This study aimed to explore the nursing students’ experience of placement in the COVID-19 Vaccination Centres.

This observational cross-sectional study was conducted in 2021 to evaluate the students’ experience of placement in the COVID-19 Vaccination Centres.

South Western Sydney Local Health District (SWSLHD).

The study involved a purposive sample of consecutive students from Western Sydney University (WSU), who undertook clinical placements in the five COVID-19 Vaccination Centres [South Western Sydney, Bankstown, Prairiewood, Ngara (Liverpool), Macquarie Park] in 2021. The online survey was created via REDCap and distributed to 627 students. Invitations to complete the survey were sent by the University’s Student Administration Department using the students’ university email address. The email invitation included a brief description of the survey, the Plain Language Statement (PLS), and a link to access the survey. A reminder email to complete the survey was sent approximately two weeks after the initial invitation. Participants were advised that submission of the survey indicated consent to participate.

Data were collected via surveys. The survey comprised the Placement Evaluation Tool (PET) ( Cooper et al., 2020 ). The PET was found to be valid, reliable, and feasible across a range of measures in a study conducted in Australia ( Cooper et al., 2020 ; Luders et al., 2021 ). A Likert scale was used to rate the items about the experience of participants in the Vaccination Centre. The tool included 22-items (rated on a 5-point agreement scale from “strongly disagree-1” to “strongly agree-5”) covering the domains of “Clinical Environment” and “Learning Support” and one global satisfaction rating (a 10-point scale, rated 1 “very dissatisfied” to 10 “extremely satisfied”). The tool was slightly modified to collect additional information in this study. Three extra items were added to the tool: “I was satisfied with the Public Health response to the pandemic”; “I feel as a nursing student I was well prepared for the pandemic”; “I would choose the Vaccination centre as a future clinical placement.” The survey also contained three open-ended questions regarding positive and negative impacts of the placement in the Vaccination centres. The questions were “What worked well?”, “What didn’t work?” and “The key learnings.”

Quantitative data from the surveys were analysed descriptively using IBM Statistical Package for the Social Sciences (SPSS), Version 29. The qualitative data obtained from open-ended survey questions was analysed using a thematic analysis approach ( Braun & Clarke, 2006 ). Once all responses were coded and the patterns were identified, the codes which shared a common pattern were grouped together as overarching themes.

The approval for this study was obtained from South Western Sydney Local Health District Human Research Ethics Committee (2021/ETH11746). Participants were advised that submission of the survey would be considered formal consent to participate. Participation was strictly voluntary, and all the participants were informed that their decision to participate or withdraw would not affect their current or future relationship with the Local Health District.

The Cronbach’s alpha was calculated to measure the internal consistency of the items ( Table 2 ). The Cronbach’s alpha value obtained for factor “Clinical environment” was 0.95 and 0.97 for “Learning support”, overall value combining the two factors was 0.98, indicating a high level of internal consistency.

Twenty-two items were rated on a scale of 1 to 5 and the final global rating was from 1 to 10, with a potential score ranging from 23 to 120 ( Table 2 ). The total PET score (22 items) shows a mean rating of 73.1 [average of (average response to each item × 22)] from a maximum of 110 (22 items × 5 scales in each item). Out of the two factors in the survey tool, “Clinical environment” had a mean rating of 79.3 with higher rating for the “staff attitude towards students” and lowest for “feeling valued”. For the other factor “Learning support”, the mean rating was 69.5 with higher ratings for the item “supported to work within my scope of practice” and lowest for “choosing the Vaccination Centre as a future clinical placement”.

Majority of the students strongly agreed/agreed they were fully orientated to the clinical area (73%, 38/52) and received good support from the staff: Staff were willing to work with students (65.4%, 34/52); Staff were positive role models (63.5%, 33/52); Staff were ethical and professional (69.2%, 36/52); Staff demonstrated respect and empathy towards patients/clients (76.9%, 40/52). Nearly 60% (31/52) of the students strongly agreed/agreed that they felt safe in the clinical environment and were supported to work within their scope of practice (67%, 35/52). They were adequately supervised in the clinical environment (53.8%, 28/52) and their supervisor(s) understood how to assess their clinical abilities (63.5%, 33/52). ( Figure 1 )

A higher percentage of disagreement (Strongly disagree/disagree) was observed for items: I felt valued during this placement (44%, 23/52); This placement was a good learning environment (52%, 27/52); I received regular and constructive feedback (48%, 25/52); I had opportunities to interact and learn with the multi-disciplinary team (52%, 27/52); I feel as a nursing student I was well prepared for the pandemic (44%, 23/52); I would choose the vaccination centre as a future clinical placement (57%, 30/52).

The participants’ overall satisfaction with this placement experience varied scores ranged between the scales of 1 to 10. Out of 48 responses, 21 participants (44%, 21/48) scored their experience within 7 to 10, four (8%) of them were extremely satisfied (score 10) with their placement. 27 participants scored their satisfaction level as 1 to 5, and three of them were very dissatisfied (score 1).

Data obtained from the open-ended survey questions provides additional information on experience of participants during the placement. Four core themes emerged summarizing respondents’ placement experiences: learning experience, challenges, potential opportunities for clinical practice and suggestions for improvement. ( Figure 2 ) They are summarised in the following paragraphs.

1) Learning experience

The students acknowledged that the placement was well organized, coordinated, and structured. The orientation and training during the placement were appropriate and adequate. Some students perceived this placement as an opportunity to learn and practice various clinical skills during a short duration of time. They acquired confidence in drawing vaccines and giving injections, and learnt about needle safety and how to prevent needle stick injuries. Other than vaccination

they also had the opportunity to participate in different areas of the Vaccination Centre operations including screening, post-vaccine monitoring for any adverse effect, patient anaphylactic assessment, medication checks, symptom management, signing off, cold chain management and documentation of vaccine administration.

“Switching between admin, vaccination and observation roles was quite useful in getting experience in different parts of the vaccination experience, and the training was quite good, being paired with nurses until we were comfortable with administering vaccines ourselves.” (Participant 34)

“We were given the benefits in having the chance to practice and utilise our skills and knowledge and put it in action. It has boosted my confidence with handling needles, being aware and cautious for needle stick injuries and implementing 5 rights to medication.” (Participant 47)

Students felt that it was beneficial in terms of improving communication and interpersonal skills. They had the opportunity to communicate with diverse range of people. They became more confident in terms of managing individuals with anxieties. Some of them mentioned that they learned how to effectively communicate with consumers from culturally and linguistically diverse (CALD) background utilising the interpreter service.

“I also felt my people skills developed further, particularly with reassuring hyper stressed patients.” (Participant 34)

“The vaccination centre allowed me to practice independently with a senior nurse close by to ask for assistance when required. I perfected the skill of IM injections. I also learned how to effectively communicate with consumer’s from CALD background utilising the interpreter service.” (Participant 47)

Students had the opportunity to work with the experienced team, better understand organization and division of labour at the Centre. Students acknowledged that they were very well supported by the staff and felt as a part of the team during their placement. The staff was understanding with regards to the fear of the students at the beginning and supported them with the training of various skills. Apart from working as a part of the team, students also mentioned that they had the opportunity to practice independently under the supervision of a senior nurse.

“I felt I were the lucky one that I had an opportunity to do IM. Some staff are really nice and helpful, such as an on-site manager, mental-health manager and other RNs. My facilitator said the clients were satisfied with my performance.” (Participant 32)

“We were able to act quite independently, building skills with confidence and skills that normally would not be found on a regular ward placement” (Participant 2)

2) Challenges

Student’s expectation from their placements in the Vaccination Centre was recognized as one of the challenges to placement. Most of the students’ expectation was to learn and apply various clinical skills. However, they felt that there was no clarity around what they were expected to do in their role. Some of the students stated that they were exploited and used as a free labour, as they had to do nonclinical work such as crowd controlling, marshalling and helping with administrative work.

“Everything else. I’m not a crowd controller, I’m a student. We were just being used for slave labour. This should have been a paid placement. The bulk of our time was spent on non-clinical work that other people were getting paid for.” (Participant 30)

“I was there to learn, not to work as crowd control. Absolutely pointless, learned nothing except IM injections and that I would never work in a vax clinic.” (Participant 20)

Long shift hours (12 hours) were also identified as a challenge by many students. At times, it was really busy, putting a lot of pressure on the students, and they got really tired from sitting for hours and giving injections all day. On the contrary, some felt it was slow paced as there were not many people coming for vaccination at their Centres. The task was repetitive at times which made it boring and monotonous.

“Sitting for 12 hours straight, giving injections doesn’t allow for much of a positive experience. And the weeks that I was there was right at the peak, so I was giving up to 130 immunisations a day, so you literally didn’t move other than morning tea and lunch and afternoon tea you didn’t move.” (Participant 18)

“Once our skills and clinical abilities in the vaccination hub were assessed, there wasn’t much more enhancement to learning. It was very repetitive and most of the long 12 hours days, I personally thought were wasteful.” (Participant 4)

3) Potential opportunities for clinical practices

Some students felt that the placement in the Vaccination Centres provided them with potential opportunities to learn various skills. However, the placement was very restricted in terms of growth, and not many nursing skills were applied in terms of what the facility allowed. They were mostly administering vaccines and missed a good chance to learn other clinical skills. They noted that there was hesitation in the staff in allocating certain tasks and fear of students making mistakes, which caused them to have to observe or just continue the same task. The participants expressed a strong desire for more in-service training and rotation through different tasks.

“As a third-year student placed in a vaccination hub, I felt I needed much more from my placement than what the hub could provide. I needed to hone a vast array of skills while the hub only catered to me practicing only a handful of skills, most of which being non-clinical.” (Participant 11)

“Sitting at the station for 12 hours and not being rotated through different roles is a manual handling risk and mind numbing. After doing 130+ vaccines per day you get over it pretty quick. As AINs were involved in preparing vaccinations and the cold chain section, I think it would have been valuable as students to have experience in that area.” (Participant 34)

Suggestions for improvement to future placements

The students expressed a strong desire for more in-service training, and rotation through different tasks so that all students could have the opportunity to learn other skills apart from injections. They also suggested advertising the sort of skills that students would be offered to learn so that they had more clarity around their role and what to expect from the placement.

The results of this study need to be considered in the context of some potential limitations. One of the limitations of this study was the low response rate. This could have been due to the timing of the survey administration; by the time the surveys were sent out, most of the students had moved out of the university or were busy with other activities. The unprecedented pandemic was a major barrier to the recruitment and response rate. Also, their feedback via Interview would have provided richer data on their perspective about placement in the Vaccination Centres.