High and increasing prevalence rates of mental health problems among young people mean that youth mental health is a key priority for policymakers worldwide.¹

University students around the world have increased vulnerability to poor mental health.^2,3 Studying nursing is often regarded as more stressful than other healthcare studies, leading to compromised mental wellbeing in students.⁴ This is due to learning to care for acutely ill patients amongst staff, resource shortages, fear of making mistakes during high-intensity workloads and stressful learning environments.³

When compared with the general population of the same age, university students have more mental health problems, such as depression, anxiety, suicidal thoughts, psychosis, addiction, suicide risk, the use of mental health drugs and other chronic mental illnesses.⁵

The plight of extensions

A study comprising 3,736 undergraduate nursing students showed that students struggled to adjust and cope with stress arising from their nursing programs. This was particularly felt among third-year students nearing completion with increased responsibilities and autonomy.³ Students with mental ill-health require more academic support, such as individual follow-up and extending assignment due dates.⁶

Higher education institutions support nursing students needing to request extensions on assignments for various reasons, such as personal or family illness, unexpected emergencies, or other unforeseen circumstances. It is up to the discretion of the nursing faculty to determine whether an extension is warranted, and they may require documentation or other evidence to support the request. By providing reasonable accommodations, higher education institutions can help ensure the success and wellbeing of their students while maintaining academic standards. What students do not often factor in, is the flow-on effect an extension may have on subsequent assessments, often leading to further distress and management issues of academic workload.

For example, in 2022, one nursing subject saw 839 student enrolments, of which 92% of the student cohort (n=769) requested an extension on an assignment. By far, the reasons for requesting an extension was poor mental health impacting on workload and academic study, mental distress, and anxiety. The plight of extensions on nursing teachers means that most teacher-student time goes into administrative tasks and individual-topic counselling time with students in distress. Whilst staff are empathetic to situations causing stress, each extension request read, review, reset, further marking provision, assignment drop box settings and communication with students would take a minimum of five minutes. The time totalled a minimum of 64 hours of one semester and one nursing subject, almost two full weeks of work dedicated to extensions, on top of other expected work.

Another aspect is that many nursing teachers feel the emotional demands of the interpersonal interactions with distressed students. Emotion is a compelling factor in the retention and job satisfaction of professionals, and the impact of emotions, feelings, and reactions has become an issue in the nursing teaching workforce.⁷ Even though nursing students’ mental health can be a significant factor in their need to request extensions on their assignments, and the demanding nature of nursing school can lead to high levels of stress and anxiety, which can negatively impact a student’s ability to complete their work within the designated timeframe, the impact of approving or rejecting extensions for nursing teachers has by some been described as ‘emotional blackmail’ and can lead to lowered job satisfaction and high turnover of staff.⁷

Furthermore, the mental load is a common reason for burnout in nursing students and a common reason for why they are ‘dropping out’ of the degrees before completion, and this could impact on the profession of nursing, which is already in desperate need of more qualified nurses.^8,9

What interventions improve students’ wellbeing

One way to mitigate student distress could be to implement support officers. Nursing student support officers play a vital role in ensuring the success and wellbeing of nursing students. These professionals provide students with guidance, support, and resources to help them navigate the challenges of nursing school. Nursing student support officers can assist students in accessing academic support services, such as tutoring and study groups, and can assist with time management, organisation, and study skills. Additionally, they can provide emotional support to students struggling with the demands of nursing school, such as stress or anxiety. By working closely with nursing students, support officers can help them to achieve their academic and personal goals while promoting their overall health and wellbeing. However, research conducted in Northern Ireland found that only 4% of university students seek help from their institution.⁵

Other interventions to improve student wellbeing are free mental health and wellbeing support programs and 24/7 confidential counselling.⁵ Midwifery research evaluated ‘student support circles’, which were reflective groups for all first-year students at two Australian education institutions, and the student support circles were found ‘extremely useful’ by 30%.¹⁰ Organisations, particularly academic ones, continually add to staff scope of practice without adding to their knowledge base. A further intervention is to improve the training in mental health for academic and professional staff within the University. A study comprising over 5,000 students showed that although effective, increasing rates of mental ill-health among students in higher education have led to rising demand for campus counselling services and longer waiting times for at-risk students.¹ Some higher education institutions limit counselling to six sessions,¹¹ whilst COVID-19 has caused significant disruption, particularly evident within the university student population where their traditional ways of learning were abruptly reorganised and support structures removed.⁶

Concluding remarks

Nursing students are at risk of experiencing mental health challenges due to the demanding nature of their studies and the stresses of the healthcare environment. This can potentially impact nursing teachers’ wellbeing and job satisfaction. Students are often exposed to high levels of stress, including long hours of study, clinical rotations, and exposure to patients with complex and sometimes traumatic medical conditions. As a result, it is essential for nursing schools to prioritise the mental health and wellbeing of their students. This can be achieved by providing support services, such as counselling and therapy, mindfulness, and stress reduction techniques, and promoting healthy lifestyles in addition to the required learnings for the qualification. Additionally, nursing schools can work to create a supportive and inclusive learning environment, fostering a sense of community and collaboration among students and nursing teachers. By doing so, nursing schools can help their students thrive both academically and personally, thus producing balanced and well-rounded graduates who can carry these skills into the broader nursing profession.

References

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2. He FX, Turnbull B, Kirshbaum MN, Phillips B, Klainin-Yobas P. Assessing stress, protective factors and psychological well-being among undergraduate nursing students. Nurse Educ. 2018 Sep 1;68:4–12.

3. Li ZS, Hasson F. Resilience, stress, and psychological well-being in nursing students: A systematic review. Nurse Educ. 2020 Jul 1;90:104440.

4. Kotera Y, Cockerill V, Chircop J, Kaluzeviciute G, Dyson S. Predicting self-compassion in UK nursing students: Relationships with resilience, engagement, motivation, and mental wellbeing. Nurse Educ Pract. 2021 Feb 1;51:102989.

5. Cilar L, Barr O, Štiglic G, Pajnkihar M. Mental well-being among nursing students in Slovenia and Northern Ireland: A survey. Nurse Educ Pract. 2019 Aug 1;39:130–5.

6. Alomari A, Hunt L, Lord H, Halcomb E, Fernandez R, Middleton R, et al. Understanding the support needs of Australian nursing students during COVID-19: A cross-sectional study. https://doi.org/101080/1037617820211997147 [Internet]. 2021 [cited 2023 Mar 20];57(3–4):258–68. Available from: https://www.tandfonline.com/doi/abs/10.1080/10376178.2021.1997147

7. Lo WY, Lin YK, Lin CY, Lee HM. Invisible erosion of human capital: The impact of emotional blackmail and emotional intelligence on nurses’ job satisfaction and turnover intention. Behavioral Sciences 2023, Vol 13, Page 37 [Internet]. 2022 Dec 31 [cited 2023 Mar 20];13(1):37. Available from: https://www.mdpi.com/2076-328X/13/1/37/htm

8. Valero-Chillerón MJ, González-Chordá VM, López-Peña N, Cervera-Gasch Á, Suárez-Alcázar MP, Mena-Tudela D. Burnout syndrome in nursing students: An observational study. Nurse Educ. 2019 May 1;76:38–43.

9. Bakker EJM, Verhaegh KJ, Kox JHAM, van der Beek AJ, Boot CRL, Roelofs PDDM, et al. Late dropout from nursing education: An interview study of nursing students’ experiences and reasons. Nurse Educ Pract. 2019 Aug 1;39:17–25.

10. Oates J, Topping A, Arias T, Charles P, Hunter C, Watts K. The mental health and wellbeing of midwifery students: An integrative review. Midwifery. 2019 May 1;72:80–9.

11. Broglia E, Millings A, Barkham M. Challenges to addressing student mental health in embedded counselling services: a survey of UK higher and further education institutions. https://doi.org/101080/0306988520171370695 [Internet]. 2017 Jul 4 [cited 2023 Mar 20];46(4):441–55. Available from: https://www.tandfonline.com/doi/abs/10.1080/03069885.2017.1370695

Authors

Dr Nina Sivertsen RN, BN(Hons), Grad Cert Ed (Higher Ed), PhD is Senior Lecturer, Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide South Australia

Paul Cooper, MA MH Nursing is Associate Lecturer and Student Engagement Coordinator, College of Nursing and Health Science, Flinders University, Adelaide, South Australia

Tahlia Johnson BMidwif, BHlthSc(Hons) is Lecturer in Aboriginal Health, College of Medicine and Public Health, Flinders University, Adelaide South Australia

Tegan Putsey RN, BNg (Hons), RM, BM, MACN is Associate Lecturer in Nursing, Teaching Specialist (Clinical), College of Medicine and Public Health, Flinders University, Adelaide South Australia

David Copley RN, BNg, Grad Dip (MHN), Dip App Sc (Dev-Dis), Cert 1V TAE is Mental Health Academic – Rural and Remote Health (SA), College of Medicine and Public Health, Flinders University, Adelaide South Australia