Challenges and support for working nurses preparing for graduate school: A qualitative study guided by
Xin Tan1, Xiaohui Wang1, Xiaoyan Wen1
1Department of Nursing, The Affiliated Hospital of Chengdu University, No.82, North Second Section of Second Ring Road, Chengdu, Sichuan, China.
Aim:
To explore the multilevel challenges and support needs of employed clinical nurses preparing for graduate entrance examinations, guided by Ecological Systems Theory.
Background:
An increasing number of registered nurses pursue graduate degrees while working full-time, yet the multifaceted challenges of entrance examination preparation in this population remain poorly characterized in the literature.
Design:
Qualitative descriptive design.
Methods:
Fourteen registered nurses from three tertiary hospitals in Southwestern China completed individual semi-structured interviews between September 2023 and March 2024. Data were analyzed using directed content analysis within the Ecological Systems Theory framework.
Results:
Five themes were identified: (1) Microsystem: Personal Physical and Mental Resource Depletion; (2) Mesosystem: Cross-Domain Role Conflict and Practice-Academia Synergy; (3) Exosystem: Structural Barriers in Organizational Contexts; (4) Macrosystem: Policy and Cultural Support Deficits; (5) Chronosystem: Temporal Pressures and Cumulative Burden.
Conclusions:
Working nurses preparing for graduate entrance examinations face profound multilevel challenges. Somatic symptoms, emotional exhaustion and identity concealment imposed significant personal costs (microsystem); severe role strain and time scarcity coexisted with bidirectional practice-academia synergy that enhanced professional self-efficacy (mesosystem); information asymmetry and uncertain educational return on investment constituted structural deterrents (exosystem); fragmented social support and absent institutional infrastructure left nurses without formal scaffolding (macrosystem). Chronosystemic analysis further revealed compounding burdens: credential inflation, cognitive resource depletion and accumulating psychological costs across repeated examination attempts. A coordinated response-encompassing organizational support, transparent career pathways, accessible preparatory information and career-stage-responsive policies-is essential to advance nursing education and sustain healthcare quality.
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