Impact of unmet expectations in clinical practice on nursing student competencies in a multi-center study

Abstract

Clinical practice is essential for competency acquisition in nursing education. However, unmet expectations can negatively affect nursing students’ clinical competency. Factors related to unmet expectations among nursing students remain unclear within the Ethiopian context. To understand the factors related to unmet expectations in clinical practice, it is crucial to investigate these issues. This study aimed to explore the factors related to unmet expectations of nursing students in clinical practice and its impact on competency. A qualitative descriptive study was conducted at Bahir Dar University and the University of Gondar, Ethiopia, from November 1 to December 31, 2024. The study participants were undergraduate nursing students, preceptors, head nurses, hospital administrators, and lecturers. Data were collected through five focus group discussions (each with six purposively selected students) and four key informant interviews, both using semi-structured guides. All interviews and discussions were recorded. The recorded data were transcribed, translated, and analyzed thematically with the help of ATLAS.ti 9. Finally, themes were identified and presented with narration. 34 participants (18 male and 16 female), 30 nursing students, and 4 key informants were involved from two public universities having teaching hospitals. Three main themes were identified: insufficient clinical support and mentorship, gaps between nursing education and practical application, and communication gaps along with a lack of initial orientation. This study concluded that unmet expectations in a clinical learning environment affect the student’s learning experiences. Factors contributing to these unmet expectations included inadequate supervision and guidance, discrepancies between theory and practice, communication gaps, a theory focused clinical practice, lack of initial orientation, and unsupportive clinical settings. All these factors hinder the development of nursing students’ competency. These findings imply the need for stronger collaboration between clinical instructors and nurses, offering incentives and training for clinical staff, improving resource allocation, creating less crowded clinical setting and the establishing of structured orientation and effective communication systems. These are essential to improve students’ learning outcomes and competency.