We’re facing more of a challenge than ever with our new graduate nurses as they transition into practice. We’re experiencing a nursing shortage, and healthcare facilities continue to lose nurses within the first 2 years of practice. The practice gap with regard to applying theoretical knowledge to the clinical practice environment continues to grow. Nursing education programs remain focused on getting students to pass the NCLEX-RN. Van Horn and Lewallen note that although the Next Generation Exam assists with critical thinking and decision-making, there’s no guarantee of competence in the workplace.
This brief article will explore three key strategies aimed at changing how we prepare entry level nursing students and soon-to-be new graduates for practice.
Strategy 1: Limit 12-hour clinical days for nursing students
There’s a current trend in nursing school clinical placement to have nursing students do 12-hour clinicals once a week. There continues to be a growing shortage of clinical sites nationwide; obtaining clinical placement is competitive for schools.
The literature doesn’t support 12-hour shifts for nurses in practice. We acknowledge that the work–life balance and more time off is a priority with the younger generation and a common retention strategy. However, the American Nurses Association landmark paper notes that 12-hour shifts result in more job fatigue, extra recuperation time, weaker performance, and increased errors. Dall’Ora and colleagues note that the value of 12-hour shift is unsupported by evidence, and a considerable body of evidence points to direct risk to the quality of patient care and unintended consequences for staff well-being associated with longer shifts.
From a learning perspective, the 12-hour clinical day for a student can lead to cognitive overload and more fatigue. Gallego-Gomez and colleagues state that students frequently feel anxious before the clinical day and typically don’t sleep well—two factors that add to cognitive overload. Collins adds that nurses are generally more likely to suffer from cognitive overload due to their work environment, affecting mental and physical well-being, ultimately leading to errors that impact the quality of care and patient safety.
Students work in similar clinical environments, where the bustle and activity of a clinical floor with bed alarms, cardiac monitor alarms, and call lights add to cognitive overload. It takes a well-prepared, knowledgeable clinical faculty person who’s skilled enough to see the impact of cognitive overload on students to put safeguards in place.
This brings us to our next strategy, mentoring clinical faculty, as knowledge and skill gaps exist. Individual State Boards of Nursing guide qualifications for serving as clinical faculty, which leads to inconsistency.
Strategy 2: Mentoring clinical faculty
To complicate matters, not all nursing clinical faculty have the educational background or expertise to support nursing students in clinical practice. Many clinical faculty lacked strong mentorship due to the ongoing faculty shortage, and clinical education is primarily facilitated by contract or adjunct nursing instructors. Sefton and colleagues acknowledge that although adjunct clinical faculty are often expert bedside clinicians, many have little to no teaching or academic experience.
Munangatire and colleagues found that student nurses expect the clinical environment to be an ideal place for learning with supportive teachers and opportunities to gain knowledge and integrate theory into practice; however, this isn’t always the case. Strong clinical faculty are necessary to improve communication and enhance collaboration among the healthcare team and students, allowing for a conducive learning environment where theoretical knowledge is translated into practice.
To address the clinical faculty gap, the Massachusetts Board of Nursing has several initiatives in place. For example, 2023 guidelines for clinical education experiences require clinical faculty to have a master’s degree, be in pursuit of a master’s degree, or be certified as an academic nurse educator. To assist with certification, the Massachusetts Nursing Council on Workforce Sustainability set aside funding this year to cover qualified nurses to prepare and take the certification exam.
Sefton and colleagues acknowledge that learning a new role as a clinical instructor can prove stressful if not supported. Furthermore, if instructors feel stressed, overwhelmed, and isolated, they’ll not stay in the role long-term, disrupting students’ learning experiences. Mentorships help foster connectedness or a sense of community, which enhances retention and ultimately strengthens faculty teaching skills.
New types of apprenticeships also can help entry-level nursing students make the transition to practice.
Strategy 3: Apprenticeships
Typical apprenticeships promote hands-on experience and training with variations of compensation. The apprenticeship model, which has deep history within the nursing profession, would supplement the growing interest in a practice–academic model at the state level with federal funding.
The Massachusetts Nursing Council on Workforce Sustainability (MNCWS) and several other states are actively developing apprenticeship strategies to sustain the nursing workforce. MNCWS highlighted in their executive summary that the Idaho Board of Nursing has nursing students practice under the direct supervision of an experienced nurse. The state of Utah created a temporary nursing apprentice license for individuals in good academic standing in their final semester of an associate or bachelor’s degree in nursing.
Several states have implemented variations of the apprenticeship models. California established an earn-and-learn nursing apprentice program for nursing candidates employed within the state’s prison system. This allows the candidates to maintain their employment and wages, while dedicating half their work hours to training to be registered nurses.
The Alabama State Board of Nursing implemented statutory changes to create a new Nursing Apprenticeship License under the law. The supervising licensed nurse would be responsible for validating an apprentice’s competency to perform nursing skills or activities in the clinical setting. The nursing apprentices in Alabama have a 100% NCLEX pass rate. Several nursing school programs offer a 4-year plan with two 6-month co-ops. The co-ops allow for hands-on experience with pay; however, some programs can be costly and extend graduation into another year (from 4 to 5 years).
What incentives could healthcare facilities offer a nursing student in clinical placement working for their facility who comes on board as a new graduate nurse? Apprenticeship models can assist with practice-ready transitions and retention.
This article highlights three key strategies that have the potential for assisting pre-entry nursing students as they transition into the role of new graduate nurses into clinical practice.
Jo Anne Foley DNP, RN –BC, CNE, CNEcl, CCRN, NPD-BC , is an NPD Specialist and Professor at Boston Medical Center Laboure College, Duxbury, Mass. Katelyn Monti RN-BC, MSN is a Nursing Professional Development Specialist at Boston Medical Center, Boston, Mass.
References
Alabama Board of Nursing. Student nurse apprentice. www.abn.alabama.gov/licensing/apply/special-permits/student-nurse-apprentice
American Nurses Association. Position Statement: Addressing Nurse Fatigue to Promote Safety and Health: Joint Responsibilities of Registered Nurses and Employers to Reduce Risks. September 10, 2014. nursingworld.org/~49de63/globalassets/practiceandpolicy/health-and-safety/nurse-fatigue-position-statement-final.pdf
Collins R. Clinician cognitive overload and its implications for nurse leaders. Nurs Lead. 2020;18(1):44-7. doi:10.1016/j.mnl.2019.11.007
Dall’Ora C Ejebu OZ, Griffiths P. Because they’re worth it? A discussion paper on the value of 12-h shifts for hospital nursing. Hum Resour Health. 2022;20(1):36. doi:10.1186/s12960-022-00731-2
Gallego-Gómez, JI, González-Moro MTR, González-Moro JMR, et al. Relationship between sleep habits and academic performance in university nursing students. BMC Nurs. 2021;20(1):100. doi:10.1186/s12912-021-00635-x
Massachusetts Nursing Council on Workforce Sustainability. The apprenticeship advantage: Building a sustainable future nursing workforce. June 2025. ncwsma.org/siteassets/council-recommendations/policy-practice/the-apprenticeship-advantage-rewrite_ncws-2025-final.pdf
Munangatire T, Tomas N, Asino HMM. Nursing students’ experiences and expectations of clinical learning: A qualitative study. Nurs Edu Today. 2023;124:105758. doi:10.1016/j.nedt.2023.105758
Sefton K, Harder N, Kramer M. Mentorship outcomes for clinical nursing instructors: A scoping review. Teach Learn Nurs. 2025;20(3): 262-7. doi:10.1016/j.teln.2025.02.021
Van Horn E, Lewallen LP. Clinical evaluation of competence in nursing education: What do we know? Nurs Edu Perspect. 2023;44(6):335-40. doi:10.1097/01.NEP.0000000000001156158
