Student Interviews Exploring the Influence of the Coronavirus Pandemic on Graduate Nursing Education

Study Design

Within a social constructivist approach we used a descriptive qualitative design which is appropriate when direct experience of a poorly understood or novel situation in historical context is needed from a naturalistic perspective of those involved, where there is a limitation of time and resources, and can form part of a subsequent mixed methods analysis (Kim et al., 2017). Knowledge of a phenomenon is context specific for each individual and influenced by the social relationships in which those experiences are situated (Guba & Lincoln, 1989). The researcher is part of the re-construction and re-telling of subjective experiences. Thus, multiple realities and experiences can be constructed through individual or group interviews, and reflexive strategies are used by the researchers to provide a low-inference theme interpretation within and across experiences (Bradshaw et al., 2017). Data included 1. Individual interviews and 2. Naturalistic student group gatherings in program virtual “Town Halls”. Recruitment, data collection and analysis were conducted iteratively to build a comprehensive picture of the experience of being a graduate nursing student during early stages of a global pandemic. The study is reported consistent with international consolidated criteria for qualitative research (Tong et al., 2007).

Setting and Sample

We used semi-structured interviews of students enrolled in graduate school during the spring semester 2020 at one college of nursing in the Rocky Mountain area of the U.S. Students included MS, DNP, and PhD students. This was an independent study whose participants had completed a survey (Nodine et al., 2021; Rosenthal et al., 2021). The survey was initiated by a data administrator from outside the university system. After completing the survey, students were asked to note if they were interested in participating in an interview, provide contact information, age, gender, with whom they live and graduate program type (MS, DNP, PhD). Of the 103 students who completed the online form, 38 were selected using maximum variation sampling for diversity across these characteristics. Students were then contacted via email to set up an interview. A final convenience sample of 11 students who responded were asked to sign, date, and return a consent document to the researchers either electronically by email or by regular mail within 2 weeks and a verbal review of the consent took place at the time of the interview. Participants were compensated $25 through debit card.

Being graduate students, all participants were over 18 year of age and were fluent in spoken English. Interviews were conducted using Zoom video conferencing (Archibald et al., 2019; Zoom Video Communications Inc., 2016) by faculty not directly involved in the students’ education. The study received exempt status from the state research review board (COMIRB #20-1069).

Interview Guide

An initial broad semi-structured interview guide was developed based on the experience and expertize of the research team around nursing education, graduate pedagogy/andragogy, teaching and learning strategies, bi-weekly COVID clinical-academic strategic initiative meetings, and academic literature. Open-ended questions that explored the impact of the COVID-19 pandemic on students’ lives during the spring semester 2020, including any educational barriers and benefits from the pandemic were used at the first interview and refinements were made as interviews progressed allowing for re-contextualization of the novel experiences over time. Circumstances that improved their graduate school education during spring semester 2020 were also elicited (Table 1). Additional probes, including “tell me more”, were used throughout the interviews to remain close to the participant experience.

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Table 1.

Interview Guide.

Establish rapport and trusting relationship with participant so that the participant feels comfortable and safe during the interview. Start with questions that will help to clarify the participant's situation prior to the onset of the COVID-19 pandemic. Did you work prior to and/or during the pandemic? Were you in a didactic course during the spring semester (2020)? Were you in a clinical course during the spring semester (2020)? Explore perspectives around the impact of the pandemic on the participant's life. How has your home life changed since the pandemic? How has your work life changed since the pandemic? How has your graduate schooling changed since the pandemic? Further explore perspectives around graduate school changes during the pandemic. What were some barriers to your graduate education during the pandemic? Was any aspect of graduate school made easier or better with the pandemic? Explore circumstances that improved the participant's experience of graduate school during the pandemic. What suggestions would you make for faculty and CON administration to help graduate students through this pandemic?

Data Collection and Analysis

Data collection and analysis were concurrent (Figure 1). The interviews were conducted by two study trained team faculty members. We used an emergent, iterative approach where we refined our questioning on the basis of our analysis of interviews (Creswell & Poth, 2018). Interviews continued until informational saturation was reached as components that described the experience became repetitive (Creswell & Poth, 2018; Kim et al., 2017). Iterative data collection builds understanding along the way thus reducing the need for further interviews. The interviews were conducted between July 19th and July 31st, 2020 via Zoom video conferencing at a mutually designated time, were audio-recorded, then professionally transcribed verbatim. The transcribed interviews were assigned numbers and de-identified. Field notes were not collected. Demographic data were collected from the survey that preceded the interview.

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Figure 1.

Flow chart of data collection and analysis.

Consistent with an exploratory descriptive qualitative design, a team-based inductive then deductive analytic toolkit was used for low-inference theme analysis (Fereday & Muir-Cochrane, 2006). This involved individual and paired line by line inductive analysis of each transcript using manual labeling techniques to describe experience components, ascribe codes and create categories (Vaismoradi et al., 2016). After the third interview the team compared within and across all transcripts, building a list of similarities and differences within and across experiences. We looked for deviant cases and outlier experiences to examine closely for situated understanding and relevance to the graduate nursing student experience. Deductive strategies were then used to look for the established inductive experience components by graduate program, age, gender and living arrangements to identify patterns of meaning and highlight any outliers. No conceptual lens was applied. Themes were then generated as experience components, codes and categories were re-contextualized and compared and abstracted to the level of the graduate student group experience (Fereday & Muir-Cochrane, 2006; Vaismoradi et al., 2016). A reflexive, team-based set of triangulation strategies for low inference interpretation and abstraction included subject matter expertize, qualitative expertize, data characteristics, interviewer, team member and audit trail discussions (Creswell & Poth, 2018; Vaismoradi et al., 2016). A consensus approach was used to inform theme labeling and theme structure. We resolved differences by finding consensus through active listening and discussion, and prolonged engagement with the data working online over nine months.

For confirmation of themes, minutes from naturally occurring townhall meetings with graduate students were included in the analysis. Townhall meetings were conducted by the Assistant Dean of Graduate Student Academics with students from each master's specialty program. The purpose was to elicit student feedback about their graduate education; to hear the voice of students; and listen for inductive themes related to successes of our program and opportunities for improvement. We used the townhall meetings in fall 2020 to ask a question, “how did the COVID-19 pandemic contribute to your graduate nursing school experience?”. Twelve townhall meetings were held via Zoom. The number of students attending each session ranged from 6–27 (Total n = 180). Student feedback from townhall sessions was written verbatim by a notetaker and transferred to password protected word documents. We confirmed themes identified by analysis of student interviews by deductively comparing and contrasting to themes from townhall sessions. Thus, extending the transferability of an adequate sample of 11 participants by re-contextualizing findings into the same graduate student context of a larger group (Vaismoradi et al., 2016). Further, abstracting themes and theme structures (how the themes fit together as a higher level of abstraction) into the graduate student group was also vital in the absence, at the time, of established COVID literature as a final analytic step (Figure 2). Together these aspects reflect criteria for trustworthiness (credibility, transferability, dependability and confirmability) and integrity in qualitative research (Guba & Lincoln, 2018; Morse, 2015). Credibility can be found in the prolonged engagement with participant data and group data confirmation of analytic themes. Confirmability is established through team-based, reflexive processes, investigator triangulation, participant demographics and inclusion of participant quotes. Dependability is documented through team meetings and an audit trail. Finally, transferability is established through maximum variation and purposeful sampling combinations, iterative sampling and analysis leading to informational data saturation and rich description of the experiences through themes and theme structures.

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Figure 2.

Thematic schema.

Alteration in Human Connections

This theme described the effects of the social isolation and changes in communication due to the pandemic on students’ graduate education. A recurrent theme that arose during interviews was the importance of communication. Since in-person teaching and mentoring was, by necessity, radically decreased, the importance of maintaining lines of communication increased. The essential nature of human connection was highlighted both between faculty and student and between students. One student commented, “Transparency and consistency in communication was huge” (Townhall meeting, 9/16/20).

The alterations in human connections were viewed as both positive and negative. For example, use of Zoom “kept us going” [communicating], but “lacked physical presence” (#7, p. 4). Communication with faculty took the form of group or one-on-one interactions by phone, email or video conferencing. Students appreciated the efforts of most of the faculty to reach out more than before the pandemic. On the other hand, some students were perturbed by faculty who did not demonstrate any compassion for the students and went on “as if there was no pandemic” (#3, p. 5).

Several students in our study commented on the limitations of distanced forms of communication exclusively. One student noted that it was important “not to just have [communication through] Zoom, but talking back to us about the assignment, which is really great” (#7, p. 6). Someone else stated that “I think there is also that disconnect of, you know, not being able to get to have that one on one interaction and real time feedback” (#4, p. 4). The individual support of students by faculty, such as timely responses to their emails or checking on their well-being during Zoom sessions, was appreciated during the early phase of the pandemic.

Communication between the students was also felt to be essential during the pandemic. A student commented that “the relationships that I have established with my peers in the program [prior to the pandemic] have been tremendously helpful for me. [It is important] to be able to reach out to them” (#2, p. 8). Student-to student communication was seen as something that helped them through their courses during the pandemic.

It was interesting that although communication was important during this period, and helped reinforce human connections, some students felt that the ability to reduce constant interaction was helpful. One student commented that “I was ok with a little bit of calm in my personal life” (#1, p. 3). For many students, human connection at the university was essential for getting through the pandemic, both with the faculty and with each other. For other students, the decrease in pressures for in-person meetings may have helped them and allowed them to feel less stress than they did pre-pandemic.

Agility in Action

This theme described the manner in which both the institution and the students adapted to continue didactic and clinical education during the pandemic. Given social distancing and overall disruption owing to COVID-19, faculty and students were forced to become nimbler in order to continue their work and maintain their responsibilities.

Changes in course structure and clinical experiences were applied rapidly and with a large amount of originality. It was noted that many faculty and students had to think outside the box. Innovation was required of faculty to adapt curricula that were traditionally offered in-person to online. Students remarked on the provision of academic grace, faculty flexibility, and “adapting on the fly to the changes that need to be done” (#5, p. 3), and transparency with prompt decision making.

All MS students enrolled in an APN degree program are required to complete practicum hours demonstrating their skills with patients in multiple different clinical settings. As the certification agencies were not willing to change the 500 h of supervised clinical experience for graduate students, there was not leeway in the graduate curriculum for APN students. This contrasted with undergraduate programs for which the governor of the state where the research took place, and other governors, gave an executive order decreasing required clinical hours to urgently matriculate undergraduate nursing students if needed (Polis, 2020).

The abrupt changes in clinical sites caused students and faculty to shift gears swiftly. Fortunately, students felt they had a “variety of different things to pull from (#4, p. 6)” to assist in the completion of these practicum hours. These new resources included newly-developed simulations and the use of safe alternate clinical sites and preceptors. One student noted the agility of her program director when they said, “She is basically trying to do anything that she possibly can to have us succeed and make sure we are getting the learning that we need” (#6, p. 6).

As the spring semester 2020 finished with pandemic uncertainty, a few students noted the lack of confidence surrounding those changes, and the need to be agile during this period of time. Two students interpreted messages from the school's administration quite similarly as, “We are going to try to go forward with this and try kind of a new way of doing it” (#6, p. 7) and, “We will get more information as we go. You know, don't go into crisis mode yet. We are still trying to figure out how we are going to do this” (#8, p. 10).

Within the predominant theme of agility to develop new norms during the pandemic was the need of both faculty and student to be flexible. Students discussed the need to change to online learning environments and how to remain engaged. DNP students needed to adapt proposals and a PhD student mentioned dissertation data collection difficulties. The need to be flexible with time management, for example, due to evening Zoom sessions and classroom meetings, was also mentioned. The thought that best explains the need for flexibility within the predominant theme of agility is, “Teachers and the students have been pretty flexible and understanding that everything is in flux right now and nobody has the answer so we kind of just have to take things as they come” (#5, p. 2).

Collaborative Construction of Change

This theme described how both faculty and students worked together to adapt education to the pandemic. A discernment of mutual appreciation, respect, and understanding between students and faculty emerged. Faculty and students worked collaboratively, interacting bidirectionally, to adapt to changes in courses due to the pandemic. Students reported feeling that interactions with faculty were more open, honest, and understanding. Students voiced that faculty were more likely to listen to students and to take student suggestions more seriously. A student noted “everybody is working together to get through it [pandemic]” (#5, p. 9).

Flexibility on the part of both faculty and students has been crucial to getting through the challenges during the pandemic. Emerging from this collaboration and mutual flexibility was an adjustment in the hierarchy of power in academia and noted faculty benevolence. Communication was more transparent. There was a realization that the faculty and students were “living it together” (#10, p. 7).

Students with clinical site closures were particularly stressed about how they would be able to move forward through graduate school. In general, students felt that faculty and preceptors were responding to their needs. They saw that adjustments were made by faculty at the prompt of students.

Metamorphosis Emerging from Disruption

This theme described the overarching changes that occurred in graduate nursing education from the crisis of the pandemic. With emphasis on communication during the pandemic, quick action to provide clinical experiences and didactic opportunities, and faculty and students working together, to remain flexible and open to innovation, brought a transformation to graduate nursing education.

Faculty worked together creating innovative methods to teach graduate nursing student skills. Rapid development of simulation experiences occurred and faculty shared their knowledge across programs. Simulation hours substituted for supervised clinical hours above 500 in some programs with requirements for greater than 500 h. In addition to simulation, supervised telehealth substituted for in-person clinical experience. Many faculty members also adopted a policy for academic grace during the pandemic. Assignment due dates were extended; students could make arrangements for alternative assignments when they were working extended hours as registered nurses due to the pandemic; and semester deadlines for clinical hours were made fluid. The flexibility, fluidity, and grace faculty used in constructing innovative options for student education was aided and honored by students.

Thematic Overview and Associations

These four themes were then analyzed for associations. Agility in Action and Collaborative Construction of Change within academia were rarely present prior to the pandemic but culminated because of the academic stressors of the pandemic. Human connections have been both hindered and helped by the pandemic. Students noted sadness at not being able to be closer to some family members and their student colleagues during the pandemic and the imperfections of online communication formats. But the students’ appreciation of connections and communication increased.

Agility in Action, Collaborative Construction of Change, and Alterations in Human Connections were found to be fluid and interconnected. This fluid connection brought new possibilities and a Metamorphosis within the graduate nursing programs during the pandemic. The metamorphosis included the students’ highlighted appreciation for close connections with other students, improved communication between faculty and students, and faculty's innovation, agility, and benevolence.