The students were only exposed to checking an emergency trolley, which is a skill linked to emergency nursing. According to students, this was insufficient for application in emergency situations such as resuscitation. Students asserted:

Citolino et al. (2015) conducted a study in Brazil on factors affecting the quality of cardiopulmonary resuscitation (CPR) in inpatient units. They also identified that participants were not familiar with the emergency trolley (98.0%) and lacked harmony during CPR. Although nurses are responsible for checking and restocking the emergency trolley, they have insufficient knowledge and practice in this regard (Kaushik 2019).

Salifu, Heymans and Christmas (2022) conducted a study in Ghana on the exploration of nursing students’ experience and perception in the teaching and learning of clinical competencies and found non-prioritisation of practical skills. This is a concern, as patients who are admitted to emergency units are at high risk of acute deterioration and death (Bogossian et al. 2013). Considine et al. (2021) observed an increase in mortality in emergency units when deterioration in the patient’s condition is not identified and responded to promptly.

Skills laboratories are safe spaces for student nurses to be prepared to recognise and intervene when a patient’s condition worsens and to prevent patient death. The use of immersive technologies such as virtual reality (VR) and augmented reality (AR) makes clinical education more life-like (Sipamla 2022). Together with training in basic life support, the use of these technologies in clinical education prepares student nurses for the real world, for example, the training of students in triaging, to initially assess and prioritise patients using the South African Triage Score.

The discrepancy between the teaching of clinical skills and the practice of skills in the emergency unit was highlighted. A student explained:

However, such discrepancies should be used as discussion points between students, clinical facilitators and emergency nurses to develop students’ critical thinking and clinical reasoning.

Kertu and Nuuyoma (2019) conducted a study among student nurses and found an inconsistency between theory and clinical practice, which caused confusion and discouragement. Hashemiparast, Negarandeh and Theofanidis (2019) argue that performing clinical skills in a skills laboratory is different from when performing it in clinical practice. Some emergency clinical skills, according to Kalyani et al. (2019), are not easy to simulate. Hence, Svellingen et al. (2021) suggest integration of simulation and practice (Sipamla 2022).

Curricula must therefore be reviewed to establish the effectiveness of clinical learning and the integration of knowledge and skills (Abu Salah, Aljerjawy & Salama 2018). This allows for the alignment of learning and teaching to evolving nursing practice (Fawaz, Hamdan-Mansour & Tassi 2018). Collaboration between higher education institutions and speciality clinical areas is, however, essential to ensure the smooth integration of theory to practice.

Students were dissatisfied with their preparation around the specific learning outcomes and prerequisite knowledge required for placement in the emergency units. They were unclear about their roles and duties in the emergency unit (Sipamla 2022). This was expressed as follows:

Studies by Dulandas and Brysiewicz (2018) in KwaZulu-Natal and by Aloyce, Leshabar and Brysiewicz (2014) in Dar es Salaam revealed that most nurses working in emergency units lack formal training in emergency nursing. The lack of training, according to Aloyce et al. (2014), affects clinical judgement and threatens effective emergency management, which increases the risk of disability and mortality. According to Hynus and Karama (2017), formal and structured emergency nursing guidelines and a well-trained workforce are needed to deliver quality emergency care (Sipamla 2022). According to the CCARE model, effective collaboration and feedback between the preceptors, clinical facilitators and students regarding students’ learning needs and the gaps could have prevented students’ negative experiences (Zyoud 2023).

The lack of synchrony between theory and practice was highlighted. Lectures on emergency nursing did not coincide with simulation in the skills laboratory and placement for work-integrated learning. Students opined that they also had limited exposure to emergency units and did not rotate to all types of emergency units, resulting in lost learning opportunities. A student reported:

Kalyani et al. (2019) found that inadequate educational planning led to difficulties in the clinical setting, particularly in terms of insufficient preparedness and diminished self-confidence. Similarly, Safazadeh et al. (2018) highlighted that ineffective planning in education often results in students engaging primarily in routine tasks within emergency units. Aligning students’ clinical experiences with theoretical preparation is therefore critical to facilitate effective learning (Saifan et al. 2021).

Students reported a lack of consistency in communication between the nursing school and the healthcare facility where they undertook work-integrated learning. They indicated that the breakdown in communication negatively impacted their learning experiences in emergency units. The absence of clearly defined roles and learning outcomes led to inadequate supervision and guidance from clinical nursing staff. Furthermore, students felt apprehensive about expressing their learning needs within the clinical setting. They believed that improved communication between the school of nursing, clinical facilities and students could boost their confidence and motivation to engage in learning within emergency units (Sipamla 2022). Students reported:

This finding corroborates results by Jahanpour et al. (2016) on nursing students in Iran and by Fadana and Vember (2021) in the Western Cape, which found that poor communication between nurse educators, clinical nurses and student nurses negatively impacted students’ clinical learning experience (Sipamla 2022). Mamaghani et al. (2018) similarly identified issues of educational ambiguity among participants in Iran, which contributed to confusion in the learning process. Such challenges have been linked to a range of negative emotional responses among student nurses, including feelings of vulnerability, anxiety, worry, decreased confidence and motivation, a sense of isolation and a lack of preparedness during clinical training (Atakro et al. 2019; Farzi, Shahriari & Farzi 2018). Jamshidi et al. (2016) suggest that proper communication increases students’ motivation. According to the CCARE model, collaboration is a key behaviour for linking theory to practice (Zyoud 2023). Evidently, collaboration between the clinical facilitators, preceptors and students, regarding the synchrony of theory and practice and learning outcomes for work-integrated learning, is crucial to improve students’ experiences.

Students reported insufficient theoretical knowledge and exposure to clinical competencies prior to their placement in emergency units for work-integrated learning. They highlighted limited exposure to emergency units and noted a disparity between their expectations and the actual demands encountered in emergency units. According to the students, the lack of preparedness hindered their readiness for clinical practice in emergency units. This contrasts with the view of Althiga et al. (2017), who assert that student nurses should have a solid theoretical foundation, essential clinical skills, effective communication, cultural competence, professional values and ethical behaviour before clinical placement (Sipamla 2022). The following were students’ assertions:

These findings support those of Wahyuningsih et al. (2020), who found that 77.3% of student nurses felt unprepared to manage emergency situations because of limitations in their education and clinical experience. Similarly, Memarian et al. (2015), in a study involving nursing students in Iran, identified several barriers to effective clinical learning, including insufficient theoretical knowledge, inadequate clinical preparation and a lack of proper clinical supervision (Sipamla 2022).

Majority of the students reported experiencing emotional distress during their clinical placements, primarily because of unexpected exposure to traumatic events for which they felt unprepared. Consequently, many indicated a need for emotional support as they found that supportive resources within the clinical environment were insufficient. Students perceived that such traumatic experiences often elicited a range of negative emotional responses, including fear, anxiety and sadness (Sipamla 2022). The following was shared:

According to Sipamla (2022), students experienced psychological trauma as a result of their exposure to critical incidents in the trauma unit. These findings are supported by Motsaanaka, Makhene and Ally (2020), whose study on student nurses’ clinical placement experiences in Gauteng revealed that students frequently encountered negative emotional responses. Emotional distress among student nurses has also been linked to their strong desire to save lives despite lacking the necessary clinical experience (Getiérrez-Puertas et al. 2021). Similarly, Jiménez-Herrera et al. (2020) reported in Spain that emergency nurses often face emotional challenges when they are unable to implement best practices because of external constraints. These nurses, being morally attuned to patient vulnerability, experience a loss of control in situations where they are prevented from delivering optimal care, which in turn leads to negative emotions such as helplessness, frustration, anger and guilt (Getiérrez-Puertas et al. 2021; Jiménez-Herrera et al. 2020).

The emergency care unit is a dynamic and unpredictable environment, with a constant influx of diverse patients, which can be overwhelming for students. Although this setting can stimulate motivation to learn, it also fosters feelings of helplessness and fear of the unknown. Meng et al. (2019) argue that clinical facilitators play a critical role in reducing this psychological stress by properly orienting and supporting students. Although somewhat limited, evidence suggests that realistic simulation-based training can enhance students’ understanding, communication skills and psychological readiness to cope with complex clinical settings (Zeng et al. 2020).

Students reported experiencing fear, nervousness and a sense of helplessness while placed in emergency units. These emotional responses were primarily attributed to their anxiety about managing unpredictable and unfamiliar situations, compounded by a perceived lack of preparedness. Reflecting on their experiences, students noted that exposure to unforeseen clinical scenarios triggered negative emotions, which in turn adversely affected their ability to engage effectively in the learning process within emergency care settings (Sipamla 2022). Students mentioned the following:

Belayneh et al. (2021), in a study conducted in Ethiopia, reported that nurses employed in emergency units experienced elevated levels of anxiety. To mitigate anxiety during clinical placements, Simpson and Sawatzky (2020) recommend that nurse educators adopt proactive strategies, including providing thorough orientation, conducting pre-clinical workshops, ensuring students possess foundational knowledge and incorporating simulation-based learning. Feedback, as a means of collaboration is key, according to the CCARE model (Zyoud 2023). As proposed by the model, regular meetings and in-service training could afford the student the space to share their concerns, fears and anxiety, which could be addressed timeously by the preceptors and clinical facilitators (Sipamla 2022).

Students reflected on their experiences of work-integrated learning and the informal exchange of knowledge among nursing staff. They described emergency units as dynamic, high-pressure environments characterised by complexity and unpredictability when dealing with a wide range of patient conditions. According to the students, emergency nursing demands specialised expertise and the ability to adapt quickly, think critically, prioritise care, manage complex situations and implement resuscitative interventions, all within a collaborative multidisciplinary framework. They viewed this clinical setting as offering valuable hands-on learning opportunities that not only enhanced their motivation but also provided insight into the scope and specialised nature of emergency nursing practice (Sipamla 2022). Students stated the following:

This is congruent with a study done in Sweden by Ewertsson et al. (2017), which reported that student nurses experience of hands-on learning is important to complement previous knowledge and increase students’ confidence. The development of clinical experience and competence is highly dependent on sufficient clinical exposure of student nurses (Sipamla 2022).

Several students reported inadequate clinical supervision during their placements. They indicated that clinical facilitators appeared primarily concerned with verifying clinical hours rather than actively engaging in clinical teaching. Facilitators often lacked clarity regarding their supervisory role within the emergency unit, which resulted in students being assigned routine tasks instead of participating in meaningful learning activities. The absence of defined roles and specific learning outcomes for the placement further hindered meaningful clinical engagement. Students emphasised that effective clinical supervision is essential for bridging the gap between theoretical knowledge and clinical application, as well as for mitigating negative emotional experiences during work integrated learning. A student commented:

Their experiences are aligned with the findings of a study on student nurses by Berhe and Gebretensaye (2021) in Ethiopia, which reported on clinical supervision inadequacy. Clinical supervision is one of the pillars in nursing education, which is necessary for efficient learning and teaching in clinical education (Donough & Van der Heever 2018). In this regard, clinical facilitators are the first source of student support (Zabihi, Jafarian-Amiri & Qalehsari 2020). Atakro et al. (2019) and Safazadeh et al. (2018) revealed that clinical supervision in emergency units is difficult because of some clinical facilitators being inexperienced, having insufficient knowledge and showing incompetence in working with some equipment in emergency units. This leads to student nurses expressing feelings of vulnerability, anxiety, worry, loss of confidence, motivation, isolation and unpreparedness during clinical learning (Atakro et al. 2019; Farzi et al. 2018).

Some students reported feeling rejected during resuscitation. In their opinion, students lost the learning opportunity and teamwork with the multidisciplinary team. The following were some students’ assertions:

This observation is contrary to findings by Roel and Bjørk (2020) and Nasr-Esfahani, Yazdannik and Mohamidiriz (2019), who argued that nursing students should be able to initiate and perform CPR when they start their nursing career. Often, the nurse arrives first at a scene of cardiac arrest in the hospital; therefore they must be competent in CPR.

Student’s rejection at the point of CPR results in loss of the opportunity to experience and perform the procedure, master the skill, transfer theory into practice and reduces interaction with the multidisciplinary team, patient and family (Memarian et al. 2015).

Students indicated they are regarded as part of the team and not a student with learning needs. Students reported that they often did routine work such as observations, transferring patients to the ward and theatre and were asked to work in other units because of a shortage of nurses. Based on their reflections, emergency units focused on patient care over student learning needs. There was limited exposure, insufficient support, guidance and supervision both from clinical facilitators and facility staff.

Some students reported:

Using student nurses as an extra pair of hands results in inadequate exposure to learning experiences, while doing routine duties lead to frustration (Jamshidi et al. 2016). Engaging in routine-based tasks and repetitive procedures may also reduce student’s motivation to learn.