Changes and continuities in undergraduate nursing education during and after COVID-19: a European comparative study from the perspective of health science

Background: The education of healthcare professionals, including nurses, represents a critical intersection with health systems science (HSS), which is often considered the third pillar of healthcare education alongside basic and clinical sciences. Despite the amount of research on nursing education during the COVID-19 pandemic, there remains a gap in analysis from an HSS perspective. Methods: A Comparative Education Approach involving undergraduate nursing programs (UNPs) across Europe, with longitudinal data collection from 2002 to 2023. The aim of the study was threefold: (a) to summarize the overall changes in UNPs during the COVID-19 pandemic; (b) to identify the changes retained in the post-pandemic era; and (c) to identify the impact of the pandemic on nursing education as perceived by nurse educators across nine European countries. Results: This study compares the changes in nursing education in European countries during and after the COVID-19 pandemic using a qualitative approach with data from nine universities. The COVID-19 pandemic had a significant impact on education provision. During the first wave, government restrictions forced a complete shift to online learning for theory classes, clinical training and laboratories. In subsequent waves, a hybrid format was chosen that combined online and face-to-face sessions. A major challenge was the placement of nursing students alongside general university students. This approach neglected their need for practical clinical training, which is crucial for their future careers. To compensate for the lack of clinical hours, various alternative teaching methods were introduced. Students were also offered the opportunity to volunteer in large-scale public health initiatives such as vaccination and testing campaigns, although bedside care for COVID-19 patients remained limited. The pandemic has also left its mark in the post-pandemic period. Some UNPs have retained elements of online education, notably lectures, research seminars, meetings, consultations and even online exams. Interestingly, an initial increase in applicant numbers was observed at six of the nine participating UNPs. Conclusions: The COVID-19 pandemic has widened the gap between university-educated nurses and the clinical setting, i.e. between theory and practise, underlining the importance of HSS in nursing education. Rebuilding strong partnerships is crucial, but simply returning to the pre-pandemic model is not enough. To ensure uninterrupted education during future crises, proactive planning, including the creation of predefined protocols for collaboration, is essential. The pandemic underscores the need for closer alignment between the two sectors, which would better equip future nurses with the skills they need to thrive in the nursing workforce and ensure they are prepared for the challenges of the 21st century.