Study Characteristics
The eight included studies are summarized in Table 2. All eight studies had qualitative data and themes as major findings. Seven of the eight studies used a qualitative approach [14-22]; among these studies, two applied phenomenological qualitative methods [16, 18], and one used the grounded theory approach [15]. One study involved a mixed method design with qualitative responses [21].
The data from the included studies were collected between spring 2020 and April 2022, which were the first and/or second waves of the COVID-19 pandemic. The year of publication ranged from September 2021 to March 2023, and five of the eight papers were published in 2022. All eight studies were performed in regions around the United States. Hopkins et al. [17] targeted nursing faculty from one university in the southwestern United States. Due to the risk of COVID-19 transmission and the restrictions of lockdown, data were collected via personal informal semi-structured interviews. Five studies used a videoconferencing platform, and two used telephone interviews. The remaining two studies used an online survey link with open-ended questions [17, 20].
A total of 230 nursing faculty members participated in the eight studies. All of them had a registered nurse license, had an advanced degree related to nursing, and had taught theoretical or clinical nursing courses (didactic, clinical, or laboratory) either full-time or part-time at the university or college; their employment status included tenure-track, tenured, adjunct, clinical, and teaching professor positions. The targeted nursing educational programs included undergraduate and graduate (master’s or doctoral) programs, associate degree programs in nursing, and RN-to-BSN programs. The participants’ ages and work experience were not reported exactly; however, all of them started teaching before the pandemic. All participants were selected purposively, and some nursing faculty members had online teaching experience before the COVID-19 pandemic; however, none of them had fully taught online. Approximately half of the participants had no experience with online nursing programs. While there was limited information about the gender and ethnicity of the participants, it was apparent that most of the participants were female and White.
The data were analyzed using thematic analysis (n = 3), content analysis (n = 3), grounded theory data analysis, and Barritt et al.’s five-step process (each n = 1). One study utilized an existing theoretical framework [19], and none of the included studies developed conceptual frameworks of COVID-19-related concepts based on their findings.
To evaluate the quality of the included studies, the CASP 2013 tool [13] was used. The first and second authors independently scored the eight studies using the CASP 2013. Both authors compared the results of the tool, and differences were discussed. All eight included studies had appropriate methodological rigor (see Additional file 2).
Main findings
Through thematic synthesis, this review identified five common themes related to nursing faculty members’ perspectives and experiences of teaching during the COVID-19 pandemic: (1) concerns about changes in traditional nursing pedagogy, (2) overwhelmingly heavy workloads, (3) acceptance of and coping with the pandemic, (4) the need for continuous and various forms of support, and (5) opportunities for the improvement of nursing programs (see Table 3).
Theme 1: Concerns about changes in traditional nursing pedagogy
The first theme that emerged from the studies under review was that the pandemic aroused concerns among the participants about changes in traditional nursing pedagogy. The impact of the emergent transition from teaching strategies involving in-person and on-site traditional nursing education pedagogy to remote online formats during and after COVID-19 is still uncertain [19, 22]. In six studies, disruptions in traditional nursing educational teaching pedagogy were mentioned in the nursing faculty interviews [16-20, 22]. The nursing faculty participants described the challenges and worries that they faced as a result of their didactic and clinical teaching strategy changes due to the COVID-19 pandemic [19, 22].
First, since the pandemic began, nursing faculty, especially clinical teaching professors, had to manage the restriction of access to on-site clinical sites; thus, clinical education needed to be provided via virtual simulation [20]. As many nursing faculty participants mentioned, on-site clinical learning and hands-on experience are essential for nursing education, preparation as nurses, and the nursing workforce [18, 19, 22]. One participant in the study by Power et al. [20, p. 35] expressed worries about nursing students who had limited on-site clinical learning: “My biggest concern is lack of hands-on experience due to restrictions in their clinical education. Simulation activities are good, but they are not a replacement for hands-on learning.” Similarly, many participants worried about their nursing students who graduated during the pandemic and missed many clinical practicum hours in direct patient care [18, 22]. For example, one nursing faculty member stated that nursing students who did not have much experience as front-line staff during the pandemic would never be nurses in hospital settings.
Another concern that nursing faculty members commonly reported was a lack of interpersonal relationships with students and little opportunity to interact with actual patients in remote learning [16-19, 22]. Participants reported that online didactic education was able to provide theoretical knowledge that allowed them to succeed academically; however, the ability to translate such knowledge into actual patient care was limited [20-22]. In a study by Power et al. [20, p. 35], a nursing faculty member said that nursing students can be prepared “theoretically” but not “clinically”. Additionally, some nursing faculty reported that they missed connections with their students [16]. For example, one faculty member stated, “I just really miss the live interaction with the students…you just can’t have the same interactions with the students over Zoom” (p. 77). Moreover, some remote nursing learning courses were not conducted in real time, which is synchronous, but rather were recorded; thus, both faculty and students lost opportunities for live Q&A sessions [17, 19].
Theme 2: Overwhelmingly heavy workloads
Overwhelmingly heavy workloads was the second theme that emerged. Nursing faculty demonstrated significant stress and exhaustion due to an increase in their workload as educators compared to their work before the pandemic. [15-19, 21, 22]. First, nursing faculty members had to emergently transition their courses from didactic to online nursing curricula in only one or two weeks in spring 2020 without clear notice from universities and without sufficient training [16, 19, 22]. Moreover, they needed to change teaching strategies, exams, assignments, or supplementary files to an online format [16, 19, 22]. The spring of 2020 and the summer of 2020 constituted the initial the wave of the COVID-19 pandemic, and the first semester required emergently closing campuses and starting online. Many participants reported that even though some had experienced online teaching before the pandemic in the United States, they had no experience with full-time online teaching or virtual practicums; thus, they had to spend more hours preparing materials in an online format, which they were not accustomed to [15, 16, 18]. One participant in the study by Iheduru-Anderson and Foley [18] said, “The workload was above and beyond. We were literally on the computer with students from 9:00 am to 9:00 pm. And it was brutal” (p. 3). In Gazza [16], one clinical professor expressed an extremely increased workload: “For two weeks, it was utter chaos, and it was maddening and I couldn’t get off [my computer]…I was online all day long” (p. 76).
Some studies also reported that nursing faculty members’ burnout was caused by the additional workload associated with COVID-19 (5). In addition to transferring their nursing course resources into an online format, nursing faculty also had to make their students “learner mindset” [19. 21]. Some students were not ready to learn in different learning environments, such as at home instead of on campus; thus, nursing faculty members were required to facilitate, engage in, and pay attention to the students as participants in online classes or clinicals [17-19, 22]. One faculty member mentioned that “...keeping them (students) motivated… can be a little bit exhausting…” [22, p. 479].
Typically, nursing faculty members has already experienced normal stress from their teaching, maintaining their clinical expertise, and qualifying for tenure requirements [21]. However, nursing faculty worked more hours because of the significantly increased workload related to developing the course in an online format and motivating their students to study online during the COVID-19 pandemic [21]. In one study, participants expressed this as “technology burnout” [18, p. 2].
Theme 3: Acceptance of and coping with the pandemic
The third theme, acceptance of and coping with the pandemic, emerged from seven studies under review. The studies demonstrated that nursing faculty understood the serious, emergent, and critical events of the COVID-19 pandemic and accepted an alternative way of teaching, i.e., remote or virtual full-time teaching [16-22]. Moreover, they coped with their transitions in teaching strategies [18, 19].
Even though it is not easy for nursing faculty to prepare all related elements for virtual clinical teaching, many participants reported that they could meet the aim of their course objectives [17]. One clinical nursing faculty member noted that “it enabled achievement of the key academic objective of DNP residency for students. Students were able to obtain further input from a variety of faculty and peers regarding their capstone project” [17, p. 29].
In addition to accepting the emergent transition, participants also tried to flexibly cope with this situation for themselves [18, 19, 21]. For example, one participant of McKay et al. [19] stated, “It's kind-of like we have to do this right now and everybody is panicking, and nobody knows what’s going to happen and, you know nurses are good at being flexible, so I was able to manage that” [19, p. 3].
Some nursing faculty members reported feeling that they were in chaos preparing for an emergent transition to remote teaching in Spring 2020, which was the first semester of lockdown due to the pandemic; however, as the pandemic continued into fall 2020, they became accustomed to remote teaching and coping with alternative teaching strategies [16, 20, 22].
Theme 4: The need for continuous and various forms of support
The fourth theme, the need for continuous and various forms of support, was identified from five studies. Nursing faculty participants in five studies reported that they needed continuous support at various levels [15, 16, 18-20]. Participants demonstrated that technical assistance that can help faculty members apply new technologies in nursing courses, national or state-level professional nursing organizations, and psychological support are required [15, 16, 18-20].
First, they demonstrated that they need continuous support from technology experts for technical assistance [15, 18, 19]. Some participants had utilized remote learning as a part of hybrid courses before the pandemic; nonetheless, this was the first time that they had transitioned to full-time remote teaching and virtual simulations [16, 18]. Some faculty members were accustomed to internet video teaching skills; however, some of them had challenges [16]. Moreover, some faculty members lacked internet access; furthermore, some faculty members worried about time needed to learn new technologies and apply them to their courses [16, 19].
Additionally, studies reported that faculty needed ‘helpers’ who could educate and train them, such as educational associations or professional nursing organizations, at the state or national levels [15,18]. These kinds of helpers could provide updated new modules for remote learning and continuous education via online video conferencing during the pandemic [15]. At the beginning of the pandemic restrictions, several institutional and nursing organizations prepared webinars for nursing faculty on how to survive the abrupt teaching transition and how to teach with contingent infections [15, 16, 20]. For instance, faculty mentioned the Association of College and University Educators (ACUE) training, which helped them learn how to perform online teaching and utilize this training course [15].
In addition, participants reported that they required emotional and psychological support [18, 19]. Due to the pandemic, lockdown, and transition to different teaching environments, many participants had no opportunity to communicate or interact with students or their colleagues face to face, which made them feel lonely and isolated [19]. Thus, participants stated that emotional support was pivotal for nursing faculty at the administrative level [18, 19].
Theme 5: Opportunity for the improvement of nursing educational programs
In all eight studies reviewed, participants expressed that an emergent transition to remote learning due to the pandemic represented a good opportunity to develop themselves as nursing educators, to learn future teaching delivery methods and to follow and prepare for the movement of teaching delivery methods [15-22]. Finally, they had the opportunity to innovate traditional nursing teaching strategies by renewing, redesigning, modifying, and reevaluating as the pandemic continued and as the future required it while still maintaining the course objectives and outcomes [15-22].
According to many nursing faculty members involved in these studies, the pandemic was an opportunity for growth as a nursing educator [15, 16, 18, 19]. With the emergent transition from didactic to remote teaching and from on-the-ground to virtual simulations, nursing faculty showed tremendous, quick development of new teaching tools. One participant used a simile to describe their efforts: “…necessity is the mother of invention” [18, p. 9]. Similarly, a nursing faculty member commented, “I learned a lot of new things. I had never heard about Google forms before this crisis, but I learned very quickly. I used it to create evolving case studies to augment the clinical learning for the students” [18, p. 9]. One associate professor stated that abrupt changes to remote teaching had made them reflect on the objectives of programs and had the chance to support students. These kinds of efforts were beneficial to faculty, nursing students, nursing programs, and universities [16]. Even though nursing faculty were very stressed due to the pandemic and the accompanying heavy workloads, they said that the pandemic presented an opportunity to improve their programs and promote professional development in the future [15, 16].
Several studies have reported that moving from an on-the-ground clinical practicum to virtual simulations is a new opportunity and is beneficial for both faculty and students [18, 22]. While virtual simulations were being performed, faculty and students were able to flexibly conduct clinical labs and adapt their abilities to access nursing skills in unique ways [22]. In a study by Power et al. (p. 35), one nursing faculty member stated, “We all know there can be a lot of waiting around for a faculty member [in clinical], but in simulation, that did not happen.” In Christoffers et al. [15], one nursing faculty member mentioned, “I think that [COVID-19 caused] a lot of growth., you know, talk about doing impossible things. I see the good stuff that came out of that for a lot of people that I work with and maybe myself too, that there’s things that probably [we] needed to work on anyway, and it just pushed it forward” [15, p. 112]. Thus, even during the crisis, nursing faculty members had been using the pandemic situation to develop themselves as well as nursing programs.