Clinical Learning Barriers Among Undergraduate Nursing Students in Norway: A Cross-Sectional Survey Study (Preprint)

Abstract

<sec> <title>BACKGROUND</title> Clinical placements constitute a core component of undergraduate nursing education. However, increasing service demands, staffing pressures, and variability in supervisory practices have introduced structural and relational challenges that may undermine students’ learning, motivation, and psychological safety. Despite growing recognition of the role of organizational and pedagogical conditions in shaping clinical learning experiences, contemporary evidence that integrates student, supervisory, and institutional perspectives remains limited in Norway. </sec> <sec> <title>OBJECTIVE</title> This study aimed to identify the types of clinical learning barriers experienced by undergraduate nursing students in Norway and to examine how supervision quality, feedback practices, and organizational workload are associated with stress, motivation, confidence in applying theory to practice, fear of making mistakes, and self-reported language-related barriers. </sec> <sec> <title>METHODS</title> A descriptive cross-sectional survey was conducted among undergraduate nursing students enrolled in clinical placements at three public universities in southern, eastern, and western Norway during spring 2025. A structured, self-administered questionnaire assessed individual, supervisory, and organizational learning barriers, as well as key learning-related outcomes. Descriptive statistics were used to summarize participant characteristics and clinical experiences. Associations were examined using Spearman rank correlations, ordinal logistic regression for stress, motivation, and confidence outcomes, and binary logistic regression for language-related barriers. </sec> <sec> <title>RESULTS</title> A total of 322 students completed the survey. More than half reported experiencing stress often or always during clinical placement (53.4%), while most reported high motivation (88.2%) and moderate to high confidence in applying theory to practice (75.5%). Perceived staffing shortages and high workload were independently associated with higher stress (OR 1.86, 95% CI 1.37–2.53), whereas a supportive clinical learning environment was associated with lower stress (OR 0.60, 95% CI 0.42–0.87) and higher motivation (OR 2.40, 95% CI 1.72–3.35). Constructive feedback from clinical supervisors was positively associated with motivation (OR 1.37, 95% CI 1.06–1.75). Individual background characteristics showed limited associations with reported learning barriers. </sec> <sec> <title>CONCLUSIONS</title> Clinical learning barriers among Norwegian nursing students are shaped primarily by organizational and supervisory conditions rather than individual characteristics. Interventions targeting staffing adequacy, learning climate, and the quality of supervisory feedback may reduce student stress and strengthen motivation and psychological safety during clinical placements. </sec>