Wed, Jul 30, 2025
[Archive]
Volume 18, Issue 2 (2025)
JMED 2025, 18(2): 113-120 |
Back to browse issues page
Ethics code: IR.GUMS.REC.1402.529
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Nasiri K, Tabari Khomeiran R, Jafaraghaee F, Taheri Ezbarami Z, Emami Sigaroudi A. Exploration of final-year nursing students’ experiences from the nursing management internship course: A qualitative study. JMED 2025; 18 (2) :113-120
URL: http://edujournal.zums.ac.ir/article-1-2401-en.html
URL: http://edujournal.zums.ac.ir/article-1-2401-en.html
Khadijeh Nasiri1 
, Rasoul Tabari Khomeiran1 , Fateme Jafaraghaee1 , Zahra Taheri Ezbarami2 , Abdolhosien Emami Sigaroudi *3
, Rasoul Tabari Khomeiran1 , Fateme Jafaraghaee1 , Zahra Taheri Ezbarami2 , Abdolhosien Emami Sigaroudi *3
1- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences. Rasht. Iran
2- Department of Pediatrics Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences. Rasht. Iran
3- Department of Community Health, School of Nursing and Midwifery, Guilan University of Medical Sciences. Rasht. Iran ,emamisig@gmail.com
2- Department of Pediatrics Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences. Rasht. Iran
3- Department of Community Health, School of Nursing and Midwifery, Guilan University of Medical Sciences. Rasht. Iran ,
Full-Text [PDF 897 kb]
(57 Downloads)
| Abstract (HTML) (284 Views)
Full-Text: (4 Views)
Abstract
Background & Objective: Clinical education is a fundamental part of nursing education. Management's role in nursing is vital and is closely related to the quality of care in medical centers. The present study was conducted to explain the experiences of final-year nursing students from the nursing management internship course.
Materials & Methods: The present study is a conventional content analysis study conducted with the participation of 18 final-year nursing students. Data collection was done through semi-structured interviews. The interviews were transcribed verbatim and analyzed using MAXQDA software version 2020, from which themes were inductively extracted. Data analysis led to the extraction of two themes and seven categories.
Results: The first theme was guiding experiences, which included five categories of professional communication practice: strengthening teamwork skills, understanding multiple roles, understanding legal aspects, and enhancing personal development. The second theme was obstacles and experiences, which included two categories: understanding work stress and an inappropriate organizational atmosphere.
Conclusion: According to the findings of the present study, passing the nursing management internship course can lead to the formation of a real perception of the tasks and responsibilities of the nursing profession in students. These perceptions can either strengthen or weaken students' professional outlooks. Therefore, the findings of this study can be valuable in designing nursing internships.
Materials & Methods
Design and setting(s)
The present study is a qualitative research project employing a conventional content analysis approach, conducted from May 1, 2024, to November 30, 2024. Content analysis is a qualitative research method used to classify words and phrases within text. It describes the content obtained from communications systematically and objectively [21]. Therefore, in the present study, using this method, individuals' perceptions and behaviours in the real world were examined in depth, and the phenomenon was described.
Participants and sampling
The participants included 18 undergraduate nursing students from Shahid Beheshti School of Nursing and Midwifery in Rasht who had experience in completing an internship course in nursing management. Purposive sampling was employed to achieve maximum variation in characteristics such as age, professional interest, gender, and grade point average, providing the researcher with more comprehensive insights into students' understanding of working with nurses. The inclusion criteria for the study included eighth-semester undergraduate nursing students completing a management internship course and desiring to participate.
Data collection methods
Table 1. Demographic characteristics of study participants
Table 2 presents an example of how participants' statements were inductively organized into themes, categories, and subcategories.
The results of this study regarding students' perceptions of the nursing management internship reveal two themes and seven categories. Some experiences contribute positively to students' professional development, while others result in stress and uncertainty about their future careers (Table 3).
Table 2. Sample of them, category, and Subcategory and participant statement
Table 3. Themes, categories, and conceptual codes extracted from the data
Guiding experiences
This theme includes the following categories: 1- Practicing professional communication 2- Strengthening teamwork 3- Understanding role diversity 4- Understanding legal aspects 5- Strengthening personal development.
Professional communication practice
Nursing Management Internships and working with nurses lead nursing students to learn and practice professional communication.
In this regard, Participant Number 4, a working female studying in semester 8, said: "Another thing was communication. When I was in the ward, I learned how to communicate with the doctors and the nursing office."
Participant number 8, a working female studying in semester 8, said: "… I think my best experience was the ability to communicate with staff, patients and other wards, which was very limited before this course, and we only had contact with the instructor …"
Strengthening teamwork skills
Experience working as a team with nurses is one of the advantages of a nursing management internship, as the participants mentioned.
Participant number 5, a working female studying in semester 8, said: "... When I saw that in a CPR operation, the ward nurse was responsible for the drug therapy, the nurse in the adjacent ward was responsible for the Cardiac compression, and the anaesthesia team worked on the respiratory system, the importance of division of labour and teamwork became clear to me..."
Understanding legal aspects
The nursing management Internship has increased students' awareness of the legal aspects of the nursing profession. In this regard, participant number 3, a working male studying in semester 8, said: "The nurses helped us a lot and taught us the legal aspects of nursing."
Enhancing personal development
The experience of working with nurses has enhanced the practical and personal skills of nursing students, which will be advantageous for their professional futures. In this regard, student number 13, a working female studying in semester 7, said: "...One of the important things I learned was when I entered the ward, which tasks to do first and in what order to do them so that I could finish the tasks on time..."
Obstacles experienced
This theme includes two categories: 1- Perception of work stress and 2- Inappropriate organizational atmosphere.
Understanding work stress
Working with nurses in a real environment without a trainer has led to an understanding of the working conditions of the nursing profession. Participant number 9, a working male studying in semester 8, said: "...I was in a very busy ward with 26 patients and two nurses, and the nurses had to do their work very quickly..."
Participant number 11, a working female studying in semester 7, said: "... We felt the hardship of nursing more than before, all this work pressure and coordination and responsibility..."
Participant number 15, a working female studying in semester 8, said: "... One day, we were in the supervisor's office, where there was a lot of work, and it was different from the ward, and we saw a new and special aspect of nursing..."
Inappropriate organizational atmosphere
Nurses' mistreatment of students in the wards, including shifting their responsibilities onto the students and holding them accountable for mistakes, has led to dissatisfaction among students in the nursing management course. Moreover, the education provided to students is frequently contingent upon completing clinical tasks nurses assign. Participant number 6, a working male studying in semester 7, said: "... I was very annoyed; the nurses would blame their work on the students, or if there was a problem in the ward, they would blame the students and quickly say that the students were failing.…" Participant number 12, a working male studying in semester 8, said: "….They gave me most of the clinical work, and when I protested that they were giving me management tasks, they said, "You're a student, and you have to do it..." In other words, they were officially abusing me.…"
Discussion
The present study aims to explain the experiences and perceptions of final-year nursing students about nursing management internship courses. The present study's findings showed that students' understanding and experience of nursing management internship included two main themes: 1. Guiding experiences and 2. Obstacles experienced.
Very few studies have been conducted on nursing management internships. In Iran, only a limited number of studies exist, which may be attributed to variations in nursing curricula across different countries. In some cases, the nursing management course may be absent from the curricula of other nations or presented under different titles, making it challenging to conduct extensive comparisons with results from other studies. The results of a qualitative study by Rigobello et al. in Brazil [24], which aimed to explore the perceptions of students, nurses, and nursing professors regarding the Supervised Curricular Internship (SCI) course—seemingly equivalent to the nursing management internship course in Iran—indicated that this course is essential for acquiring and developing management and leadership skills, as well as effectively managing nursing resources and bureaucratic processes. Also, in a study conducted by Bahrami Rad [25] using qualitative content analysis in Iran, the presence of students on night shifts and working alongside nurses led to the extraction of two main themes: gaining new experiences and students' work independence. The comparison of the mentioned studies' findings with the present study's findings indicates that the results are consistent. The presence of students alongside nurses in the absence of the instructor helps them gain professional competency and an understanding of their real job situation; in other words, these experiences guide students. The value of high-quality clinical education in fostering personal and professional development and enhancing clinical nursing skills is undeniable [26]. However, students may also face harm and bullying, which can contribute to psychological reactions that lead to an intention to leave the nursing profession [27]. Part of the student's experiences in the present study is the perception of work stress and inappropriate organizational atmosphere. Presence in clinical environments during internship courses exposes nursing students to professional challenges. One of the challenges identified in a qualitative study conducted in Saudi Arabia with final-year nursing students was that nurses instructed students to perform non-nursing tasks, aligning with the present study's findings [28]. Additionally, Ahmadi's study [29] in Iran revealed that a lack of support and shortcomings in welfare and professional identity pose challenges for internships, which is also consistent with the findings of this study. The results of the study by Rezakhani et al. also showed that inappropriate organizational atmosphere and incorrect social norms, such as abuse of students and inappropriate behaviour towards them, are the major problems of students in nursing management internships [30]. Blaming students for errors inwards, forced labour, and ignoring the role of students are issues that students mentioned in the present study. In this regard, the results of a qualitative study showed that bullying and physical and psychological violence against nursing students occur in clinical environments, which requires fundamental reform in the organizational culture of educational and medical centres [31]. This aligns with the findings of the present study. In a qualitative study, an ineffective professional practice environment—characterized by inappropriate professional interactions and poor adherence to clinical standards—was identified as a challenge in professional education, which also corresponds with the findings of this study [32]. Clinical learning is challenging, unpredictable, stressful, and ever-changing, and negative clinical experiences affect students' self-confidence, attitudes, and learning. In addition to wasting time and energy for learners, significant financial burdens are imposed on the educational system, along with mental stress and burnout among students by the end of their training period [33]. Therefore, it is essential to implement policies that enhance collaboration between hospital education systems, managers, and nursing personnel. Creating a supportive culture and environment for teaching and learning is vital, which includes clearly defining students' job descriptions to improve the quality of education and increase nursing students' satisfaction.
Another finding of the present study is the enhancement of professional experiences, which is consistent with the findings of other studies. In this context, the results of BahramiRad's study indicated that internship courses are associated with acquiring new experiences and developing professional independence [34]. In this study, students reported understanding the diverse roles of nurses practising professional communication and strengthening teamwork skills, which is consistent with the study's findings by Adel Mehraban et al. [18]. Conversely, Chuan and Mamaghani report that high workloads and insufficient opportunities negatively impact the relationship between students and nurses [12, 35]. The clinical learning environment includes four characteristics: the physical space, psychosocial and interactive factors, organizational culture, and teaching and learning components that affect students' learning experiences, and these characteristics often determine the achievement of learning outcomes and students' self-confidence [36]. One of the limitations of the present study was the unwillingness of some nursing students to be interviewed, so it is recommended that further studies be conducted with a larger sample size.
Conclusion
According to the findings of the present study, passing the nursing management internship course can lead to the formation of a real perception of the tasks and responsibilities of the nursing profession in students. These perceptions can either strengthen or weaken students' professional outlooks. Therefore, the findings of this study can provide valuable insights for designing nursing internships
Ethical considerations
This study was approved by the Ethics Committee of Guilan University of Medical Sciences, following the code of ethics (IR.GUMS.REC.1402.529). First, the objectives of the study were explained to the participants, and informed consent was obtained from them. Participants were assured of confidentiality and privacy. Additionally, permission was obtained from them to record the interviews.
Artificial intelligence utilization for article writing
Not applicable.
Acknowledgment
The researchers would like to thank all nursing students of Shahid Beheshti Faculty of Rasht who participated in the present study.
Conflict of interest statement
The authors declare that they have no conflicts of interest.
Author contributions
KN was the primary investigator responsible for collecting the data and writing the initial draft. AED and RT contributed to some study aspects and provided the final manuscript. FJ helped in the analysis. All authors read and approved the paper.
Supporting resources
The authors received no financial support for this article's research, authorship, and/or publication.
Data availability statement
The corresponding author can provide the datasets analyzed in this study upon a reasonable request.
Background & Objective: Clinical education is a fundamental part of nursing education. Management's role in nursing is vital and is closely related to the quality of care in medical centers. The present study was conducted to explain the experiences of final-year nursing students from the nursing management internship course.
Materials & Methods: The present study is a conventional content analysis study conducted with the participation of 18 final-year nursing students. Data collection was done through semi-structured interviews. The interviews were transcribed verbatim and analyzed using MAXQDA software version 2020, from which themes were inductively extracted. Data analysis led to the extraction of two themes and seven categories.
Results: The first theme was guiding experiences, which included five categories of professional communication practice: strengthening teamwork skills, understanding multiple roles, understanding legal aspects, and enhancing personal development. The second theme was obstacles and experiences, which included two categories: understanding work stress and an inappropriate organizational atmosphere.
Conclusion: According to the findings of the present study, passing the nursing management internship course can lead to the formation of a real perception of the tasks and responsibilities of the nursing profession in students. These perceptions can either strengthen or weaken students' professional outlooks. Therefore, the findings of this study can be valuable in designing nursing internships.
Introduction
The primary mission of nursing education programs is to train competent nurses with the knowledge and skills necessary to provide high-quality nursing care and maintain and promote community health [1]. Nursing education is a part of the higher education system that deals with human life, and paying attention to its various aspects is particularly important [2]. Nursing education comprises two complementary parts: theoretical and clinical education [3]. Clinical practice is a vital and inseparable aspect of nursing learning [4] and provides a unique opportunity for students to encounter and experience the complexities and realities of patient care [5]. During their four-year education, in addition to theoretical courses, nursing students must complete many practical courses, mostly clinical internships, in real environments to gain the necessary preparation to work in these environments [6]. In Iran, the internship program was implemented as an innovation in the nursing education structure to improve the quality of nursing education and provide clinical services, and providing a comprehensive and community-oriented approach to nursing since 1992 and currently, students in the last year of their bachelor's degree enter the internship course [7]. Nurses play a vital role in implementing this plan and facilitating the learning process for nursing students [8]. Collaborating with knowledgeable and supportive nurses can help reduce nursing students' stress levels in the clinical learning environment [9]. On the other hand, nurses' negative attitude and behaviour hinders students' learning in the clinical environment [10]. Nurses make a huge difference in the learning experience of nursing students and have a profound impact on them [11]. A qualitative study in Tabriz showed that educational, communication, and psychological factors are important in establishing relationships between students and nurses. Self-confidence was reported to be the most important factor in establishing such a relationship [12]. The results of Rebeiro's systematic review showed that insufficient time and educational materials are the main factors in poor communication between nursing students and nurses [13]. One of the sections in nursing internships is nursing management, a crucial role that nursing students will encounter after graduation [14]. Nursing management is not a trivial responsibility; it is vital and closely linked to the quality of care provided in healthcare settings [15]. Therefore, the nursing service management internship course is particularly important due to its leadership role in clinical nursing activities [16]. Some learning activities in clinical education will increase management and leadership skills in nursing students, which will improve the provision of nursing care and achieve the goals of healthcare organizations. By completing the management course, they can play a successful role in today's complex healthcare system [17]. The results of a mixed study by Mehraban et al. showed that students often became very skilled in performing routine activities such as writing daily reports, handovers, and ward rotations. Still, they had little skill in specific and non-recurring activities such as monthly requests for needed equipment and participation in training for nursing staff. In the qualitative section, two categories of learning experiences (five subcategories of organization, coordination, control, cognition and planning, and recording and reporting) and internship problems (three dimensions of problems related to the instructor, nature of the internship, and internship environment) were obtained [18]. Despite the significance of the nursing management internship course for nursing students' professional competence and career success, very few studies have been conducted on the topic. Additionally, while both instructors and nurses play a role in this internship, the absence of an instructor with the students and the varied nature of management tasks taught by nurses in different wards present a significant challenge for nursing students. Therefore, it is essential to explore the experiences and perceptions of nursing students, as they are the primary participants in this internship. Given our limited knowledge, qualitative research is particularly suitable for this situation, as it focuses on understanding and exploring rather than simply explaining or manipulating variables [19, 20]. Considering the importance of nursing management education and the limitations of studies in this field, the present study was conducted to explain the experiences of final-year nursing students from the nursing management internship course in 2024.Materials & Methods
Design and setting(s)
The present study is a qualitative research project employing a conventional content analysis approach, conducted from May 1, 2024, to November 30, 2024. Content analysis is a qualitative research method used to classify words and phrases within text. It describes the content obtained from communications systematically and objectively [21]. Therefore, in the present study, using this method, individuals' perceptions and behaviours in the real world were examined in depth, and the phenomenon was described.
Participants and sampling
The participants included 18 undergraduate nursing students from Shahid Beheshti School of Nursing and Midwifery in Rasht who had experience in completing an internship course in nursing management. Purposive sampling was employed to achieve maximum variation in characteristics such as age, professional interest, gender, and grade point average, providing the researcher with more comprehensive insights into students' understanding of working with nurses. The inclusion criteria for the study included eighth-semester undergraduate nursing students completing a management internship course and desiring to participate.
Data collection methods
Data collection was conducted through semi-structured interviews that lasted 20 to 40 minutes after explaining the study objectives and obtaining informed consent from the participants. The interview began with general guiding questions from the researcher, followed by clarifying questions (such as "Why?" "How?" and "When?") based on the content and experiences shared by the participants. Additionally, the interviews were recorded with the participant's consent and transcribed verbatim. The interviews were conducted individually in the quiet settings of the educational classrooms at Poursina and Razi hospitals in Rasht. The interview began with the main question, "What was it like working with nurses in the course?" and, as needed, probing questions such as "Can you explain further?" or "When you say..., what do you mean?" were used to guide the interview. Sampling continued until data saturation was reached, meaning no new information emerged from participants during the interviews.
Data analysis
Data analysis was performed using the Graneheim method [22] and simultaneously with data collection. First, the interviews were typed word by word. Then, the texts were reread several times, and the initial codes were extracted. Similar codes were placed in the same category, then more comprehensive categories were formed, and finally, the main themes hidden in the data were extracted. In the present study, conventional content analysis was performed using MAXQDA software version 2020 to analyze the data.
Accuracy and trustworthiness
To ensure the accuracy and reliability of the data, the Lincoln criterion was applied, which includes validity, verifiability, transferability, and dependability [23]. The researcher engaged with the participants over an extended period. After extracting the initial codes, these were shared with the participants to gather their feedback on the accuracy of the codes and interpretations. If any codes were found to be inconsistent with the participants' views, corrections were made accordingly. Also, two members of the scientific committee and experts in the field of qualitative research used the control method, and consensus was reached on the selected codes and classifications.
Results
The study's purpose was to interview 18 final-year nursing students, resulting in the extraction of 680 codes. The participants had a mean age of 22.38 years, with a standard deviation of ± 1.52. Twelve were female, and six were male. The demographic characteristics of the study participants are shown in Table 1.
Data analysis
Data analysis was performed using the Graneheim method [22] and simultaneously with data collection. First, the interviews were typed word by word. Then, the texts were reread several times, and the initial codes were extracted. Similar codes were placed in the same category, then more comprehensive categories were formed, and finally, the main themes hidden in the data were extracted. In the present study, conventional content analysis was performed using MAXQDA software version 2020 to analyze the data.
Accuracy and trustworthiness
To ensure the accuracy and reliability of the data, the Lincoln criterion was applied, which includes validity, verifiability, transferability, and dependability [23]. The researcher engaged with the participants over an extended period. After extracting the initial codes, these were shared with the participants to gather their feedback on the accuracy of the codes and interpretations. If any codes were found to be inconsistent with the participants' views, corrections were made accordingly. Also, two members of the scientific committee and experts in the field of qualitative research used the control method, and consensus was reached on the selected codes and classifications.
Results
The study's purpose was to interview 18 final-year nursing students, resulting in the extraction of 680 codes. The participants had a mean age of 22.38 years, with a standard deviation of ± 1.52. Twelve were female, and six were male. The demographic characteristics of the study participants are shown in Table 1.
Table 1. Demographic characteristics of study participants
Table 2 presents an example of how participants' statements were inductively organized into themes, categories, and subcategories.
The results of this study regarding students' perceptions of the nursing management internship reveal two themes and seven categories. Some experiences contribute positively to students' professional development, while others result in stress and uncertainty about their future careers (Table 3).
Table 2. Sample of them, category, and Subcategory and participant statement
Table 3. Themes, categories, and conceptual codes extracted from the data
Guiding experiences
This theme includes the following categories: 1- Practicing professional communication 2- Strengthening teamwork 3- Understanding role diversity 4- Understanding legal aspects 5- Strengthening personal development.
Professional communication practice
Nursing Management Internships and working with nurses lead nursing students to learn and practice professional communication.
In this regard, Participant Number 4, a working female studying in semester 8, said: "Another thing was communication. When I was in the ward, I learned how to communicate with the doctors and the nursing office."
Participant number 8, a working female studying in semester 8, said: "… I think my best experience was the ability to communicate with staff, patients and other wards, which was very limited before this course, and we only had contact with the instructor …"
Strengthening teamwork skills
Experience working as a team with nurses is one of the advantages of a nursing management internship, as the participants mentioned.
Participant number 5, a working female studying in semester 8, said: "... When I saw that in a CPR operation, the ward nurse was responsible for the drug therapy, the nurse in the adjacent ward was responsible for the Cardiac compression, and the anaesthesia team worked on the respiratory system, the importance of division of labour and teamwork became clear to me..."
Understanding legal aspects
The nursing management Internship has increased students' awareness of the legal aspects of the nursing profession. In this regard, participant number 3, a working male studying in semester 8, said: "The nurses helped us a lot and taught us the legal aspects of nursing."
Enhancing personal development
The experience of working with nurses has enhanced the practical and personal skills of nursing students, which will be advantageous for their professional futures. In this regard, student number 13, a working female studying in semester 7, said: "...One of the important things I learned was when I entered the ward, which tasks to do first and in what order to do them so that I could finish the tasks on time..."
Obstacles experienced
This theme includes two categories: 1- Perception of work stress and 2- Inappropriate organizational atmosphere.
Understanding work stress
Working with nurses in a real environment without a trainer has led to an understanding of the working conditions of the nursing profession. Participant number 9, a working male studying in semester 8, said: "...I was in a very busy ward with 26 patients and two nurses, and the nurses had to do their work very quickly..."
Participant number 11, a working female studying in semester 7, said: "... We felt the hardship of nursing more than before, all this work pressure and coordination and responsibility..."
Participant number 15, a working female studying in semester 8, said: "... One day, we were in the supervisor's office, where there was a lot of work, and it was different from the ward, and we saw a new and special aspect of nursing..."
Inappropriate organizational atmosphere
Nurses' mistreatment of students in the wards, including shifting their responsibilities onto the students and holding them accountable for mistakes, has led to dissatisfaction among students in the nursing management course. Moreover, the education provided to students is frequently contingent upon completing clinical tasks nurses assign. Participant number 6, a working male studying in semester 7, said: "... I was very annoyed; the nurses would blame their work on the students, or if there was a problem in the ward, they would blame the students and quickly say that the students were failing.…" Participant number 12, a working male studying in semester 8, said: "….They gave me most of the clinical work, and when I protested that they were giving me management tasks, they said, "You're a student, and you have to do it..." In other words, they were officially abusing me.…"
Discussion
The present study aims to explain the experiences and perceptions of final-year nursing students about nursing management internship courses. The present study's findings showed that students' understanding and experience of nursing management internship included two main themes: 1. Guiding experiences and 2. Obstacles experienced.
Very few studies have been conducted on nursing management internships. In Iran, only a limited number of studies exist, which may be attributed to variations in nursing curricula across different countries. In some cases, the nursing management course may be absent from the curricula of other nations or presented under different titles, making it challenging to conduct extensive comparisons with results from other studies. The results of a qualitative study by Rigobello et al. in Brazil [24], which aimed to explore the perceptions of students, nurses, and nursing professors regarding the Supervised Curricular Internship (SCI) course—seemingly equivalent to the nursing management internship course in Iran—indicated that this course is essential for acquiring and developing management and leadership skills, as well as effectively managing nursing resources and bureaucratic processes. Also, in a study conducted by Bahrami Rad [25] using qualitative content analysis in Iran, the presence of students on night shifts and working alongside nurses led to the extraction of two main themes: gaining new experiences and students' work independence. The comparison of the mentioned studies' findings with the present study's findings indicates that the results are consistent. The presence of students alongside nurses in the absence of the instructor helps them gain professional competency and an understanding of their real job situation; in other words, these experiences guide students. The value of high-quality clinical education in fostering personal and professional development and enhancing clinical nursing skills is undeniable [26]. However, students may also face harm and bullying, which can contribute to psychological reactions that lead to an intention to leave the nursing profession [27]. Part of the student's experiences in the present study is the perception of work stress and inappropriate organizational atmosphere. Presence in clinical environments during internship courses exposes nursing students to professional challenges. One of the challenges identified in a qualitative study conducted in Saudi Arabia with final-year nursing students was that nurses instructed students to perform non-nursing tasks, aligning with the present study's findings [28]. Additionally, Ahmadi's study [29] in Iran revealed that a lack of support and shortcomings in welfare and professional identity pose challenges for internships, which is also consistent with the findings of this study. The results of the study by Rezakhani et al. also showed that inappropriate organizational atmosphere and incorrect social norms, such as abuse of students and inappropriate behaviour towards them, are the major problems of students in nursing management internships [30]. Blaming students for errors inwards, forced labour, and ignoring the role of students are issues that students mentioned in the present study. In this regard, the results of a qualitative study showed that bullying and physical and psychological violence against nursing students occur in clinical environments, which requires fundamental reform in the organizational culture of educational and medical centres [31]. This aligns with the findings of the present study. In a qualitative study, an ineffective professional practice environment—characterized by inappropriate professional interactions and poor adherence to clinical standards—was identified as a challenge in professional education, which also corresponds with the findings of this study [32]. Clinical learning is challenging, unpredictable, stressful, and ever-changing, and negative clinical experiences affect students' self-confidence, attitudes, and learning. In addition to wasting time and energy for learners, significant financial burdens are imposed on the educational system, along with mental stress and burnout among students by the end of their training period [33]. Therefore, it is essential to implement policies that enhance collaboration between hospital education systems, managers, and nursing personnel. Creating a supportive culture and environment for teaching and learning is vital, which includes clearly defining students' job descriptions to improve the quality of education and increase nursing students' satisfaction.
Another finding of the present study is the enhancement of professional experiences, which is consistent with the findings of other studies. In this context, the results of BahramiRad's study indicated that internship courses are associated with acquiring new experiences and developing professional independence [34]. In this study, students reported understanding the diverse roles of nurses practising professional communication and strengthening teamwork skills, which is consistent with the study's findings by Adel Mehraban et al. [18]. Conversely, Chuan and Mamaghani report that high workloads and insufficient opportunities negatively impact the relationship between students and nurses [12, 35]. The clinical learning environment includes four characteristics: the physical space, psychosocial and interactive factors, organizational culture, and teaching and learning components that affect students' learning experiences, and these characteristics often determine the achievement of learning outcomes and students' self-confidence [36]. One of the limitations of the present study was the unwillingness of some nursing students to be interviewed, so it is recommended that further studies be conducted with a larger sample size.
Conclusion
According to the findings of the present study, passing the nursing management internship course can lead to the formation of a real perception of the tasks and responsibilities of the nursing profession in students. These perceptions can either strengthen or weaken students' professional outlooks. Therefore, the findings of this study can provide valuable insights for designing nursing internships
Ethical considerations
This study was approved by the Ethics Committee of Guilan University of Medical Sciences, following the code of ethics (IR.GUMS.REC.1402.529). First, the objectives of the study were explained to the participants, and informed consent was obtained from them. Participants were assured of confidentiality and privacy. Additionally, permission was obtained from them to record the interviews.
Artificial intelligence utilization for article writing
Not applicable.
Acknowledgment
The researchers would like to thank all nursing students of Shahid Beheshti Faculty of Rasht who participated in the present study.
Conflict of interest statement
The authors declare that they have no conflicts of interest.
Author contributions
KN was the primary investigator responsible for collecting the data and writing the initial draft. AED and RT contributed to some study aspects and provided the final manuscript. FJ helped in the analysis. All authors read and approved the paper.
Supporting resources
The authors received no financial support for this article's research, authorship, and/or publication.
Data availability statement
The corresponding author can provide the datasets analyzed in this study upon a reasonable request.
Article Type : Orginal Research |
Subject:
Education
Received: 2025/01/27 | Accepted: 2025/04/23 | Published: 2025/07/13
Received: 2025/01/27 | Accepted: 2025/04/23 | Published: 2025/07/13
References
1. Coyne BM, Kennedy C, Self A, Bullock L. A comprehensive approach to undergraduate nursing students' research experiences. Journal of Nursing Education. 2018;57(1):58-62. [DOI]
2. Mahdavian M, Reahani M, Jajvandian R, Bashirian S. Investigating the problems of clinical education from the perspective of nursing and midwifery students of Bojnourd Azad university. Horizon of Medical Education Development. 2023;14(3):28-37. [DOI]
3. Dağ GS, Kılıç HF, Görgülü RS. Difficulties in clinical nursing education: views of nurse instructors’. International Archives of Nursing and Health Care. 2019;5(1):114 [DOI]
4. Rikhotso SR, Williams MJ, De Wet G. Student nurses' perceptions of guidance and support in rural hospitals. Curationis. 2014;37(1):1-6. [DOI]
5. Shahsavari H, Yekta ZP, Zare Z, Sigaroodi AE. Iranian effective clinical nurse instructor evaluation tool: Development and psychometric testing. Iranian Journal of Nursing and Midwifery Research. 2014; 19(2):132-8.
6. Alzayyat A, Al‐Gamal E. A review of the literature regarding stress among nursing students during their clinical education. International Nursing Review. 2014;61(3):406-15 [DOI]
7. Aieen F, Hasheminia S, Moghadai J. Preceptors and student's experiences on the implementation of perceptorship model in clinical practice. Journal of Nursing Education. 2012;1(1):25-37. [DOI]
8. Lee JJ, Clarke CL, Carson MN. Nursing students’ learning dynamics and influencing factors in clinical contexts. Nurse Education in Practice. 2018:1;29:103-9. [DOI]
9. Panda S, Dash M, John J, et al. Challenges faced by student nurses and midwives in clinical learning environment–A systematic review and meta-synthesis. Nurse Education Today. 2021;1071:10485 [DOI]
10. Makhene A, Ally H, Motsaanaka MN. Student nurses’ experiences regarding their clinical learning opportunities in a public academic hospital in Gauteng province, South Africa. Health SA Gesondheid. 2020;25(1):1-7 [DOI]
11. Wang Q, Cao X, Du T. First-year nursing students’ initial contact with the clinical learning environment: impacts on their empathy levels and perceptions of professional identity. BMC Nursing. 2022;21(1):234 [DOI]
12. Mamaghani EA, Rahmani A, Hassankhani H, et al. Effective characteristics of Iranian nursing students in their relationship with clinical nurses. Journal of Caring Sciences. 2019;8(3):173. [DOI]
13. Rebeiro G, Edward K-l, Chapman R, Evans A. Interpersonal relationships between registered nurses and student nurses in the clinical setting—a systematic integrative review. Nurse Education Today. 2015;1;35(12):1206-11 [DOI]
14. Iwasiw CL, Goldenberg D. Curriculum development in nursing education. Jones & Bartlett Publishers; 2014.
15. Pegram AM, Grainger M, Sigsworth J, While AE. Strengthening the role of the ward manager: a review of the literature. Journal of Nursing Management. 2014;22(6):685-96. [DOI]
16. Tavakoli M, Khazaei T, Tolyat M, Ghorbani S. The Quality of clinical education from the viewpoints of students and instructors of paramedical and nursing-obstetrics schools of Birjand university of medical sciences. Daneshvar Medicine: Basic and Clinical Research Journal. 2014;22(1):41-48.
17. Gaberson KB, Oermann MH. Clinical teaching strategies in nursing. Springer publishing company; 2010
18. Adel Mehraban M, Moladoust A. Evaluation of nursing management internship: a mixed methods study. Iranian Journal of Medical Education. 2015;14(11):972-87 [DOI]
19. Glaser B, Strauss A. Discovery of grounded theory: strategies for qualitative research. Routledge; 2017
20. Nassaji H. Good qualitative research. Language Teaching Research. 2020;24(4):427-31
21. Grove SK, Burns N, Gray J. The practice of nursing research: appraisal, synthesis, and generation of evidence. Elsevier Health Sciences; 2012
22. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24(2):105-12.
23. Polit D, Beck C. Essentials of nursing research: appraising evidence for nursing practice: Lippincott Williams & Wilkins; 2020
24. Rigobello JL, Bernardes A, Moura AA, Zanetti AC, Spiri WC, Gabriel CS. Supervised curricular internship and the development of management skills: a perception of graduates, undergraduates, and professors. Escola Anna Nery.2018;22(2):20170298. [DOI]
25. Bahramirad F, Heshmatifar N, Rad M. Students’ perception of problems and benefits of night shift nursing internship: a qualitative study. Journal of Education and Health Promotion. 2020;9(1):287. [DOI]
26. Nielsen AE, Noone J, Voss H, Mathews LR. Preparing nursing students for the future: an innovative approach to clinical education. Nurse Education in Practice. 2013;13(4):301-9. [DOI]
27. Abdollahi Z, Barkhordari-Sharifabad M, Nasiriani K, Fallahzadeh H. Investigation of bullying behaviors in clinical settings from the nursing students’ views. Iranian Journal of Medical Education. 2020;20:91-102 [DOI]
28. Althaqafi SS, Alhatimi HA, Almalki AM, Alyamani OM, Banakhar MA. Nursing students’ clinical practice experience during the internship year at different hospitals: a qualitative study. American Journal of Nursing Science. 2019;8(5):255-62 [DOI]
29. Ahmadi S, Abdi A, Nazarianpirdosti M, Rajati F, Rahmati M, Abdi A. Challenges of clinical nursing training through internship approach: a qualitative study. Journal of Multidisciplinary Healthcare. 2020:891-900. [DOI]
30. Rezakhani Moghaddam H, Aghamohammadi V, Jafari M, Absalan M, Nasiri K. Challenges faced by nursing students to work with nursing personnel: a qualitative study. Advances in Medical Education and Practice. 2020:313-9. [DOI]
31. Jafarian-Amiri SR, Zabihi A, Qalehsari MQ. The challenges of supporting nursing students in clinical education. Journal of Education and Health Promotion. 2020;9(1):216 [DOI]
32. Jasemi M, Whitehead B, Habibzadeh H, Zabihi RE, Rezaie SA. Challenges in the clinical education of the nursing profession in Iran: a qualitative study. Nurse Education Today. 2018;67:21-6. [DOI]
33. Jamshidi N, Molazem Z, Sharif F, Torabizadeh C, Najafi Kalyani M. The challenges of nursing students in the clinical learning environment: a qualitative study. The scientific world journal. 2016;2016(1):1846178 [DOI]
34. Bahramirad F, Heshmatifar N, Rad M. Students’ perception of problems and benefits of night shift nursing internship: a qualitative study. Journal of Education and Health Promotion. 2020;9(1):287 [DOI]
35. Chuan OL, Barnett T. Student, tutor and staff nurse perceptions of the clinical learning environment. Nurse Education in Practice. 2012;12(4):192-7. [DOI]
36. Flott EA, Linden L. The clinical learning environment in nursing education: a concept analysis. Journal of Advanced Nursing. 2016;72(3):501-13 [DOI]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
