Practice Readiness: Who, What, When, and Where?

A recent study on new graduate nurse readiness raises an important question for both educators and healthcare organizations:

What does it actually mean to be ready for practice?

New graduate nurses are entering complex clinical environments. They are expected to recognize changes in patient conditions, manage competing priorities, communicate with patients and colleagues, use technology, and make safe decisions under pressure.

Those expectations are real. But we also need to be careful not to confuse entry-level competence with the judgment and efficiency that develop through experience.

In Partnering for Change: A Qualitative Study on Practice Readiness, Stephanie Nicely and Bev Wilgenbusch explore how clinical leaders and educators view the readiness of new graduate nurses. Their findings point to four areas that influence the transition into practice:

• Professional communication

• Clinical judgment

• Essential clinical readiness

• Professional identity and engagement

  
  

These areas will sound familiar to anyone who works with students or new graduates.

New nurses may hesitate to speak up, struggle to prioritize several patient needs, need support organizing care, or feel uncertain about their role on the team. These are important areas for development, but they are not always evidence that an academic program has failed to prepare them.

Sometimes the issue is a mismatch between what we expect of a novice and what a novice can reasonably demonstrate at the start of practice.

Readiness Develops Over Time

Graduation and licensure indicate that a learner has met the standards required to enter practice. They do not mean that the learner will perform like an experienced nurse on day one.

A new graduate should be able to practice safely, recognize when help is needed, communicate concerns, and continue learning. At the same time, clinical judgment, confidence, efficiency, and pattern recognition continue to develop through experience.

That development happens across settings.

Students begin building competence in the classroom, laboratory, simulation, and clinical environment. After graduation, they continue to develop through orientation, preceptorship, residency, coaching, and patient care.

This is why practice readiness cannot be treated as a handoff from education to employment.

It is a shared responsibility.

Readiness Is More Than Clinical Skill

One lesson that continues to surface in my work teaching interprofessional collaboration is that healthcare readiness involves much more than knowing how to complete a task.

Students and new professionals must learn how to function within a healthcare system.

They need to understand who is on the team, what each profession contributes, when to ask for help, and how to communicate when something does not feel right. They must learn to manage hierarchy, clarify roles, navigate differences in professional perspectives, and include patients and families in decisions.

They also need to understand the conditions surrounding care.

A clinically correct plan may still fail because of a poor handoff, unclear responsibility, limited access to resources, technology burden, health literacy needs, or a patient’s inability to carry out the plan after discharge. Readiness therefore includes the ability to see beyond an isolated clinical task and consider the larger system in which care takes place.

This is especially important during transitions.

Handoffs, referrals, discharge planning, family meetings, and changes in care settings all create opportunities for important information to be missed. Preparing learners for practice means giving them opportunities to work through these moments before they are responsible for managing them independently.

What This Means for Competency-Based Education

Competency-based education gives programs an opportunity to be more specific about what learners should be able to do by graduation.

However, listing competencies in a curriculum is only the beginning.

Programs also need to determine:

• What does the competency look like in practice?

• What behaviors should faculty be able to observe?

• Where will students practice it?

• How will students receive feedback?

• How will progression be measured?

• What support is provided when a student is not yet meeting expectations?

  
  

These questions matter because competencies should not live only in course objectives or curriculum maps.

Students need repeated opportunities to practice, receive feedback, reflect, and improve. Faculty also need consistent ways to assess performance.

A learner may demonstrate a skill successfully in one setting and still need support applying it in a more complex or unfamiliar situation. That does not mean the competency is absent. It means the learner is still developing the ability to transfer it across contexts.

We also need to assess the less visible parts of practice.

Can the learner recognize that the plan is no longer working? Can they identify the right person to involve? Can they communicate a concern clearly? Can they respond when another team member disagrees? Can they account for the patient’s goals, social circumstances, and ability to follow the plan?

These behaviors are difficult to measure through knowledge-based testing alone, but they are central to safe and effective practice.

Simulation Can Help Bridge the Gap

Simulation is well suited to many of the concerns raised in the study.

It can provide structured opportunities for learners to practice:

• Communicating with other professionals

• Recognizing patient deterioration

• Prioritizing competing needs

• Managing interruptions

• Escalating a safety concern

• Working through uncertainty

• Coordinating care as a team

• Including patients and families in decisions

• Navigating a handoff or care transition

• Reflecting on their decisions

  
  

The value of simulation is not simply that students complete a scenario.

The value is that educators can observe how students think, communicate, and respond when the situation becomes more complex.

For example, did the learner miss an important clinical cue? Did they recognize the problem but hesitate to act? Did they know what to do but struggle to communicate it clearly? Did workload, hierarchy, technology, or uncertainty affect their response?

Those are different problems and require different support.

A checklist may show that an action did not occur. Observation and debriefing help us understand why.

Simulation can also make challenges visible that learners may not otherwise recognize.

A scenario can show how an unclear role, an incomplete handoff, a distracting electronic health record, or a team member’s reluctance to speak up affects care.

These experiences help learners understand that patient safety is not only about individual knowledge. It is also shaped by communication, teamwork, workflow, technology, and the culture of the clinical environment.

Learners Need Opportunities to Speak Up

One area that deserves particular attention is speaking up.

We often tell students and new graduates to advocate for patients, question unsafe decisions, and escalate concerns. But speaking up can be difficult when a learner is still developing confidence, working within a hierarchy, or unsure whether their concern is valid.

Telling learners to “use their voice” is not enough.

They need opportunities to practice recognizing a concern, choosing an appropriate communication strategy, and responding when the first attempt is dismissed. They also need learning environments where asking questions and acknowledging uncertainty are treated as part of safe practice rather than signs of weakness.

Healthcare organizations have a role here as well.

A graduate may know how to use a communication tool, but that tool will have limited value in a workplace where questions are discouraged or concerns are ignored. Practice readiness depends partly on the learner, but it also depends on whether the environment allows safe behaviors to occur.

Technology Has Changed What Readiness Requires

Practice readiness must also reflect the digital environment in which healthcare now takes place.

New graduates are expected to use electronic health records, clinical decision support, telehealth platforms, secure communication tools, and, increasingly, artificial intelligence-supported technologies.

These tools can improve access and coordination, but they can also create new challenges.

Learners must be able to recognize when technology supports good care and when it introduces distraction, fragmented communication, automation bias, or additional workload. They need to know that documentation is not the same as communication and that information entered into a system does not guarantee that the right person has seen or understood it.

Digital competence should therefore include judgment, not only technical navigation.

Being able to click through an electronic record is different from being able to find meaningful information, recognize what is missing, communicate across the team, and remain attentive to the patient.

Faculty and Preceptors Need Clear Expectations

Students and new graduates are not the only people who need support.

Faculty, clinical instructors, simulation facilitators, and preceptors need shared expectations for what entry-level performance should look like.

Without that alignment, learners may be evaluated very differently depending on the instructor, preceptor, or clinical site.

One educator may view a learner’s request for help as appropriate novice behavior. Another may see it as a lack of readiness. One preceptor may coach a developing skill. Another may expect the learner to perform independently from the start.

This inconsistency can make practice readiness feel subjective.

Faculty and preceptor development should include clear performance expectations, behavior-based feedback, psychological safety, and an understanding of how competence develops over time.

We also need to separate confidence from competence.

A learner may sound confident and still need support. Another may be cautious but demonstrate sound judgment. Good assessment requires more than an impression.

Academic and Practice Partners Need Ongoing Dialogue

Academic–practice partnership is often discussed broadly, but this study shows why it needs to be built into the work.

Schools and healthcare organizations need regular opportunities to compare expectations, review patterns in learner performance, and identify where additional support is needed.

That could include:

• Jointly defining entry-level expectations

• Reviewing competency data

• Developing shared simulation experiences

• Preparing faculty and preceptors together

• Improving feedback between clinical sites and academic programs

• Connecting final-semester learning with transition-to-practice needs

• Designing residency programs that build on what graduates have already learned

  
  

Clinical partners offer valuable insight into the realities of current practice. Academic programs bring expertise in learning design, assessment, and developmental progression.

Both perspectives are needed.

These conversations should also look beyond individual learner performance. When several learners struggle with the same transition, communication process, or workflow, the answer may not be another lecture or assignment. It may point to a need for better alignment, clearer expectations, stronger coaching, or changes within the practice environment itself.

A Better Question

Instead of asking only, “Why aren’t graduates ready?” we should also ask:

Have we built a system that supports readiness across the transition from education into practice?

That system includes clear competencies, realistic expectations, meaningful practice, consistent assessment, prepared educators, supported preceptors, and strong communication between academic and clinical partners.

It should also prepare learners to work across professional boundaries, respond to system pressures, use technology thoughtfully, speak up for safety, and keep the patient and family at the center of care.

Academic programs should remain responsive to changes in practice.

Healthcare organizations should also examine whether their onboarding, workload expectations, preceptor preparation, technology, and workplace culture support novice development.

New graduates should be ready to enter practice safely.

They should not be expected to enter practice fully formed.

Practice readiness is not something one organization creates and another receives. It is something education and practice build together.

Putting This Into Practice

This is a major focus of my work through MWD Consulting.

I help healthcare education programs and workforce partners translate competencies into practical learning and assessment strategies. That may include curriculum mapping, simulation design, competency-based assessment, faculty development, preceptor support, or stronger alignment between academic preparation and workforce expectations.

My work with learners continues to reinforce that professional preparation must extend beyond discipline-specific knowledge. Learners need opportunities to understand healthcare as a system, work across professional roles, communicate through difficult situations, and consider how human factors, technology, culture, and social context influence care.

The goal is not to add more content or more assignments. The goal is to create learning experiences that help students develop, demonstrate, and carry competencies into practice.

Thoughtful strategy. Engaging learning. Practical implementation.

About the Author

Meredith Deegan, DNP, MSN, RN, CNE, CHSE, CNL, is the Founder and Principal Consultant of MWD Consulting LLC. She works with healthcare education programs, academic institutions, healthcare organizations, and workforce partners to strengthen simulation-based learning, competency-based assessment, faculty development, interprofessional education, and the transition from education to practice.

Featured Article

Nicely, S. E., & Wilgenbusch, B. (2026). Partnering for change: A qualitative study on practice readiness. Journal of Professional Nursing, 65, 23–29.