Self-Perceived Professional Preparedness of Final-Year Nursing Students for Entering the Profession

1 Katarina Fofić

2,3 Vesna Konjevoda

3 Marta Čivljak

3 Ivica Matić

1 University Hospital Centre Zagreb, Zagreb, Croatia

2 University Hospital Sveti Duh, Zagreb, Croatia

3 Catholic University of Croatia, Zagreb, Croatia Article received: 13.01.2025.

Article accepted: 27.02.2025. https://doi.org/10.24141/2/9/1/6

Author for correspondence:

Vesna Konjevoda

University Hospital Sveti Duh, Zagreb, Croatia E-mail: vesna.konjevoda@unicath.hr

Keywords: nursing students, entering the profession, nursing education

Abstract

Introduction. Nursing students’ preparedness for entering their professional careers is crucial for en- suring quality healthcare.

Aim. To evaluate the self-perceived preparedness of final-year nursing students as they transition into the nursing profession focusing on clinical competen- cies, evidence-based practice, administrative skills, and patient-centered care.

Methods. A cross-sectional observational study was conducted among 200 final-year nursing students from the Catholic University of Croatia and the Uni- versity of Applied Health Sciences. Data were collect- ed using the Professional Preparedness of Nursing Students (PPNS) questionnaire.

Results. Most respondents rated their readiness as excellent. This perception was more prevalent among graduate students (54.2%) compared to undergradu- ate students (44.4%). Part-time students reported significantly higher levels of perceived readiness compared to full-time students (77.94 vs. 71.50).

Conclusion. Final-year nursing students feel ade- quately prepared to enter the nursing profession and commence their professional practice. These findings highlight the importance of recognizing diverse stu- dent experiences and needs in designing educational programs to enhance professional competence.

Introduction

Globally, healthcare systems are navigating unprec- edented challenges in delivering effective care. Changes in healthcare have created demanding working conditions that strain the continuity and quality of services (1). At the same time, the need to provide high-quality, evidence-based care to pro- tect public health has become more urgent (2). These shifts affect all stakeholders in healthcare, from man- agement and frontline staff to students and auxiliary personnel.

Nursing students, who spend a substantial portion of their training in clinical settings, are highly exposed to these pressures. Educators tasked with preparing future nurses recognize the complexities of clinical environments and their influence on student devel- opment (3). Clinical practice provides students with essential exposure to patient care realities. However, ensuring that students are adequately prepared for these experiences is becoming increasingly challeng- ing, undermining the ability to maintain high stand- ards of care and patient safety (4, 5).

Nursing education integrates theoretical knowledge with clinical training, aiming to develop students with critical skills and foster clinical reasoning. Clini- cal placements are pivotal, offering students op- portunities to develop hands-on experience and problem-solving capabilities at the bedside (6). The effective evaluation and ongoing enhancement of clinical education are essential to bridge existing gaps and attain educational objectives, particularly in the training of competent healthcare providers (7). One significant approach to this process is self-as- sessment, which allows students to critically evalu- ate their own clinical performance. This method has been recognized as a valuable tool for improving learning outcomes (8). Furthermore, understanding students’ perspectives on their training experiences offers critical insights that can inform the refinement of educational programs (9).

Despite the emphasis on clinical education, research indicates that many students fail to acquire suffi- cient clinical experience. For instance, studies in Shi- raz and Tehran reported inadequate clinical environ- ments and a lack of essential skills for safe practice among nursing students (10, 11). Similar findings

in Kurdistan and Shahroud revealed gaps in compe- tencies and clinical skills, respectively (12, 13). The transition from student to practicing nurse presents additional challenges.

Newly graduated nurses often face a steep learn- ing curve as they adapt to organizational protocols, policies, and tools unfamiliar from their training (14). Duchscher describes this transition as a process of professional socialization, characterized by learning the skills, knowledge, and values of nursing culture

(15). New graduates often report difficulties with pri- oritization and fulfilling their roles, leading to frustra- tion and a sense of being ill-prepared (16). The tran- sition from nursing education to professional practice is further complicated by organizational challenges and the high expectations placed upon newly gradu- ated nurses by senior colleagues. This dynamic often leads to culture shock and contributes to increased turnover rates within healthcare settings. Despite the critical role that newly graduated nurses play in healthcare systems, their level of preparedness for the demands of the profession remains a significant concern (17, 18). While newly graduated nurses are essential to healthcare systems, their preparedness remains a concern. According to Benner’s novice- to-expert framework, these nurses often lack the technical skills and clinical experience required for independent practice (16). Transitional programs have been implemented in many institutions to ad- dress these gaps, focusing on skill development and role adaptation during the first year of employment. Such programs, while beneficial, are often stressful for participants, highlighting the need for enhanced preparatory training before employment.

Aim

The primary aim of this study is to assess the self- perceived readiness of final-year nursing students as they prepare to transition into professional prac- tice and compare the perceptions of preparedness between full-time and part-time nursing students. The investigation is grounded in the complexities in- herent in nursing education and the dynamics of the transition process. Two primary hypotheses guide

this research. First, we hypothesize that more than half of the final-year nursing students will perceive themselves as adequately prepared for clinical prac- tice. This expectation is based on the structured design of nursing curricula, which effectively inte- grates theoretical knowledge with practical training experiences (19). Second, we propose that part-time students will report higher levels of preparedness compared to their full-time peers. This hypothesis is informed by the additional practical exposure and clinical experience that part-time students typically acquire through concurrent employment in health- care settings. Such dual engagement in both work and academic environments may enhance their con- fidence and overall preparedness to meet the de- mands of professional nursing practice (20).

Methods

This cross-sectional study was conducted in January 2024 to assess the preparedness of final-year nurs- ing students for entering the profession. The study utilized a questionnaire-based approach. Participants were recruited through a link disseminated via email and WhatsApp groups, ensuring a broad outreach to potential respondents. The study emphasized vol- untary participation and maintained the anonymity of all respondents throughout the data collection process. The target population comprised full-time and part-time final-year nursing students from the Catholic University of Croatia and the University of Applied Health Sciences. Inclusion criteria required participants to be enrolled in the current academic year, while exclusion criteria eliminated students not enrolled or those participating in international mobil- ity programs. A total of 200 nursing students partici- pated in the study. Of these, 117 were undergradu- ate students, including 61 full-time and 56 part-time students. Additionally, 83 graduate students took part, with 37 full-time and 46 part-time students.

The survey instrument utilized in this study consist- ed of two distinct sections designed to gather com- prehensive data on the participants. The first section focused on sociodemographic information. This foun- dational information was essential for understanding

the demographic context of the participants and for analyzing potential correlations with the perceived professional preparedness outcomes. The second section of the survey employed the Perceived Pro- fessional Preparedness of Nursing Students (PPPNS) questionnaire, a validated instrument specifically designed to assess nursing students’ perceptions of their readiness to enter professional practice (21). Prior to its implementation, permission to use the PPPNS questionnaire was obtained from the original authors. The questionnaire was subsequently trans- lated into Croatian, adhering to standardized transla- tion and adaptation protocols to ensure linguistic and conceptual equivalence. The PPPNS questionnaire comprises 19 items rated on a five-point Likert scale, where participants indicate their level of agreement with each statement, ranging from 1 (strongly disa- gree) to 5 (strongly agree). The items are catego- rized into four domains that reflect critical aspects of professional preparedness: Clinical Competence: Evaluates preparation for administering therapy, measuring vital signs, diagnosing, and managing a range of conditions encountered in healthcare set- tings. Evidence-Based Nursing: Focuses on gradu- ate-level skills, including personal education, patient education, and mentoring colleagues. Respect for Patients: Addresses ethical considerations, patient rights, and interpersonal relationships. Profession- al Collaboration: Evaluates respect for colleagues, teamwork, and holistic care approaches. Students rated each item on a scale from 1 (strongly disagree) to 5 (strongly agree), indicating the extent to which the statements applied to them. The questionnaire’s raw scores are transformed to scores in the range of 0–100 by subtracting the lowest possible raw score from the obtained raw score, then dividing this differ- ence by the range of possible scores (i.e., the high- est possible raw score minus the lowest possible raw score) and finally multiplying the result by 100. Scores below 25% indicate weak perceived prepar- edness; scores of 25–50%, 50–75%, and above 75% imply medium, good, and excellent perceived prepar- edness, respectively. The results can be analyzed at the level of the overall scale or domains.

Prior to performing data analysis, the distribution of the results from the PPPNS questionnaire, along with its four subscales, was evaluated for normality using the Kolmogorov-Smirnov test. Therefore, parametric procedures were used for data analysis. Continuous variables were reported as mean ± standard deviation

(SD). Univariate comparisons were conducted using Student’s t-test. A p-value of <0.05 was considered statistically significant for all analyses. Statistical analyses were performed using JASP software.

Results

Characteristics of study participants and PPPNS domain scores

(EBP)

The sample was predominantly female. The aver- age age of respondents was 26.38 years (SD=7.64), reflecting a diverse age range. Regarding academic level, 59% (N=117) were enrolled in undergraduate programs, while 41% (N=83) were in graduate pro- grams. Additionally, 49% (N=98) were full-time stu- dents, and 51% (N=102) were part-time students (Table 1).

The results indicate a generally high level of self- perceived professional preparedness among final- year nursing students. Among the four domains, Pa- tient-Centered Care stands out as the strongest area. Clinical Competency emerges as the relatively weak- est domain, suggesting a potential need for further practical training and experience before transitioning into professional practice (table 2).

Differences in preparedness based on study level

The comparison of self-perceived preparedness be- tween undergraduate and graduate nursing stu- dents shows no statistically significant difference (p=0.176). Both groups generally assess their pre- paredness as high, with graduate students reporting slightly higher self-perceived readiness compared to undergraduate students (table 3).

Table 3. Preparedness* by study level

Study Level

N

M

SD

t

df

p

-1.359

198

0.176

*Preparedness < 25% = poor, 25–50% = average, 50–75% = good, > 75% = excellent

performance

Preparedness of undergraduate students

The t-test showed a statistically significant differ- ence in self-perceived preparedness between full- time and part-time undergraduate nursing students (p=0.003). Part-time students report a higher level of preparedness, while full-time students perceive their readiness as somewhat lower. According to the pre- defined classification, part-time students fall within the “excellent” category, while full-time students are closer to the upper range of the “good” category” (ta- ble 4).

Preparedness of graduate students

The t-test showed a statistically significant dif- ference in self-perceived preparedness between full-time and part-time graduate nursing students (p=0.012). Similar to the findings among undergrad- uate students, part-time graduate students report a higher level of preparedness compared to their full- time counterparts (table 5).

Discussion

The study confirmed the hypothesis that more than 50% of nursing students feel prepared to transition into the nursing profession, with findings indicating that all participants expressed readiness to com- mence their professional practice. The assessment

evaluated students’ agreement with statements related to clinical competencies, evidence-based practice, administration, and patient-centered care. Furthermore, a comparative analysis between full- time and part-time students revealed that part-time students exhibited a higher level of readiness for the labor market.

This research addresses a critical gap by exploring the practical knowledge and clinical competencies of final-year nursing students, areas often overlooked in favor of psychological preparedness. By providing insights into students’ actual abilities and confidence levels, the study contributes to understanding the impact of different educational pathways and high- lights the need for targeted support to facilitate their transition into professional practice. Clinical compe- tence is broadly defined as the application of knowl- edge in decision-making, psychomotor skills, and in- terpersonal communication aligned with nursing role expectations. The work of Fallatah and Laschinger

(22) indicates that supportive professional practice environments are crucial for new graduate nurses, as they enable the application of clinical knowledge and skills in real-world settings.

The results of the study reveal that students exhibit the highest levels of confidence in the Patient-Cen- tered Care domain. This reflects a robust understand- ing of the significance of individualized care, adher- ence to ethical principles, and the ability to identify changes in patients’ physical and psychological con- ditions. Such findings suggest that the educational framework effectively fosters the competencies re- quired for delivering patient-oriented nursing care. Conversely, the Clinical Competency domain received the lowest scores, indicating a degree of uncertainty

among students regarding the practical application of theoretical knowledge, clinical decision-making, and the execution of therapeutic procedures accu- rately. This underscores the necessity for enhanced practical training and a stronger focus on clinical skills within the nursing curriculum.

In this study, students self-assessed their ability to create nursing care plans tailored to patients’ cul- tural and spiritual needs, apply evidence-based nurs- ing practices, and evaluate their preparedness and knowledge regarding care planning and implemen- tation. While clinical competence is fundamental to nursing practice, concerns persist about the readi- ness of new graduates, both at the bachelor’s and master’s levels, to meet these expectations (23). Research suggests that improving nursing education programs to enhance clinical competencies is criti- cal for ensuring high-quality care and patient safety (23, 24). Evidence-Based Practice (EBP) emerged as another key factor in this study’s assessment crite- ria. EBP bridges the gap between available evidence and current nursing practices by combining the best research with clinical expertise and patient prefer- ences (24). Studies indicate that positive attitudes towards EBP among nurses correlate with higher im- plementation rates in clinical settings (25, 26). How- ever, barriers such as lack of support and opportuni- ties often hinder nurses from applying EBP in daily practice (26).

The results of a study conducted in Iran highlight the issue of isolation measures and behavior under different circumstances, suggesting that isolation precautions are mainly applied in departments deal- ing with infectious diseases or conditions linked to weakened immune systems. However, due to short stays in such departments and rapid rotations, stu- dents lack familiarity with the concept of isolation

(27). Safe execution of medical procedures, including knowledge of legal frameworks and administrative tasks, was rated significantly below the top score of four.

Patient-centered care was identified as a crucial ele- ment for professional development among new nurs- es (28). A positive perception of patient-centered care in nursing would aid nurses in implementing such care approaches in clinical settings (29). This aligns with the findings of this study, where the first hypothesis — that more than 50% of students are ready to transition into professional practice — was confirmed. While self-assessment results indicated

that students feel prepared, previous studies have reported that many nursing students feel inade- quately prepared for the responsibilities and roles of nursing professionals (30).

Analysis of student readiness for the labor market revealed differences based on the level of study (undergraduate vs. graduate). Most participants rat- ed their readiness as good. Part-time students, of- ten with prior clinical experience, displayed greater readiness compared to full-time students. This aligns with Benner’s “From Novice to Expert” theory, which suggests that nurses progress through five stages of competence: novice, advanced beginner, compe- tent, proficient, and expert. Upon entering the pro- fession, nurses generally possess limited practical experience but have theoretical knowledge gained during education. Therefore, ongoing support and mentorship programs are crucial to ensuring the ef- fective application of theoretical knowledge in prac- tice. Research also emphasizes the importance of continuous education and professional development for maintaining and enhancing nursing competen- cies throughout their careers (16). Previous studies have highlighted that nurses often require additional clinical exposure to develop practical skills and gain real-life experiences that can later be integrated into their roles (31). Some studies have also reported dis- satisfaction with educational programs, citing inad- equate coverage of pharmacology, pathophysiology, electronic skills, leadership, and management com- petencies necessary for nursing practice (31). These challenges can lead to frustration and even prompt new nurses to leave the profession.

One of the earliest studies conducted in the UK on nursing students’ readiness for the workforce found that only 52% of respondents felt prepared for their roles post-graduation, and only 63% believed they possessed sufficient competencies and knowledge

(32). Similar findings emerged in a 2002 study, where students self-reported inadequate prepara- tion for the responsibilities of nursing professionals, indicating gaps in the skills and knowledge neces- sary for the job (33).

The results of this study suggest that students’ self-assessments of their skills and knowledge in- dicate that nursing curricula are effectively meeting their educational goals. However, it is important to acknowledge that during clinical practice, students operate under supervision and are not fully account- able for the duties they will undertake as employed

nurses. Previous research has demonstrated that the responsibilities of student nurses and those of em- ployed graduates differ significantly, often resulting in students overestimating their competencies (34).

Limitations

This study included a sample of only 200 nursing stu- dents from two institutions, which may limit the gen- eralizability of the findings. Additionally, the localized sample, as both institutions are based in Zagreb, re- stricts the broader applicability of the results. Another limitation is the reliance on self-assessment, which may introduce subjective biases, including overesti- mation or underestimation of personal abilities.

Future studies should involve larger and more di- verse samples from various institutions to allow for broader comparisons. Despite these limitations, the questionnaire used in this study offers practical ben- efits. It can help students identify potential fears and weaknesses, encouraging them to improve dur- ing their education. Furthermore, the questionnaire could be a valuable tool for evaluating nursing cur- ricula and informing employment planning. Achieving favorable outcomes on the questionnaire may en- hance professional confidence and help individuals address areas for improvement, ultimately support- ing their transition into the workforce.

Conclusion

The findings of this study underscore the essential importance of comprehensive education and prepa- ration in facilitating a smooth transition for nursing students into professional roles, thereby minimizing the risk of transitional shock. By enhancing nursing curricula to prioritize practical skills and clinical com- petencies, educational institutions can significantly improve students’ readiness to meet the demands of the workplace. Additionally, the implementation of supplementary support programs — such as work- shops, mentoring schemes, and hands-on experi- ences — can further facilitate this transition, ensur- ing that teaching methods are aligned with student needs and enhancing their preparedness for profes- sional practice. For healthcare institutions, the re- sults emphasize the critical importance of structured internship and mentorship programs designed to as- sist new nurses in adapting to their roles while de- veloping essential skills. Well-prepared nursing grad- uates are better positioned to deliver high-quality care, which can lead to improved patient outcomes and increased job satisfaction among healthcare pro- fessionals. Furthermore, this preparedness can con- tribute to reducing staff turnover and the associated costs of recruitment and training.

Author contributions

Conceptualization (FK, MI, ČM); Data Curation (VK, FK); Data Analysis (FK, KV, ČM), Writing – Original Draft (FK, MI).

Conflict of interest

The authors declare no conflicts of interest.

Acknowledgments

The authors would like to thank all participants who contributed their time and insights to the study.

Funding

This research received no external funding.

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