Virtual learning modalities and clinical competence in baccalaureate nursing education: An integrative review

The COVID-19 pandemic accelerated the use of digital education in nursing, including simulation, virtual reality (VR), telehealth, and AI-supported tools. Despite increased access and engagement, concerns remain about preparation for clinical practice.

To examine associations between virtual learning modalities and clinical competence and workforce readiness among undergraduate nursing students.

The authors conducted an integrative review guided by PRISMA and SWiM and used Whittemore and Knafl's five-step methodology to synthesize evidence from diverse study designs.

Five themes were identified: foundational skill development, perceived clinical readiness, communication and psychosocial competency, instructional design and faculty capacity, and equity and access. Virtual learning was generally associated with cognitive and affective outcomes, while evidence related to psychomotor skill development and readiness for hands-on care was mixed. Perceived preparedness differed across studies and was commonly described in relation to instructional quality, faculty support, and access to technology.

Virtual learning supports clinical education but does not replace hands-on experiences. Blended models integrating virtual and in-person learning, supported by faculty development and equitable access, are recommended to promote clinical competence and workforce readiness.