Clinical Learning Environments Associate With Higher Nursing Competence and Lower Stress

A new cross-sectional investigation reports that nursing students who experience more positive clinical learning environments demonstrate higher self-reported clinical competence, whereas higher perceptions of clinical stressors correlate with lower competence levels. In adjusted statistical models, both the clinical learning environment and clinical stressor perceptions remained significantly associated with student competence after controlling for demographic variables. The authors noted that the clinical learning environment, clinical stressors, and competence level are important factors related to nursing students' adaptation to the profession, perspective, and clinical success.

Published in BMC Medical Education, the study evaluated the direct relationships among clinical learning environments, stressor perceptions, and competence levels among nursing students.

The study utilized a cross-sectional research design conducted with a sample of 300 nursing students enrolled at a state university. Data collection was carried out through face-to-face administration of structured measurement instruments.

Statistical evaluation of the survey data incorporated multiple complementary techniques to assess group differences and variable relationships. The investigators conducted independent-samples t tests, one-way analysis of variance, and Pearson correlation analyses to examine associations across the dataset. Simple and multiple linear regression models were subsequently estimated to determine predictive relationships, with effect sizes and 95% confidence intervals calculated across analyses to evaluate precision.

The quantitative results showed that the mean clinical learning environment score across participants was 61.20 ± 11.43, while the clinical stressor perception score averaged 82.64 ± 19.60, representing a moderate perception of stress. The mean self-reported competence score reached 215.22 ± 42.40, placing the cohort above the theoretical midpoint of the competence scale. Bivariate correlation analyses revealed a statistically significant negative correlation between the clinical learning environment and perceived clinical stressors, as well as a statistically significant positive correlation between the clinical learning environment and competence level (p < 0.05). In the adjusted multiple linear regression model controlling for sex and class level, both the clinical learning environment (β = 0.456, p < 0.001) and clinical stressor perceptions (β = −0.156, p = 0.008) maintained significant independent associations with competence, with the full model explaining 28.4% of the total variance in competence scores (R² = 0.284).

The authors concluded that fostering supportive clinical learning environments and maintaining manageable clinical stress levels are critical considerations for nursing education programs. However, the researchers explicitly cautioned that because the investigation relied on a cross-sectional design, the observed associations cannot demonstrate direct cause-and-effect relationships.

The research paper was conducted by Ayşe Eminoğlu Güven, Sebahat Kuşlu, and Ömer Taha Emi̇noğlu.

Subject of Research: Relationships among clinical learning environments, stressor perceptions, and competence levels in nursing students

Article Title: Clinical learning environment, stressor perceptions, and competence levels of nursing students: a cross-sectional study

Article References: Eminoğlu Güven, A., Kuşlu, S., & Emi̇noğlu, Ö. T. (2026). Clinical learning environment, stressor perceptions, and competence levels of nursing students: a cross-sectional study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10787-6

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10787-6

Keywords: nursing students, clinical learning environment, clinical stressor perceptions, nursing competence, cross-sectional study, nursing education, state university, multiple linear regression, Pearson correlation, one-way ANOVA, Clinical Learning Environment Scale, Clinical Stressor Perception Scale, Nursing Students Competence Scale, face-to-face data collection, self-reported competence, adaptation to the nursing profession