By: Christine L. Heid, PhD, MSN/Ed, RN, CNE, CHSE 

Nursing Simulation Specialist, Labster/UbiSim

I remember it like it was yesterday: sweaty palms, brand new Ceal Blue scrubs, and the white scrub jacket my aunt gifted me for graduation just a few months prior—along with a lump the size of Texas in my throat. As I stood nervously in the hallway, waiting to meet my preceptor and begin my first shift as a registered nurse, I thought, "What if I make a mistake?" "What if I can't remember everything I've learned?" An overwhelming sense of anxiety overshadowed the excitement of finally stepping into my dream job.

That was over twenty years ago, but my experience is common among new nurses navigating the transition from academic learning to real-world practice today. The reality of patient care can be daunting, and many new graduates feel unprepared for the challenges they face.

The Transition to Practice Challenge

The jump from nursing school to the reality of clinical practice can be daunting. Newly Licensed Registered Nurses (NLRNs) often find themselves caught between the idealized preparation of academia and the complex realities of patient care (Toothaker, et al., 2022). Discontinuity during the transitional period can lead to stress and uncertainty about work expectations, confusion in executing tasks, and potentially unsafe practices that put patients, colleagues, and even themselves at risk.

Transition to Practice models bridge the gap between academic learning and real-world nursing, emphasizing structured learning experiences with preceptors to enhance critical thinking and clinical competence (Garcia, 2023; Jadalla, et al., 2024).

Clinical preparedness requires the ability of a nurse to provide safe and high-quality care based upon standards of care (ANA Scope and Standards of Practice), regulated by Nurse Practice Acts, and demonstrated excellent through accreditation programs (e.g. ANCC; CCNE). Transitioning from student to registered nurse (RN) can be stressful due to "reality shock" or “transition shock” which refers to the significant strain, anxiety, and psychological distress new nurses experience when moving from an academic environment to a real-world setting while adapting to the professional nursing role (Labrague & Santos, 2020). 

A Steep Learning Curve

Newly licensed registered nurses face many challenges as they transition from education to practice, leading to a steep learning curve during the first year of practice. These challenges encompass various aspects of nursing, including: 

• Lack of Confidence: New nurses often lack confidence due to insufficient real-world experiences, decision-making abilities, and clinical judgment skills. This can be exacerbated by stress caused by colleagues' degrading behavior, lack of support from management, and a gap between theoretical education and practical application (Najafi & Nasiri, 2023). 
• Technical Skills: New nurses may struggle with performing complex technical skills, such as operating medical equipment, administering medications, and managing intravenous lines. This can lead to anxiety and a fear of making mistakes that could harm patients. Many NGNs were uncomfortable with skills such as codes/emergency responses, ventilation care/management, and chest tube care (Catarelli et al., 2025).
• Complex Patient Care:  NLRNs must rapidly adapt to the demands of clinical practice, which can cultivate fear and anxiety, especially when managing unfamiliar or highly complex patients​ (Alharbi, et al., 2023). Managing complex patient cases with multiple comorbidities and needs can be overwhelming for new nurses, with 41% reporting the increased workload challenging (Catarelli, et al., 2025).
• Workplace Dynamics: Understanding and navigating workplace policies, procedures, and interprofessional dynamics can be challenging (Alharbi, et al., 2023). They may feel intimidated by experienced colleagues or struggle to assert themselves in team settings, leading to communication breakdowns and errors.
• Medical Errors: According to a study by Song and Kim (2023) investigating the prevalence of errors during clinical practice, 28-30% of nursing students experience medication administration errors, 39% make errors without harming patients, and 29% witness adverse events, 85% of which harm patients (Song & Kim, 2023). Unfortunately, these experiences negatively impact nursing students' willingness to report patient safety accidents
• Psychological and Emotional Factors: Sixty-two percent of new graduate nurses lack confidence in their abilities, and forty-five percent report fears, often related to harming a patient or making an error (Catarelli et al., 2025). They may also face anxiety, stress, and burnout due to increased workloads, long shifts, and exposure to traumatic events (Sterner et al., 2023). 
• Orientation and Role Expectations: Orientation programs often fail to prepare new nurses for the realities of practice, resulting in role confusion and unrealistic expectations. According to Catarelli et al. (2025), 27% of new nurses reported difficulties in understanding and meeting role expectations. Additionally, new nurses may struggle to balance their professional responsibilities with their personal lives.
• Ethical Dilemmas: Nurses often face ethical dilemmas such as end-of-life decisions, informed consent, and patient autonomy. For instance, a recent study of new graduate nurses found that 50% were uncertain about how to care for a dying patient (Catarelli et al., 2025). This uncertainty may lead to feelings of being unprepared to navigate complex situations, potentially impacting decision-making and causing moral distress.
• Technological Advancements: The adoption of advanced technology systems can enhance nurses' job performance by improving efficiency, reducing errors, and providing better patient care (Hussain, et al., 2025). New nurses may struggle to keep pace with rapidly evolving technology and integrate it into their practice (Alharbi, et al., 2023). They might require additional training and support to utilize new technologies in patient care effectively. 

These challenges can significantly impact new nurses' job satisfaction, retention, and overall well-being, which can lead to negative emotional states, decreased job satisfaction, increased stress and burnout, and a higher likelihood of intent to leave their position (Labrague & Santos, 2020). ​Healthcare organizations and nursing education programs need to provide adequate support and resources to help new nurses successfully transition into practice and thrive in their careers, which can elevate the quality of patient care delivery across healthcare environments (Garcia, 2023). 

New Graduate Nurses Aren’t Ready for Practice

Given the crucial nature of this transition to practice period, how well nurses are supported during this time directly impacts patient safety and nurse retention. The stark reality is that 91% of new nurses fell outside the acceptable range of competency when first entering practice (Kavanaugh & Sharpnack, 2021). 

Recent reports on the nurse readiness crisis revealed that new graduates and current students feel unprepared due to inadequate preparation, insufficient exposure to high-stress environments, lack of support, and emotional unpreparedness (UbiSim, 2025). By comparison, faculty members cite the effects of an increasing faculty shortage, time constraints, heavy workloads, gaps in educational approaches, and limited clinical exposure as contributing factors. 

Competent Nurses are the Safety Net

Nurses are critical to the healthcare safety net, advocating for patient safety and quality care efforts to detect and resolve potential and actual risks (Oster & Oster, 2024). Over 50% of healthcare workers commit errors affecting patients during their careers, with 49-53% of newly graduated RNs involved in medical errors within their first year (Song & Kim, 2023). ​

Licensure is Only the Beginning

Transition to Practice models bridge the gap between academic learning and real-world nursing, emphasizing structured learning experiences with preceptors to enhance critical thinking and clinical competence (Garcia, 2023; Jadalla, et al., 2024). 

Focused on the knowledge, skills, values, and attitudes necessary for nursing practice, the American Association of Colleges of Nursing (2021) The Essentials: Core competencies for Professional Nursing Education go beyond what nurses know and can do. 

Clinical competence involves using a combination of technical, communication, and reasoning skills, as well as knowledge, emotions, and values, to effectively carry out professional duties within the clinical practice setting (Hui, et al., 2023). 

When transitioning from a student to a professional nurse, key competencies may include: ​

• Competency in Communication: Effective communication skills with patients, families, and healthcare teams. ​
• Critical Thinking and Clinical Reasoning: Analyzing and evaluating information to make sound clinical decisions. ​
• Problem-Solving Skills: Identifying issues and implementing solutions in clinical settings. ​
• Skill-Based Tasks: Proficiency in performing clinical procedures and tasks. ​
• Professional Behaviors: Adherence to ethical and legal standards, accountability, and advocacy. ​
• Knowledge Application: Applying theoretical knowledge to real-world practice. ​
• Interprofessional Collaboration: Working effectively with other healthcare professionals.
• Self-Reflection: Engaging in self-reflection to promote personal wellness and resilience (Jadalla, et al., 2024).

Competencies serve as measurable outcomes of practice readiness, ensuring patient safety and quality care, and help new nurses confidently confront what lies ahead in their professional nursing careers. 

Shoring Up Patient Safety 

Supporting new nurses is essential to transition smoothly into their roles and deliver safe, effective patient care. In a recent study of new graduate nurses, Alhari et al. (2024) identified several factors that contributed to new nurses’ successful integration into the workplace, such as:

• The Positive Role of Trainers: Trainers help NGNs become familiar with the work environment, teach essential skills, and provide continuous support. ​
• Gradual Handling of Patients: NGNs start by caring for stable patients and gradually take on more critical cases, which helps them adapt and build confidence. ​
• The Benefit of Pre-Employment Training and Volunteering: Prior experience as a locum or volunteer helps NGNs gain skills and confidence, easing their transition into full-time roles.

The nurse readiness crisis was investigated in two recent investigations targeting the perspectives of nursing faculty and students, revealing a host of concerns and opportunities (UbiSim, 2025).

A Bright Future for Nursing Practice Readiness

My first week as a nurse was filled with a mix of emotions and experiences that I'll always remember. I constantly worried about forgetting crucial information or procedures, leading to countless double-checks before entering a patient's room - only to realize I'd left something behind. Despite the challenges, the gratitude expressed by patients and their families brought immense joy, mixed with the exhaustion and emotional weight of the job. Each day was a whirlwind of learning, adapting, and finding fulfillment in providing care.

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Twenty years later, I've drawn on those vivid memories and the lessons I've learned since to develop clinical experiences and simulation-based training for nursing students and practicing nurses. My goal is to prepare them for healthcare environments that are even more intricate, demanding, and technologically advanced than I could have ever envisioned as a new nurse. 

Leveraging Immersive Virtual Reality Simulation to Enhance Nurse Readiness 

Clinical nurse educators are charged with taking the lead in ushering newly licensed nurses from the classroom into the complex care landscape of today’s healthcare environment (Mulligan, 2024). Current strategies that predominate transition to practice include lectures, direct experiential learning, clinical skills simulations, and reflection seminars (Ernawaty, Hariati, & Saleh, 2024). 

Virtual reality (VR) simulation is emerging as a powerful tool to smooth this transition and empower new nurses as they begin their careers and bridge the gap between nursing education and practice. A study of published in the Journal of Nurses in Professional Development revealed that 77.7% of new nurses felt VR met educational objectives, and 98.3% said it enhanced knowledge retention; most participants found the VR environment enjoyable (69.8%) and effective for learning clinical skills (66.7%)with 38.1% preferring VR to traditional teaching methods (Coughlin, et al., 2024). 

As digital natives enter the nursing workforce, nurse leaders are called on to incorporate technologies and modalities to support nurses as they transition into practice (Morin, et al., 2024).  By immersing nurses in realistic, interactive scenarios, VR simulation offers a safe and controlled environment for skill development, critical thinking, and decision-making as well as familiarizing nurses with hospital policies and procedures. 

Enhanced Learning and Skill Retention

VR simulation provides a dynamic and engaging learning experience, allowing nurses to practice and refine skills in a realistic and risk-free setting, reducing performance anxiety (Coughlin, et al., 2024). Many nurses may be nervous about learning new skills as they enter the practice arena. The immersive nature of VR promotes active learning, leading to improved knowledge retention and transfer of skills to real-world clinical practice (Ichihara, et al., 2025). 

Safe and Controlled Environment

New nurses often struggle with time management, responding to critical situations, and communicating effectively, which can lead to adverse patient outcomes (ERCI, 2024). In immersive VR simulation, new nurses can practice critical skills, communication, and decision-making through scenarios that mirror real-world healthcare experiences they will encounter without fear of harming real patients (Jans et al., 2023). By eliminating these risks, VR simulation offers a safe environment for nurses to make mistakes and learn from them, fostering a culture of continuous learning.  

Increased Confidence and Competence

Nurses can build confidence and competence in their abilities by repeatedly practicing skills and managing complex scenarios customized to the unique needs of their new roles. Ryu and Yu (2023) found that VR simulation provided immersive, realistic scenarios that allowed nurses to practice and refine their skills in a safe environment, leading to higher levels of confidence and competence in their clinical practice. ​This translates to improved performance and job satisfaction in real-world clinical settings.

Standardized Training and Assessment

VR simulation offers a standardized platform for training and assessment, ensuring consistency and objectivity in evaluating nursing competencies. This allows targeted feedback and personalized learning plans to address individual needs and promote professional growth. Inclusion of National Patient Safety Goals such as correct patient identification, improved staff communication, safe medication administration, and enhanced alarm safety (The Joint Commission, 2025) are efficiently designed and assessed in VR simulation scenarios. 

Applications of VR Simulation in Nursing

VR simulation can be customized to reduce variation in care and familiarize new nurses with facility-specific workflows, hospital policies, and procedures. The use of VR can help prepare nurses for real-world challenges encountered in patient care delivery by offering realistic scenarios to practice skills, critical thinking, and decision-making in a safe environment (Park, et al., 2024). 

Among the many benefits of VR simulation, customizable scenarios support Newly Licensed Registered Nurses (NLRNs) practice complex procedures and handle emergencies. UbiSim’s platform and intuitive editor allowed Monarch Healthcare Management to map some of the 16 Minnesota state competencies to ensure relevant training, compliance, and standardization across the organization. Here are a few key examples of how UbiSim immersive VR simulation for nursing can help address these in bridging the gap from academia to practice:

• Facility Policies and Evidence-Based Procedures: Ensuring best practices and communicating facility-specific policies and evidence-based protocols is essential for new nurses joining any health system. In a study by Ryu and Yu (2023), knowledge and recognition of infection control practices was significantly enhanced using VR simulation.
  
  • How UbiSim Helps: Each UbiSim scenario includes a transparent design, including evidence-based needs assessment as required by the Healthcare Simulation Standards of Best Practice and aligned with the NCSBN Clinical Judgment Measurement Module. Institutions can easily customize or develop their own scenarios to highlight unique policies, treatment protocols, and align to specific regulatory competencies and standards using the UbiSim no-code editor. 
• Medication Administration and Blood Transfusions: VR scenarios can simulate the entire medication administration process, from verifying patient identity and allergies to preparing and administering medications via different routes (oral, IV, injection). This can help NLRNs practice medication safety procedures and prevent medication errors as well as improve clinical skill performance (Kim & Park, 2024).
  
  • How UbiSim Helps: From solo mode tutorials introducing the basics in blood transfusions and  medication administration to intravenous blood transfusions, UbiSim levels up scenarios to help nurses gain knowledge, reinforce deliberate practice, and demonstrate competency across the lifespan. 
• Managing Patients with Multiple Health Issues: VR can simulate complex patient cases with multiple comorbidities, requiring NLRNs to prioritize care, manage medications, and monitor vital signs effectively. These simulations can help them develop their critical thinking and time management skills. 
  
  • How UbiSim Helps: Our intuitive, no-code editor allows you modify each scenario to meet the unique needs of your facility, unit, and individual nurse. Change up the facilitator cues, add distractors or additional family members, trigger a call from the provider with new orders, and adjust transitions to relay critical lab results.
• Managing Complications and Reducing Nosocomial Infections: VR can be used to simulate various surgical procedures, allowing NLRNs to observe and participate in a virtual operating room setting. This can help them understand the surgical process, anticipate the needs of the surgical team, and prepare for their role in postoperative care. VR scenarios can simulate postoperative complications like bleeding, infection, or respiratory distress. NLRNs can practice assessing the patient, implementing interventions, and communicating with the healthcare team.
  
  • How UbiSim Helps: New bandages and wounds, hip pt
  • How UbiSim Helps: The power of immersive, experiential learning that engages the senses using audio, visual, and haptic feedback as part of the virtual environment, interactive chart, audio, video and haptic feedback, learners are able to
• Communicating with Difficult Patients/Families: VR can create challenging communication scenarios, where NLRNs must deal with anxious patients, angry family members, or language barriers. These simulations can help them improve their communication skills and de-escalate tense situations.
  
  • How UbiSim Helps: Every VR simulation scenario offers endless opportunities to practice communication techniques with patients, family members, and healthcare team members. Evidence-based practices are used in the design and delivery of age-appropriate therapeutic communication specific objectives for a variety of patient needs, settings, conditions in the UbiSim immersive VR environment leveled for learners with vary practice experiences.   
• Special Populations (Peds, OB, Mental Health): VR can provide a safe environment for NLRNs to practice neonatal resuscitation techniques, which are critical for saving newborn lives. The use of VR in orientation programs significantly improved new nurses' ability to recognize pediatric respiratory distress and impending respiratory failure (Raab, et al., 2024). 
  
  • How UbiSim Helps: Unique, customizable simulation scenarios with evidence-based simulation guides to support Pediatrics, Obstetrics, and Mental Health make design and implementation a breeze.

By providing these types of realistic and immersive VR simulation scenarios, and the opportunity to intuitively customize training specific to their needs, healthcare organizations can better prepare NLRNs for the complexities of real-world clinical practice and improve patient safety.

Some of the ways UbiSim is meeting this need with trusted content, an intuitive editor, the ability to add family members, and new features including updated Tutorials and an all new Medication Administration tutorial, the addition of a penlight with pupillary response, enhanced skin assessment and edema detection, updated scenario alignment with key nursing concepts such as Clinical Judgment, Communication, and Teamwork.

As we embrace this technology, we pave the way for a future where new nurses can thrive in their roles, bolstered by immersive VR simulation that equips them with the confidence needed to tackle real-life challenges head-on. 

Strategies identified from the faculty and student reports on ways to address the nurse readiness crisis include:

• enhanced clinical access
• supporting emotional readiness and self-advocacy
• strengthening faculty capacity
• leveraging modern learning tools like simulation and virtual reality (UbiSim, 2025).

Integrating immersive virtual reality into transition-to-practice programs signifies a transformative shift from the classroom to clinical practice. By offering engaging, personalized learning in realistic, safe environments on a standardized platform for education and assessment, immersive VR simulation can help diminish anxiety and enhance competency among new graduate nurses. Supporting nurses as they transition to practice leads to improved quality of nursing care, better patient outcomes, and the continued development of a skilled and competent nursing workforce. 

Author

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Dr. Christine "Christy" Heid is a seasoned nursing educator, simulationist, and healthcare advocate with over 20 years of experience. Currently pursuing a post-master's Nurse Practitioner certificate in Psychiatric-Mental Health Nursing at Maryville University, she is also committed to raising awareness and research funding for Ovarian Cancer. Holding a PhD in Nursing and an MSN focused on Healthcare Education from the University of Phoenix, along with a BSN from Mount Carmel College of Nursing, Christy blends academic rigor with clinical expertise. Her professional journey includes roles as a Nursing Education Consultant, Principal Investigator on a multi-site research project, and various faculty positions at Ashland University and Marion Technical College. Her clinical practice has taken her from large hospital systems and community care centers as a specialist in medical-surgical, oncology, palliative care, and vascular nursing. An advocate for innovative teaching, Dr. Heid has contributed to curriculum development and active learning strategies in nursing education. She serves as the chair of the International Nursing Association for Clinical Simulation Learning Education Committee and is involved with the Organization for Associate Degree Nursing Simulation Committee.

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