Abstract
Background
The transition from nursing student to professional nurse is a crucial phase in nursing education, significantly impacted by clinical competence, anxiety during clinical practice, and resilience. This descriptive, cross-sectional, and correlational study aims to explore how these factors influence the role transition of nursing students during their clinical practice, with a focus on identifying key contributors to successful role adaptation.
Methods
Data were collected from 158 third- and fourth-year nursing students at a university in Seoul, South Korea, from June 10 to June 14, 2024. The study utilized the Clinical Competence Scale, Anxiety during Clinical Practice Scale, Resilience Scale, and Role Transition Scale for assessments. Data analysis involved descriptive statistics, Pearson’s correlation coefficient, and multiple regression analysis.
Results
The mean score for role transition was 3.60 ± 0.59, with significant positive correlations found between role transition and clinical competence (r = .380, p < .001) and resilience (r = .581, p < .001), while a significant negative correlation was observed with anxiety during clinical practice (r = -.455, p < .001). In the multiple regression analysis (adjusted R² = 0.438, p < .001), resilience (β = 0.435, p < .001), anxiety during clinical practice (β = -0.232, p = .001), and clinical competence (β = 0.210, p = .001) were significant predictors of role transition.
Conclusions
Clinical competence and resilience are critical factors in facilitating the role transition of nursing students, while anxiety during clinical practice hampers it. The findings suggest that interventions to enhance clinical skills and resilience, along with strategies to reduce anxiety, are essential for improving the transition process. Future research should continue to explore these relationships and develop targeted educational strategies to support nursing students in their professional role adaptation.
Clinical trial number
Not applicable.
Keyword: Nursing, Student, Clinical, Role Transition, Anxiety, Competence
Introduction
The ultimate goal of nursing education is to enable students to perform professional nursing roles after completing their curriculum. To this end, clinical practice education, which translates theoretical knowledge into actual practice, must be an essential part of the nursing curriculum [1, 2]. Clinical practice is a critical educational experience for improving students’ professionalism and facilitating their role transition as nurses [3]. Building on the importance of clinical practice, it is essential to address the process of clinical role transition, the shift from being primarily a learner to functioning as a competent professional nurse. This transition is a pivotal stage in a nurse’s development, with significant implications for patient safety, quality of care, and workforce readiness. The success of this process is shaped by multiple factors, including the student’s clinical competence, the anxiety experienced in practice settings, and resilience in overcoming challenges. Understanding these relationships provides a foundation for educational interventions that promote smoother transitions [3–5].
Our study is grounded in two important theoretical perspectives. Meleis’s Transition Theory focuses on how individuals manage and adjust to major life transitions, such as the shift from student to professional nurse [6]. This framework is especially useful for understanding the difficulties nursing students may encounter when they lack sufficient preparation, often due to issues like anxiety or inadequate clinical skills [6]. In addition, Benner’s Novice to Expert Theory is highly relevant, as it describes the development of nursing proficiency through various stages [7]. Students usually begin at the novice or advanced beginner level, and clinical training is essential for helping them gain the practical experience needed to enhance their competence and ease their transition into professional roles [8].
The theoretical frameworks guiding this study; Meleis’s Transition Theory and Benner’s Novice to Expert Theory, clarify how the three key variables influence role transition. Meleis’s Transition Theory explains the importance of preparation, role clarity, and stress management in moving from learner to practicing professional [6]. Benner’s Novice to Expert Theory describes how students develop clinical competence through experience, with anxiety and resilience shaping their progression through the stages of proficiency [7]. Together, these theories provide a conceptual foundation for examining the combined effects of clinical competence, anxiety during clinical practice, and resilience on role transition [9–11].
Clinical competence represents the comprehensive skills, knowledge, attitudes, and communication abilities required for nurses to perform their duties. It focuses on improving patient safety and treatment effectiveness and encompasses the ability to make appropriate decisions in complex physical, emotional, and mental patient care situations [12]. Clinical competence of nurses develops based on continuous learning and experience and plays a crucial role in patient safety, disease prevention, and treatment. Previous studies have indicated that clinical competence is an essential factor influencing role transition among nursing students [9, 13].
Successful role transition of nursing students as nurses is critical for providing safe patient care and managing hospital staff efficiently [14, 15]. However, with increasing emphasis on patient rights and safety in clinical settings, nursing students have fewer opportunities to practice direct nursing care, often relying on observation-based clinical practice and simulation training, leading to increased anxiety during clinical practice [16]. Moreover, when nursing students first enter clinical practice, they frequently experience tension and anxiety when directly facing patients in unfamiliar hospital environments [16, 17].
Nursing students often face anxiety and stress in clinical settings due to insufficient professional knowledge and underdeveloped nursing skills which affects role transition [16–18]. This anxiety, particularly concerning nursing procedures, is a significant contributor to reality shock, which can impede their smooth transition into the nursing profession [19]. They also experience fear and stress when interacting with healthcare personnel and commonly encounter challenges in interpersonal communication, especially with patients and professionals from other disciplines [19]. Research on newly licensed nurses has similarly revealed difficulties in communicating effectively with patients and their caregivers [20].
Along with anxiety during clinical practice, resilience is another factor that is associated with role transition. Resilience refers to the ability to adapt to changing environments and utilize those environments to one’s advantage, helping individuals maintain their mental and physical health and activate positive inner energy [21]. Students with high resilience can quickly recover and regain balance when faced with stress or risk factors, which is essential not only in clinical settings but also in various aspects of life for maintaining health and adaptability [22, 23].
Existing studies on clinical competence have shown that higher competence is associated with improved clinical decision-making, self-confidence, and reduced stress. Research on anxiety in clinical practice has linked higher anxiety levels to impaired performance, decreased confidence, and lower satisfaction with clinical learning experiences. Similarly, resilience has been shown to help nursing students adapt to challenging clinical situations and persist despite setbacks. However, these factors have largely been examined separately or without specific focus on the role transition process. To our knowledge, no prior research has simultaneously examined these three variables in the context of role transition among Korean nursing students. So, this study uniquely integrates clinical competence, anxiety, and resilience within a single framework to predict clinical role transition, applying both Meleis’s Transition Theory and Benner’s Novice to Expert Theory to provide a comprehensive conceptual basis. This integrated approach advances current knowledge by clarifying the combined effects of cognitive, emotional, and adaptive capacities on successful transition to professional nursing roles.
Purpose and research questions of the study
The purpose of this study is to identify the impact of clinical competence, anxiety during clinical practice, and resilience on the role transition of nursing students during clinical practice. The specific research questions are as follows:
What are the differences in role transition according to the general characteristics of nursing students?
What are the levels of clinical competence, anxiety during clinical practice, resilience, and role transition among nursing students?
What are the relationships between clinical competence, anxiety during clinical practice, resilience, and role transition among nursing students?
What factors influence role transition among nursing students?
Research methods
This study is a descriptive, cross-sectional, correlational study aimed at identifying the impact of clinical competence, anxiety during clinical practice, and resilience on role transition among nursing students.
Participants
The research participants consisted of 158 third- and fourth-year nursing students engaged in clinical practice at a nursing college in Seoul, South Korea. All participants understood the purpose of the study and agreed to take part in data collection. The sample size was calculated using the G*Power 3.1.9.2 program, with a significance level set at 0.05, power at 0.80, a medium effect size of 0.15, and 18 main predictor variables, resulting in a requirement of 150 subjects. To account for potential dropout, a target of 160 participants was established.
Instruments
Clinical competence
Clinical competence is the combination of knowledge, skills, attitudes, and clinical judgment abilities acquired to perform desirable nursing roles in clinical settings [24]. We used a tool developed by Lee et al. [25] and modified and supplemented by Choi [26] to measure nursing students’ clinical competence. The tool consists of 45 items across five subscales: nursing process (11 items), nursing skills (11 items), educational cooperation (8 items), interpersonal relationships/communication (6 items), and professional development (9 items). Each item is rated on a 5-point Likert scale from 1 (not at all) to 5 (very much), with higher scores indicating higher levels of clinical competence. The reliability of the tool was Cronbach’s α = 0.96 in Lee’s study, and in this study, Cronbach’s α ranged from 0.78 to 0.91 for each domain, with an overall α of 0.96.
Anxiety during clinical practice
Anxiety during clinical practice refers to the specific clinical experiences that induce anxiety in nursing students in clinical practice settings, based on the assumption of a curvilinear relationship between anxiety and learning, where high anxiety reduces learning [27]. This study used a tool developed by Kleehammer, Hart, and Keck [27] and translated by Lee Wol-sook, Uhm Ju-yeon, and Lee Tae-hwa [13]. The tool consists of 16 items across three subscales: communication and nursing procedures during patient care, interpersonal relationships with medical staff, and interactions with faculty. Each item is rated on a 5-point Likert scale from 1 (not at all) to 5 (very much), with higher scores indicating higher levels of anxiety during clinical practice. The reliability was Cronbach’s α = 0.82 during tool development, and in this study, Cronbach’s α was 0.90.
Resilience
Resilience refers to the psychological and social characteristics that enable individuals to overcome, adapt to, and grow from serious life challenges such as adversity or hardships. We used the Korean version of the Connor-Davidson Resilience Scale (K-CD-RISC), translated by Baek et al. [28]. The tool consists of 25 items across five subscales: hardiness (9 items), persistence (8 items), optimism (4 items), support (2 items), and spirituality (2 items). Each item is rated on a 5-point Likert scale from 0 (not at all) to 4 (very much), with higher scores indicating higher levels of resilience. The reliability of the tool was Cronbach’s α = 0.93 in Baek et al.’s study, and in this study, Cronbach’s α ranged from 0.43 to 0.90 for each domain, with an overall α of 0.94.
Role transition
Role transition for nurses refers to the preparation, competence, support, and contribution to the organization as a nurse [24]. Role preparation includes items related to practical role readiness based on major knowledge and practice acquired through nursing courses, and role competence includes attributes that nurses should have, as well as support and organizational contributions as nurses [29]. We used the instrument developed by Doody et al. [29] and modified by Lee, Uhm, & Lee [13] for nursing students. The tool consists of 28 items across three subscales: role preparation (6 items), role competence (9 items), and organization and support (13 items). Each item is rated on a 5-point Likert scale from 1 (not at all) to 5 (very much), with higher scores indicating better role transition as a nurse. The reliability of the tool was Cronbach’s α = 0.97 during development, and in this study, Cronbach’s α ranged from 0.79 to 0.92 for each domain, with an overall α of 0.94.
Data collection
Data collection took place between June 10 and June 14, 2024, targeting third- and fourth-year nursing students at S University in Seoul, South Korea. Participants were provided with an explanation of the study’s objectives, and those who willingly chose to take part gave their written consent. Graduate researchers conducted the survey, ensuring that participants fully understood the study’s purpose before obtaining their consent in writing. The survey included the researcher’s contact information for any questions or clarifications. A total of 160 surveys were distributed, considering the dropout rate, and 158 completed surveys were collected and analyzed, excluding two with missing responses.
Data analysis
The collected data were analyzed using IBM SPSS Statistics 28.0. Descriptive statistics were employed to analyze the general characteristics and research variables of the nursing students. The relationships between variables were examined using means, standard deviations, and Pearson’s correlation analysis. Comparisons of research variables according to general characteristics were conducted using t-tests, ANOVA, and Scheffe’s test. Multiple regression analysis was performed to identify factors influencing role performance.
Ethical considerations
Data collection was conducted after obtaining approval from the Institutional Review Board of S University in Seoul, South Korea (IRB No: SYU 2024-04-040-001, committee date: April, 25, 2024). Ethical considerations for the subjects were based on the Declaration of Helsinki. The purpose, content, and intent of the study were fully explained to the participants, ensuring privacy protection by promising anonymity and confidentiality. Participants were informed that they could refuse or withdraw from the study at any time without any disadvantage. Their data would be encoded and used solely for research purposes, stored for three years after the study’s conclusion, and then destroyed. Written consent was obtained from participants who voluntarily agreed to participate, and they were provided with a beverage coupon worth 5,000 KRW as a token of appreciation.
Research results
Common method bias
In our study, Harman’s single-factor test was performed using SPSS to assess the potential presence of common method bias (CMB). The analysis revealed that the first factor explained 19.8% of the total variance. As this is below the commonly accepted threshold of 50%, the results suggest that common method bias is unlikely to pose a significant issue in this study [30].
Differences in role transition according to general characteristics of the participants
Table 1 displays the general characteristics of the participants. Analysis of the differences in role transition according to the general characteristics of the participants showed statistically significant differences based on health condition (F = 7.685, p < .001), satisfaction with the nursing program (F = 15.105, p < .001), satisfaction with clinical practice (F = 6.355, p < .001), and post-graduation plans (t = 2.905, p = .004). Post-hoc analysis revealed that participants with better health had higher role transition compared to those with poor health. Those who were very satisfied with the nursing program had higher role transition compared to those who were dissatisfied or merely satisfied. Similarly, participants who were very satisfied with their clinical practice had higher role transition compared to those who were dissatisfied or merely satisfied. Participants planning to work in a hospital after graduation had higher role transition compared to other groups.
Table 1.
Characteristics of participants
| Characteristics | Categories | n | % | M ± SD | t or F | p | Scheffė |
|---|---|---|---|---|---|---|---|
| Gender | female | 132 | 83.5 | 3.61 ± 0.57 | -0.355 | 0.723 | |
| male | 26 | 16.5 | 3.57 ± 0.69 | ||||
|
Age(yr) M ± SD = 22.37 ± 2.27 |
≤ 20 | 19 | 12.0 | 3.53 ± 0.52 | 1.125 | 0.347 | |
| 21 | 50 | 31.6 | 3.60 ± 0.58 | ||||
| 22 | 34 | 21.5 | 3.48 ± 0.59 | ||||
| 23 | 22 | 13.9 | 3.81 ± 0.65 | ||||
| ≥ 24 | 33 | 20.9 | 3.64 ± 0.59 | ||||
| Grade | 3rd | 76 | 48.1 | 3.59 ± 0.60 | -0.396 | 0.692 | |
| 4th | 82 | 51.9 | 3.62 ± 0.59 | ||||
|
Health condition |
Bada | 6 | 3.8 | 3.11 ± 0.60 | 7.685 | < 0.001 |
a < c a = b, c = d |
| Moderateb | 51 | 32.3 | 3.37 ± 0.53 | ||||
| Goodc | 61 | 38.6 | 3.69 ± 0.50 | ||||
| Very Goodd | 40 | 25.3 | 3.85 ± 0.65 | ||||
| Residential type | Living alone | 43 | 27.2 | 3.53 ± 0.62 | 0.623 | 0.538 | |
| Living with Family | 80 | 50.6 | 3.62 ± 0.60 | ||||
| Dormitories | 35 | 22.2 | 3.67 ± 0.52 | ||||
| Motivation of choosing nursing as a major | Good image about nurses | 62 | 39.2 | 3.72 ± 0.46 | 2.370 | 0.055 | |
| Job prospects | 67 | 42.4 | 3.61 ± 0.64 | ||||
| Recommendations from family & relatives | 16 | 10.1 | 3.23 ± 0.70 | ||||
| High school GPA considerations | 10 | 6.3 | 3.58 ± 0.64 | ||||
| Others | 3 | 1.9 | 3.39 ± 0.70 | ||||
| Satisfaction of nursing program | Very Satisfied | 14 | 8.9 | 4.18 ± 0.53 | 15.105 | < 0.001 |
a > b > d b = c, d = e, |
| Satisfied | 70 | 44.3 | 3.74 ± 0.46 | ||||
| Moderately satisfied | 51 | 32.3 | 3.52 ± 0.51 | ||||
| Dissatisfied | 20 | 12.7 | 3.09 ± 0.62 | ||||
| Very dissatisfied | 3 | 1.9 | 2.49 ± 0.45 | ||||
| Relationship with others | Good | 131 | 82.9 | 3.62 ± 0.57 | 0.377 | 0.687 | |
| Moderate | 25 | 15.8 | 3.52 ± 0.71 | ||||
| Bad | 2 | 1.3 | 3.46 ± 0.30 | ||||
| Difficult relationship | Head Nurse | 42 | 26.6 | 3.69 ± 0.52 | 1.540 | 0.181 | |
| Team leader | 52 | 32.9 | 3.46 ± 0.61 | ||||
| Patient | 10 | 6.3 | 3.46 ± 0.83 | ||||
| Patient care giver | 23 | 14.6 | 3.78 ± 0.40 | ||||
| Pear | 20 | 12.7 | 3.71 ± 0.64 | ||||
| Others(none) | 11 | 7.0 | 3.56 ± 0.66 | ||||
| Satisfaction with clinical practice | Very Satisfieda | 17 | 10.8 | 3.80 ± 0.69 | 6.355 | < 0.001 |
a > b > d b = c |
| Satisfiedb | 75 | 47.5 | 3.74 ± 0.50 | ||||
| Moderately Satisfied c | 54 | 34.2 | 3.46 ± 0.57 | ||||
| Dissatisfacd | 12 | 7.6 | 3.12 ± 0.71 | ||||
|
Grade point average score |
2.0 ~ 2.9 | 22 | 13.9 | 3.55 ± 0.65 | 0.738 | 0.480 | |
| 3.0 ~ 3.9 | 103 | 65.2 | 3.58 ± 0.60 | ||||
| ≥ 4.0 | 33 | 20.9 | 3.71 ± 0.51 | ||||
|
Post-graduation plans |
Hospital Nurse | 148 | 93.7 | 3.64 ± 0.56 | 2.905 | 0.004 | |
| others | 10 | 6.3 | 3.09 ± 0.76 |
SD: Standard Deviation; GPA: Grade Point of Average; a, b,c, d,e: Different superscripts (a, b, c, d, e) denote significant differences between groups according to Scheffé’s post hoc test (p < .05). Groups that share the same superscript do not differ significantly
Levels of clinical competence, clinical practice anxiety, resilience, and role transition
Participants reported a generally high level of clinical competence, with an average score 4.12 out of 5, particularly in the areas of nursing skills and the nursing process. Clinical practice anxiety showed a relatively low average score, indicating moderate levels of anxiety during practicum. Regarding resilience, participants demonstrated moderate levels overall, with the highest subdomain score observed in perceived support, and the lowest in spirituality. Role transition levels were moderately high, with participants reporting the strongest perceptions of role competency and relatively lower levels of perceived role preparation. Detailed descriptive statistics for all variables and their subdomains are presented in Table 2.
Table 2.
Levels of clinical Competence, anxiety during clinical Practicum, Resilience, and role transition
| Variables | Categories | item M ± SD |
min | max |
|---|---|---|---|---|
| Clinical Competence | Total | 4.12 ± 0.51 | 2.47 | 5.00 |
| Nursing process | 4.13 ± 0.59 | 1.73 | 5.00 | |
| Nursing skill | 4.18 ± 0.57 | 1.91 | 5.00 | |
| Education/Cooperation | 4.09 ± 0.66 | 1.38 | 5.00 | |
| Interpersonal relation/Communication | 4.07 ± 0.62 | 2.50 | 5.00 | |
| Professional development | 4.07 ± 0.58 | 2.44 | 5.00 | |
| Anxiety during clinical practicum | 2.23 ± 0.70 | 1.06 | 4.13 | |
| Resilience | Total | 2.89 ± 0.64 | 1.12 | 4.00 |
| Hardiness | 2.78 ± 0.76 | 0.44 | 4.00 | |
| Persistence | 2.95 ± 0.74 | 0.50 | 4.00 | |
| Optimism | 2.98 ± 0.73 | 1.25 | 4.00 | |
| Support | 3.33 ± 0.69 | 1.50 | 4.00 | |
| Spirituality | 2.56 ± 0.89 | 0.00 | 4.00 | |
| Role transition | total | 3.60 ± 0.59 | 1.96 | 5.00 |
| Role preparation | 3.23 ± 0.69 | 1.00 | 5.00 | |
| Role competency | 3.81 ± 0.59 | 2.00 | 5.00 | |
| Organization and support | 3.64 ± 0.70 | 1.31 | 5.00 |
Correlations between research variables
Analysis of the correlations among clinical competence, anxiety during clinical practicum, resilience, and role transition showed that role transition had a significant positive correlation with resilience (r = .581, p < .001) and clinical competence (r = .380, p < .001), and a significant negative correlation with clinical practice anxiety (r=-.455, p < .001) (Table 3).
Table 3.
Correlations among clinical competence, anxiety during clinical practicum, resilience, and role transition
| Variables | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
|
r
(p) |
r
(p) |
r
(p) |
r
(p) |
|
| Clinical Competence | 1 | |||
| Anxiety during clinical practicum |
− 0.244** (0.002) |
1 | ||
| Resilience |
0.260** (0.001) |
− 0.393** (< 0.001) |
1 | |
| Role transition |
0.380** (< 0.001) |
− 0.455** (< 0.001) |
0.581** (< 0.001) |
1 |
1: Clinical Competence, 2: Anxiety during clinical practicum, 3: Resilience, 4: Role transition
Factors influencing role transition
Multiple regression analysis was conducted to examine the explanatory power of clinical competence, clinical practice anxiety, and resilience on role transition and to identify the most significant influencing variables. Prior to performing regression analysis, autocorrelation of the dependent variable and multicollinearity among independent variables were checked. The Durbin-Watson statistic was 2.022, indicating no autocorrelation. Multicollinearity was assessed using VIF values, which ranged from 1.101 to 1.224, indicating no multicollinearity. Therefore, the data were deemed suitable for regression analysis. The results of the multiple regression analysis showed that the variables influencing perceived role Transition were resilience (β = 0.435, p < .001), anxiety during clinical practicum (β=-0.232, p = .001), and clinical competence (β = 0.210, p = .001). The model was statistically significant (F = 40.045, p < .001) and explained 43.8% of the variance in role transition (Table 4).
Table 4.
Factors affecting role transition
| Variables | B | SE | β | t | p | VIF |
|---|---|---|---|---|---|---|
| (Constant) | 1.872 | 0.385 | 4.856 | < 0.001 | ||
| Clinical Competence | 0.244 | 0.074 | 0.210 | 3.306 | 0.001 | 1.101 |
| Anxiety during clinical practicum | -0.194 | 0.056 | -0.232 | -3.492 | 0.001 | 1.214 |
| Resilience | 0.402 | 0.062 | 0.435 | 6.516 | < 0.001 | 1.224 |
| R2 | 0.662 | |||||
| Adj. R2 | 0.438 | |||||
| F (p) | 40.045 (< 0.001) | |||||
Durbin-Watson = 1.920, B = unstandardized coefficients; β = standardized coefficients; SE = standard error; VIF = Variance Inflation Factor
Discussion
Findings
The purpose of this cross-sectional descriptive study was to explore the impact of clinical competence, clinical practice anxiety, and resilience on the role transition of nursing students during clinical practice. It was conducted on 158 third- and fourth-year nursing students participating in clinical practice at a nursing college in Seoul. The results provide valuable insights into how these factors influence the students’ ability to transition effectively into professional nursing roles.
This study explored how clinical competence, anxiety during clinical practice, and resilience affect the role transition of nursing students during their clinical training. The discussion is organized around the study’s four research questions to ensure alignment with the findings and to integrate relevant theoretical perspectives.
Differences in role transition according to general characteristics
Statistically significant differences emerge in role transition based on students’ health status, satisfaction with the nursing program, satisfaction with clinical practice, and post‑graduation plans. Nursing students who report better physical and mental health, stronger satisfaction with their educational experiences, and clear career intentions demonstrate smoother transitions into professional roles [31–33]. These observations align with Self-Determination Theory (SDT) [34], which posits that fulfillment of the psychological needs for competence, autonomy, and relatedness fosters greater intrinsic motivation and readiness to take on new challenges—attributes essential for effective transition [24]. Moreover, SDT‑based research in healthcare transition has shown that individuals with higher perceived competence and support readiness navigate complex role changes more successfully [35–37]. Additionally, existing literature on newly graduated nurses emphasizes that health and job satisfaction are critical factors in easing role transition, with poor health and low satisfaction increasing turnover risk. Within Meleis’s Transition Theory, both internal conditions (e.g., well‑being, preparation) and external supports (e.g., educational satisfaction, clear career pathways) critically influence the quality of the transition experience [6]. These findings suggest that nursing curricula should not only focus on clinical skills but also prioritize student health, program quality, and career planning, creating a supportive, holistic environment that underpins successful role development [35].
Levels of clinical competence, anxiety, resilience, and role transition
Nursing students in this study demonstrated relatively high clinical competence (M = 4.12/5), which may be attributed to structured skills training, simulation-based practice, and consistent faculty feedback in our program. This aligns with prior reviews emphasizing the importance of structured environments for skill acquisition [38–40]. Despite this, students reported only moderate anxiety (M = 2.23/5), suggesting that while they have mastered technical skills, they continue to experience stress related to evaluation and role transition, an observation consistent with studies highlighting the “transition shock” commonly encountered during initial clinical exposure. Moderate resilience (M = 2.89/4) scores may reflect a reliance on optimism and social support, while gaps in hardiness and spirituality point to limited internal coping strategies, as reported in resilience literature. Finally, moderately high role transition (M = 3.60/5) indicates that although students are adjusting, confidence and professional identity formation remain ongoing. Benner’s Novice to Expert theory underscores this pattern, as students move beyond technical proficiency toward the development of professional judgment and intuition [7]. Taken together, these findings suggest that while structured simulation-based education effectively enhances competence, nursing curricula should incorporate strategies to reduce anxiety, foster internal resilience, and strengthen identity formation to ensure a smoother and more sustainable transition into professional practice.
Relationships between clinical competence, anxiety, resilience, and role transition
Significant correlations were identified between role transition and all three key variables in this study-clinical competence and resilience showed positive correlations, while anxiety was negatively correlated. These findings are supported by a recent Taiwanese study, which found that higher clinical practice stress-analogous to anxiety-was significantly associated with lower clinical competence among nursing students (r = –.311, p = .001) [41, 42]. Meanwhile, resilience, and its subdomains such as optimism and support has been consistently shown to correlate positively with clinical competence and transition readiness in nursing students globally. According to Social Cognitive Theory, mastery experiences strengthen self-efficacy, which leads to improved behavior and adjustment in clinical settings [29]. This aligns with the positive link observed between competence and role transition in this study. Furthermore, Cognitive Appraisal Theory [43] posits that anxiety impedes students’ ability to frame clinical situations as manageable challenges, instead interpreting them as threats. This perception diminishes learning and performance, contributing to poorer transition outcomes [44]. Taken together, these findings highlight the necessity for structured interventions in clinical education-such as simulation-based mastery experiences, reflective debriefing, and cognitive reframing workshops to bolster competence, reduce anxiety, and improve transition effectiveness.
Factors influencing role transition
Multiple regression analysis identified resilience as the strongest predictor of role transition, followed by anxiety (negative) and clinical competence. These results align with Resilience Theory [45] and the Transactional Model of Stress and Coping [46], which emphasize that adaptability and positive coping are essential for managing clinical stressors. High resilience enables nursing students to rebound from challenges and engage more confidently in clinical environments. For instance, a study of newly graduated nurses found that resilience significantly predicted compassion satisfaction and reduced burnout and secondary traumatic stress during their transition into professional roles [27]. Similarly, qualitative and integrative reviews highlight that resilience supports academic persistence and stress management by promoting optimism, self-efficacy, and social support [47]. While clinical competence remains essential, it is undermined by anxiety. Competent students may still struggle to transition effectively if anxiety is high, indicating the need for comprehensive interventions that address both emotional and technical readiness [13]. Practical strategies like simulation training, mentorship, and wellness programs have been shown to foster both competence and emotional resilience. For example, simulation-based resilience workshops helped reduce burnout and enhance coping in nursing students. Group-based resilience and stress management programs also significantly improved students’ ability to manage clinical stressors [13]. These interventions provide structured opportunities to practice technical skills while building emotional preparedness-key to supporting a successful role transition.
This study underscores that nursing students’ role transition is shaped by a complex interplay of clinical, emotional, and contextual factors. Resilience, competence, and anxiety are key determinants that can be targeted through holistic educational strategies. The findings call for the integration of resilience-building, skill-based learning, and stress-management interventions into nursing curricula [48]. Future research should explore longitudinal outcomes, the impact of mentorship, and broader psychosocial factors to deepen understanding and support smoother transitions into professional nursing roles.
Implications
Educational implications:
Nursing curricula should go beyond technical training to support students’ physical and mental well-being through wellness programs, career counseling, and psychological support.
Emotional intelligence, mindfulness, and reflective practices should be integrated into coursework to build resilience—identified as the strongest predictor of role transition.
Simulation-based experiences and stress management training can help reduce clinical anxiety, which negatively affects students’ ability to transition even when competent.
Mentorship programs and consistent feedback mechanisms are essential to strengthening clinical competence and fostering student confidence.
Theories such as Meleis’s Transition Theory and Benner’s Novice to Expert Theory should inform curriculum design to frame transition as a developmental and emotional process.
Nursing programs should also consider longitudinal approaches to track students’ readiness and adapt support over time.
Clinical practice implications:
Clinical sites should collaborate with academic institutions to foster environments that support both skill development and emotional resilience.
Structured clinical mentorship and peer support should be emphasized to guide students through transitional stress.
Healthcare settings should cultivate a resilience-oriented culture through access to counseling, regular debriefings, and recognition of student growth.
Practical strategies like simulation-based resilience training and group stress management interventions can help students manage clinical stressors effectively and support smoother integration into professional roles.
Limitations
This study has several limitations that should be considered when interpreting the findings. First, the sample was drawn from a single nursing college in Seoul, which may limit the generalizability of the results to other institutions or regions with different educational systems, clinical training environments, or cultural contexts. Second, the cross-sectional design captures associations at a single point in time and does not allow for conclusions about causality or changes in role transition over time. Longitudinal studies are needed to examine how resilience, anxiety, and competence evolve and interact throughout the clinical education process.
Third, all data were collected through self-report questionnaires, which are subject to social desirability and recall bias. Participants may have over- or under-reported their levels of anxiety, competence, or resilience, potentially affecting the accuracy of the results. Fourth, while validated tools were used to measure key variables, other potentially influential factors—such as clinical environment quality, peer or instructor support, or personal coping styles—were not assessed and may have provided a more comprehensive understanding of role transition.
Lastly, the study focused primarily on quantitative data. Incorporating qualitative insights from students’ lived experiences could enrich the understanding of the emotional and practical challenges faced during transition. Future research could adopt mixed-methods approaches to gain deeper insights and inform targeted interventions more effectively.
Conclusion
In conclusion, this study examined how clinical competence, anxiety, and resilience influence nursing students’ role transition. Resilience emerged as the strongest predictor, followed by clinical competence, while anxiety negatively affected outcomes. General factors such as health status, satisfaction with education and clinical experiences, and career plans also influenced transition. These findings highlight that nursing education should address both technical proficiency and emotional preparedness. Incorporating simulation-based learning, mentorship, and resilience-building strategies may help students adapt more smoothly to professional roles. Future longitudinal studies are needed to further explore how role transition develops over time and how best to support students in this process.
Acknowledgements
Not applicable.
Author contributions
SJH and HJY made substantial contributions to conception and design and drafting the article. Analysis and interpretation of data were performed by SJH. SJH, HJY and SN read and approved the manuscript.
Funding
This paper was supported by the Sahmyook University Research Fund in 2024.
Data availability
The dataset supporting the conclusions is available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Ethics approval and consent to participate prior to data collection, ethical approval was obtained from the Institutional Review Board of Sahmyook University (SYU 2024-04-040-001, committee date: 2024.4.25). The participants were informed about the study and voluntarily decided to participate in the study. The anonymity and confidentiality of the participants were assured and data were treated as strictly confidential. Nursing students who agreed to participate in the study were provided with an informed consent form stating that the data would not be used for any purpose other than the research. All methods were performed in accordance with the relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Benner P, Sutphen M, Leonard V, Day L. Educating nurses: A call for radical transformation. San Francisco: Jossey-Bass; 2010. [Google Scholar]
- 2.Ironside PM, McNelis AM, Ebright P. Clinical education in nursing: rethinking learning in practice settings. Nurs Outlook. 2014;62(3):185–91. 10.1016/j.outlook.2013.12.004. [DOI] [PubMed] [Google Scholar]
- 3.Kaihlanen AM, Gluschkoff K, Koskinen S, Salminen L, Strandell-Laine C, Fuster Linares P, Sveinsdóttir H, Fatkulina N, Ní Chianáin L, Stubner J, Leino-Kilpi H, ProCompNurse Consortium. Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe—a longitudinal study. J Adv Nurs. 2021;77(12):4782–92. 10.1111/jan.15060. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Li F, Zeng Y, Fu Y, et al. Stressors and coping styles of nursing students in the middle period of clinical practicum: a qualitative study. BMC Nurs. 2024;23:394. 10.1186/s12912-024-02063-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Bantell MD. Clinical evaluation methods used by baccalaureate nursing educators in traditional and nontraditional clinical areas [doctoral dissertation]. Columbia University; 2005.
- 6.Meleis, Sawyer LM, Im EO, Hilfinger Messias DK, Schumacher K. Experiencing transitions: an emerging middle-range theory. ANS Adv Nurs Sci. 2000;23(1):12–28. [DOI] [PubMed] [Google Scholar]
- 7.Benner P. (1982). From Novice to expert: excellence and power in clinical nursing practice.
- 8.Benner P. Using the Dreyfus model of skill acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education. Bull Sci Technol Soc. 2004;24:188–99. [Google Scholar]
- 9.Kang H, Kim YY, Lee HS. Predictive factors influencing clinical competence in nursing students. J Korea Acad Ind Coop Soc. 2018;19(3):389–98. 10.5762/kais.2018.19.3.389. [Google Scholar]
- 10.Lee W, Um JY, Lee T. Fourth-year nursing students’ perceptions of role performance as nurses and influencing factors. J Korean Nurs Adm Acad Soc. 2014;20(2):187–94. 10.11111/jkana.2014.20.2.187. [Google Scholar]
- 11.Han MR. The mediating effect of resilience on the relationship between clinical practicum satisfaction and nursing role performance among nursing college students. J Korean Soc Ind Converg. 2020;21(11):171–9. [Google Scholar]
- 12.Kim HW, Kim MG. The relationship among academic achievement, clinical competence, and confidence in clinical performance of nursing students. J Korean Acad Soc Nurs Educ. 2021;27(1):49–60. 10.5977/jkasne.2021.27.1.49. [Google Scholar]
- 13.Huang HM, Fang YW, Liao SJ. (2023). The process and indicators of resilience among nursing students in clinical practicum in Taiwan: a qualitative study. Heliyon, 9(12). [DOI] [PMC free article] [PubMed]
- 14.Chae HJ. The relationship between nursing competence, emotional intelligence, and role performance of nursing students. Digit Converg Res. 2019;17(9):221–9. [Google Scholar]
- 15.Kaihlanen AM, Lakanmaa RL, Salminen L. The transition from nursing student to registered nurse: the mentor’s possibilities to act as a supporter. Nurse Educ Pract. 2013;13(5):418–22. 10.1016/j.nepr.2013.01.001. [DOI] [PubMed] [Google Scholar]
- 16.Kim EY, Yang SH. The effect of clinical practicum educational environment on nursing students’ clinical practicum stress and anxiety. J Korean Acad Nurs Adm. 2015;21(4):417–25. [Google Scholar]
- 17.Ko YJ, Kim SY. Transition shock experience of nursing students in clinical practice: A phenomenological approach. Healthc (Basel). 2022;10(4):613. 10.3390/healthcare10040613. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Casey K, Fink R, Krugman M, Propst J. The graduate nurse experience. J Nurs Adm. 2004;34(6):303–11. [DOI] [PubMed] [Google Scholar]
- 19.Hoffart N, Waddell A, Young MB. A model of new nurse transition. J Prof Nurs. 2011;27(6):334–43. 10.1016/j.profnurs.2011.04.011. [DOI] [PubMed] [Google Scholar]
- 20.Ellerton ML, Gregor F. A study of transition: the new nurse graduate at 3 months. J Contin Educ Nurs. 2003;34(3):103–quiz107136. [DOI] [PubMed] [Google Scholar]
- 21.Kunzler AM, Helmreich I, König J, Chmitorz A, Wessa M, Binder H, et al. Psychological interventions to foster resilience in healthcare students. Cochrane Database Syst Rev. 2020;7(7). 10.1002/14651858.CD013684. [DOI] [PMC free article] [PubMed]
- 22.Sisto A, Vicinanza FL, Campanozzi LL, Ricci G, Tartaglini D, Tambone V. Towards a transversal definition of psychological resilience: A literature review. Med (Kaunas). 2019;55(11):745. 10.3390/medicina55110745. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Aryuwat P, Asp M, Lövenmark A, Radabutr M, Holmgren J. An integrative review of resilience among nursing students in the context of nursing education. Nurs Open. 2023;10(5):2793–818. 10.1002/nop2.1559. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Stephens SB, Raphael JL, Zimmerman CT, Garland BH, de Guzman MM, Walsh SM, Wiemann CM. The utility of self-determination theory in predicting transition readiness in adolescents with special healthcare needs. J Adolesc Health. 2021;69(4):653–9. [DOI] [PubMed] [Google Scholar]
- 25.Lee WH, Kim JJ, Yoo JS, Heo HK, Kim KS, Lim SM. A study on the development of a measurement tool for clinical performance ability in nursing students. Yonsei Univ Nurs J. 1991;13:17–29. [Google Scholar]
- 26.Choi MS. A study on teaching effectiveness and clinical performance ability in clinical practice education for nursing students [master’s thesis]. Ewha Womans University; 2005.
- 27.Kleehammer K, Hart AL, Keck JF. Nursing students’ perceptions of anxiety-producing situations in the clinical setting. J Nurs Educ. 1990;29(4):183–7. [DOI] [PubMed] [Google Scholar]
- 28.Baek HS, Lee KW, Cho EJ, Lee MY, Choi KS. A study on the Korean version of the Connor-Davidson resilience scale: reliability and validity. J Korean Soc Biol Psychiatry. 2010;7:109–15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Shorey S, Lopez V. Self-Efficacy in a nursing context. health promotion in health care–vital theories and research; 2021. pp. 145–58.
- 30.Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. 2003;88(5):879–903. 10.1037/0021-9010.88.5.879. [DOI] [PubMed] [Google Scholar]
- 31.Alsalamah YS, et al. The relationship between work readiness and perceived clinical competence among graduates transitioning into professional practice. Int J Afr Nurs Sci. 2023;18:100555. [Google Scholar]
- 32.Zhang J, Shields L, Ma B, Yin Y, Wang J, Zhang R, et al. The clinical learning environment, supervision and future intention to work as a nurse in nursing students: a cross-sectional and descriptive study. BMC Med Educ. 2022;22(1):849. 10.1186/s12909-022-03609-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Tuckett A, Parker D, Eley R, Hegney D. The influence of clinical placement environment on career intentions of nursing students. Collegian. 2023;30(5):571–8. 10.1016/j.colegn.2023.05.004. [Google Scholar]
- 34.Deci EL, Ryan RM. Self-determination theory. Handb Theor Social Psychol. 2012;1(20):416–36. [Google Scholar]
- 35.Utvær BK, et al. Nursing students’ emotional state and perceived competence during the COVID-19 pandemic: the vital role of teacher and peer support. Front Psychol. 2022;12:793304. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Black Dorn W. An analysis and evaluation of basic needs theory and transition theory. Academic clinical nurse educators in nigeria: becoming a clinical instructor. Nurs Sci Q. 2025;38(1):76–83. 10.1177/08943184241291564. [DOI] [PubMed] [Google Scholar]
- 37.Chen F, Liu Y, Wang X, Dong H. Transition shock, preceptor support and nursing competency among newly graduated registered nurses: a cross-sectional study. Nurse Educ Today. 2021;102:104891. 10.1016/j.nedt.2021.104891. [DOI] [PubMed] [Google Scholar]
- 38.Daneshfar M, Karimi Moonaghi HK. The impact of clinical simulation on bridging the theory–practice gap in nursing education: a systematic review. BMC Med Educ. 2025;25:192. 10.1186/s12909-025-07790-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Jallad ST, Abu-Rish E, Al-Ghabeesh SH, Alrimawi I, Salameh AB. Effectiveness of simulation-based education on communication, student satisfaction, confidence, and critical thinking among nursing students. J Nurs Educ. 2025;64(2):84–92. 10.1177/10784535241301115. [Google Scholar]
- 40.Mishra R. Simulation-based learning in nursing curriculum-time to Bridge the gap. Heliyon. 2023;9(12):e23915. 10.1016/j.heliyon.2023.e23915. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Curtis K, Fry M, Shaban RZ, Considine J. Translating research findings to clinical nursing practice. J Clin Nurs. 2017;26(5–6):862–72. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Wu PL. The impact of clinical practice stress on nursing professional competence among undergraduate nursing students: A Cross-Sectional study. Florence Nightingale J Nurs. 2024;32(3):312. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Watson L, Spence MT. Causes and consequences of emotions on consumer behaviour: A review and integrative cognitive appraisal theory. Eur J Mark. 2007;41(5/6):487–511. [Google Scholar]
- 44.Taylor I, Bing-Jonsson PC, Finnbakk E, Wangensteen S, Sandvik L, Fagerström L. Development of clinical competence–a longitudinal survey of nurse practitioner students. BMC Nurs. 2021;20:1–15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Masten AS. Resilience theory and research on children and families: Past, present, and promise. J Family Theory Rev. 2018;10(1):12–31. [Google Scholar]
- 46.Goh YW, Sawang S, Oei TP. The revised transactional model (RTM) of occupational stress and coping: an improved process approach. Australasian J Organ Psychol. 2010;3:13–20. [Google Scholar]
- 47.Mcdermott RC, Fruh SM, Williams S, Hauff C, Graves RJ, Melnyk BM, Hall HR. Nursing students’ resilience, depression, well-being, and academic distress: testing a moderated mediation model. J Adv Nurs. 2020;76(12):3385–97. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Franklin AE, Lee CS. Effectiveness of simulation for improvement in self-efficacy among novice nurses: A meta-analysis. J Nurs Educ. 2014;53(11):607–14. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The dataset supporting the conclusions is available from the corresponding author on reasonable request.