way to help reduce stress in the moments when you are in a tense situation since it helps to regulate your nervous system.

Daily inspiratory muscle training also helps lower blood pressure and improves endothelial function and oxidative stress. Daily training may also help improve your response to deep-breathing strategies when you are under stress.

Journal regularly to help with emotional regulation.

Talking about problems has been a source of stress relief for centuries. Writing and journaling is another way of releasing emotional stress and gaining a better perspective over a situation. Journaling is a strategy where you keep a record of your thoughts, feelings, and insights on paper or a computer.

It may initially feel like work, but the benefits include:

Reducing anxiety and stress
Creating greater awareness of the situation
Regulating emotions
Speeding physical healing

It is important to find a technique that works for your lifestyle. For example, “morning pages” is a strategy for writing your thoughts first thing in the morning. This technique may be great to practice on your days off or if you work a night shift.

A gratitude journal trains your brain to prioritize things for which you are grateful. Another form of journaling is a prayer journal where you write your prayers and the concerns you want to share. Others find relief by writing letters in their journal as if they are talking to their friend about what’s happening in their life. However you choose to use a journal, it’s easily some of the best 10 minutes you’ll spend relieving stress.

Laughter has healing benefits.

Reader’s Digest had it right for many years: Laughter really is the best medicine. Laughter can lower your stress hormone levels, distract you from stress and negative emotions, give you perspective, and help you connect with others. As you laugh, you take in more oxygen, which helps your muscles relax. Laughter supports your immune system, lowers your blood pressure, and raises endorphins.

During a busy day, you can listen to a funny podcast on the drive to or from work, follow a funny social media account, or watch a comedy routine on YouTube. Think about hosting a game night with friends and family or watch a funny movie after work. By seeking out and finding humor, you can change your attitude, change your stress level, and even change your life.

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How to Deal With Nursing School Stress

Statistically, nursing school is stressful. Psychological studies have found it’s more stressful than just about any other academic program—including, some studies say, medical school. The reasons why makes sense. Like with any medical program, you have to learn a huge amount of information fully and quickly, in addition to juggling personal/family responsibilities. The clinical experience on top of all this, though, is what makes nursing students stand apart. After classes, after homework and studying, after taking care of your kids or parents or both, you have clinicals, which can demand all of your mental, physical, and emotional energy.

Nursing school requires a lot, so avoiding stress entirely just isn’t always realistic. Some days you have to accept the reality of nursing school stress, but you can always stress less, and sometimes defeat it entirely with a few techniques.

1. Practice Self Care Ritually

“Self-care” doesn’t mean what it’s sometimes used for—skipping class to watch rom coms in bed. Though that indulgence might relieve a little stress in the moment, in the long-run, trying to catch up on missed material will only exacerbate the problem.

Real self-care isn’t an excuse to be irresponsible, but a reminder to attend to your own physical, emotional, and spiritual needs. This is always important, and somehow it seems to be easiest to forget when you’re immersed in the study and practice of caring for others. Nursing students have to remember to take care of themselves and making that a priority.

Given your time commitments, new demands, and a hundred new terms to memorize every week, you may not be able to “take care of yourself” by doing things like drawing a hot bath for an hour every night, but you can and should sleep enough, eat right, and exercise in the midst of nursing school. In fact, this proper self-care will help alleviate nursing school stress, or at least can keep it from getting worse.

Related Resource: How to Prepare for Nursing School

2. Schedule Your Sleep

People organize their lives and work in myriad ways, and no one way is better than another—but some kind of organization is essential for reducing the stress of nursing school. Whether it’s with Google Calendar, sticky notes on your bathroom mirror, or a color-coordinated daily planner, you need to create and stick to a schedule for managing your study, class, sleep, and personal time. Nursing school stress often arises from feeling like you have a million things to do, and worrying that you won’t get them done. You might actually have close to a million things to do, but you can get them done, and a visible, functional schedule will assure you of that.

3. Forgive Yourself During Clinicals

Clinicals tend to be the most stressful part of nursing school. The moment the information you learned is put into practice, you’re going to feel the weight of responsibility, the fear of making a mistake, and all the stresses that nurses have to deal with on a daily basis. As you’re learning a new role, you’re also learning how to tactfully deal with angry and demanding patients, how your current hospital or field site operates, and how to work alongside staff. It’s demanding, but instead of buckling under the pressure, one way to stress less is by forgiving yourself.

You’re not going to be a perfect nurse overnight. You won’t even be a perfect nurse by the end of your first clinical rotation. Nursing is a profession that requires a lot of knowledge and experience, and clinicals are a time to provide both. You might be expected to be perfectly patient and knowledgeable in your first nursing job (but even there a lot of administrators have some grace). In clinicals, you’re there to learn, and so it’s important to forgive yourself for the small errors you make and the things you forget.

4. Remember the End Goal

If you feel completely exhausted and brain-dead at some point during nursing school, you may start to question why you’re even there, and if the education is worth it. This is natural, but despairing can make stress worse, not better. The real solution is to answer that question: Why did you decide to become a nurse?

Was it to provide for your family?

Was it to have a career that helped and sometimes saved lives?

Was it because a nurse positively affected your life—or a family member’s?

Every nursing student will answer this question in a different way, but no one decides to go to nursing school because they think it will be a breeze. Everyone expects hard work and yet chooses to become a nurse anyway. Remembering your choice will keep you motivated and keep things in perspective, which helps combat stress.

5. Communicate With Others

It’s tempting to go into isolation when you’re stressed. With a full class schedule, clinical, sleep, and the looming NCLEX, nursing school stress will make you feel like you never have time for anyone, but this is not the case. While it might be harder to carve out the time for others, time with loved ones and peers is as essential as ever. You need emotional support when you’re in nursing school, and you need some camaraderie that only comes from talking with other students. If you’re feeling a lot of stress, there’s a good chance they are too. Just knowing you’re not the only person who feels overwhelmed can bring some relief and reduce some of that stress.

If you’re ready to start your journey toward a fulfilling career in nursing, read more about our associate of science in nursing program , where you can become a registered nurse in as little as 20 months.

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Home / Nursing Articles / How to Manage Your Stress as a Nurse

How to Manage Your Stress as a Nurse

Talk About It

Recruit support, find a hobby, breathe deeply.

Nursing is an incredibly stressful career. From the moment nursing students start their education program when they retire, they face difficult situations and stressors on a daily basis. In fact, stress and burnout affect 10-70% of nurses. Sources of stress can be the patients and cases they observe, time constraints to get work done, conflict with leadership or co-workers, or a feeling of lack of control in their work environment. Stress can lead to fatigue, exhaustion, and detachment from their work which may lead to patient safety concerns. Therefore, successful management of stress is essential to the well-being of not only the nurse but patients as well.

So how do nurses manage high levels of stress and the accompanying emotions? Below are ways nurses can help deal with (sometimes) overwhelming stress and prevent burnout.

It's easy for nurses to finish a shift, come home, and just want to zone out in front of the TV or computer. However, the stresses don't go away. Challenging events and situations may replay when the nurse is trying to sleep, and when the next shift rolls around, the stressor is still there. After a long and harried shift, it may help to talk about it. Sometimes it's difficult with a friend or spouse who is not in healthcare. However, the point of talking things out is to get it out, not necessarily to find a solution. Talking about stressors helps to recognize them – which, later on, can help address and hopefully resolve them.

Talking about stressors also helps the nurse identify what the actual issues are. For example, a nurse may have a tough day because staffing has been poor. In speaking about it later, he or she may discover that the extra work isn't necessarily the problem, it's that the manager isn't hearing the nurse's concerns about patient safety. To resolve the issue, the nurse would need to address the communication between the staff and the manager.

RELATED : Why New Nurses are Leaving the Profession

Nursing co-workers are a tight-knit family. They are down in the trenches with one another and for this reason, talking about work-related stressors with one another is extremely valuable. Basically, they can all relate. Having a therapeutic vent session is extremely helpful not just to get concerns out in the open, but to share ideas on how to improve things. Sometimes it helps to arrange a gathering outside of work. Night-shift workers can meet for breakfast, and day workers can have a late lunch or dinner. By removing the group from the environmental source of stress (work), nurses can be more candid in verbalizing their concerns.

Let's face it, the last thing a nurse on the verge of burnout and at the end of a 12-hour shift wants to do is exercise (although kudos to those who do). However, exercise has been proven as an effective stress reducer. Exercise helps reduce adrenaline and cortisol as well as boost endorphins. It also helps boost energy, so nurses aren't so exhausted at the end of their shift.

The question of when and how much can be answered easily. Whenever a nurse can exercise however much they are able to be better than nothing. Counting running around at work as exercise is probably not sufficient; it helps to go somewhere else and do something different. Listening to music while exercising is extremely helpful in reducing stress as well. Squeezing in the form of exercise before or after work or on a nurse's day off will have long-lasting physical as well as mental health benefits. The bottom line is you must exercise to keep your immune system healthy.

RELATED : Nurse Manager Leadership Recommendations for Staff Engagement and Success

Finding a hobby is another great way to reduce stress. It gives nurses something else to focus on, and it's something that they enjoy. Hobbies make people feel good and sometimes provide a feeling of pride and accomplishment. Hobbies don't need to be time-consuming; it could include reading, knitting, working on an art project, even exercise (which is a double-whammy when it comes to stress reduction). The possibilities for hobbies are endless and have enormous health benefits as well.

Many people eschew the notion that deep breathing helps to reduce stress. Nurses, especially, should take notice, as there is a scientific basis for this method of stress relief. According to stress.org , deep breathing helps to bring oxygen to the brain and stimulates the parasympathetic nervous system which helps to reduce stress. Heart rate and blood pressure decrease and muscles relax.

Deep breathing is a quick and easy way to reduce stress; it can even be done at work in the midst of chaos. Slipping away to the break or supply room for a minute or two can help. At home, deep breathing in the form of yoga or meditation is a more in-depth method for stress relief. Yoga is especially focused on breathing patterns so practitioners can become aware of the mind-body relationship.

For some, the stress is too much to handle independently using the techniques listed above (and more). Nurses need to know that it's okay to seek professional help when necessary. When stressors at work become unbearable to the point that it manifests into physical symptoms, if interpersonal relationships are strained, or if work performance suffers and patient safety is at risk, nurses should seek professional help immediately. Many organizations offer some type of assistance program for staff, but there are also resources out in the community. Nurses should definitely know that caregiver stress is rampant and taking the first step to getting help is paramount to their well-being.

Nurses often care for others without stopping to care for themselves. This culture needs to shift. After all, how can one effectively care for others when their own mental health is suffering? It's easy for nurses to experience "compassion fatigue" as compassion is engrained in their DNA. However, staying in touch with one's own feelings and emotions and recognizing stress and the effect it has on one's life will help nurses maintain a long and healthy career.

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8 Ways to Optimize School/Life Balance for Nursing Students

Posted on September 5, 2024

Balancing the rigors of nursing school with the demands of personal life is no small feat. At Bolivar Technical College, we understand that our nursing students face unique challenges—whether it’s managing clinical rotations, mastering complex material, or juggling family responsibilities. Finding harmony between your studies and personal life is crucial for long-term success, mental well-being, and ultimately, your ability to provide compassionate care. Here are eight strategies to help you thrive both in and out of the classroom:

Craft a Flexible, Yet Structured Schedule

The first step in managing school and life is to create a well-structured, yet flexible schedule that caters to your academic and personal needs. Begin by identifying your non-negotiables—class times, clinical hours, and study blocks—then weave in personal commitments like family time, exercise, and hobbies. Use color-coded planners or digital tools like Google Calendar to visually map out your week. Flexibility is key; build in buffer time for unexpected events and be ready to adjust your schedule as needed. Think of your schedule as a dynamic guide rather than a rigid blueprint.

Prioritize Physical and Mental Self-Care

In the demanding field of nursing, self-care is not just a luxury—it’s a necessity. Prioritizing your physical and mental health ensures you have the stamina and resilience to meet your academic challenges. Develop a morning routine that energizes you, whether it’s a 10 minute workout, a nutritious breakfast, or a few minutes of journaling to set your intentions for the day. Consider adopting mindfulness practices such as prayer, meditation or deep breathing exercises during study breaks to keep stress in check. Remember, self-care is an ongoing commitment; it’s about creating small, sustainable habits that nurture your well-being.

Harness the Power of Academic Resources

Bolivar Technical College offers a wealth of academic resources designed to support your success. BTC provides many different modalities of support so students can find success from more than one angle. From Success Labs and study groups to academic advising, these tools are there to help you excel without becoming overwhelmed. Don’t wait until you’re struggling to seek help—reach out early and often. Studying with a classmate can be particularly beneficial, fostering a sense of community and learning through different perspectives and techniques. By tapping into the various resources at your disposal, you can create a smoother, more manageable study routine, backed by support from multiple directions.

Integrate Study into Your Daily Life

Studying for nursing school doesn’t have to be confined to a desk. Get creative by integrating study into your everyday activities. For example, record yourself reading key concepts or lecture notes, and listen to them while driving, cooking, or exercising. Use apps like Quizlet or Anki to review flashcards while you’re waiting in line or during lunch breaks. You can even turn your home into a mini-clinic by practicing skills like taking blood pressure or monitoring other vitals on family members (with their consent, of course!) These creative strategies can make studying more enjoyable and less of a chore.

Develop Healthy Boundaries and Learn to Say No

One of the most valuable skills you can develop as a nursing student is the ability to set healthy boundaries. It’s tempting to say yes to every opportunity, whether it’s an extra shift at work, a social event, or taking on additional responsibilities at home. However, overcommitting can lead to burnout and diminish your effectiveness in all areas of life. Be honest with yourself and others about your limits, and don’t be afraid to say no when necessary. Setting boundaries helps you protect your time and energy, ensuring that you can give your best to both your studies and personal life. Remember, nursing school is just a season of life and you can give more during other seasons of your life.

Stay Connected with a Diverse Support Network

Maintaining strong connections with your support network is crucial for emotional well-being. Whether it’s family, friends, classmates, or mentors, having people to lean on can make all the difference during challenging times. Schedule regular check-ins with loved ones, even if it’s just a quick text or phone call. Don’t underestimate the power of peer support; forming study groups or simply chatting with classmates about shared experiences can reduce stress and foster a sense of camaraderie. Additionally, consider seeking out a mentor—someone who has successfully navigated nursing school—to provide guidance and perspective. While you may not have as much time to devote to your social life, with a little creativity, you can maintain those relationships on a tighter schedule instead of feeling like it’s all or nothing.

Incorporate Micro-Breaks and Mindful Moments Throughout Your Day

Productivity isn’t about working non-stop; it’s about working smart. Incorporating micro-breaks and mindful moments throughout your day can significantly boost your focus and reduce stress. Try the Pomodoro technique, where you work intensely for 25 minutes, followed by a 5-minute break. During these breaks, engage in activities that relax and refresh you—stretching, deep breathing, or simply stepping outside for fresh air. For longer study sessions, treat yourself to a 15-20 minute walk. These brief pauses help prevent burnout and keep you mentally sharp.

Cultivate a Growth Mindset and Celebrate Small Wins

Finally, cultivate a growth mindset—an understanding that challenges and setbacks are opportunities for learning and growth. It’s normal to encounter difficulties along the way. Instead of viewing these as failures, see them as chances to improve and refine your skills. Celebrate your small wins, whether it’s acing a quiz, mastering a clinical skill, or simply making it through a tough week. Recognizing your progress, no matter how small, can boost your motivation and remind you of why you chose this path in the first place.

Balancing the demands of nursing school with personal life requires a blend of planning, self-care, and adaptability. By crafting a flexible schedule, prioritizing your well-being, and leveraging academic resources, you can achieve a healthy school/life balance. Remember, the journey through nursing school is as much about personal growth as it is about professional development. With these strategies in hand, you’re not just surviving nursing school—you’re thriving, laying the foundation for a fulfilling career as a compassionate and capable nurse. Embrace the challenge and take control of your journey in nursing school!

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Open access
Published: 02 September 2024

Evaluation of stress, bio-psycho-social response and coping strategies during the practical training in nursing students: a cross sectional study

Müjgan Solak ORCID: orcid.org/0000-0001-6201-3139 1 ,
Sevcan Topçu ORCID: orcid.org/0000-0002-6228-1720 2 ,
Zuhal Emlek Sert ORCID: orcid.org/0000-0002-2809-5617 2 ,
Satı Doğan ORCID: orcid.org/0000-0002-9935-3265 3 &
Fatma Savan ORCID: orcid.org/0000-0002-4846-9129 2

BMC Nursing volume 23 , Article number: 610 ( 2024 ) Cite this article

Metrics details

The aim of the study was to identify stress level, bio-psycho-social response and coping behavior of nursing students during the practical training.

A cross-sectional study was carried out with the 1st, 2nd, 3rd, 4th-year nursing students ( n = 1181) between September 2018-may 2019. Data was collected using by Socio-Demographic Questionnaire, The Student Nurse Stress Index, The Bio-Psycho-Social Response Scale and Coping Behavior Inventory.

The fourth-grade nursing students’ stress level was found to be statistically significantly higher than of other graders. Nursing students have shown emotional symptoms and social-behavioral symptoms the most. To cope with stress, nursing students used the strategies transference, staying optimistic, problem-solving and avoidance, respectively.

Conclusions

These findings highlight the need to routinely evaluate nursing students for stress, bio-psycho-social response, and coping strategies during practical training. Thus, counseling units can be constituted by the nursing schools, and nursing students who have higher stress levels and inadequate coping strategies benefit from these units.

Peer Review reports

According to Lazarus and Folkman’s transactional theory of stress and coping, stress is a two-way process. Stress is defined as exposure to stimuli (as harmful, threatening, or challenging) that exceed the individual’s coping capacity [ 1 ]. There is a complex transaction between individual subjective reactions to stressors and stressors produced by the environment complex transaction. Transactional theory consists of cognitive appraisal, and coping. After a primary appraisal of the threat or challenge is made, a secondary appraisal process of identifying and selecting available coping options is made. Coping processes produce an outcome, which is reappraised as favorable, unfavorable, or unresolved [ 1 , 2 ].

Stress is accepted as a disease of the 20th century that affects many professions [ 3 ]. Health professionals, especially nurses encounter higher levels of stress and stress factors when their level of exposure to stress and the number of stress-sources are evaluated [ 4 ]. For nurses, stress starts from the beginning of training period and they experience the negative effects of stress on health for many years [ 5 , 6 , 7 ].

Nursing students experience different levels of stress both during their theoretical and practical training [ 8 , 9 ]. Sources of theoretical stress are constantly subjected to examinations, assignments about courses, length of lecture time despite the lack of free times and preparation process before practical evaluations [ 10 , 11 , 12 ]. But sources of practical training stress comprise of the followings; starting to practice for the first-time, clinical evaluations, feeling inadequate in practice, scaring to give patients any harm, caring for patients, relationships with healthcare workers, friends and patients [ 13 , 14 ]. Although nursing students experience stress due to many reasons both in practical and theoretical settings, practical training periods are expressed as periods in which nursing students experience the highest levels of stress [ 15 , 16 ].

Stress can sometimes be a source of motivation, however, high stress can affect coping, self-confidence, concentration, motivation, academic performance [ 9 , 17 ]. In addition, high stress levels may cause students to experience health problems such as hypertension, heart diseases, nutritional disorders, stammering, nausea, vomiting, exhaustion and depression [ 5 , 6 ]. It is stated that nursing students experience higher levels of stress and relevant physical and psychosocial symptoms when compared with the students of other health-related disciplines [ 15 , 18 ].

This situation makes coping strategies crucial for stress management. Coping is defined as constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person [ 1 ]. The impact of stress on health depends on the adequacy of coping strategies that play a vital role in managing the stress [ 6 ]. As a strategy to cope with stress, nursing students prefer problem solving the most [ 8 , 11 , 19 ] and avoiding the least [ 5 , 6 , 8 ].

It was found in previous studies that the stress levels of nursing students differed according to classes. It is reported that stress levels are higher in nursing students in the upper grades and the initial clinical practice affects their stress levels [ 20 , 21 , 22 ]. In order to reduce the stress and its negative effects in nursing students, first of all, to determine their stress levels, their responses to stress, coping strategies and the factors affecting their stress levels is very important.

Research questions

What are the stress levels, bio-psycho-social responses, and coping behavior of nursing students during the practical training?

Which variables affect the stress level of nursing students?

A cross-sectional design was used.

Procedure and samples

The study’s population consisted of 1st, 2nd, 3rd, and 4th-year students [ n = 1181] of nursing school. A cross-sectional study was conducted between September 2018-May 2019.Since it was aimed to reach the entire population, no sample selection method was used. The inclusion criteria for the study were (1) voluntary acceptance of study participation (2) being during the period of practical training. The number of students was 300 for first grade, 309 for second grade, 285 for third grade and 287 for fourth grade. All of the students [ n = 996] who meet inclusion criteria are included in the study. The response rate of the questionnaires is 84%. ( n = 996/1181).

Data was collected during the practical training for each grade. The Faculty of Nursing has an integrated education system. The integrated education system is based on holistic learning. It enables the student to see the big picture instead of learning small parts and subject areas are associated according to a subject. The integrated education programme, which includes a structuring from health to disease, is organised to include basic knowledge, attitudes and skills related to the subjects related to care. In the first, second and third years of the integrated education programme, courses are conducted as modules, active education methods are used, and skills training is provided in laboratories and clinics. The fourth year is organised as an internship programme. Practical training starts to in the second term of the first year in the Faculty of Nursing. 1st-year students have practical training consist of 13 h per week for one month in Primary and Secondary Schools. 2nd and 3rd-year students have practical training in Hospitals and Primary Care. The practical training of 2st-year students in the third semester consists of 24 h per week for one month in dermatology, otolaryngology clinics, eye clinics, etc. In the fourth semester, their practical training includes 24 h per week for two months in İnternal Medicine and Surgery clinics. The practical training of 3rd-year students comprises 24 h per week for three months in pediatrics, obstetrics (fifth semester) clinics and psychiatry clinics, primary care (sixth semester). 4th-year students (internship) are in practical training (eight different nursing fields fundamentals of nursing, internal nursing, surgery nursing, pediatric nursing, obstetric and gynecological nursing, psychiatric nursing, public health nursing) during the seventh and eighth semesters. They have practical training 32 h per week each semester.

Data collection tools

Data was collected using by Socio-Demographic Questionnaire, The Student Nurse Stress Index (SNSI), The Bio-Psycho-Social Response Scale (BPSRS) and Coping Behavior Inventory (CBI) Socio-Demographic Questionnaire consists of seven questions such as age, gender, grade, employment status, smoking status, choosing nursing profession willingly and academic status.

The student nurse stress index (SNSI): SNSI that developed by Jones & Johnstone (1999), consisted of 22 items, and four subscales which include academic load, clinical concerns, personal problems, and interface worries [ 23 ]. SNSI is a five-point Likert-type scale ranging from 1 [not stressful] to 5 [extremely stressful]. The Turkish validity and reliability study was conducted by Sarıkoç, Demiralp, Oksuz, Pazar, [ 24 ]. Its Cronbach α coefficient was 0.86. Turkish version of the scale consists of four subscales as personal problems, clinical concerns, interface worries, and academic load. The higher scores obtained from SNSI indicate the high-stress level.

The bio-psycho-social response scale (BPSRS): The BPSRS, developed by Sheu, Lin, Hwang (2002), consist of 21 items and three subscales about symptoms relating to the students’ physical, psychological and social health [ 25 ]. BPSRS five-point Likert-type scale from 0 to 4. Its Cronbach’s alpha coefficient was 0.90. A higher score indicated the presence of more symptoms and poorer physio-psychosocial status [ 25 ]. The Turkish validity and reliability study was conducted by Karaca et al. [ 26 ]. The Cronbach’s alpha coefficient of the Turkish version was found to be 0.91 [ 26 ].

Coping behavior inventory (CBI): The original version of CBI that developed by Sheu, Lin, Hwang, (2002), consists of 19 items and four subscales as avoidance, problem solving, stay optimistic and transference [ 25 ]. The scale is a five-point Likert-type scale from 0 to 4. Its Cronbach’s alpha coefficient was 0.76. A higher score in one factor indicated more frequent use of this type of coping behavior [ 25 ]. The Turkish validity and reliability study was conducted by Karaca et al. (2015) and its Cronbach’s alpha coefficient was 0.69 [ 26 ].

Data analysis

The data were evaluated using the SPSS 21 (Statistical Package for the Social Sciences). Descriptive statistics was used as mean and standard deviation. One way anova test was used to compare scale scores (SNSI, BPSRS, CBI) according to graders. Multiple regression analysis was used to determine the variables (gender, employment status, smoking status, willingness of the choice of the nursing profession, academic achievement status) affecting stress level. For all effects, we used the standard significance level of α = 0.05.

Ethical considerations

This study was approved by Ege University Scientific Research and Publication Ethics Committee (Approval Number: 56/2018). The participants received information about the research objectives and procedures, and their written permission was obtained by means of informed consent form before data collection.

The mean age of nursing students is 21.32 ± 1.57 years. Of the students, 91.9% are females and 26.5% are freshmen, and 5% are working outside the school (Table 1 ).

When nursing students’ total and subscale SNSI mean scores were compared, a statistically significant difference was found between the mean scores of total SNSI and academic loads, interface worries and clinical concerns subscale (Table 2 ). The first grade nursing students’ mean score of academic load subscale was found to be statistically significantly higher than of second and third graders ( p < 0.05). The third and fourth grade nursing students’ interface worries subscale scores were also statistically significantly higher than of the first and second graders. In the clinical concerns subscale, the second and fourth grade nursing students had significantly higher clinical anxiety than the other graders and the first-year nursing students had lower clinical concerns than other graders. When the total SNSI mean scores were compared, fourth grade nursing students’ stress level was found to be statistically significantly higher than of other graders, and the first grade nursing students’ stress level was statistically lower than of other graders.

It was established that nursing students have shown emotional symptoms and social-behavioral symptoms the most, whereas physical symptoms were shown the least (Table 3 ). When the total and subscale mean scores of BPSRS were compared according to nursing students’ grades, a statistically significant difference was detected in subscales of total BPSRS, emotional symptoms and social behavioral symptoms. In the emotional symptoms subscale, the first year nursing students had less emotional symptoms than other graders. In the social behavioral symptoms subscale, the mean scores of fourth grade nursing students were found to be significantly higher than of other graders. When total BPSRS mean scores were compared, it was observed that the fourth grade students had more bio-psycho-social behavioral symptoms than the first grade students.

It was found that to cope with stress, nursing students used the strategies transference, staying optimistic, problem-solving and avoidance, respectively (Table 4 ). When nursing students’ behaviors related to coping with stress were evaluated according to grades, no statistically significant difference was found between the subscale scores of avoidance, staying optimistic and transference, whereas only the problem-solving subscale was statistically significant. In the problem-solving subscale, the problem-solving skills have increased significantly as the class increased ( F = 72.63; p = 0.00).

The relationship between nursing students’ stress level and gender, willingness to choose nursing profession, smoking status, employment status and academic achievement status was evaluated using regression analysis (Table 5 ). The extent to which nursing students’ stress levels were predicted by variables such as gender ( β =-0.22, p = 0.00), choosing nursing profession willingly ( β =-0.27, p = 0.00), smoking status ( β = 0.28, p = 0.00), employment status ( β = 0.14, p = 0.00) and academic achievement status ( β =-0.34, p = 0.00) was determined by applying linear multiple regression. As a result of this process was detected as R = 0.84, R2 = 0.70, and 70% of the total variance on stress level was explained by these variables. The stress level was found significantly higher in female students, working students, smokers, those who did not want to choose the nursing profession and those with low academic achievement.

One of the most important stress factors for nursing students is practical training periods especially an initial period of practical training [ 21 ]. It is stated that nursing students experience more stress in clinical practice periods than other periods [ 16 , 21 ]. In the literature, studies investigating the effects of grade on the stress level of nursing students have shown mixed results. Eswi, Radi, Youssri reported that there was no relationship between grade and stress level [ 27 ]. In a study conducted by Shaban, Khater, Akhu-Zaheya, it was found that nursing students were more sensitive to stress due to reasons such as transition to university life, managing their own needs and gaining new social skills, especially during the first years of education. In this study, unlike other studies, the first-year nursing students’ stress level was found lower than of other graders [ 6 ]. Aedh, Elfaki & Mohamed, reported that nursing students who are in the second year of nursing education have experienced higher level of stress than other grades [ 28 ]. In this study, although the second grade was not the highest stress level group, the stress level showed a rapid increase compared to the first grade and the clinical concerns subscale scores were found higher than other grades. Third and fourth grade nursing students’ mean interface worries scores were found high the other grades. Several studies have similarly reported that, nursing students’ stress level was found higher in the last period of nursing education compared to other periods [ 15 , 22 ]. In a qualitative study conducted by Admi et al. (2018) it was found that conflict between professional beliefs and the reality of hospital practice were stressors for final year students [ 19 ]. In the study conducted by Bhat (2021) et al. it was reported that training on invasive procedures (safe catheter etc.) should be standardised in undergraduate education and this should be made part of the annual or biannual compulsory training for healthcare personnel [ 29 ]. Similarly, in this study, the stress level of fourth-grade nursing students was found higher than of other graders, and fourth-grade nursing students’ mean scores of clinical concerns and interface worries were higher than of other graders. The results of our study indicate that the first-grade nursing students had problems adapting to the intensive pace of nursing education and that they experienced stress; accordingly, second-grade nursing students who first-time took to practical training and fourth-grade nursing students who had the longest practical training period also experienced stress due to practical training.

In several studies found that nursing students experienced higher levels of stress, physical and psychological symptoms than the students in other health disciplines [ 6 , 30 ]. Chen & Hung reported that nursing students demonstrated physical symptoms toward stress mostly, and social-behavioral symptoms the least [ 8 ]. In the study carried out by Kassem & Abdou, when the bio-psycho-social responses experienced by nursing students were evaluated, it was found that emotional symptoms were the most common and social-behavioral symptoms were the least [ 11 ]. In another study conducted by Durmuş & Gerçek with nursing students, it that bio-psycho-social responses were found to be occurred mostly in fourth grade students [ 31 ]. In all classes, the most often emotional symptoms were observed in nursing students followed by social behavior symptoms and physical symptoms respectively [ 31 ]. The present study showed that nursing students demonstrated emotional symptoms and social-behavioral symptoms the most, whereas physical symptoms were demonstrated the least, and these results were consistent with results from most of previous similar studies. It was found that fourth-grade nursing students experienced more Bio-Psycho-Social Responses than freshmen and emotional symptoms were higher in second, third and fourth grade nursing students and social behavioral symptoms were higher in fourth-grade nursing students. This difference may be explained by the fact that because fourth-grade nursing students’ stress levels were higher than of other graders, they showed more Bio-Psycho-Social Responses.

Durmuş & Gerçek found that first, and the third-year nursing students have usually used strategies for coping with stress such as stay optimistic and avoidance, respectively [ 31 ]. Also, the same study showed that second and fourth-year nursing students have used problem-solving most [ 31 ]. Many studies found that nursing students have generally used problem solving as a coping strategy [ 5 , 8 , 11 , 19 , 32 ] and the avoidance at least [ 5 , 6 , 8 ]. Sheu, Lin, Hwang reported that using effective ways of coping with the problem will facilitate returning to stable status by allowing reduction of negative consequences of stress [ 25 ]. The present study showed that nursing students most often used transference and least avoidance strategies to cope with stress, and as the students’ grade levels increased, also the level of using problem-solving skills increased. This situation indicates that the problem-solving competencies involving in nursing education are being provided to the students. The fourth grade of nursing students who has highest practical-training hours possess problem-solving skills more than other grades because of the positive effects of the practical applications encountered in a large number of complicated situations on the problem-solving skills of the nursing students.

In the present study, when the interaction between nursing students’ stress level and gender, working status, smoking status, willingness to choose nursing profession and academic achievement status was evaluated, it was found that female students, employees, smokers, those that have chosen nursing profession unwillingly, and those with low academic achievement had significantly higher stress levels. It was reported in different studies that academic success [11,20,], gender [ 20 , 21 , 33 ] have affected students’ stress levels and also their working hours outside of nursing education have affected their stress level [ 11 ]. Although it is important for all students to reduce stressors and to provide support for the use of coping mechanisms; especially female students, employees, smokers, those that choose the nursing profession unwillingly, and those with poor academic achievement should be supported more.

Limitations

This study has some limitations. Unlike other nursing schools in our country, this research was carried out in a nursing school where an integrated education system was applied. The findings could be specific to this college of nursing. Therefore, the generalizability of results may be limited. Besides, the small number of male students is another limitation of the study. SNSI, BPSRS, and CBI are a self-reported questionnaire. This can lead to social desirability bias in respondents.

Reccommendations

It is recommended that long-term studies be conducted to understand the long-term effects of stress experienced during nursing education and to develop sustainable support mechanisms. Support mechanisms may decrease stress levels and their negative effects on nursing students and can promote nursing students’ well-being and academic success, especially during practical training. Exploring what is nursing students of stress levels and coping strategies during education, can inform post-graduation preventive strategies. Also, evaluating the current stress levels and coping strategies in different nursing education programs is crucial for identifying gaps and areas for improvement. Interventional and qualitative studies are crucial to providing concrete recommendations for educational institutions and policymakers to address stress among nursing students.

According to results of the present study, the stress levels of fourth-grade nursing students were higher than of other graders and causes of stress varied as regards grades. The higher level of stress in the senior nursing students that have the maximum responsibilities and stay times of practical training and the bio-psycho-social responses given by students associated depending on this stress indicate that those clinical practices are one of the main sources of stress for nursing students. Due to the nature of nursing education and nursing practices, students use their problem solving skills as a coping strategy. However, the presence of stress-related emotional and social-behavioral symptoms in nursing students indicates that they cannot cope with stress sufficiently. Internship, which is the preparation period for the transition to professional life for nursing, is the period in which nursing students experience the most stress. Students’ learning to cope with stress in this period will enable them to use these strategies in their professional lives. Nursing schools can consider this period as an opportunity period to reduce and cope with stress, which is one of the important risk factors for nurses.

To develop stress management and the stress-coping mechanism of nursing students, it was recommended that courses or counseling units should be available, nursing educators should support students in the clinical areas, receive regular feedback from the students about practical training, and cooperate with clinical nurses to increase nursing students’ clinical compliance. Also, in particular, female students, working students, smokers, those that have chosen nursing profession unwillingly, and those with low academic achievement should be encouraged to receive individualized or group support for stress management and in coping with stress.

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

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Surgical Nursing, Faculty of Nursing, Ege University, Izmir, 35030, Turkey

Müjgan Solak

Public Health Nursing, Faculty of Nursing, Ege University, Izmir, 35030, Turkey

Sevcan Topçu, Zuhal Emlek Sert & Fatma Savan

Psychiatric Nursing, Faculty of Nursing, Ege University, Izmir, 35030, Turkey

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M. S Conception and design, data acquisition, data analysis and interpretation, writing, give final approvals. S. T Conception and design, data acquisition, data analysis, writing, give final approvals. Z. E. S Data acquisition, data interpretation, give final approvals. S. D Data acquisition, data analysis, give final approvals. F. S Conception, writing, give final approvals.

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Solak, M., Topçu, S., Sert, Z.E. et al. Evaluation of stress, bio-psycho-social response and coping strategies during the practical training in nursing students: a cross sectional study. BMC Nurs 23 , 610 (2024). https://doi.org/10.1186/s12912-024-02265-5

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Article Body	August 15, 2024 The researchers interviewed 27 health care workers from five organizations in New York State. The study’s findings conclude that burnout affects both workers’ well-being and the quality of patient care. Additionally, workers cited a lack of support from organizational leadership when it comes to managing their stress levels and mental health. This study addresses a critical need for more research about stress management and burnout from the perspective of health care professionals. “Organizations should know what it is that they can do to better support our health care workers, and this study reveals some of what is needed," Kober said. as a phenomenon caused by “chronic workplace stress that has not been successfully managed.” An of more than 7,400 nurses conducted in 2023 indicated that 56% of nurses report feeling burned out. The study’s respondents discussed staff shortages, coworker conflict and interactions, strategies to mitigate stress, impacts of work-related stress and managing stress and burnout in the workplace. Chang noted that the study’s findings suggest an urgent need for programmatic changes within health care organizations to address burnout. Chang and Kober conducted this study as part of a nearly $2 million grant from the Health Resources and Services Administration, which is designed to increase the mental health workforce in Western New York. Chang is the principal investigator of the HRSA-funded , which promotes using Mindfulness-Based Stress Reduction (MBSR) to reduce stress and burnout among health care workers. Kober explained that the study’s results show that mental health support and resiliency trainings are essential for new employee onboarding and should be offered annually so health care organizations can provide continuous support for their workforce. Chang echoed the need for organizational implementation of resiliency trainings and mental health supports. “The findings of this paper underscore the urgent need for a comprehensive and sustainable resilience training program within healthcare organizations,” Chang said. By SHANNON O'SULLIVAN Director of Marketing, Communications & Alumni Engagement School of Nursing 105 Beck Hall (South Campus) Email: Tel:
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Stress, coping and professional identity among nursing students during the COVID-19 pandemic: a latent profile analysis

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Published: 27 August 2024

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Qiong Sun 1 ,
Wen Qian 1 , 2 ,
Yixuan Yao 3 ,
Jing Zhu 4 ,
Jinqi Xu 5 ,
Leifeng Zhang 6 ,
Chun Yao 4 ,
Lili Wang 7 &
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This study aimed to characterize the patterns of psychological stress among nursing students during the COVID-19 pandemic, and evaluate for profile differences in demographic characteristics, coping styles and professional identity.

A cross-sectional study was conducted among nursing students with convenient sampling from four colleges in China from April to June 2022. A total of 1978 nursing students completed an online questionnaire of psychological stress, coping styles and professional identity. Latent profile analysis (LPA) was performed to identify subgroups of nursing students with distinct stress profiles.

Four distinct profiles were identified: high employment stress (HES, 18.0% of the sample), low stress (LS, 40.2%), moderate stress (MS, 20.4%), and high stress (HS, 21.4%). HES nursing students were more likely to be fourth-year students and had chosen nursing program primarily for easy employment, while HS students were more likely to have transferred to nursing program. LS students scored highest in problem-solving coping, while HS students scored highest in negative coping (i.e., expectancy, avoidance). LS students had highest level of professional identity compared to the other three subgroups. No gender differed among the four classes ( P > 0.05).

Psychological stress among nursing students is at an overall moderate to high level and shows heterogeneity during the COVID-19 pandemic. Early identification of stress characteristics of high-risk groups and development of targeted interventions to manage stress and coping are recommended to promote nursing students’ professional adaptability and identity.

Trajectory of change in perceived stress, coping strategies and clinical competence among undergraduate nursing students during clinical practicum: a longitudinal cohort study

Perceived stress among university students in south-east Serbia during the COVID-19 outbreak

Stressors and coping styles of nursing students in the middle period of clinical practicum: a qualitative study.

Avoid common mistakes on your manuscript.

Introduction

The COVID-19 pandemic has had a significant impact on people’s physical and mental health, leading to widespread disruptions in daily life and the implementation of government restrictions worldwide (Kuriala, 2021 ; Violant-Holz et al., 2020 ; Ganesan et al., 2021 ). These actions, which include lockdowns and social isolation, have raised stress and anxiety levels and negatively impacted people’s mental health (Buheji et al., 2020 ; Hawryluck et al., 2004 ; Doğan et al., 2020 ). Research indicates that a notable proportion of youth, outside the US, are experiencing mental health problems as a result of the uncertainty brought on by the global pandemic (Bavel et al., 2020 ; Huang, 2020 ). Among the most often reported problems are psychiatric illness, stress, and fear of virus transmission (Krishnamoorthy et al., 2020 ; Rajkumar, 2020 ). Additionally, research indicates that health professional students are particularly susceptible to psychological distress and acute stress disorder linked to the COVID-19 pandemic, with prevalence rates as high as 37.73% (Li, 2021 ).

Nursing is widely recognized as a challenging profession, and nursing education can be stressful for students (Papazisis et al., 2014 ). Existing evidence shows that academic and clinical stressors are the two main sources of stress for nursing students, with the latter being felt more intensely by students across the board in nursing education (Pulido-Martos et al., 2012 ). While all university students experience academic stress, the unique aspect of nursing education lies in the practice-based component of the program, where the combination of academic and clinical courses provides the major stress for students (Bartlett, 2016 ). Thus, it is often known that stress levels among nursing students are higher than those of students in other health-related disciplines (Ching et al., 2020 ; McGrath, 2003 ).

Stress is thought to be beneficial in small doses since it boosts excitement and motivation (Gibbons & Gibbons, 2010 ). On the other hand, persistent, unmanageable stress or the inability to manage ongoing stress can be harmful to one’s health and well-being (Watson et al., 2008 ). Prolonged stress can impair nursing students’ ability to study, make decisions, think critically, and succeed academically in the end (Sheu, 2002 ). They might even think about quitting the nursing program as a result of stress (Watson et al., 2008 ). Their professional identity and health may suffer from extended exposure to unmanageable stress (Edwards, 2010 ; Altiok & Ustun, 2013 ). Studies have found that stressful life experience are linked to anxiety and depression in nursing students, but stress itself is positively correlated with depressed mood (Ross et al., 2005 ; Støen Grotmol et al., 2013 ). The continuation of the COVID-19 pandemic and the involvement of healthcare professionals on the frontlines could potentially have adverse effects on nursing students.

Professional identity in nursing refers to an individual’s positive attitude toward the nursing profession with the intention of fully practicing the nursing skills and sense of responsibility acquired from professional training (Zhang, 2021 ). In the fight against the COVID-19 pandemic, nursing staff have shown their professional strengths and values, which has considerably boosted nursing students’ sense of professional pride. Reports have indicated that the COVID-19 pandemic has increased professional identity among Chinese nurses (Li et al., 2021 ), and similar results have been observed among Chinese nursing students (Nie, 2021 ). However, on the other side, nursing students have had to reevaluate the hazards connected with their future employment, which may have an impact on their career choices, in light of public accounts of healthcare workers contracting infections or even losing their lives.

Coping mechanisms are necessary for managing stress and preventing its adverse consequences (Labrague, 2017 ). Coping styles can be categorized into positive and negative coping, where individuals adjust their cognitive and behavioral patterns to alleviate negative emotions under stress (Compas, 2001 ). When under stress, people who employ positive coping strategies may develop a positive mindset and seek out support in order to manage their negative feelings (Lazarus & Folkman, 1984 ). The COVID-19 pandemic is a stressor that has altered human physiology, brain, mind, and behaviour in multiple ways (Al-Hindawi et al., 2022 ). However, various nursing students have varied ways of seeing and responding to stressors, as well as different ways of coping with them. Therefore, it is crucial to investigate the stress levels and coping styles of nursing students during public health emergencies and to implement prompt and efficient interventions to enhance their mental health and promote their professional identity.

Although stress experienced by nursing students has been adequately documented, what is less known is whether there is heterogeneity of stress among nursing students, as well as variability in coping styles and professional identity. Most nursing research has adopted a variable-centered strategy, which focuses on examining the links between each aspect of stress and other variables. While this method offers insightful data regarding the specific and direct relationships between each aspect of stress and other variables, it fails to consider the possibility that (a) different stress profiles exist within the population and (b) these profiles could be associated with variations in other variables (coping, professional identity, etc.). This viewpoint is in line with the person-centered approach to conceptualizing stress, which acknowledges the possibility of different stress profiles. Most research focuses on the individual effects of stressors (Labrague et al., 2018 ; Bhurtun, 2019 ), but little consideration is given to the interactions among various stressors. To better assess inter-individual variability and explain the multidimensional nature of stress, a person-centered approach is required. Latent profile analysis (LPA) is a person-centered approach that identifies latent subgroups by examining how individuals naturally cluster together (Lanza et al., 2013 ). One major strength of this approach is that it can be used to “identify shared symptom patterns” in a sample (Au et al., 2013 ). This understanding can then be leveraged to identify the groups to which each nursing student belongs, guiding appropriate interventions tailored to the unique needs of each group, rather than just targeting the outcome variable.

To the best of our knowledge, this is the first study looking into nursing students’ stress profiles during the COVID-19 pandemic using latent profile analysis (LPA). The aim of this study is to identify subgroups of nursing students with different stress profiles during the COVID-19 pandemic using a person-centered LPA, and assess the differences in demographic characteristics, coping styles, and professional identity among these subgroups, providing a basis for early intervention and further development of individualized educational strategies. We hypothesized that:

Hypothesis 1

(H1). There may be heterogeneity of psychological stress among nursing students during the COVID-19 pandemic, which can be identified using latent profile analysis (LPA).

Hypothesis 2

(H2). Stress profiles based on LPA may demonstrate differences in coping styles and professional identity among nursing students.

Materials and methods

Data and study design.

A cross-sectional study with latent profile analysis was conducted among nursing students in China from April to June 2022. Ethics approval was granted by the Institutional Review Board of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine.

This was an online survey. We sent the questionnaire QR code to the nursing students in four colleges in Shanghai and Jiangsu, China. The students scanned the QR code and completed the questionnaire on the online survey platform. Participation was completely voluntary and no financial incentives were offered. Data were collected through the online platform, and all participants completed the questionnaire online providing informed consent on the survey platform. The questionnaire was administered in simplified Chinese. A total of 1978 valid questionnaires were obtained. We performed an analysis using G*Power 3.1 to calculate the sample size required for this study. The results showed that 107 was the minimum sample size needed to achieve sufficient power (95%) in detecting a medium effect size (f2 = 0.15). Thus, the number of participants ( n = 1978) in this study was an adequate sample size.

The demographic characteristics of the survey included gender, grade, and reasons for choosing nursing program.

The Psychological Stress Questionnaire for College Students (PSQCS) was used to assess the sources and levels of psychological stress among nursing students (Cui, 2009 ). It consists of 36 items assessing stress in five domains: emergency stress, financial stress, employment stress, academic stress, and social and interpersonal stress. It is a self-reported measure rated by a 5-point Likert scale (0 no stress, 1 mild stress, 2 moderate stress, 3 high stress, and 4 very severe stress). The average score of each domain is the total score of the stress values of the questions in the domain divided by the number of related questions. Higher scores indicate greater psychological stress. The questionnaire has been widely used in China and has demonstrated good validity and reliability (Zhao et al., 2021 ; Li et al., 2021 ). The Cronbach’s alpha coefficient for the questionnaire was 0.926, indicating good internal consistency and high construct validity.

The Coping with Psychological Stress for College Students (CPSCS) was used to measure the coping strategies employed by nursing students in response to psychological stress (Cui, 2009 ). The scale has been widely used and has demonstrated good validity and reliability (Zhao et al., 2021 ; Li et al., 2021 ). It consists of 22 items assessing four coping strategies: problem solving, support seeking, expectancy, and avoidance. It is a self-reported measure, rated on a 5-point Likert scale (1 = “non-conformity” to 5 = “fully conforming”). The average score of each strategy is the total score of each item of the factor divided by the number of related items. If an average score is higher than 3, it indicates a strong tendency to respond to this strategy. Conversely, an average score lower than 3 indicates a weaker tendency to respond to this strategy. The Cronbach’s alpha coefficient for the scale was 0.811, with good internal consistency and high construct validity.

The Professional Identity Questionnaire for Nursing Students (PIQNS) was used to assess the professional identity among nursing students (Hao, 2011 ). The questionnaire has been widely used in China and has been proven to have good reliability and validity (Zhang, 2021 ; Gao et al., 2021 ). It consists of 17 items, rated on a 5-point Likert scale (1 = “not true at all” to 5 = “true nearly all the time”). The total score ranges from 17 to 85. Higher scores indicate better professional identity. The Cronbach’s α coefficient for the PIQNS in this study was 0.947.

Statistical analysis

SPSS 25.0 and Mplus 8.2 were used in the analyses. Latent profile analysis was utilized to identify potential stress profiles of nursing students. The one- to six-class groups were applied and compared based on a set of fit statistics. A good model fit was indicated by (1) lower comparative values of the Akaike information criteria (AIC), the Bayesian information (BIC), and the adjusted BIC (ABIC) values, as well as higher values of entropy with numbers closer to 1; (2) a significant Lo-Mendell-Rubin likelihood ratio test (LMRT) and bootstrap likelihood ratio test (BLRT) (Jung & Wickrama, 2008 ; Berlin et al., 2014 ). After determining the best-fitting profile model, chi-square tests and ANOVA were used to conduct inter group comparison. Multiple logistic regression model was used to explore the differences in demographic characteristics, coping styles, and professional identity among nursing students with different profiles of psychological stress. P < 0.05 was considered statistically significant.

Latent profile analysis of psychological stress

A total of 1978 nursing students were selected for this study. In the latent profile analysis, the average scores of each dimension of PSQCS were used as the exogenous variables to develop the model. Starting with a model with one potential class, the number of potential classes was gradually increased, and the fitness of each model was evaluated one by one to determine the best-fit latent class model. The fit indices of the six LPA models were presented in Table 1 . The values for AIC, BIC, and A-BIC showed the biggest reduction from the three-profile model to the four-profile model, starting with the two-profile. The six-profile model’s p-values for LMRT and BLRT were not significant ( p > 0.05), indicating that the fitting effect of the six-profile model was not as good as that of the five-profile model. Although the fitting effect of the five-profile model was better than that of the four-profile model ( p < 0.05), there was one category in its classification that only accounted for 2% (< 5%) and did not have classification significance. Additionally, the four-profile model’s entropy test value was higher than that of either the five-profile or three-profile model. Therefore, the four-profile model was considered to be the optimal solution.

The average scores for each dimension of PSQCS for the four subgroups of nursing students were presented in Table 2 , and the results were also displayed in Fig. 1 . Among all five stressors, nursing students in subgroup-1 had the highest average scores on employment stress. Therefore, subgroup-1 was named High Employment Stress (HES). There were 356 nursing students in this subgroup, representing 18.0% of the total sample. Subgroup-2 had lower mean scores on each dimension compared to the other three subgroups. Thus, we named subgroup-2 as Low Stress (LS). It was the largest subgroup, with 796 students, accounting for 40.2% of the total sample. Subgroup-3 was named Moderate Stress (MS) because it had moderate scores on each dimension compared to the other three subgroups. Subgroup-3 consisted of 403 students, or 20.4% of the total. Subgroup-4 was named High Stress (HS) as the mean scores on each dimension were higher than any other subgroup. In total 423 students were in subgroup-4, accounting for 21.4%.

Four-profile solution of the latent profile analysis

Profile differences in coping styles and professional identity

Univariate analysis revealed significant differences ( P < 0.01) among the four profiles of psychological stress in terms of grade, reasons for choosing nursing program, coping styles, and professional identity. As shown in Table 3 , HES nursing students were more likely to be fourth-year students and were more likely to have chosen nursing program primarily for easy employment compared to the other three subgroups. LS students were more likely to have enrolled in nursing primarily out of interest, while HS students were more likely to have transferred into the program. LS students scored highest on problem solving, while HS students scored highest on support seeking, expectancy, and avoidance. LS students also scored highest on PIQNS compared to the other three subgroups. Moreover, there were no gender differences among the four classes ( P > 0.05).

Multiple logistic regression analysis was conducted, using “Low Stress” as the reference group, to compare the characteristics of different stress profiles. As shown in Table 4 , the results showed that HES nursing students were more likely to be fourth grade students (OR = 1.832, P = 0.001), and were positively correlated with expectancy (OR = 1.497, P < 0.001), avoidance (OR = 1.556, P = 0.001), while negatively correlated with problem-solving (OR = 0.714, P = 0.001), and professional identity (OR = 0.494, P < 0.001). Moderate stress nursing students were less likely to be fourth grade students (OR = 0.630, P = 0.018), and had a positive correlation with support seeking (OR = 1.686, P < 0.001), avoidance (OR = 1.494, P = 0.001), and a negative correlation with problem solving (OR = 0.462, P < 0.001). HS nursing students were positively correlated with support seeking (OR = 1.651, P < 0.001), expectancy (OR = 1.605, P < 0.001), and avoidance (OR = 2.672, P < 0.001), while negatively correlated with problem-solving (OR = 0.358, P < 0.001), and professional identity (OR = 0.577, P < 0.001). There were no significant differences in gender and reasons for choosing nursing program among the four potential stress profiles of nursing students ( P > 0.05).

In this study, four psychological stress characteristics of nursing students were identified based on five psychological stress sources through latent profile analysis: High Employment Stress (18.0%), Low Stress (40.2%), Moderate Stress (20.4%) and High Stress (21.4%). The results indicated that the psychological stressors and stress levels of nursing students were heterogeneous during COVID-19 pandemic. Nursing students from different subgroups exhibited unique stress profiles which implicated different supporting. For example, the HES group seems to need more guidance on job searching and establishing realistic career expectations. The number of nursing students with HS, MS, and HES accounted for 60% of the total sample, indicating that the psychological stress levels of nursing students were generally at moderate to high levels, similar to the findings of Liu et al. (Liu et al., 2020 ). This highlights the importance of identifying the stress characteristics of high-risk individuals early on and developing targeted counseling interventions.

Nursing students often encounter multiple interconnected stressors. The findings of this study revealed that nursing students in MS and HS groups exhibited high stress levels across all five stressors. Similarly, Liao et al. (Liao et al., 2018 ) identified stress profiles among university freshmen based on five stressors (academic, financial, intimacy, peer relationships, and parent-child relationships), where the general subgroup experiencing moderate to high stress showed elevated stress levels across all stressors. These findings suggest that nursing students are susceptible to concurrent or sequential superimposed stress. MS and HS nursing students reported the highest levels of emergency stress, which could be attributed to the impact of the COVID-19 outbreak during the survey period. Public health emergencies are sources of stress that trigger a range of effects in the daily life, work, and behavior of nursing students. Apart from concerns about their own and their families’ risk of infection, these students also worry about the negative impact of the outbreak on their studies, graduation, and future employment, thereby amplifying their psychological stress. Additionally, approximately 18.0% of nursing students reported high levels of employment stress coupled with high levels of financial stress and academic stress. The HES nursing students were mainly fourth-year graduates whose academic and employment-related issues formed the primary stressful events during the graduation phase. Job searching can be financially burdensome, and those nursing students with limited financial support from their families may experience heightened employment stress (Lavoie-Tremblay et al., 2022 ). On the other hand, the LS nursing students, accounting for 40.2% of the total sample, exhibited low stress levels across all five stressors due to effective stress regulation and coping skills. Since nursing students are exposed to numerous stressful life events, nurse educators should pay special attention to the possibility of simultaneous exposure to additional stressors when specific stressors affect individual nursing students, and help them improve their adaptive abilities to cope with stress.

The present study found that LS nursing students demonstrated proficient problem-solving coping skills and scored highest on the problem-solving dimension of the coping styles scale. Proactive coping helped mitigate the stress resulting from life events (Fornés-Vives, 2016 ). In contrast, HS nursing students were more prone to negative coping strategies such as expectancy and avoidance. This can be attributed to the positive association between the number and accumulation of stressful events and the use of negative coping mechanisms (Ferrari, 2020 ). It is worth noting that nurse educators should adopt a balanced perspective on nursing students’ coping strategies. Temporary use of negative coping styles like expectancy and avoidance may provide some relief from overwhelming psychological stress. However, nursing students experiencing high stress levels should be provided with timely and effective psychological counseling, guiding them to seek help and support, enhance their mental resilience, and choose positive coping styles that are appropriate for their situation.

Compared to LS nursing students, HS and HES students exhibited lower levels of professional identity. HES nursing students may lack job search assistance, face a competitive employment environment, and have high expectations for their careers, which may affect their professional recognition. HS nursing students, burdened with higher psychological stress, tend to have weaker professional identity, which is consistent with the findings of Zhong et al. (Zhong et al., 2020 ). Therefore, nursing educators and administrators should guide nursing students in improving their professional qualities, expanding their employment opportunities, establishing correct professional values, making suitable career choices, and leveraging role models as sources of support to enhance their psychological resilience and professional identity (Zhang, 2021 ).

Currently, the existence of gender differences in various stressors is still controversial (Helbig et al., 2017 ; Moksnes et al., 2016 ). The results of this study showed that male students scored significantly higher than female students only on the social and interpersonal stress dimension (1.83 vs. 1.73, F = 7.838, p = 0.005), which is consistent with previous findings (Liao et al., 2018 ). This could be attributed to male students being less inclined to communicate when faced with interpersonal conflicts. No gender differences were found in any other stressors ( P > 0.05). To eliminate possible gender bias in the results, this study conducted separate LPA for male and female nursing students to identify psychological stress profiles. The results yielded the same latent characteristics, indicating that the present study was less influenced by gender differences and the results obtained were reliable.

As far as we are aware, this is the first study to use latent profile analysis to try to identify stress profiles among nursing students during the COVID-19 pandemic. This will help with early intervention and future development of individualized educational strategies. However, there are several limitations to this study. Initially, a convenience sampling technique was employed, which could lead to bias in selection. Furthermore, there is limited generalizability of the study to the overall population of nursing students because it was conducted solely in China. It is necessary to conduct more research using a variety of samples from various locations and civilizations. Another disadvantage of this study that calls for future research is the absence of a reliable instrument to measure the stress among nursing students directly related to the COVID-19 pandemic.

Overall, nursing students suffer moderate to high levels of psychological stress. There is heterogeneity in psychological stress profiles among nursing students, which can be categorized as High Employment Stress, Low Stress, Moderate Stress, and High Stress. To support nursing students’ professional adaptation and identity, it is advised to identify stress profiles early on among high-risk groups (HS and HES) and establish focused counseling interventions to manage stress and improve coping abilities.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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SAGE Open Nurs
v.10; Jan-Dec 2024
PMC11337188

Nursing Students’ Experiences and Challenges in Their Education During COVID 19 Pandemic: A Mixed-Method Study

Puvaneswari kanagaraj.

1 Department of Nursing, College of Applied Medical Sciences, University of Bisha, Bisha, Kingdom of Saudi Arabia

Judie Arulappan

2 Department of Maternal and Child Health, College of Nursing, Sultan Qaboos University, Al Khoudh, Muscat, Sultanate of Oman

Arpita Pradhan

3 Narayana Multi Specialty Hospital, Kolkata, West Bengal, India

* Current address: Durgapur City Hospital and Clinic Pvt. Limited, Durgapur, West Bengal, India.

Shimmaa Mansour Moustafa Mohammed

4 Faculty of Nursing, Zagazig University, Zagazig, Egypt

Associated Data

Supplemental material, sj-docx-1-son-10.1177_23779608241272484 for Nursing Students’ Experiences and Challenges in Their Education During COVID 19 Pandemic: A Mixed-Method Study by Puvaneswari Kanagaraj, Judie Arulappan, Arpita Pradhan and Shimmaa Mansour Moustafa Mohammed in SAGE Open Nursing

Supplemental material, sj-docx-2-son-10.1177_23779608241272484 for Nursing Students’ Experiences and Challenges in Their Education During COVID 19 Pandemic: A Mixed-Method Study by Puvaneswari Kanagaraj, Judie Arulappan, Arpita Pradhan and Shimmaa Mansour Moustafa Mohammed in SAGE Open Nursing

Introduction

The COVID-19 outbreak disrupted the nursing education across the world. The nursing students faced many challenges in their learning process.

The study explored the experiences and challenges faced by nursing students who had virtual education in India.

The study adopted an exploratory sequential mixed-methods design. The study was conducted as two phases. Phase 1: Qualitative data were collected using direct focus group interview with 18 students. Phase 2: Quantitative data were collected from 477 students using a Likert scale prepared by the investigators of the study on challenges experienced by nursing students on their education. The analysis was done using the descriptive and inferential statistics and thematic analysis.

Phase 1: The analyzed data produced seven themes and 10 sub-themes; (1) technical issues—a concern, (2) regular rhythm in educational training—but not complete, (3) stress and strain, (4) evaluation—a concern, (5) communication, (6) comfort zone, and (7) easy distraction. Phase 2: Majority of the students (54.71%) experienced high-level challenges with the nursing education during pandemic. The overall mean and SD of all the domain-wise challenges were 103.39 + 7.11 with the range from 30 to 150. The mean and SD with educational challenges were (20.27 + 3.04), environmental challenges (6.92 + 1.66), communication challenges (17.61 + 4.01), technical challenges (17.39 + 3.75), evaluation challenges (7.09 + 1.94), physical and mental challenges (20.47 + 4.33), career challenges (7.06 + 1.91), and financial challenges (6.61 + 2.1). The demographic variable gender ( P = 0.045) showed a statistically significant association with the challenges.

Considering the experiences and challenges faced by the nursing students, the nursing administrators shall design educational strategies to mitigate these challenges in nursing education during a pandemic.

Implication

Virtual nursing education offers flexibility in teaching and learning, self-paced learning opportunity, lower the costs, career advancement, comfortable learning environment, more opportunities for participation, easier to track documentation and improves skills in technology. Therefore, the challenges in virtual nursing education should be lessened to have successful teaching learning experiences.

Introduction/Background

The world faced unprecedented challenges during COVID-19 global pandemic ( World Health Organization, 2020 ). The pandemic changed the lives of people at different levels. Additionally, social distancing shaped the social relationship and behavior ( Kaveh et al., 2022 ). COVID-19 significantly strained the healthcare system. In addition, it affected the education in academic institutions and universities to a greater extent ( Dewart et al., 2020 ). As a preventive and control measure, all the schools, colleges, and universities were closed ( Mustafa, 2020 ). In April 2020, 94% of learners worldwide were affected by the pandemic, representing 1.58 billion children and youth in 200 countries ( De Giusti, 2020 ). Likewise, nursing education has undergone many radical changes both in developed and developing countries. The situation affected the learning opportunities of nursing students as their clinical placements were suspended and the face-to-face teaching moved into online teaching. Additionally, the pre-clinical activities such as laboratory and simulation-based teaching were affected due to social and organizational restrictions to limit unnecessary access and contact with others ( Tomietto et al., 2020 ).

To continue the teaching–learning activity, the academic institutions adopted various digital platforms including Zoom, Google meet, WebEx, Udemy, Edmodo, Google classroom, etc. ( Mishra et al., 2020 ). Moreover, web-based conferences were routinely organized by educational institutions during this pandemic ( Kaware, 2022 ). In addition, educational institutions have placed greater emphasis on ERP systems, library modules, fee modules, and examination modules. The virtual learning enhanced the comfort, accessibility, and encouraged remote learning ( Mukhtar et al., 2020 ). Similarly, the learners found it easy to access the online material, were able to record meetings and sessions and retrieve information ( Alsayed & Althaqafi, 2022 ). The faculty and students expressed that online education is useful during the COVID-19 pandemic; it was convenient, flexible, cost low, and encouraged self-learning ( Almahasees et al., 2021 ). Likewise, online education improved the flexibility, ability to teach large classes, increased interaction between the teachers and students and increased learning opportunities for the learners ( Hako, 2021 ). Ultimately, these educational technologies have had significant positive impact on the learning of the students. Additionally, it paves the way toward the blending of technology synchronously or asynchronously into education ( Thaheem et al., 2022 ).

Review of Literature

Although online education was beneficial to both the teachers and learners, it posed various challenges to the faculty and students ( Nimavat et al., 2021 ). Poor student attendance, loneliness, issues with internet connectivity and lack of information and technology skills were reported as challenges of online education ( Hako, 2021 ). The faculty and students indicated that efficacy of online teaching and learning is less effective than face–face teaching and learning. Moreover, online learning is ineffective for deaf and hard of hearing students. Likewise, online education is linked to lack of interaction and motivation, data privacy and security and technical issues ( Almahasees & Amin, 2021 ; Alsayed & Althaqafi, 2022 ). Furthermore, online education was inefficient in terms of maintaining academic integrity ( Mukhtar et al., 2020 ). The teachers reported difficulties in motivating the students without visual connection during online teaching ( Moustakas & Robrade, 2022 ). Also, Atout et al., (2022) reported lack of resources for the clinical learning, distracting home environment and challenging evaluation of learners as the barriers for virtual learning.

The challenges faced by the instructors includes transitional difficulties from offline to online teaching, communication barriers, changes in the teaching style and additional time and resources for preparation of teaching. The institutions experienced challenges such as need for additional training for faculty and students, technical and multimedia support, online counselling sessions for teachers and the need to have technical troubleshooting team. Students experienced challenges related to having technical skills to learn online, lack of readiness, network and speed issues, and lack of identity, interaction and participation. There were challenges related to content such as development of new material, regular assignments, multimedia tools, and checking assignments and sharing regular feedback with the students. Technological challenges included device suitability, network stability and speed, tools of conferencing software for online teaching and ease of use. Lastly, the motivational factors included lack of sense of job security, non-availability of salary on time, and lack of family support, mental and emotional support from colleagues and higher authorities ( Siddiquei & Kathpal, 2021 ).

To enhance the online teaching and learning, technical aptitude enhancement, resource management and utilization, time management, control over the learning environment and help seeking are essential ( Barrot et al., 2021 ). Furthermore, formal training for the teachers, and enhancement of psychosocial wellbeing of both the learners and teachers are necessary to curb the feelings of loneliness and isolation. Moreover, the nature of the problems related to the shift from face to face to online learning should be identified to combat these challenges ( Hako, 2021 ). In India, both the undergraduate and postgraduate students were badly affected during the COVID-19 pandemic and experienced many challenges with online education ( Joshi et al., 2020 ; Kamal & Illiyan, 2021 ; Muthuprasad et al., 2021 ; Pandit & Agrawal, 2022 ; Rannaware et al., 2022 ; Sengupta, 2022 ). However, very few studies explored the challenges encountered by the nursing students during the online learning ( Gaur et al., 2020a ; George et al., 2022 ; Kanagaraj et al., 2022 ; Lata & Kudi, 2022 ). Therefore, the authors decided to understand the experiences and challenges encountered by nursing students in their nursing education during the COVID-19 pandemic. We believe that the study finding will be beneficial to the educational authorities, curriculum developers, and policy makers to design appropriate measures and strategies to enhance effective learning both in nursing education and practice.

An exploratory sequential mixed-methods design was utilized in this study. The study integrated qualitative data into quantitative data to understand the experiences and challenges experienced by nursing students’ during the pandemic.

Research Setting

The study was conducted among nursing students of Narayana Hrudayalaya College of Nursing, Koshy's College of Nursing and Kirubanidhi College of Nursing, Bengaluru, Karnataka, India. These colleges initiated virtual classes from April 2020. Therefore, these colleges were selected as settings for the study.

The target population of the study included both Diploma and BSN students. The accessible population included both Diploma and BSN students studying in Narayana Hrudayalaya College of Nursing, Koshy's College of Nursing and Kirubanidhi College of Nursing, Bengaluru, Karnataka, India.

Sample, Sample Size, and Sampling Techniques

Three nursing colleges were conveniently selected for the study. In Phase 1, the researchers used purposive sampling technique to collect the qualitative data from six students in each college (Narayana Hrudayalaya College of Nursing, Koshy's College of Nursing and Kirubanidhi College of Nursing, Bengaluru, Karnataka, India). The data collection was done face to face. Thus, in total, 18 students participated in the focused group interview during phase I. For Phase 2, the sample size calculation was done based on the previous cross-sectional study ( Thapa et al., 2021 ). Having the expected proportion of challenges experienced by nursing students as 15%, with 95% confidence interval, and with the precision, the minimum required sample size was 400. In total, all the three nursing colleges had 654 students. Convenient sampling technique was used to collect the data in phase II.

Inclusion and Exclusion Criteria

The study included nursing students who were enrolled for Diploma and BSN program, exposed to online learning, and second, third, and fourth year nursing students. The study excluded those who were not willing to participate, and first year nursing students as they had limited exposure to the virtual theory and clinical classes, which may give a limited and inaccurate data. Considering the inclusion and exclusion criteria, 477 students participated in the study.

Description and Interpretation of Study Instrument

The instruments used in the study were prepared by the researchers of the study. The qualitative data collected during the first phase of the study was utilized in preparing the tool used for the quantitative phase of the study. It included four parts namely demographic variables, background variables, open-ended questions to explore the participant's experiences and challenges and Likert scale to assess the challenges.

Part 1 included the demographic variables of the participants including age, gender, course of study, year of study, residence, and place of attending online classes.

Part 2 comprised of the background variables such as gadgets used for attending online classes, source of internet, mode of theory classes taken during the last 6 months, mode of practical training, methods of teaching theory classes, audio visual aids used, and the virtual platform used.

Part 3 consisted of a questionnaire related to students’ experiences and challenges. It included 15 open-ended questions related to the aspects of theoretical learning, practical learning, study materials, teaching methodology, evaluation process, issues related to physical and mental health, issues related to technology and issues related to finance.

Lastly, Part 4 included a Likert scale on challenges having 30 questions with eight domains; educational challenges (six items), environmental challenges (two items), communication challenges (five items), technical challenges (five items), evaluation challenges (two items), physical challenges (six items), career challenges (two items), and financial challenges (two items). Dimensions were evaluated using 5-point Likert scale varying from strongly disagree (1), disagree (2), neutral (3), agree (4) and strongly agree (5). The total score ranges from 30 to 150. The domain-wise challenges were interpreted as 1–50 = low challenges, 51–100 = moderate challenges, 101–150 = high challenges. The instrument was prepared in English and no translations were done.

Reliability and Validity of the Tool

Content validity was obtained from eight experts in the field of nursing education. The calculated content validity index was 0.80. Pilot study was conducted with 10% of the study participants (42 students) to test the reliability of the tool before administering to the main study participants. Using Cronbach's alpha (inter-item reliability), the internal consistency assessed was 0.89, which is highly reliable. The participants participated in the pilot study were excluded from the main study.

Ethical Considerations

Ethical approval was obtained from the Research and Ethics Committee of Narayana Hrudayalaya College of Nursing (NHH/AEC-CL.2022-BI5 dated 22/3/2022), Kirubhanidhi College of Nursing (KCC/22/22 dated 04/3/2022), and Koshy's College of Nursing (KCN/15 dated 07/3/2022) and Institutional review board. After getting the ethical approvals, formal permission was obtained from the Head of Nursing colleges to collect data. The researchers explained the purpose of the study to the participants involved in both quantitative and qualitative data collection. The participants were informed that their participation in the study was voluntary. Since the participants were not forced to participate in the study, they were given the freedom to withdraw from the study at any time without any penalty. The participants signed the informed consent and responded to all the questions and returned the completed questionnaire. All the audio recordings were coded and password protected. It was explained to the participants that they were not exposed to any kind of risk. To keep the data anonymous, no identifying information was collected from the participants. The researchers maintained confidentiality of information throughout the study period. All the collected data were stored in a password protected file. Only, the investigators of the study had access to the data.

Data Collection (Qualitative Phase)

In Phase I of the study, three focus groups were selected using purposive sampling technique. Each group included six participants with a total of 18 nursing students. After getting the consent, the participants shared their experiences and challenges faced during their educational training in the pandemic. The interviews were conducted from 25/2/2022 to 25/3/2022 and each interview lasted for 1.30 h to 2 h. The first and third authors conducted the interview. The first author is a PhD and the third author is a BSN holder. The first author is an assistant professor and the third author is a staff nurse. Both of them were females. Both of them were trained in qualitative data collection. The researchers established rapport with the study participants. The researcher used 15 open-ended probing questions and the participants were given the freedom to express additional views and comments. All the interviews were conducted in person in the college and audio recorded with their consent. Focus group discussions were continued till the data saturation occurred. The transcripts were returned to the participants for their correction.

Data Collection (Quantitative Phase)

In Phase II, the quantitative data were collected using convenient sampling technique. The total number of students participated in the study were 477. The questionnaires were transferred to Google forms and were circulated to the students after explaining the objectives and getting the informed consent. The quantitative data were collected from 11/04/2022 to 20 /04/2022. The response rate was 72.9% (477) which included Narayana Hrudayalaya College of nursing (88 participants), Koshy's College of nursing (235 participants) and Kirubanidhi College of nursing (154 participants).

Data Analysis (Qualitative Phase)

The data were analyzed using thematic analysis. The collected data were transcribed and analyzed using Braun and Clarke's thematic analysis. Reflexive thematic analysis was performed in this study ( Clarke & Braun, 2017 ).

Data Analysis (Quantitative Phase)

The quantitative data were analyzed using descriptive and inferential statistics using SPSS version 22.

Credibility, Dependability, and Transferability

To ensure credibility of the data, the researcher strongly engaged with the focused group interviews by means of observation, documentation, and taking notes. Dependability was achieved through reviews and comments given by the research guide, who is the second author of the study who has full knowledge of the study design and methodology. The data collected from participants and the findings could be applicable to other contexts, situations, times, and populations and the study setting. It ensures transferability.

The researcher adhered to rigor by carefully collecting data via audio recordings and by taking field notes. Each focus group interview was transcribed immediately after the interview. The transcripts were given to the participants for cross-checking and approval. In addition to ensuring rigor through trustworthiness criteria, the authors followed mixed-methods research legitimation criteria by ensuring design quality, design suitability, within design consistency, design fidelity, and analytic adequacy ( Teddlie & Tashakkori, 2009 ).

Trustworthiness

Trustworthiness was established by using an unbiased approach in selecting the participants and by participant's being honest, clearly recorded, and accurately presented inputs. The transcriptions, coding, and themes–subthemes were discussed by the research team for their verification. Then based on the themes and subthemes the quantitative questionnaire was created by the researchers.

Phase 1 Qualitative Phase

Table 1 shows the frequency and percentage distribution of background variables of 18 participants who shared their experiences and challenges faced during their educational training in the pandemic. Table 2 shows the frequency and percentage distribution of participants’ background variables.

Table 1.

Frequency and Percentage Distribution of Demographic Variables of Nursing Students.

Demographic variables	Qualitative data		Quantitative data
	Frequency		Frequency
	Phase 1 ( = 18)	Percentage	Phase II ( = 477)	Percentage

18–23 years	16	88.9	432	90.6
23–29 years	2	11.1	45	9.4
Gender
Male	4	22.2	111	23.3
Female	14	77.8	366	76.7
Course
B.Sc. Nursing	14	77.8	331	69.4
GNM	4	22.2	146	30.6
Year of study
Second year	4	22.2	226	47.4
Third year	9	50	226	47.4
Fourth year	5	27.8	25	5.2
Residence
Urban	11	61.1	216	45.3
Semi-urban	2	11.1	113	23.7
Rural	5	27.8	148	31
From where you attended the online classes most of the time
Home	7	38.9	79	16.6
Hostel	11	61.1	398	83.4

Table 2.

Frequency and Percentage Distribution of Baseline Variables of Nursing Students.

Demographic variables	Qualitative data		Quantitative data
	Frequency		Frequency
	Phase 1 ( = 18)	Percentage	Phase II ( = 477)	Percentage
Gadget used for attending online classes (multiple choice)
Mobile	18	100	469	98.3
Laptop	2	11.11	52	10.9
Tablet	1	5.55	13	2.7
Desktop			4	0.8
Source of internet (multiple choice)
WiFi	3	16.66	87	18.2
LAN	-	-	1	0.2
Mobile data	18	100	451	94.5
Mode of theory classes taken for the last 6 months
Online	1	5.6	69	14.5
Offline	5	27.7	157	32.9
Both online and offline	12	66.7	251	52.6
Mode of the practical training
Online	1	5.6	50	10.5
Offline	7	38.9	289	60.6
Both online and offline	10	55.5	138	28.9
Methods of teaching used for theory classes (multiple choice)
Lecture cum discussion	18	100	451	94.5
Seminar	1	5.55	98	20.5
Role play	-	-	38	8
AV aids used (multiple options)
Power point presentation	17	94.4	445	93.3
Videos	7	38.9	218	45.7
White / Black board	-	-	88	18.4
Virtual platform used (multiple options)
Zoom	8	44.4	250	52.4
Google meet platform	10	55.6	286	60
Cisco	-	-	106	22.2
Web-ex	4	22.2	179	37.5

Experiences and Challenges Faced by the Nursing Students

In Phase 1, the experiences and challenges experienced by nursing students with their educational training during the pandemic were analyzed using thematic analysis. Table 3 reports seven themes and 10 sub-themes. The themes identified includes: (1) technical issues—a concern, (2) regular rhythm in educational training—but not complete, (3) stress and strain, (4) evaluation—a concern, (5) communication, (6) comfort zone, and (7) easy distraction. The sub-themes were: (1.1) problems with internet connectivity, (1.2) issues with the digital platform, (2.1) theoretical learning experience-better, (2.2) deficient practical skills, (3.1) physical stress, (3.2) mental stress, (4.1) unfair evaluation and lack of feedback, (5.1) decreased quality of communication, (6.1) very convenient, and (7.1) difficult to concentrate.

Table 3.

Themes and Subthemes of Experiences and Challenges Faced by Nursing Students.

S. no.	Themes	Sub-themes
	Technical issues—a concern	1.1. Problems with internet connectivity
	Technical issues—a concern	1.2. Issues with the digital platform
	Regular rhythm in educational training—but not complete	2.1. Theoretical learning experience-Better
	Regular rhythm in educational training—but not complete	2.2.Deficient practical skills
	Stress and strain	3.1.Physical stress
	Stress and strain	3.2.Mental stress
	Evaluation—a concern	4.1.Unfair evaluation
	Communication	5.1.Decreased quality of communication
	Comfort zone	6.1.Very convenient
	Easy distraction	7.1.Difficult to concentrate

Theme 1: Technical Issues: A Concern

Modern technology is progressive in all sectors. With this technology, it was possible to deliver training in all educational sectors including nursing education during COVID-19. Though it was helpful, technical problems interrupted the teaching–learning process. Most of the participants expressed their concern related to technical issues. It includes issues with internet connectivity, and issues with the digital platform.

Subtheme 1: Problems with Internet Connectivity

Constant network issues were an unavoidable fact for many students. Students could not be connected to the virtual class on time due to the internet connectivity issues and they had to miss attending the classes.

“Sometimes it keeps on showing error code and by the time I get connected the class is completed by the faculty” (5A).

Students stated that they faced technical and network issues while attending the classes.

“During online classes, we have faced a lot of technical and network issues” (2A).

In addition, fluctuations in the network connectivity were another technical issue faced by students and it affected the virtual learning of the students.

“I faced fluctuations in my network during a natural calamity in my place so I missed many classes during that time” (13A).

Subtheme 2: Issues with the Digital Platform

There are various platforms used to deliver online educational training. The participants expressed their difficulties as they had hitches in updating the digital platforms, and mentioned that the lack of experience in using the platforms affected their learning.

Digital platform did not work if the application is not updated on time. This was stated as below;

“If I did not update the app on time, it will not work” (1A).

Students faced problems in joining the virtual platform due to issues with the virtual platform.

“Sometimes I faced problems with joining with the virtual platform” (8A).

Lack of experience in using the virtual platform by both the faculty and student was another challenge stated by the students.

“Had struggle to join the meeting initially for both students and faculties because it was very new to us” (5A).

Students faced difficulties in submitting the assignments and answer sheets, as they did not have previous experience in submitting it through digital platforms.

“I struggled while submitting the answer sheets /assignment through digital platforms” (4A).

Theme 2: Regular Rhythm in Educational Training: But not Complete

Virtual education is a boon during pandemic. It took the education system in a rhythmic manner. Though the online lectures were beneficial, at times, students faced few challenges.

Subtheme 1: Online Theoretical Learning Experience

The students utilized the opportunities to learn from online classes with few challenges in attending online classes.

Commencement of online classes helped the students to have continuity in their studies. As the online classes were started on time immediately, it did not affect their theoretical learning.

“…It was not at all possible for the colleges to continue the offline classes so that the apex body instructed to start with online classes and it's good that we were in touch with our studies” (12A).

Different methods and techniques of teaching adopted during online classes enhanced interest in their learning.

“During online classes teacher used to teach with PPTs, and some good videos to make the session interesting. Sometimes they used to conduct lecture cum discussion. That time I was interested to listen to the class” (15A).

“I was interested to attend the online theory classes when teachers used to take a class by showing some videos related to theory content. It was good” (16A).

Students encountered issues with the storage of study materials as they had minimal storage space in their gadgets.

“Teachers used to send notes in PDF form in the mail or by WhatsApp. When I have storage issues in my gadgets, I deleted the content because of storage issues” (18A).

Subtheme 2: Deficient Practical Skills

Practical training is a major part of nursing profession. Students faced many challenges while attending online practical classes.

Most of the students stated that their theoretical learning through virtual mode was excellent. However, students felt that learning practical skills through direct clinical experience is rewarding than learning through virtual platform.

“…theory classes were very good. But in case of practical, like IV infusion, it was very easy to watch the procedure in a virtual platform, but it was very difficult to perform. I feel offline clinical exposure is better than online” (3A).

Students stated that they learnt basic nursing skills through direct clinical experience before the pandemic. However, the students lack confidence in performing the skills that they learnt through videos. The students felt nervous while performing the skills directly on the patients, as they did not get hands-on experience during virtual learning.

“…During my first-year clinical posting, I learnt basic procedure like vital signs checking, wound care, surgical dressing, etc with the direct clinical experience, suddenly everything goes on online, the faculty used to show us best videos. While watching videos I feel I can do. But when it's time to do directly, my hands were shivering and I was not confident. I feel offline exposure is better, we can get more exposure” (1A).

Huge gap in practical learning due to the pandemic affected the learning of the students. Thus, the students did not recommend online learning for learning the skills.

“I did not get adequate practical posting in my first year because of COVID-19. It continued with the second year too. So I have a huge gap with practical learning. For practical learning, online learning is not appropriate” (7A).

Theme 3: Stress and Strain

Prolonged online training affects the students’ physical as well as mental health. They felt more stressful.

Subtheme 1: Physical Stress

Students experienced physical symptoms such as strain in the eyes, neck pain, back pain and numbness in the legs due to prolonged usage of phone and sitting.

“I have to write my notes by seeing my phone. Every time I need to continuously see my mobile and make notes. It was straining my eyes and stressful for me” (16A).

“While attending online classes I used to keep my video on and listen to the class. Due to prolonged sitting, I have neck pain, eye strain also” (5A).

“I felt back pain and numbness in my leg while attending the online classes with prolonged sitting. I used to walk in between for some time to reduce the numbness” (12A).

Subtheme 2: Mental Stress

Students were anxious, as they could not complete the given tasks in online classes.

“I was anxious because I did not complete my task given in online classes, I was lazy” (4A).

As the students did not get practical experience in the clinical area, their confidence levels were low during the pandemic. Moreover, as the students did not get any opportunity to practice directly in the clinical area during the pandemic, they felt tensed and lacked confidence to directly practice on the patient after the pandemic.

“Due to lack of practice in clinical, my confidence had come down” (8A).

“I felt stressed out when I am thinking about my practical learning. I did not get adequate opportunity to practice” (10A).

“After lockdown when I came in the clinical setting, I was tensed about how I will handle the patient” (15A).

Theme 4: Evaluation: A Concern

Evaluation is the process of providing feedback to the students to improve themselves. The test, examination, assignment, and evaluation were new for the students and faculty during the pandemic and there were malpractice incidences by the students.

Sub-Theme 1 - Unfair Evaluation and Lack of Feedback

Students felt conducting exam using Google form as useful.

“Some faculties conducted few exams in Google Form, it was good because at that time I studied and attend the exam” (16A).

Malpractice in the online exam could be observed in the students during virtual learning.

“For the online exam, I never used to study because I can copy from PPT, my screenshots, or from Google and score good marks” (2A, 8A, 17A, 18A).

Students stated that they did not get proper feedback on their assignments.

“In my point of view, some faculties did not give us proper feedback on my assignment writing” (6A).

One student stated the unfair evaluation as the students copied scored well.

“I feel very bad when I write without copying and score very less marks; while the students who did malpractice scored well. So the evaluation was going very wrong” (4A).

Theme 5: Communication

It is necessary to build proper communication between the teachers and students to continue a smooth training session online. However, students felt that this distance learning created a communication gap between teachers and students.

Sub Theme 1- Decreased Quality of Communication

Limited and disrupted communication with the friends and teachers created distress in the students.

“It was not possible for me to communicate face to face with my friends and teachers during the online classes. It was quite distressing” (1A).

“Online class communication was the major problem. We could not communicate with faculties and peers like offline” (18A).

Students felt that they could not clarify their doubts with the faculty. However, faculty responded to their queries through WhatsApp and social media.

“If it comes to communication, it was very limited… During offline we can directly ask doubts to the faculty, but not now” (2A).

“During the online classes communication was not easy like face to face communication. But teachers were responding by WhatsApp and other social media after class time also” (6A).

Theme 6: Comfort Zone

Online classes were attended by the students either from hostel or home.

Subtheme 1: Very Convenient

Students felt comfortable staying home and attending online classes.

“It was convenient for me. Because I can stay at home, take care of my family and attend class also” (8A).

“For me, it was convenient, I got more time and can get up late to attend classes” (2A, 3A, 7A).

Students expressed that their transport expenses could be minimized, as they were not required to travel during the pandemic.

“I could save time. Even transport expenses could be minimized” (10A).

Theme 7: Distraction

Distraction was very high in online classes.

Sub-Theme 1: Difficult to Concentrate

Students were distracted during the online classes due to many notifications received from other online applications and disturbance from their siblings.

“As my internet is on I will get many notifications from other apps during class, it was a distraction for me” (4A, 9A, 11A).

“I attended online classes from my home only. I had disturbance from siblings, during my online classes” (7A, 16A).

Students themselves got distracted as they were using social media in between the online classes.

“I used to browse on Facebook, Instagram, YouTube, etc. during the online classes” (13A).

Phase 2: Quantitative Phase

Table 1 shows the frequency and percentage distribution of participant's demographic variables. Majority (90.6%) of the participants were in the age group between 18 and 23 years. Most of them were females (76.7%). 69.4% of the students were undergraduate (BSN) nursing students, while the rest were in Diploma nursing program. 47.4% of the participants were in their second and 47.4% were in their third year of study. Nearly half (45.3%) were from urban areas and 23.7 were from semi-urban areas, while the remaining (31%) were from rural areas. A large number (83.4%) of students attended the online classes from their hostels.

Table 2 outlines the frequency and percentage distribution of participants’ background variables. The results showed that the majority (98.3%) of the students used mobile phones to attend online classes. Most of them (94.5%) used the mobile data to have the internet connection. Almost half of the participants (52.6%) attended both online and offline classes. More than half (52.6%) of the participants had both online and offline practical exposure, and around 33% had offline clinical exposure. Most of the students (94.5%) attended lecture and discussion sessions. A huge number (93.3%) used power point presentation, and 45.7% of them used videos for teaching. Majority (60%) used Google Meet, while 52.4% used Zoom. The remaining used multiple platforms like Cisco, and Webex.

Figure 1 describes the frequency and percentage of distribution of level of challenges. It was classified as low, moderate, and high level of challenges. Majority of them (54.71%) experienced high-level challenges, 44.6% encountered moderate-level challenges, and the remaining experienced low-level challenges related to their nursing education during the pandemic.

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Frequency and Percentage Distribution of Challenges Faced by Nursing Students During Their Educational Training.

The domain-wise challenges with nursing education during pandemic were shown in Table 4 . The eight domains included educational challenges, environmental challenges, communication challenges, technical challenges, evaluation challenges, physical and mental challenges, career challenges, and financial challenges. The mean and standard deviations for educational challenges is (20.27 ± 3.04), environmental challenges (6.92 ± 1.66), communication challenges (17.61 ± 4.01), technical challenges (17.39 ± 3.75), evaluation challenges (7.09 ± 1.94), physical and mental challenges (20.47 ± 4.33), career challenges (7.06 ± 1.91), and financial challenges (6.61 ± 2.1). The overall mean and S.D. of all the domain was 103.39 ± 1 7.11 with the range from 30 to 150.

Table 4.

Assessment of Mean and Standard Deviation of Domain-Wise Challenges Faced by the Nursing Students n = 477.

Domain-wise challenges	Mean	Standard deviation	Range
Educational challenges	20.27	3.04	6–30
Environmental challenges	6.92	1.66	2–10
Communication challenges	17.61	4.01	5–25
Technical challenges	17.39	3.75	5–25
Evaluation challenges	7.09	1.94	2–10
Physical and mental challenges	20.47	4.33	6–30
Career challenges	7.06	1.91	2–10
Financial challenges	6.61	2.1	2–10
Total

Table 5 displays the item-wise challenges. The results of Educational Challenges indicated that almost 38.57% responded that they lack interest in learning. 15.93% either strongly agreed or agreed that face-to-face learning is very effective than E-learning. A larger portion (78.62%) of participants mentioned that the notes and lectures were inadequate. More than half of the participants (54.3%) agreed that virtual demonstration is not very effective for the practical patient care, and 61.21% mentioned that they lack confidence while taking care of patients. The participants provided similar responses during the qualitative phase of the study. The students lack confidence in performing the skills that they learnt through videos. Similarly, the students felt nervous while performing the skills directly on the patients, as they did not get hands-on experience during virtual learning. However, one third of the respondents (33.75%) expressed that they could learn the modern ways of handling patients through videos.

Table 5.

Item-Wise/Domain-Wise Analysis of Challenges Faced by Nursing Students.

S. no	Items	Strongly agree		Agree		Neutral		Disagree		Strongly disagree
S. no	Items	f	%	f	%	f	%	F	%	f	%

1	Lack of interest in learning	74	15.51	110	23.06	214	44.86	43	9.01	36	7.55
2	Face-to-face learning is more effective than E-learning	30	6.29	46	9.64	140	29.35	126	26.42	130	27.25
3	Notes/Lecture content are not adequate	224	46.96	151	31.66	72	15.09	16	3.35	14	2.94
4	Virtual demonstration is not very effective—practical patient care.	113	23.69	146	30.61	155	32.49	35	7.34	28	5.87
5	Lack of confidence while taking care of patients	162	33.96	130	27.25	117	24.53	44	9.22	24	5.03
6	Learnt modern ways of handling patients through videos.	56	11.74	105	22.01	185	38.78	80	16.77	51	10.69

7	Distracted very easily while attending online classes	142	29.77	139	29.14	133	27.88	38	7.97	25	5.24
8	My environment was very comfortable during pandemic to attend online classes	85	17.82	113	23.69	150	31.45	77	16.14	52	10.9

9	Difficulty in sharing my view with the teachers	83	17.4	141	29.56	169	35.43	55	11.53	29	6.08
10	Process of teacher–students interaction became passive.	74	15.51	145	30.4	197	41.3	48	10.06	13	2.73
11	Socializing with peer groups has decreased	109	22.85	167	35.01	151	31.66	27	5.66	23	4.82
12	Experience of loneliness without interacting much with peer groups.	115	24.11	155	32.49	151	31.66	32	6.71	24	5.03
13	Missed interaction with my seniors/college mates	94	19.71	138	28.93	167	35.01	43	9.01	35	7.34

14	Uncertain internet connection interrupts the learning process.	70	14.68	140	29.35	174	36.48	63	13.21	30	6.29
15	Teachers had difficulty in using technical aspects of the online platforms.	69	14.47	109	22.85	143	29.98	87	18.24	69	14.47
16	Good internet connection was there at my place.	140	29.35	148	31.03	125	26.21	38	7.97	26	5.45
17	Faced technical issues with learning platform /device.	114	23.9	151	31.66	146	30.61	37	7.76	29	6.08
18	Difficulty while submitting the answer sheets /assignment through digital platforms	140	29.35	144	30.19	122	25.58	44	9.22	27	5.66

19	Online evaluation may create irrational discrimination between students.	99	20.75	145	30.4	168	35.22	39	8.18	26	5.45
20	Evaluation/test conducted online was unfair	121	25.37	127	26.62	158	33.12	39	8.18	32	6.71

21	Experience of physical strain like headache, backache, neck pain, eye strain	147	30.82	149	31.24	158	23.27	43	9.01	27	5.66
22	I did not feel much mental stress	47	9.85	92	19.29	165	34.59	106	22.22	67	14.05
23	Developed insomnia	88	18.45	137	28.72	162	33.96	54	11.32	36	7.55
24	Addicted to phone due to prolonged using of phone other than learning purpose.	96	20.13	127	26.62	149	31.24	64	13.42	41	8.6
25	Regular life style has changed	125	26.21	146	30.61	148	31.03	38	7.97	20	4.19
26	Worry about online teaching applications that lack proper security system	99	20.75	131	27.46	160	33.54	55	11.53	32	6.71

27	Virtual practical training will affect my career as a registered nurse.	115	24.11	154	32.29	151	31.66	38	7.97	19	3.98
28	I may not be able to work as a skillful nurse	91	19.08	143	29.98	152	31.87	56	11.74	35	7.34

29	Extra money for my expenses for good internet package	149	31.24	128	26.83	126	26.42	40	8.39	34	7.13
30	Bought a new laptop/mobile/electric gadgets to attend virtual classes.	89	18.66	94	19.71	111	23.27	68	14.26	115	24.11

With regard to Environmental challenges , 41.51% expressed that they were comfortable with their home or hostel environment to attend online classes. However, more than half (58.91%) said that they were easily distracted while attending classes. Similar findings were seen in the qualitative phase of the study. Students were distracted during the online classes due to many notifications received from other online applications and disturbance from their siblings. Further, the students were distracted as they were using social media during the online class.

In terms of Communication challenges , almost half of them (46.96%) expressed that they had difficulty in sharing their view with the teachers, and 45.91% said that teacher–student interaction was passive. More than half (57.86%) of them expressed that peer group socialization has decreased, missed interaction (48.64%) with other college mates/seniors and experienced loneliness (56.6%) without interacting much with peer groups. Similar to these findings in the quantitative phase, in qualitative phase, the students mentioned that limited and disrupted communication with the friends and teachers created distress in the students. Moreover, the students could not clarify their doubts with the faculty.

Regarding Technical challenges , 44.03% had uncertain internet connection that interrupted the learning process. Around 37.32% expressed that the teachers had difficulty in using technical aspects of the online platforms initially. Around 39.63% had internet issues in their place. Almost 55.56% students faced technical issues with learning platform/device and around 59.54% had difficulty while submitting the answer sheets/assignment through digital platforms. Likewise, the qualitative findings revealed that the students faced technical and network issues while attending the classes. In addition, fluctuation in the network connectivity was another technical issue faced by students and it affected virtual learning. The participants expressed their concerns as they had difficulties in updating the digital platforms, and mentioned that the lack of experience in using the platforms affected their learning. Students faced difficulties in submitting the assignments and answer sheets, as they did not have previous experience in submitting it through digital platforms.

Related to Evaluation challenges , almost half of them (51.15%) mentioned that the online evaluation might create irrational discrimination between students with network issues, and 51.99% of them said that the evaluation/test conducted online was unfair. Consistent findings could be noted during the qualitative phase of study. Students mentioned that malpractice in the online exam occurred and it affected their grades. In addition, students stated that they did not get proper feedback on their assignments.

With respect to Physical and mental challenges , more than half 62.06% experienced physical strain like headache, backache, neck pain, and eye strain, 47.17% experienced insomnia, around 70.86% had mental stress, 46.75% got addicted to phone due to prolonged usage other than for learning purpose, 56.82% mentioned that the regular life style has changed, and lastly 48.21% were worried about the online teaching applications which lack proper security system. Likewise, same results are discovered in the qualitative phase of the study. Students experienced physical symptoms such as strain in the eyes, neck pain, back pain, and numbness in the legs due to prolonged sitting and continuous usage of phone. Additionally, students were anxious, as they could not complete the given tasks in online classes. Further, as the students did not get practical experience in the clinical area, their confidence levels were low and they felt tensed and lacked self-confidence to directly practice on the patients after the pandemic.

In terms of Career challenges , 56.4% agreed that virtual practical training may affect their career as a registered nurse, and 49.06% agreed that they may not be able to work as a skillful nurse with the virtual learning. Regarding Financial challenges , almost 58.07% agreed that extra money was spent for good internet package and 38.37% bought a new laptop/mobile/electric gadget to attend virtual classes.

With regard to association of demographic variables, only gender (χ 2 = 6.218, p = 0.045) has shown statistically significant association with problems or challenges faced by the nursing students during educational training in the pandemic at p < 0.05 level of significance.

During COVID-19 pandemic, face-to-face teaching and learning were converted to virtual learning and the clinical experiences were suspended to protect the students from the pandemic ( Agu et al., 2021 ). The experiences with the online classes were very new for the nursing students. Moreover, the online education became unavoidable and was a good choice for the faculty and students during this pandemic across the world. Even though, the students and teachers had a positive view of the technology, which helped in the teaching–learning process during pandemic, it posted many challenges ( Mousavizadeh, 2022 ).

We conducted a mixed-methods study to explore the experiences and challenges faced by nursing students in their education during COVID-19 in India. The study adopted an exploratory sequential mixed-methods design. The study was conducted as two phases; the qualitative data were collected during Phase I using focus group interview with the students. The qualitative data collected during the first phase of the study was utilized in preparing the tool for the quantitative phase of the study. The quantitative data were collected using a Likert scale prepared by the investigators of the study on challenges experienced by nursing students on their education. During Phase 1, the analyzed data produced seven themes and 10 sub-themes on the challenges. These themes produced during the qualitative phase further explained the challenges experienced by the nursing students in their education during COVID-19 pandemic in the quantitative phase.

Educational Challenges

Learning motivation encourages learners’ activities and directs and maintains their progress, allowing students to immerse themselves in learning ( Kim, 2020 ). However, virtual learning decreased students’ attention and interest in classes, which then decreased their motivation to learn ( Morfaki & Skotis, 2022 ). Likewise, in the current study most of the students expressed that they lost interest in their learning. Student's interest is very important for academic achievement, so different methods of teaching and learning need to be adopted in future to improve the learning among students during online education ( Mousavizadeh, 2022 ).

During COVID-19 pandemic, the medical and nursing institutions used learning management systems (LMS) and uploaded various reading materials, videos, quizzes, and presentations to encourage the engagement of students in asynchronous learning activities. In addition, online discussion forums were created to facilitate the virtual learning process ( Atwa et al., 2022 ). Some students preferred online learning as it provides structured learning materials and enables studying from home at their own pace and convenience ( Paechter et al., 2010 ; Zheng et al., 2021 ). However, most of the students in different studies conducted across the world preferred face-to-face learning for acquiring motor skills, for establishing interpersonal relationships, and for achieving student learning outcomes ( Arias et al., 2018 ; Faidley, 2021 ; Ramani & Deo, 2021 ; Lim et al., 2021 ). Similarly, Muthuprasad et al. (2021) advocated that the online mode of learning may not be a viable option for practical/skill-oriented courses and therefore hybrid/blended curriculum involving both face to face and online modes of learning shall be adopted by the institutions.

The faculty used different methods of teaching and audio visual aids to enhance the teaching–learning process during the pandemic ( Reimers et al., 2020 ). However, students in the present study mentioned that the notes/lecture content were inadequate. Similar findings were reported in other studies that the quality and effectiveness of lecture were low; and inconsistencies were observed in some professor's lecture during COVID-19 ( Cengiz et al., 2022 ; Dziurka et al., 2022 ; Mousavizadeh, 2022 ; Mukasa et al., 2021 ; Rohde et al., 2022 ). This warrants the educational institutions to monitor the quality of teaching delivered by the faculty to their students during this pandemic. In addition, the faculty should take self-initiatives for the professional empowerment ( Osmanovic Zajic et al., 2022 ).

The professional preparation of nurses involves many hours of practical and theoretical classes which is conducted face to face, which gives a real learning experience ( Dziurka et al., 2022 ). However, COVID-19 pandemic caused alterations, restrictions, limited clinical placements and simulation training in the campus ( Rohde et al., 2022 ). Thus, many nursing institutions adopted virtual theoretical and practical learning modes. Various studies across the world including the present study reported that virtual practical learning was inappropriate and ineffective in doing practical skills. Additionally, the nursing students lack confidence in taking care of the patients as they did not have hands on training ( Cengiz et al., 2022 ; Dziurka et al., 2022 ; Gheshlagh et al., 2022 ; Mukasa et al., 2021 ; Rohde et al., 2022 ; Wajid & Gedik, 2022 ). Therefore, in addition to direct face-to-face practical training in the clinical areas, more nursing simulations, virtual reality, artificial intelligence and telenursing should be utilized to enhance the practical learning of nursing students ( Dziurka et al., 2022 ).

Environmental Challenges

Student engagement during the virtual classes are very essential. The students are expected to actively participate, show positive conduct, self-regulated, display deep learning and understanding, and should demonstrate positive reactions to the learning environment, peers, and teachers ( Bond et al., 2020 ). However, students in the current study and many other studies were distracted very easily while attending online classes, which limited their learning during pandemic ( Bergdahl, 2022 ; Farrell & Brunton, 2020 ; Fazza & Mahgoub, 2021 ; Hollister et al., 2022 ). Therefore, more peer-to-peer conversations and faculty–student exchanges are recommended to enhance the engagement and learning during the pandemic.

Communication Challenges

Effective communication between the educator and the students enhances the learning experience and creates a positive learning environment. In addition, it improves the exchange of ideas, knowledge, and thought to fulfill the purpose of teaching and learning. However, ineffective communication creates frustration, impaired interpersonal relationships, and lack of motivation ( Alawamleh e al., 2020 ). In consistent to this study, the present participants had difficulty in sharing their view with the teachers, could not socialize with peer groups, and experienced loneliness. Furthermore, studies reported that impaired communication during online learning creates uncertainties and insufficiencies in learning ( Cengiz et al., 2022 ; Mousavizadeh, 2022 ; Mukasa et al., 2021 ). Thus, effective communication with the students should be streamlined for successful virtual learning ( Mukasa et al., 2021 ).

Technical Challenges

Online education can be effectively integrated in the nursing curriculum as it guarantees effective problem-based learning. However, the nursing colleges were not adequately prepared to effectively utilize the online teaching and learning in developing and under developed countries ( Molefe & Mabunda, 2022 ). Technical aptitude was lacking among the faculty and students, which posed various challenges ( Barrot et al., 2021 ). Moreover, technical challenges limited the satisfaction of students and faculty toward online teaching and learning ( Mahyoob, 2020 ). Furthermore, failure of internet services, website failures, problems in logging into the site disrupted the teaching–learning process during the pandemic ( Fuchs, 2022 ; Gaur et al., 2020b ). Similar to these studies, the present study participants mentioned that they experienced uncertain internet connection, faced technical issues with learning platform/device, and had difficulty while submitting the answer sheets /assignment through digital platforms. In addition, the teachers had difficulty in using technical aspects of the online platforms. This calls for improving the instructional design and pedagogical methods by training the faculty and students to utilize the digital platforms effectively, which might improve the motivation and engagement of faculty and students during the online education ( Aivaz & Teodorescu, 2022 ).

Evaluation Challenges

Significant changes in the teaching and learning during the pandemic created profound opportunities and threats. Stakeholders and students reported that the evaluation during online learning was biased and ineffective ( Krishnamurthy, 2020 ) and experienced uncertainty toward the examination ( Idris et al., 2021 ). Besides, online learning affects the test scores and grades, student outcomes, attitude, and overall satisfaction with learning ( Szopiński & Bachnik, 2022 ). In the same way, the students in the current study mentioned that the online evaluation created irrational discrimination between students and the evaluation conducted online was unfair. Therefore, standard setting in the evaluation is an essential step considering the learners and educator's perspective, which would improve the teaching–learning process ( Wasfy et al., 2021 ).

Physical and Mental Challenges

COVID-19 pandemic disproportionately affected the physical and mental health of students ( Ro et al., 2021 ). Students missed eating, did not participate in extracurricular activities, and experienced computer-related physical stress ( Idris et al., 2021 ). Likewise, students experienced increased stress due to homework, social isolation and lack of social interactions ( Rao & Rao, 2021 ). In congruent with these study findings, the participants in the present study experienced headache, backache, neck pain, eye strain, insomnia, and mental stress. The authors recommend addressing the physical and mental health issues of the students by promoting the utilization of physical, emotional, and mental health support programs ( Idris et al., 2021 ).

Career Challenges

COVID-19 pandemic impacted the career preference, career perspective, and ideal workplace ( Wang et al., 2022 ). In the same way, the students struggled with the career decision-making process during the pandemic ( Jemini-Gashi & Kadriu, 2022 ). Likewise, working students lost their jobs, which affected their lives, studies, and health ( Tsurugano et al., 2021 ). In line with these studies, students of the present study expressed that virtual practical training will affect their career as a registered nurse and they may not be able to work as a skillful nurse. This calls for the initiation of a structured and well-designed practical training program for the nursing students in the hospitals before their placement as a registered nurse in the clinical practice.

Financial Challenges

The pandemic put a number of students under financial strain, which severely affected their mental well-being ( Negash et al., 2021 ). Similarly, the university students were disproportionately affected by the economic consequences of the pandemic, which escalated the economic uncertainty ( Gewalt et al., 2022 ). The students who lost their economic resources during pandemic experienced higher prevalence of depressive symptoms ( Tancredi et al., 2022 ). Participants in the current study mentioned that they had to spend extra money for good internet package and bought a new laptop/mobile /electric gadget to attend virtual classes, which increased their economic burden. To counterbalance these economic challenges, financial aid schemes for students need to be made available to relieve distress and allow students to focus on their studies ( Gewalt et al., 2022 ).

Strengths and Limitations

The study findings are limited to only few nursing colleges in India. Therefore, the study findings may not be generalizable to other states of India. As the study population was not selected through probability sampling strategy, the representativeness of samples might be lacking in the current study. Moreover, the study instruments were prepared by the investigators of the study that did not undergo rigorous standardization process, which might limit the strength of the study. Based on the study findings, the institutions where the study was conducted should design strategies to mitigate the challenges to have effective teaching and learning.

Implications for Practice

Virtual nursing education can be improved by refining the content and delivery methods, training of nursing faculty to use online educational strategies, and by reducing the technical and environmental barriers. Hybrid and blended teaching–learning strategies may further improve the learning among nursing students.

Virtual education can be very successful if we address the challenges and experiences of the students by performing appropriate groundwork by upgrading the required hardware and software, teaching how to use the facilities, and developing innovative teaching techniques and standard protocols for virtual education.

Supplemental Material

Acknowledgments.

The authors thank the students and faculty members who participated in this study. The authors are thankful to the Deanship of Graduate Studies and Scientific Research at University of Bisha, Saudi Arabia for supporting this work through the Fast-Track Research Support Program. The authors would like to acknowledge the nursing students who have participated in the study. Special thanks to the administrators and faculty members of the institutions for their motivation and support during data collection.

Author Contributions: PK designed and conducted the study and wrote the initial draft of the manuscript. JA edited and added additional content and refined the manuscript. AP collected the data. SM edited the manuscript.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval: Ethical approval was obtained from the Research and Ethics Committee of Narayana Hrudayalaya College of Nursing (NHH/AEC-CL.2022-BI5 dated 22/3/2022), Kirubhanidhi College of Nursing (KCC/22/22 dated 04/3/2022), and Koshy's College of Nursing (KCN/15 dated 07/3/2022).

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors are thankful to the Deanship of Graduate Studies and Scientific Research at University of Bisha, Saudi Arabia for supporting this work through the Fast-Track Research Support Program.

ORCID iDs: Judie Arulappan https://orcid.org/0000-0003-2788-2755

Shimmaa Mansour Moustafa Mohammed https://orcid.org/0000-0002-2956-610X

Supplemental Material: Supplemental material for this article is available online.

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The 25 Colleges With The Highest Payoff

From mit to the city college of new york, these 25 schools send graduates out into the world with high earnings potential and little if any student debt., by francesca walton , forbes staff.

C ollege is an investment , and one more and more Americans are leery of. Most now say a college degree isn’t worth taking on student debt . A new Gallup poll finds a third of Americans—triple the number of a decade ago—have little to no confidence in higher education, with costs (along with politics) underlying this growing disenchantment.

So here’s the good news: There are lots of schools on Forbes’ America’s Top Colleges list that actually produce an excellent return on investment. This is about more than just the sticker price. Go to a cheap school that produces lousy job prospects and taking on even a few thousand in debt (plus the lost time you spent studying) may not be worth it. Pick an “expensive” school that reduces the net cost with generous aid and catapults its graduates into lucrative careers and your investment could pay off, big-time.

To determine which of Forbes ’ top 500 colleges offer the best return on investment (ROI), we looked at each school’s price-to-earnings premium, a calculation by the think tank Third Way that shows the number of years it takes graduates to recoup the net cost of their education. We also factored in the schools’ debt-to-percent-borrowed index, a figure that Forbes created for the top 500 colleges list that takes into account how many students take on debt to attend the school, and how much debt those graduates leave with.

Combined, these measures gave us 25 schools that offer a low-debt education and promise high earnings potential. In other words, a high average ROI. Some of them come as no surprise—science and technology heavy-hitters Stanford University and the Massachusetts Institute of Technology , for example, both offer their students stellar ROIs. Others, like the nine City University of New York (CUNY) schools on this list, are less well known, particularly outside of New York.

To learn more about each school, click on the college name. To see where each school ranks in the top 500, click here .

Princeton University

Princeton University continues to take the #1 spot not only in the top 500, but also in terms of students’ return on investment. The New Jersey Ivy League university offers nearly 40 majors and certificate programs; the most popular majors are computer science, economics, and public policy. Over the years, more graduates have gone into the finance and technology sectors than any other industry (with business, consulting, and hedge funds also being well represented). The median salary for a Princeton graduate ten years after receiving their diploma is just under $200,000, and the university’s generous financial aid (backed by a huge $34 billion endowment) ensures that students graduate with little to no debt.

Stanford University

“Ivy-plus” Stanford University in California is known nationwide for its focus on STEM programs and its pipeline to high-paying Silicon Valley jobs. Many students end up in the technology and startup space, and within a few years of graduating, the median Stanford grad brings home $100,000 or more per year. Only around 5% of students take out federal loans to attend the university, with the median loan amount totaling $9,851.

CUNY City College of New York

CCNY is the first of nine City University of New York schools on this list, and the oldest in the 25-college public system. It was also the first free public institution of higher education in America. It’s no longer free, but undergraduate tuition for New York state residents is just $6,930 a year. Psychology, biology and computer science are popular majors at the public college in midtown Manhattan, and graduates recoup their net cost in just six months, according to Third Way data.

California Institute of Technology

Graduates of the California Institute of Technology earn a median salary of $132,140 six years after enrolling (and for many bachelor’s-degree holders, two years after graduating). The science and technology-oriented school in Pasadena, California offers its graduates a price-to-earnings premium of 0.73, meaning it takes graduates about nine months to recoup the cost of their education.

CUNY Hunter College

CUNY’s Hunter College, located on the upper east side of Manhattan, offers more than a hundred undergraduate and postgraduate majors across its five schools. Only 6.5% of students take out loans to attend the college, and their median loan balance is $8,812. Hunter College graduates typically recoup their net cost within half a year, per Third Way data.

Massachusetts Institute of Technology

The Massachusetts Institute of Technology boasts high salaries for its graduates—MIT alumni earn a median $105,000 six years after graduating. A tiny 4% of MIT students take out federal student loans (with their median debt being $12,462) and 95% of borrowers are able to make a dent in their loan principal within five years of graduating. The Cambridge-based university is known for its intense science and technology programs, with computer science, mechanical engineering and math among the most popular majors.

CUNY Brooklyn College

Only 7% of students take out federal loans to attend CUNY Brooklyn College, and their median loan total sits at $9,218. Once graduated, Brooklyn College students make up the net cost of their education in just over half a year, according to Third Way data. The school accepts 55% of applicants, and popular majors include psychology, accounting, and business administration and management.

CUNY York College

CUNY York College in Jamaica, Queens, offers its undergraduates 60 majors to choose from, including nursing, social work and health services. About 5% of students take out federal loans to attend York College, and their median loan total is just $7,500, one of the lowest figures of the 25 schools on this list. Graduates recoup their net cost in just over a year, according to Third Way.

CUNY Queens College

CUNY Queens College, neighbor to York College, also offers its students a stand-out ROI: graduates recoup their net cost within nine months (low-income students do so within six months), and just 8% percent of students take out loans, with a median student debt of $8,580. The college accepts 70% of its applicants, and enrolls nearly 12,400 students.

CUNY John Jay College of Criminal Justice

The CUNY John Jay College of Criminal Justice offers students an education in criminal justice and forensic science, and many graduates go on to work in local police forces, earn law degrees, or work in public policy. The 7% of students who borrow to attend the school take out a median $9,250 in loans, and graduates recoup their net cost in about 10 months. Low-income students recoup their cost in around half a year.

Harvard University

Less than 3% of students borrow federal dollars to attend America’s oldest college, Harvard University, thanks in large part to the comprehensive aid packages the school grants to all students showing financial need. Like Princeton, Harvard’s generosity is funded by its $50 billion endowment. After graduation, Harvard alumni need a little over a year to recoup their net cost, and low-income students specifically take about six months to do so.

Rice University

Rice University in Houston, Texas, which made its top-ten debut on this year’s Forbes ’ America’s Top Colleges list, is known for its engineering and computer science programs. Graduates earn a median salary of $88,000 six years after graduating, and an impressive $152,100 ten years out. Rice alumni recoup their net cost in just about a year after graduating, per Third Way data.

CUNY Bernard M Baruch College

Noticing a trend? CUNY Bernard M Baruch College is the seventh CUNY school on this list, cementing the New York system’s reputation as a cost-effective option for bachelor’s degree seekers. The Manhattan college offers 29 majors, with finance and accounting being the most popular. Graduates recoup their net cost within about five months, and low-income graduates do so in about two months, the fastest of any school on this list. About 10% of students borrow to attend the school, taking out a median $10,000 in loans.

Berea College

The median loan balance for students at Berea College in Kentucky is a low $3,516, which is no surprise given the school charges $0 in tuition. About 10% of students take out federal loans to cover other costs, such as room and board, books and supplies. Graduates of the small school take about 15 months to recoup their net cost, per Third Way data.

CUNY Lehman College

Popular programs at CUNY Lehman College in the Bronx include psychology, healthcare administration and accounting. Nearly 11% of students take on debt to attend the school, with a median federal loan balance of $8,500. It takes graduates about nine months to recoup their net cost, and low-income students need about seven months to do so.

Yale University

Thanks to generous Yale financial aid, only 5% of students take out federal loans to attend this Ivy League school in New Haven, Connecticut and the median debt load for those graduates sits at $11,648. But paying back those loans shouldn’t be too hard, since two years after graduating with a four year degree, Yalies have a median salary of $81,765 and eight years later, the median is $168,300. Graduates take about 14 months to recoup their net cost, according to Third Way.

University of Florida

The University of Florida is the largest school on this list, counting nearly 33,000 undergraduates, 12% of whom take on student loans. Students who borrow take out a median $14,000 to attend the public university in Gainesville, and five years after graduating, three-quarters of those borrowers are able to make a dent in their loan principal. Popular majors among Gator Nation include engineering, marketing and communications. Earlier this year, the University of Florida was named one of Forbes ’ New Ivies , in part because of its high reputation among employers.

Embry-Riddle Aeronautical University-Worldwide

For students interested in aviation and aerospace programs, Embry-Riddle Aeronautical University in Daytona Beach, Florida offers a great return on investment. Graduates need about 14 months to recoup the net cost of their degree, and low-income graduates specifically take about 16 months. Ten percent of students borrow federal dollars to attend the university, with a median loan amount of $14,250.

CUNY College of Staten Island

Only 9% of students borrow to attend the College of Staten Island, and their median federal loan burden is $8,846. Graduates, including low-income graduates, can recoup their net cost within about a year and a half. Popular majors at the New York university include psychology, social science, and business.

University of Chicago

The rigorous University of Chicago, often dubbed an “Ivy-plus” school, is popular for its social sciences, mathematics and economics programs. Graduates recoup their net cost within about a year and a half, though low-income students can do so in less than a month, thanks largely to sizable financial aid packages that bring tuition, fees and housing costs to near-zero. About 5% of students borrow to attend the university, with a median debt load of $13,368.

Brigham Young University

Mormon mainstay Brigham Young University in Provo, Utah, offers popular programs in business, biomedical science and engineering. About 10% of students borrow to attend the university, taking on median federal student debt of $8,310. Graduates need about a year and a half to recoup the net cost of their education, and low-income students can do so in a little less than a year.

University of Pennsylvania

Graduates of the University of Pennsylvania earn a median $89,100 six years after graduating, and a median $171,800 ten years out. These high salaries allow graduates to recoup their net cost within about a year and a half, though low-income students can do so in less than a month because of the university’s comprehensive financial aid. Popular majors at the Ivy League university include finance (at Penn’s Wharton School of business), social sciences, biology and nursing.

Claremont McKenna College

Claremont McKenna College, part of the seven-school Claremont College consortium in southern California, enrolls about 1,400 students. Around 16% of students take out federal loans to attend the college, with a median debt balance of $11,948. Six years after graduating, alumni earn a median of $86,700, and $167,000 ten years out.

California State University-Dominguez Hills

California State University-Dominguez Hills in Carson, California enrolls around 12,000 undergraduates. After walking away with their degree, graduates need about 10 months to recoup their net cost, and low-income students specifically take about eight months. One in five students borrow money to attend the university, with an average federal loan balance of $11,902. Popular majors at the state university include business administration, psychology and criminal justice.

Vanderbilt University

At Vanderbilt University in Nashville, Tennessee, just under 10% of students take out federal loans and they end up with a median debt of $12,913. The university offers 70 undergraduate majors, including economics, social science and computer science. It takes graduates about a year and a half to recoup the net cost of their degree, and low-income students can do so within about eight months.

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Why is Nursing School So Stressful?
How to Reduce and Deal With Nursing School Stress

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18 Effective Ways to Deal with Nursing School Stress
Stress in nursing school can cause a multitude of physical and mental symptoms that can negatively impact your academic performance. It is crucial to recognize when you feel stressed and implement stress management techniques before your grades are affected. 5. Stress can lead to alterations in your immune system's ability to resist illness.
Stress and Health in Nursing Students: The Nurse Engagement and
At this time, little is known about how stress experienced in nursing school is associated with susceptibility to stress in the work environment. Understanding of how students experience stress could improve the performance and wellbeing of new nurses and, ultimately, the health of their patients.
Overcoming Nursing School Stress: A Guide
Identifying the signs of stress is crucial for early intervention and management. Nursing students should be aware of the following indicators: 1. Physical symptoms: - Chronic fatigue and exhaustion. - Frequent headaches or migraines. - Sleep disturbances (insomnia or oversleeping) - Muscle tension and body aches.
Prevalence of stress among nursing students: A protocol for systematic
Nursing programs should address these stress levels to ensure a greater success rate of graduating nurses to increase the worldwide supply. Future studies should address factors that affect the stress level of nursing students, such as the influence of birthplace, family income, social and cultural factors on the stress level of nursing students.
8 Expert Tips to Survive Stress and Get Through Nursing School
Think of eating well as an investment in your nursing career. It will help you bring your best game, sustainably, throughout nursing school and beyond. "Treat your body well, and you will be better equipped psychologically to deal with the stress," Johnson says.
Stress and Coping Strategies among Nursing Students in Clinical
The STROBE checklist was used. During COVID-19, there was a reliable and accurate relationship between stress and coping strategies. Furthermore, both stress and coping strategy scores were lower before COVID-19 and higher during COVID-19. Nursing students are struggling to achieve a healthy stress-coping strategy during the pandemic.
How to Reduce and Deal With Nursing School Stress
Resources like The 9 Circles of Nursing School Hell and How to Stay Motivated During Nursing School further underscore this point. Fortunately, there are ways to cope and emerge as a successful professional in the field. Keep reading for important tips to reduce nursing school stress. Why Is Nursing School So Stressful?
7 Ways to Cope With Anxiety in Nursing School
Coping with panic attacks in nursing school can look like: seeking regular therapy, deep breathing, mindfulness, muscle relaxation, light exercise, or aromatherapy. Building a relationship with a therapist can give you the tools to cope with anxiety throughout many parts of your nursing career.
Mental Health & Wellness for Nursing Students
Some of the major mental health challenges that nursing students face include stress, anxiety, and depression. Plus, the stress of nursing school can exacerbate already existing challenges, including substance use disorders, eating disorders, and mood disorders. Most nursing students and nurses experience burnout at some point in their career.
How to Manage and Reduce Nursing School Stress
3. Practice deep breathing to lower stress. It may seem obvious that your brain needs oxygen to function, but breathing exercises can reduce anxiety and tension while also improving concentration and focus on your studies. There is a lot of research on why breathing is so effective at reducing stress.
7 Tips for Coping with Nursing School Stress
Here are seven stress-relief techniques you can count on during your nursing education. 1. Make Self-Care a Priority. This tip is first for a reason. While it can feel like nursing school is too stressful, it is still important to take care of yourself during this time.
Stresses & Struggles of Nursing School
Make sure you don't have family or job obligations that are going to add extra stress on you, because maybe in 2 or 3 year your life will be different and you may be ready for nursing school. Consider part-time : If you find you are too busy right now or don't think you can handle the stress, consider going part-time.
How To Manage Stress As A Nurse
A routine helps you to cope with change and stress like balancing work and school as a nurse. It takes approximately 21 days to form a new habit or routine. If you set a schedule and stick with it for three weeks, you'll slowly see a reduction in anxiety and burnout.
How to Deal With Nursing School Stress
Nursing school requires a lot, so avoiding stress entirely just isn't always realistic. Some days you have to accept the reality of nursing school stress, but you can always stress less, and sometimes defeat it entirely with a few techniques. 1. Practice Self Care Ritually. "Self-care" doesn't mean what it's sometimes used for ...
How to Manage Your Stress as a Nurse
Nurses, especially, should take notice, as there is a scientific basis for this method of stress relief. According to , deep breathing helps to bring oxygen to the brain and stimulates the parasympathetic nervous system which helps to reduce stress. Heart rate and blood pressure decrease and muscles relax.
8 Ways to Optimize School/Life Balance for Nursing Students
Remember, nursing school is just a season of life and you can give more during other seasons of your life. ... forming study groups or simply chatting with classmates about shared experiences can reduce stress and foster a sense of camaraderie. Additionally, consider seeking out a mentor—someone who has successfully navigated nursing school ...
Evaluation of stress, bio-psycho-social response and coping strategies
The aim of the study was to identify stress level, bio-psycho-social response and coping behavior of nursing students during the practical training. A cross-sectional study was carried out with the 1st, 2nd, 3rd, 4th-year nursing students (n = 1181) between September 2018-may 2019. Data was collected using by Socio-Demographic Questionnaire, The Student Nurse Stress Index, The Bio-Psycho ...
Coping strategies of nursing students for dealing with stress in
1. Introduction. Nursing students experience higher levels of stress than students in other health sciences. The clinical part of nursing education is more stressful than the theoretical part ().A study in Bahrain found that all nursing students experienced moderate to severe stress in the clinical setting ().Also, a conducted study in Iran revealed that 99.3 percent of nursing students ...
Study Suggests Possible Solutions for Work-Related Stress and Burnout
Stress and burnout remain prevalent among health care professionals who cite a need for increased mental health support in the workplace. Share This Print. Two School of Nursing researchers, Michelle Kober, PhD candidate, and Yu-Ping Chang, associate dean for research and Patricia H. and Richard E. Garman Endowed Professor, recently published a ...
Nursing RN-BSN Program || St. Petersburg College
Getting your Bachelor of Science Degree in Nursing from SPC's Walter L. Schafer, MD and Vivian B. Schafer, RN College of Nursing Baccalaureate Program gives you a solid foundation for advancing your career and improving your skills. Our program is ideal for employed nurses because it is offered completely online. Nursing at St. Petersburg College.
Stress, coping and professional identity among nursing ...
Background This study aimed to characterize the patterns of psychological stress among nursing students during the COVID-19 pandemic, and evaluate for profile differences in demographic characteristics, coping styles and professional identity. Methods A cross-sectional study was conducted among nursing students with convenient sampling from four colleges in China from April to June 2022. A ...
Nursing Degrees
The Simulation Center for Excellence in Nursing Education (SCENE) is a multi-million, dollar state-of-the-art simulation lab which provides a supportive environment in a realistic clinical setting for students to learn and master nursing skills. Located at the Health Education Center, the SCENE is a safe, non-threatening teaching/learning ...
Beyond Burnout: Nurses' Perspectives on Chronic Suffering During and
Burnout refers to chronic workplace stress that includes the following three dimensions: energy depletion or exhaustion, ... RN is an Associate Professor at the Duke University School of Nursing. Her research program centers on patient- and family-centered care and support of adult patients with traumatic brain injury and their family ...
Preparing Nursing Students to Communicate with Mental Health Patients
To test a teaching- learning strategy to help nursing students decrease stress and anxiety that may be brought about by the psychiatric mental health clinical experience. Qualitative: Not identified: Overall, students reported that participating in the teaching-learning strategies (blended learning) and self reflection helped mitigate anxiety. ...
Nursing A.S. Degree || St. Petersburg College
Getting your nursing degree from SPC's Evelyn W. Jerger Nursing Program means you've made a solid career choice. With 2.7 million jobs, registered nursing makes up the largest health care field in the United States. With many nurses retiring and an aging population, Florida could face a critical nursing shortage in the coming years.
Nursing Students' Experiences and Challenges in Their Education During
As a preventive and control measure, all the schools, colleges, and universities were closed (Mustafa, 2020). In April 2020, 94% of learners worldwide were affected by the pandemic, representing 1.58 billion children and youth in 200 countries (De Giusti, 2020). Likewise, nursing education has undergone many radical changes both in developed ...
Nursing Degrees
727.791.2400. DEGREES + TRAINING | TUITION + FINANCIAL AID | ADMISSIONS | WHY SPC. A Nursing Program That Makes a Difference. SPC's College of Nursing offers nationally accredited nursing programs that give you sought-after skills that you can take anywhere. Our Associate in Science degree program trains you to become a Registered Nurse.
Back to school: How teachers can ease their stress
Some schools have turned unused rooms into spaces where teachers can relax. "It's like a teacher timeout room, where it's very quiet, there's soft music, soft lighting. Maybe there's a recliner. Maybe there's a massage chair." Davis said when she was an assistant principal, her nearly 1,000-student school had no such space. So she shared her own.
Adapting to New Work Environments: Travel Sonographer
7. Managing Stress and Work-Life Balance . Travel assignments can be stressful. Manage stress by: Setting Boundaries: Ensure a healthy work-life balance. Practicing Self-Care: Engage in activities that help you relax and recharge. Seeking Support: Don't hesitate to talk to colleagues and supervisors if needed. 8. Building a Professional Network
The 25 Colleges With The Highest Payoff
To determine which of Forbes' top 500 colleges offer the best return on investment (ROI), we looked at each school's price-to-earnings premium, a calculation by the think tank Third Way that ...