Nursing student volunteers and their level of involvement during the COVID-19 pandemic: a systematic review

Health care leaders have warned for years that hospitals face a shortage of nurses globally. One prime example is America, with a total deficit estimated to be 918,232 nurses by 2030.¹ The spikes in the incidence of COVID-19 are exacerbating the shortage of nurses globally during the pandemic. It also affects the world health care system and health care providers, such as the shortage of nurses struggling on the front lines.^2,3 Many strategic steps are being taken worldwide to meet the nursing staff’s need to control the spread of COVID-19, including recruiting student health volunteers by conducting coalitions of local health services and public health partners.⁴

Students volunteer in different ways and purposes because they can benefit society while fulfilling their own goals, assisting universities in achieving learning goals, and meeting the needs of their particular organization.⁵ There is a global debate about health students’ role and capacity as volunteers in the current COVID19 pandemic.⁶ Nevertheless, several studies revealed that recruiting nursing students as volunteers during the pandemic can help meet the shortage of nursing staff in various health facilities.^7–9 So far, volunteer nursing students’ placement and policy procedures differ from country to country. For example, they are placed in health or social care organizations.^10,11

Volunteer nursing students reported positive experiences and opportunities as an outcome of the community’s tremendous support for nurses, which enhanced their pride in choosing a career as a nurse.^12,13 However, a study from Swift et al.⁷ revealed that students as volunteers experience various difficulties in adapting and transitioning into 2 roles as a professional and a university student. They are also experiencing problems coping with exposure to conditions that increase their physical and mental health risks. The same issues were revealed when students experienced anxiety and stress due to a lack of practical courses, distance education, and increased workload. Students also revealed that no special preparation was made before becoming volunteers, which influenced them in providing services.^14,15

Studies conducted regarding the involvement of nursing student volunteers indicated that most of the individual studies reviewed experiences, views related to the extent of their participation, benefits, and obstacles during volunteering for COVID-19.^7,14,15 The previous systematic review studies that have been conducted have only assessed preparedness and preparedness in dealing with disasters and discussed the pandemic with a medical student population, but not explicitly discussed nursing students.⁶ This study explored the contribution and involvement of student nurse volunteers during COVID-19. This study resulted in a better introduction to student volunteering to provide recommendations for universities and health care providers when engaging students to become better volunteers.

This review found that nursing students were willing to volunteer during COVID-19 pandemic based on motivations, perceptions, and barriers. We highlight the existence of nursing student motivation, including intrinsic and extrinsic aspects. Another study revealed that intrinsic motivation refers to personal desires. In comparison, extrinsic motivation is an external drive such as praise or incentives.³⁷ For example, this review showed that the desire to help others is one of the most commonly found intrinsic motivations, while extrinsic motivation is an attractive incentive offer.^26,36,31 Intrinsic motivation is more expressed than extrinsic motivation. These results consistently revealed that a desire to help and feelings of moral responsibility or patriotic duty are associated with an increased willingness to volunteer.³⁸

The authors found that deciding to volunteer was also related to perceptions of COVID-19 and its barriers. Nursing students showed significant obstacles related to emotional feelings: anxiety and fear of safety for themselves and their families, although these emotions were influenced by lack of information, knowledge, training, personal protective equipment, disease transmission, and management.^{25–28,30,31,33,34} The findings of this study are supported by previous research showing that psychological factors are a common barrier where around 25% of students experience 1 or more forms of anxiety.³⁹ Emotional or psychological factors are caused by a lack of knowledge and uncertainty about situations and roles.⁴⁰ In this review, the authors highlight that exploring the factors associated with nursing student decisions is critical to determining strategic approaches to volunteer programs in critical conditions. This finding is consistent with research exploring volunteer driving factors to define strategies and ensure volunteer sustainability.⁴¹

Before starting their volunteer role, nursing students had expectations and stated that expectations and actual conditions differed. Most of their expectations are focused on themselves and their future careers, such as gaining skills and experience development. However, during their time as COVID-19 volunteers, they lack adequate information, education, training, and competence.^{27,28,30,31,34} These results are supported by a study that revealed that students who volunteer during the COVID-19 pandemic have limited knowledge and skills, so their self-confidence is low.⁴⁰ According to some studies, students experience disappointment when expectations before joining as a volunteer are not met, resulting in quitting or not volunteering at all.^42,43 However, unlike the findings in this review, students, apart from being willing, felt proud and satisfied with their contributions to critical situations.^{25–28,30,31,33,34}

Another finding was that student needs were identified, focusing on themselves or the university and its associated health system. These findings can accommodate the expectations and actual conditions felt by students. Students requested education, training, and mentoring programs from lecturers and senior staff to improve their skills and support facilities, including child care and vaccination. The results of this review support a qualitative study in Australia on aspects of student and university volunteer needs identified for activities to run effectively and efficiently.⁴²

Universities are responsible for providing integrated curriculum clinical practice.^{26–30,32,34,36} This includes professional development such as adaptation of ethical dilemmas and conflicts,^33,35 in addition to culturally sensitive occupational safety and competence protocols,^25,34,44 as well as ensuring ongoing collaboration, coordination, and communication between universities and partners^29,31 that nursing student volunteers care for the patients following their competence. In line with studies that support, for example, training, a clear framework from universities and related parties proves to be an essential factor that helps volunteer retention, development of skills, and confidence in new roles and permitted tasks.⁴⁵

The authors found that the impact of nursing students as volunteers proved to be most important in helping the shortage of health workers and supporting the control of the spread of COVID-19. Similar to a study that showed the global impact and goal of health volunteers is to help solve the problem of health crises.^46,47 Other studies have revealed that student volunteers can meet community needs, economic goals, and the reputation of universities and related organizations or systems.^48,49

In general, findings related to contributions are that all student volunteers actively provide services to patients directly or indirectly. While no studies report specifically on the effectiveness of student volunteer engagement levels during COVID-19, several studies describe the engagement they have had and have successfully contributed to the health system and themselves. According to another study, volunteering helps students develop an uncompromising attitude personally and professionally.^48,49 The same study reveals the positive potential for students and the implications for universities, health facilities, and health departments for future research, funding, and development of student volunteers^42,50 since volunteers need a support system to volunteer and continue to contribute a valuable asset.⁵¹

This review showed that most nursing students willing to volunteer during COVID-19 are influenced by motivations, perceptions, barriers, expectations, and program support from universities, health care providers, and policymakers. We highlight this review providing an overview of nursing students’ volunteer needs to help develop interventions/competency frameworks and the role of culturally sensitive volunteers in education and training, such as mentoring and supervising lecturers or senior nurses to ensure volunteers’ safety and quality of care. Universities and health care establishments can provide feedback on achieving their practice’s safety goals, professionals, service commitments, and potential competencies. In the future, student volunteers can choose volunteer programs according to their competence.