Background The final semester of nursing education is a stressful period as students prepare to transition from academic training to professional practice. This transition requires readiness, including clinical competence, psychological preparedness, and the ability to apply theoretical knowledge in patient care. Objective To explore how nursing students nearing graduation describe their transition into their future roles as registered nurses. Design Qualitative exploratory design. Setting A university in Sweden. Participants Twelve final-semester nursing students. Methods Data were collected through focus group interviews (n = 3) and individual interviews (n = 5) between November 2022 and January 2023. Inductive qualitative content analysis was applied. Results One overarching theme emerged: Leaving security—transitioning into an unpredictable storm with a feeling of ambivalent readiness. Five categories were identified: Reflecting on the nurse’s role, Feeling ready but insecure, Continued learning process after graduation, Challenges and concerns regarding future profession, and Dealing with uncertainty in the new role. Conclusions Students felt prepared and eager to begin professional practice while recognizing its complexity and challenges. They remained confident, humble, and optimistic in facing their new role.
Background The global nursing human health resources crisis has reduced mentor availability and constrained apprenticeship-based learning. Electrocardiogram (ECG) interpretation, a recognized core nursing competency, exemplifies this challenge: Persistent gaps in ECG knowledge, confidence, and clinical application remain insufficiently addressed by current educational models. Innovation Drawing on current evidence of ECG competency deficits, this paper proposes a physiology-reinforced, theory-grounded instructional model for associate degree and undergraduate nursing programs. The six-step approach integrates cardiac physiology with constructivist learning strategies, case-based learning, simulation, and digital modalities. Instructional design is aligned with staged outcome assessment frameworks (Moore’s Outcomes Framework and Miller’s Pyramid) to support evidence of competency development over time. Implications The framework offers practical guidance for curriculum design, faculty workload planning, and continuing professional development in environments where mentorship capacity is limited. Conclusions Foundational skills education must be intentionally redesigned for conditions of limited mentorship. This scalable, theory-grounded approach has direct application to nursing programs facing sustained human health resources shortages.
Background Generative artificial intelligence (AI) tools are increasingly integrated into nursing education, although evidence regarding their impact on objective learning outcomes remains limited. Aim To evaluate the effect of a GPT-based ADPIE educational assistant on nursing care planning performance among undergraduate nursing students. Methods: A randomized controlled educational study was conducted among 70 third year nursing students in Morocco. Participants were allocated to either a GPT-based ADPIE assistant group or a control group using conventional learning resources. The primary outcome was the nursing care planning performance score assessed using a standardized rubric. Secondary outcomes included confidence, satisfaction, cognitive workload, and task completion time. Results The intervention group achieved significantly higher nursing care planning performance scores than the control group (77.2 ± 4.2 vs 71.4 ± 5.1; p < 0.001). Confidence and perceived usefulness and satisfaction scores were significantly higher, whereas perceived cognitive workload was significantly lower in the intervention group. No significant difference was observed in task completion time. Conclusion A structured GPT-based educational assistant may improve expert-rated nursing care planning performance and support the systematic organization of the ADPIE process in undergraduate nursing education.
Background Despite meeting academic and licensure requirements, many new graduate nurses report feeling unprepared to manage patient assignments, prioritize competing demands, and complete documentation in real time. Traditional nursing curricula often emphasize isolated skill performance and retrospective care planning, contributing to novice nurse transition shock during entry into professional practice. Innovation This educational scholarship paper presents a theory-informed framework designed to intentionally leverage simulation to develop patient assignment management and documentation competency. The framework was progressively implemented within a prelicensure nursing program, with simulation complexity increasing across semesters. In the final semester, students participated in a sustained advanced assignment simulation embedded within a structured instructional block, managing multiple patient assignments while completing real-time electronic health record documentation. Workflow fidelity elements, including barcode medication administration, provider communication, and structured interruptions, were incorporated to replicate authentic clinical demands and support progressive development of clinical judgment and prioritization skills. Implications Purposeful simulation design that integrates progressive patient load, workflow fidelity, and sustained cognitive engagement may better prepare graduates for contemporary practice and support smoother transitions into professional roles. Conclusions Restructuring simulation to emphasize concurrent patient management offers a feasible and scalable approach to strengthening practice readiness. Further research is warranted to examine its impact on transition shock, clinical performance, and transition-to-practice outcomes.
Background Simulation programs play a critical role in supporting nursing students’ transition into clinical practice, making ongoing evaluation essential. Aim This quality improvement project examined the impact of a final-semester, multipatient simulation and explored additional simulation experiences students believed would have further enhanced their readiness for clinical practice. Methods Using a survey with both closed- and open-ended questions, data were collected from two cohorts (Spring 2024 and Spring 2025). Quantitative survey data were analyzed using Excel descriptive statistics to calculate mean scores for the Likert-scale items. Qualitative responses were reviewed through content analysis. Results Students reported increased confidence, stronger patient management abilities, and improved prioritization skills when caring for multiple patients. Students further illustrated how the simulation supported the transition to practice and identified opportunities for expanding simulation activities to better prepare students for clinical demands. Conclusions These findings highlight the importance of evaluating simulation outcomes and considering curriculum revisions to optimize students’ readiness for clinical practice.
Background As healthcare systems grow more complex, nursing graduates—particularly digital learners—require more than theoretical knowledge. They benefit from active, technology-integrated, and student-centered approaches that strengthen clinical judgment, critical thinking, and interprofessional communication. End-of-life and stroke care remain challenging due to limited exposure in traditional clinical placements, making adaptation to digital learning preferences essential for improving competence and retention. Innovation Faculty implemented a competency-based intervention emphasizing experiential learning. Instruction shifted from lecture-based delivery to an immersive learning center designed for active engagement. Students participated in simulations and skill stations addressing dysphagia screening, aspiration precautions, thrombolytic dosage calculation, postmortem care, therapeutic communication, and family support. Each session included structured prebriefing, simulation and skills rotations, and reflective debriefing. Implications General surveys and faculty observations revealed high satisfaction and engagement. Learners demonstrated improved clinical reasoning, particularly in stroke care and compassionate end-of-life care. Students requested additional opportunities for this learning format. Conclusion Immersive pedagogies offer scalable, learner-centered strategies to bridge theory-to-practice gaps and enhance readiness for nursing practice.
Background Evaluation rubrics are essential for systematizing and measuring clinical competency progression in nursing simulation. Aim To identify the rubrics used to assess clinical competencies and skills in nursing simulation. Method An integrative review was conducted across nine databases in August 2025. Study selection was double-blind. Methodological quality was assessed using the Medical Education Research Quality Assessment Instrument. Results Initially, 905 studies were identified, and 41 comprised the final sample. Thirteen different rubrics were found, with a prevalence of studies using the Lasater Clinical Judgment Rubric. Most studies had moderate methodological quality. The evidence shows that the use of rubrics favors clinical judgment, self-confidence, and the structuring of formative feedback. Conclusion Rubrics are gaining pedagogical maturity in simulation, consolidating themselves as essential tools for competency-based nursing curricula. However, the lack of psychometric validation in specific instruments and the need for tools for new digital modalities represent the main challenges for the area.
Background Black women in the United States experience disproportionately high breast cancer mortality driven by complex structural, social, and clinical factors that shape access to high-quality care. Nursing education plays an important role in preparing nurses to recognize and respond to the multilevel contributors that sustain these disparities. Innovation/major points This article demonstrates how the 5W organizational tool deepens learners’ understanding of inequitable breast cancer outcomes by examining what is occurring within a disparity, why inequities persist, who is most affected, when gaps emerge across the care continuum, and where nursing interventions can be implemented. Grounded in this structure, the 5Ws support integration of equity-focused concepts across academic and clinical environments to strengthen equity-centered decision making. Implications Barriers to implementation exist at interpersonal, cultural, institutional, and societal levels, underscoring the need for intentional curricular design, alignment with equity-focused competencies, and incorporation of policy-relevant content within nursing programs. Conclusions Equipping nurses with equity-centered competencies are essential for addressing breast cancer disparities among Black women and strengthening health equity across the cancer care continuum.
Background Simulation-based strategies are widely used to support prelicensure nursing student learning; however, faculty development opportunities focused on clinical instructors’ feedback skills remain limited. Purpose The purpose of this quality improvement project was to evaluate the impact of role-play Tag Team simulation (TTS) on newly hired clinical instructors’ confidence and preparedness to provide formative feedback in clinical settings. Methods TTS was incorporated into in-person clinical instructor orientation. Preintervention, postintervention, and 3-month follow-up surveys measured instructors’ perceived confidence and self-reported use of feedback strategies during trimester clinical orientation sessions. Data was collected from two cohorts of newly hired clinical instructors. Results Participants reported varied baseline confidence levels. Postintervention survey results indicated that 100% of respondents perceived increased confidence in providing feedback. Three-month follow-up results demonstrated sustained confidence and continued application of selected communication strategies. Conclusions Findings suggest TTS is a feasible and effective teaching and learning strategy for clinical instructor development. Further education-focused research is needed to examine how role-play simulation can be used as an educational strategy for the professional development of newly hired pre-licensure clinical instructors.
Background Digital learning resources (DLRs) may support statistics learning in nursing education, but evidence in this field remains limited. Aims To examine whether a DLR-based educational intervention was associated with improved statistics performance among nursing students. Methods A quasi-experimental one-group pretest-posttest study was conducted with 186 second-year nursing students at a Chilean university. Students completed three interactive DLRs on probability, normal distribution, and confidence intervals during a statistics course. Performance was assessed using an 18-item multiple-choice test administered before and after the intervention. Pre-post differences were analyzed using paired Wilcoxon signed-rank tests. Results Overall scores improved significantly after the intervention (median 6.0 vs. 8.0; p < .001). Significant improvements were also observed for all three learning outcomes. Effect sizes were positive, ranging from small to moderate. Conclusions The implementation of DLRs was linked to higher scores in the statistics course among nursing students. These results endorse DLRs as a valuable supplementary tool for teaching quantitative concepts in nursing education.
Background Research on shadowing in nursing education has focused mainly on student experience or on preceptorship more broadly, leaving nurses’ views of shadowing as a distinct observational activity insufficiently examined. Aim To clarify the practical conditions under which shadowing becomes educationally workable and sustainable in undergraduate nursing education by examining clinical nurses’ perceptions of its value, burden, and implementation requirements. Methods We conducted a convergent mixed-methods survey of 53 nurses at Japanese university hospitals. Quantitative data were summarized descriptively, organized into provisional dimensions using exploratory factor analysis, and compared across groups with exploratory Welch’s t-tests. Free-text responses were analyzed inductively and integrated with the quantitative findings through a joint display. Results Preceptor training was associated with higher scores for teaching behaviors and evaluation/collaboration. Across the quantitative and qualitative findings, shadowing appeared most workable and sustainable when observation goals were shared, reflection was brief but structured, and simple clinical-academic coordination was in place. Conclusions Sustainable shadowing may be supported by shared observation goals, brief reflection, and simple clinical-academic coordination.
Background Mentoring in nursing has been a long-established practice, yet literature offers limited guidance on how mentoring programs might be developed and implemented in an academic setting. Innovation This paper describes the creation, implementation, and evaluation of a faculty-led mentoring program informed by the AACN/RWJF Mentoring Program Toolkit and Crisp’s mentoring framework. Key components include defining mentoring, setting the learning goals through a needs assessment, recruiting faculty mentors, structuring mentor-mentee interactions, and evaluating program satisfaction. Implications Effective mentoring programs begin with a comprehensive student needs assessment, followed by establishment of clear definitions, faculty mentor recruitment, resource consolidation, and intentional relationship development. As students progress through their nursing education, their needs evolve, necessitating sustained mentor engagement and adaptive support. Conclusions Faculty-led student mentoring programs can create meaningful connections and address key student needs, despite challenges such as faculty workload and increasing enrollment. Long-term program success depends on resource investment and formal recognition of mentoring as essential to nursing education.
Background The American Association of Critical-Care Nurses (AACN) has prioritized establishing and sustaining healthy work environments (HWE). The HWE framework consists of six evidence-based standards: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership. Major points This article offers actionable strategies for operationalizing the standards in both classroom and clinical learning environments. Through applied curricular examples, academic–practice partnerships, and evaluation strategies, the authors illustrate how intentional integration of the HWE standards is associated with student professional identity formation, faculty well-being, and sustainable clinical practice behaviors. Implications Using the HWE standards, nursing faculty can foster an academic environment that promotes well-being, job satisfaction, and retention among educators while enhancing students’ learning experiences, critical thinking, and readiness for clinical practice. This will help shape the next generation of nurses to advocate for themselves, their patients, and the healthcare team. Conclusion Intentionally integrating AACN’s HWE standards in classroom and clinical settings can improve the work environment for faculty, staff, and students and can ultimately improve care and outcomes for patients and their families.
Background Neonatal intensive care units (NICUs) are high-acuity, emotionally demanding learning environments. How students translate emotional experiences into professional learning remains underexplored. Objective This study aimed to explore undergraduate nursing students’ experiences of NICU observation according to Kolb’s experiential learning cycle, and to identify its perceived influence on students’ life perception, professional understanding, clinical awareness, and career development. Methods A qualitative descriptive study was conducted in a tertiary hospital NICU in China. Reflective journals voluntarily submitted by undergraduate nursing students were screened, and 17 eligible journals were included and analyzed thematically. Results Four themes emerged: emotional impact and life perception; deepening of professional nursing cognition; perception of comprehensive clinical competence and professional norms; and professional identity and career development. Students progressed from emotional reactions to integrated clinical understanding. Conclusions NICU observation grounded in Kolb’s experiential learning theory may foster reflections on life, deepen understanding of nursing practice, enhance clinical competence and professional values, and promote professional identity and career development.
Aim To evaluate the effectiveness of a structured peer study group intervention in improving undergraduate nursing students’ learning outcomes related to the care of children with congenital heart defects. Methods This quality improvement project used a pretest–posttest comparison design involving 64 undergraduate nursing students assigned to either a peer study group intervention or standard learning activities. The intervention focused on clustering nursing care, early recognition of heart failure, and accurate oxygen therapy administration. Learning outcomes were measured using a 26-item knowledge test. Descriptive statistics, Welch independent-samples t tests, and paired-samples t tests were used. Results Baseline scores were similar between the control group (M = 16.50, SD = 2.03) and intervention group (M = 16.56, SD = 2.73), t(57.23) = 0.10, p = .918. Posttest scores favored the intervention group (M = 22.81, SD = 3.02) over controls (M = 19.09, SD = 3.99), t(57.72) = 4.20, p < .001, d = 1.05. Conclusion Structured peer study groups offer a feasible, low-resource strategy for improving applied pediatric cardiac nursing knowledge.
Background The Next Generation NCLEX (NGN) emphasizes clinical judgment as a core entry-to-practice nursing competency. Pre-licensure nursing programs must implement instructional strategies that support the development of clinical reasoning while engaging diverse learners. Innovation This paper describes an NGN-aligned unfolding case-based learning model implemented in a pre-licensure nursing program at a historically Black university in the southern United States. The innovation integrates Tanner’s Clinical Judgment Model with the NCSBN Clinical Judgment Measurement Model (NCJMM) to guide case development, NGN-style item construction, and structured faculty-guided debriefing. Implications The approach embeds culturally responsive patient scenarios and social determinants of health within unfolding cases to promote student engagement and support repeated clinical judgment practice. Standardized facilitation guides and structured debriefing promote consistent implementation across course sections. Conclusions NGN-aligned unfolding case-based learning offers a practical strategy for strengthening clinical judgment and supporting professional identity formation among pre-licensure nursing students. The model provides a replicable approach for educators seeking to align curriculum with NGN expectations.
