Nursing graduates transition to practice and factors affecting their readiness: a comparative study between Ha’il and Kuwait

Introduction: Work readiness refers to the preparedness level of graduates regarding their qualities and attributes for success in the workplace. Evaluating the preparedness of nursing graduates to practice is crucial to assist them during their transition from students to practicing professionals. This study assessed the preparedness of nursing graduates for practical hospital work in Kuwait and the Kingdom of Saudi Arabia, comparing both settings.

Methods: This cross-sectional study included participants who recently graduated from the University of Ha’il and started internships, along with nursing graduates from the College of Nursing in Kuwait. The Casey-Fink Graduate Nurse Experience Survey was utilized, and data were collected online using Google Forms. Data analysis was performed using the Statistical Package for Social Sciences version 26.

Results: Out of 287 respondents, 185 were from the University of Ha’il, and 102 were from the College of Nursing in Kuwait. Respondents from both institutions showed moderate levels of adaptation with mean (SD) scores of 3.01 (0.41) and 3.08 (0.40), respectively, with no significant difference [t(285) = −1.47, p = 0.14].

Discussion: Participants from both countries displayed moderate confidence in their patient care abilities, which decreased as the number of patients increased.

1 Introduction

Role transition, as revealed by Blevins, is the central process of developing new habits essential for effectively performing a new role. The degree of uncertainty experienced during this transitional phase hinges on the extent of overlap between past and future roles, alongside the anticipation of positional adjustments (Blevins, 2018). Notably, this phase poses a particularly critical challenge for nurses (Sandler, 2018).

Working as a registered nurse (RN) is a whole new world compared to college life. It is a vulnerable time for new nurses, and without the right support, they can easily become hesitant, discouraged, affecting their productivity and lower quality of patient care, and even leading them to leave the profession (Maria et al., 2020). That is why having a strong support system is essential. The accumulative cooperation between nurse educator, preceptor, and fellow staff should actively engage in the development of new nurses to set them up for success. Inexperienced nurses thrive when they can seek advice from caring and approachable professionals and receive clear explanations about procedures. When new nurses feel supported, they become more confident team members, reducing their anxiety and boosting their engagement in clinical tasks (Sandler, 2018).

Formal nursing education undertakings to produce and graduate nurses who can competently meet employers’ expectations for proficient patient care delivery (National Academies of Sciences et al., 2021). Nevertheless, the concept of readiness for nursing practice often lacks clarity, resulting in a lack of consistency across regulatory, academic, and practice domains, contributing to inconsistencies in expectations for practice readiness on nursing profession (Mirza et al., 2019). Subsequently, nurses must be armed and fulfilled with problem-solving skills styles accompanied with critical thinking skills to swiftly identify changes in patient conditions, implement independent nursing interventions, anticipate orders, and prioritize tasks. Preparing nursing students for practice readiness demands and based on an educational curriculum centered on core competencies.

Work readiness encompasses how prepared graduates are for workplace success regarding their attributes and characteristics (Walker et al., 2015). An individual is deemed “work-ready” if they possess the requisite skills to execute tasks independently and reliably within a professional environment (Winterton and Turner, 2019). This encompasses not only the ability to fulfill specific job functions but also the capacity for effective time management, communication, and collaboration with colleagues (Peersia et al., 2024).

Nurses, in particular, may experience two types of transition during their first year of work: a smooth transition or transition shock (Labrague and De Los Santos, 2020). Transition shock, coined by Duchscher (2009) and previously defined as reality shock by Kramer (1975) refers to the emotional and psychological responses individuals encounter when entering a new role or environment. This phenomenon, characterized by feelings of inadequacy, anxiety, and confusion, occurs when individuals face unexpected challenges (Nakić et al., 2023). For nursing students, transition shock can manifest during clinical practice, where real-world situations often differ significantly from theoretical training (Ko and Kim, 2022). In contrast, reality shock focuses on the dissonance between the expectations of new graduates and the realities of professional practice (Choe and Lee, 2016). Clinical practice plays a vital role in the education of nursing students, and it is imperative to ensure their smooth transition to a new clinical practice environment to facilitate effective practical learning. Identifying the characteristics of transition shock and implementing strategies to alleviate and prevent it in the clinical practice setting are crucial.

2 Review of the literature

2.1 Global context and readiness to practice

Globally, nursing students in countries such as the Republic of Korea (Lee et al., 2023), Egypt (Salem, 2021), and Turkey (Güner, 2015), have reported anxiety and a lack of confidence stemming from dissatisfaction with clinical placements, directly affecting their readiness to practice. Despite some Egyptian nursing students exhibiting low knowledge, they still felt confident in transitioning to professional practice (Salem, 2021). However, overconfidence can adversely affect patient care and management. Moreover, higher work readiness in new graduate nurses is associated with increased coping self-efficacy, occupational commitment, and intention to remain in the profession (Li et al., 2022).

In the Saudi context, regional studies reveal moderate readiness in key domains. For example, in Al Jouf, 63.7% of intern students exhibited a moderate level of readiness, with professional attitudes and patient-centeredness showing substantial room for improvement (Alruwaili et al., 2024). The assessment also evaluated factors such as professional attitudes and patient-centeredness, revealing that 70.4% of students exhibited moderate readiness in professional attitudes, while 55.6% showed moderate readiness in patient-centeredness (Alruwaili et al., 2024). Another study in the Al Bahah region of Saudi Arabia concluded that transition is the primary issue regarding the difficulties faced by nurses in the healthcare environment (Baker, 2020). Notably, new graduates report discomfort performing procedures independently without supervision, highlighting supervision quality as a pivotal factor in readiness.

In addition, this study found a strong link between preceptor support and key nursing aspects, including communication, leadership, professional satisfaction, and overall job satisfaction (Baker, 2020). Also, the study results highlighted the discomfort that new graduate nurses experience when implementing procedures and skills independently without supervision from senior nurse (Baker, 2020).

2.2 Foundational theories on transition and confidence

Numerous studies have underscored the relationship between clinical exposure, social integration, and readiness to practice among novice nurses. Washington (2012) reported that a shortage of clinical experience and the challenging nature of nursing care methods on causing functional anxiety among nurses, which can compromise the delivery of high-quality care. This work also emphasizes the protective role of effective team integration and acceptance by colleagues play a critical role in NGs’ successful transition. Feeling like part of the team and gaining respect from colleagues can mitigate the effects of transition shock (Craig et al., 2012). However, mismatched expectations, high workloads, and interpersonal challenges with colleagues may hinder the transition process. Lack of trust in new nurses can negatively impact their confidence when interacting with doctors and patients. Conversely, mismatched expectations, heavy workloads, and interpersonal tensions with colleagues may hinder the transition process, and a lack of trust in new nurses can negatively affect interactions with physicians and patients (Casey et al., 2004).

In terms of confidence grows with experience and is linked to more efficient transitions and reduced emotional exhaustion (Andersson and Edberg, 2010; Frögéli et al., 2019; Hunter and Cook, 2018). Recognizing the significance of self-confidence in the nursing profession, it is crucial to explore the experiences of novice nurses to identify factors during their preparedness period that influence their confidence levels. By addressing these underlying causes, we can enhance the quality of patient care and empower novice nurses to deliver effective care with confidence.

Previous studies have primarily focused on nursing students rather than new graduates, leaving a gap in understanding NGs’ work readiness. Research on NGs reveals high rates of reported incidents, including medication errors and miscommunication, which compromise patient safety (Herron, 2018; Treiber and Jones, 2018). Furthermore, low self-esteem stemming from insufficient knowledge may result in poor communication, reluctance to learn, and ultimately, attrition from the profession (Walker et al., 2015). Conversely, NGs with robust clinical placements show greater maturity in decision-making, independence in patient management, and higher confidence levels, suggesting placement quality as a key modulator of readiness (Salem, 2021).

Several studies findings indicated that new nurses in transition phase may benefit from additional support and special area training to build confidence in handling multiple patients and communicating with physicians (Casey et al., 2011; Usher et al., 2015; Woods et al., 2015). Research by Casey et al. (2011) highlights that only 35% of new nurses in transition feel confident in caring for more than three patients, while Woods et al. (2015) reported a mere 31% confidence level in similar circumstances. Usher et al. (2015) observed a decrease in confidence as patient workload increased, emphasizing the need for targeted support in this area. Seada and El Hanafy (2012) also pointed out a lack of confidence in managing workload, indicating the importance of addressing this issue.

In terms of communicating with physicians, it is obvious that new nurses in transition phase may require additional training and mentorship. According to Casey et al. (2011), these new nurses rated their confidence in communicating with physicians as 2.88 on a 5-Likert scale, and Usher et al. (2015) found a similar confidence level of 2.83. These findings suggest the need for structured communication training to enhance these new nurses’ confidence in interacting with physicians. Additionally, the study by Güner (2015) highlights the readiness of new nurses for communication practice, indicating a potential area for targeted intervention and support.

An effective preceptor can have a tremendous impact on the development of new nurses. When hiring a new graduate, it is crucial for the chief nursing to appropriately select a preceptor who not only has the desire but also the comprehensive training in effective precepting methods. Tolerance and consistency in preceptors are essential as new RNs may have to train across multiple shifts. When multiple preceptors are involved, new nurses may feel a lack of structure or guidance consistency. Having assigned fixed preceptors allows for the development of a relationship where the preceptor can assess the new nurse’s growth over time and provide constructive feedback on areas of strength and opportunity. It is fundamental for the feedback to be consistent and for areas of need to be identified early so that corrective training can occur (Choe and Lee, 2016). In this relationship, the preceptor plays a crucial role in building the new nurse’s confidence, which in turn supports smoother orientation and progression in patient assignments as milestones are achieved (Maria et al., 2020; Baker, 2020). However, practical considerations such as preceptor workload and potential variability in feedback quality warrant attention, and future GCC-focused research should evaluate how fixed preceptor models influence readiness outcomes in Ha’il and Kuwait.

Ensuring that new nurses are well-prepared for practice is crucial due to several pressing factors. The nursing shortage, as projected by US Bureau of Labor Statistics (2019), is anticipated to exacerbate in the coming years owing to the escalating demand for nurses. Furthermore, within hospital settings, where a majority of new graduates commence their professional practice, patient acuity has notably risen. This, coupled with constraints mandating shorter hospital stays as highlighted by Dharmarajan et al. (2016), underscores the immediate need for new nurses to be well-equipped to address the challenges in patient care. Moreover, new nurses face additional hurdles when embarking on their professional journey in healthcare facilities. The landscape of healthcare technology is constantly evolving, making it challenging for new graduates to navigate the diverse range of technologies in use (Seada and El Hanafy, 2012). Consequently, new nurses must possess the requisite skills to manage complex care in this high-technology, nursing shortage environment.

Evaluating NGs’ readiness to practice is crucial to ensuring a smoother transition into the workforce. In this study, we assess NGs’ preparedness for hospital practice in Kuwait and Saudi Arabia, with a focus on their efficiency in individual and inter-professional tasks. We compare two distinct educational pipelines: The College of Nursing in Kuwait (CoNK) and the University of Ha’il (UoH) in Saudi Arabia. Notably, NGs at UoH undergo a 1-year internship post-graduation, whereas CoNK graduates participate in a 9-month rotation program followed by assignment to specific fields. By contrasting these programs, the study aims to elucidate how internship versus rotation structures influence readiness, and to identify system-level factors within each context that promote or hinder NG development.

3 Materials and methods

3.1 Study design, period, and setting

A descriptive cross-sectional study was conducted across two nursing institutions, one in Kuwait and one in Saudi Arabia, the period for data collection was between from June 2023 to October 2023.

3.2 Study participants

Participants included NGs from the CoNK (class of 2021/2022) and UoH who engaged in clinical internships at hospitals and consented to take part. These graduates underwent training across varied clinical practice areas.

3.3 Study instrument

Data were collected during internships employing the Casey-Fink Graduate Nurse Experience Survey, chosen for its established use in prior research (Cline et al., 2017; Rush et al., 2013). Originally proposed by Casey and Fink to measure newly licensed registered nurses’ comfort levels with skills over time, the questionnaire displayed a Cronbach’s alpha coefficient of 0.89 for the overall 24-item instrument. This measures readiness by evaluating new nurses’ clinical competence, confidence, integration into professional teams, and support systems, all of which are fundamental to ensuring they are prepared for the challenges of real-world practice.

In addition to the Casey-Fink Graduate Nurse Experience Survey (CFGNES) overall score, we collected item level responses to enable more granular analyses of readiness domains (clinical skills, confidence, team integration, and perceived support). The phrase “number of review questions answered” referred to the completeness of the CFGNES responses for a given participant. Specifically:

CFGNES comprises 24 items. For each participant, we recorded the number of CFGNES items completed (0–24). If a respondent skipped items, their total CFGNES score was computed using the standard CFGNES scoring rules for complete responses, and the missing items were treated as missing data according to our pre-specified data-imputation plan.

3.4 Data collection procedure

Data were collected online, with participants contacted via email and WhatsApp. A link to the questionnaire created via Google Forms was distributed, providing a week to complete the survey.

3.5 Ethical considerations

The study received ethical approval from the Research Ethics Committee at CoNK (CoN-REC, reference no. CoN-20-11-22) and the Institutional Review Board at UoH (reference no. H-2024-375) in accordance with the Declaration of Helsinki (1964). Written informed consent was obtained from all participants, who were encouraged to participate voluntarily and informed of their right to withdraw at any time. Participants’ anonymity was guaranteed, with only aggregated data reported, and confidentiality maintained through coding during data collection and analysis.

3.6 Statistical analyses

Data were exported from MS Excel to the Statistical Package for Social Sciences (SPSS) IBM version 26 for analysis. Descriptive statistics—means, standard deviations, frequencies, and percentages were utilized to describe and categorize variables, with statistical significance set at p<0.05.

4 Results

Data from 305 participants were analyzed, but after removing incomplete and unrealistic information, the final analysis included 287 respondents: 185 from Ha’il and 102 from Kuwait. All respondents from Ha’il were under 31 years of age (n = 185; 100%), predominantly female (n = 112; 60.50%), with the majority enrolled in a traditional Bachelor of Science in Nursing program (n = 184; 97.80%). In Kuwait, over half were also younger than 31 years (n = 56; 54.90%), with most being female (n = 54; 52.90%) and enrolled in the traditional BSN program (n = 42; 41.78%) as demonstrated in Table 1.

TABLE 1

Table 1. Demographic data of the respondents.

On evaluating senior practicum experiences, Ha’il respondents engaged longest with adult Intensive Care Units (n = 58; 31.40%), while Kuwaiti respondents spent most time in adult medical-surgical units (n = 40; 39.23%). A significant number of Ha’il respondents (n = 121; 65.40%) did not work in the hospitals associated with their clinical practicums, whereas 51.00% of Kuwaiti respondents (n = 52) were employed therein. Both groups confirmed their practicum occurred in urban settings. Ha’il interns required an average of 4.81 preceptors compared to 4.03 in Kuwait. Participants in Ha’il reported answering about 57 questions weekly, while Kuwait participants answered approximately 6.33. On average, Ha’il respondents spent 7.89 h per week with charge or head nurses, whereas Kuwaiti counterparts averaged 17.38 h shown in Table 2.

TABLE 2

Table 2. Practicum experience data of the respondents.

Thirty-one (30.39%) and 68 (36.80%) respondents in Kuwait and Ha’il had nursing assistant experience, respectively. The majority of Ha’il respondents (n = 70, 93.33%) worked in healthcare settings. Nearly half of Kuwaiti respondents (n = 50, 49.00%) reported similar employment, with 86.00% (n = 43) working in the healthcare sector. Most Ha’il BSN students (n = 70; 93.33%) were required to work 16 h weekly, while over half of the Kuwaiti surveyed (n = 22; 44.00%) had the same obligation. In terms of employer-supported scholarship programs, only 4 (2.20%) Ha’il respondents were not enrolled, compared to 33 (32.40%) in Kuwait (Table 3).

TABLE 3

Table 3. Shows the employment and experience data of the respondents.

Ultimately, both groups demonstrated moderate adaptation levels, with mean SD scores of 3.01 (0.41) for Ha’il and 3.08 (0.40) for Kuwaiti respondents. T-tests indicated no significant difference at t (285) = −1.47, p = 0.14 (Table 4).

TABLE 4

Table 4. The level of adaptation of the respondents and its comparison.

Regarding correlations, Pearson’s r showed no significant link between GPA and adaptability for either group (Ha’il: r = 0.56, p = 0.45; Kuwait: r = 0.16, p = 0.11). Additionally, no significant correlation existed between hours with charge nurses and adaptation (Ha’il: r = 0.11, p = 0.13; Kuwait: r = −0.14, p = 0.17). However, there was a weak positive correlation between the number of review questions answered and adaptation for Ha’il respondents (r = 0.18, p = 0.02) as well as Kuwaiti respondents (r = 0.22, p = 0.02). A significant positive correlation was observed between adaptation and confidence in caring for two patients for both institutions (Ha’il: r = 0.32, p<0.001; Kuwait: r = 0.50, p<0.001). Furthermore, confidence in managing higher patient numbers similarly correlated with adaptation levels (Table 5).

TABLE 5

Table 5. Relationship between GPA, selected practicum data and level of adaptation.

5 Discussion

This comparative study examined the transition readiness of nursing graduates (NGs) from the University of Ha’il and the College of Nursing in Kuwait using the Casey–Fink Graduate Nurse Experience Survey. The findings showed that graduates from both countries demonstrated moderate adaptation levels, with no significant differences in overall readiness. These results suggest that, despite differences in educational structures and internship models, NGs in both settings face similar challenges as they move from student roles to practicing nurses.

5.1 Confidence in caring for patients

Participants in both Kuwait and Ha’il reported moderate confidence in providing patient care; however, their confidence declined as patient load increased. This practice is consistent with earlier studies showing that NG confidence decreases when workload increases or when they are required to manage multiple patients independently (Casey et al., 2021; Güner, 2015; Hallaran et al., 2023; Herron, 2018; Masso et al., 2022).

The literature also identifies low confidence as a barrier to smooth transition, especially among new graduates entering high-acuity clinical environments (Herron, 2018; Hallaran et al., 2023). Although our study did not examine the specific barriers contributing to low confidence, research commonly points to inadequate clinical exposure, limited skills mastery, and insufficient workplace support as key contributors (Alkubati et al., 2023; Inayat et al., 2020).

To boost the confidence of NGs, adequate preparation and a supportive clinical environment are of utmost importance before transitioning. Similar to our study, the educational strategies such as offering final practicums and using high-fidelity simulations were found to be effective in achieving this (Tonapa et al., 2023). Research linked the development of self-efficacy with workplace readiness (Inayat et al., 2021). In line with the literature, NGs in our study reported supportive clinical environment which contributed to significantly enhance new graduates’ confidence in their ability to practice (Baharum et al., 2023; Hallaran et al., 2023).

5.2 Adaptation clinical practice

The results showed moderate adaptation across domains such as professional identity, clinical problem solving, and trials and tribulations. This aligns with findings from Ulupinar and Aydogan (2021), who reported that nearly half of NGs experienced difficulties adjusting to their new roles within the first year. Our t-test results revealed no significant differences between institutions regarding adaptation subscales except for clinical problem solving, in which Kuwait graduates scored slightly higher. This may reflect differing clinical exposures, as Kuwaiti graduates spent more weekly hours with charge nurses and had greater alignment between practicum sites and future workplaces.

Further in our study, over 40% of the students considered leaving the nursing profession, and more than 50% planned to leave their current institutions. Our findings and previous research suggest that NGs struggle to settle in their jobs without adequate support, potentially leading to high staff turnover in healthcare facilities which is similar to Regan et al. (2017) findings.

The current study reported about the initial experiences of the NGs that affected their adaptability to clinical practice. According to Duchscher (2009), nurse graduates experience feelings of anxiety, insecurity, and inadequacy that affect their integration and adaptability into professional practice. These findings are supported by other author (Casey et al., 2021). Therefore, it has been suggested that nurse graduates require support to navigate the obstacles to adaptation and integration. Another study suggested that the adaptation process of nurse graduates should be initiated during their nursing training and supported by the workplace environment along with individual nurses’ efforts (Baharum et al., 2023). Similarly, a study (Kim and Shin, 2022) agree that nurse graduates need more support in addition to formal training to adapt adequately to their workplace, which enhances patient safety and quality of care.

5.3 Relationship between selected variables and adaptation

Our findings showed no significant relationship between GPA, number of preceptors, or hours with charge nurses and adaptation scores in either country. This supports research suggesting that academic performance alone does not reliably predict readiness for clinical practice (Ulupinar and Aydogan, 2021). However, a weak but significant positive correlation was noted between the number of review questions answered and adaptation. This may indicate that consistent engagement in review activities reinforces knowledge recall and boosts NGs’ confidence findings supported by Inayat et al. (2021), who linked active self-directed learning with improved workplace readiness.

The strong positive correlation between adaptation and confidence in caring for two, three, and four patients suggests that experiential exposure contributes to readiness. Literature similarly reports that NGs who engage in more diverse and challenging clinical tasks tend to develop stronger confidence and smoother transitions (Harrison et al., 2020; Lee et al., 2023).

5.4 Confidence and adaptability

Our results showed that confidence and adaptability increase together, reinforcing that NGs’ ability to manage patients comfortably is tied to their overall transition success. Previous studies highlighted our reported relationship by which confidence is influenced by self-esteem, anxiety levels, and the clinical learning environment (Lee et al., 2023).

Further, fear of handling new patients, difficulties dealing with the health system and challenges of applying policies and procedures in the workplace were reported to be significant barriers to integration into practice (Alharbi et al., 2023). Therefore, it can be asserted that in our study the new graduates attend to more patients and participate in several clinical tasks, their confidence increases, which motivates them to become enthusiastic to practice, as supported by Harrison et al. (2020).

Cooperation and teamwork, participation in decision-making, increased self-esteem, fair distribution of tasks, and engagement in continuous professional development have been suggested to improve NGs’ confidence in their jobs and decrease the chances of turnover (Alharbi et al., 2023; Lee et al., 2023; Ulupinar and Aydogan, 2021). These practices seem to help nursing students transition from nursing school to real-world practice signposting our nurse graduates to engage in several practice areas and being empowered to participate in decision-making will likely increase their confidence and result in better adaptability to the work environment.

6 Implications for practice

These findings, overall, indicate that NGs initially lack confidence, which can improve with practice and is intrinsically linked to workplace adaptability. Identified strategies to bolster both emotional competencies include enhancing educational groundwork and fostering supportive environments for NGs, allowing for collaboration across institutions to tackle shared challenges. A qualitative follow-up study is recommended to explore transitional experiences in greater detail.

To enhance the readiness of NGs in Kuwait and KSA, key recommendations are significant to be addressed; (1) The demanding nature of the work, coupled with inadequate staffing and heavy responsibilities, often leads to stress and high turnover rates among nurses, especially those who are new to the profession. To address these challenges, offering dedicated mentorship during the internship period has been proven to elevate patient care, enhance staff morale, and improve overall unit efficiency. It is fundamental to implement structured mentorship programs that connect NGs with experienced nurses to provide ongoing support and practical knowledge; (2) increase the use of high-fidelity simulations in nursing education to build clinical skills and confidence. The simulated scenarios play a crucial role in addressing the weaknesses of new nurses before they graduate. By immersing themselves in these experiences, new nurses are exposed to the real-life challenges and demands of the nursing profession, which better prepares them for their transition into professional practice. It is believed that these hands-on experiences not only help new nurses to identify and strengthen their weaknesses but also instill a sense of confidence and readiness as they embark on their professional nursing journey; (3) develop tailored transition programs to address the specific challenges faced by NGs; (4) emphasize training on patient management and adaptability in high-stress situations through workshops and continuing education; (5) a successful transition for new nurses relies on robust clinical and administrative leadership, as well as accessible management and governance structures. By establishing smaller, supportive teams within the larger structure, we can provide better support for new nurses and set them up for success; and (6) conduct longitudinal studies to track the long-term experiences and outcomes of NGs.

By adopting these strategies, healthcare organizations and nursing educational institutions can better support NGs during their transition, ultimately improving patient care outcomes.

6.1 Strengths and limitations

The strength of this study was the inclusion of NGs and nursing internship students from two universities in two different countries; however, it also has multiple shortcomings. This was a cross-sectional study, and future longitudinal studies should explore additional factors. The data were gathered online, and relying on self-reported survey data might have led to response bias or inaccuracy because of participant subjectivity and social desirability.

7 Conclusion

The findings from this comparative study of NGs transitioning to practice in UoH and CoNK reveal several critical insights into their readiness for the professional environment. Both groups of NGs exhibited moderate levels of adaptability and confidence in their patient care abilities, with no significant differences between the two institutions in overall adaptation scores. However, it was observed that confidence levels decline as the number of patients increased. This pattern suggests that although the NGs generally feel prepared, the pressures of real-world clinical environments challenge their confidence. Moreover, the results indicate a lack of significant correlation between academic performance (GPA) and adaptability in the workplace, highlighting that factors beyond educational background significantly influence readiness for practice. Given these results, there is an evident need for targeted strategies to enhance the confidence and adaptability of NGs. Support systems within clinical environments are critical to facilitate their transition from the academic setting to professional practice.

Data availability statement

The original contributions presented in this study are included in this article/supplementary material, further inquiries can be directed to the corresponding author.

Ethics statement

The study received ethical approval from the Research Ethics Committee at CoNK (CoN-REC, reference no. CoN-20-11-22) and the Institutional Review Board at UoH (reference no. H-2024-375) in accordance with the Declaration of Helsinki (1964). Written informed consent was obtained from all participants. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

MA: Conceptualization, Formal analysis, Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing. RD: Conceptualization, Investigation, Validation, Writing – original draft, Writing – review & editing. AA: Investigation, Writing – original draft, Writing – review & editing. AH: Conceptualization, Investigation, Writing – original draft, Writing – review & editing. JL: Investigation, Methodology, Validation, Writing – original draft, Writing – review & editing. BA: Data curation, Formal analysis, Investigation, Methodology, Validation, Writing – original draft, Writing – review & editing.

Funding

The author(s) declared that financial support was not received for this work and/or its publication.

Acknowledgments

We want to thank all the nursing internships and nursing students who participated in this study. Special thanks to the faculties and administrators in College of Nursing in Kuwait and the University of Hail for their support and encouragement during the progress of this research project.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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The author(s) declared that generative AI was not used in the creation of this manuscript.

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