International evidence on foundational knowledge and skills required for entry into nursing practice: A scoping review

Registered nurses play a pivotal role in delivering safe, effective, and person-centred care across diverse healthcare settings. There is a global trend towards an all-graduate nursing profession. However, the need for university-prepared registered nurses continues to be challenged since the foundational knowledge required for entry into nursing practice remains unclear.

This review aims to synthesise international evidence on the foundational knowledge and skills required for nursing students at the point of entry to nursing practice or registration.

Four electronic databases (MEDLINE, CINAHL, Scopus, and ERIC) were searched between July and August 2025. Articles reporting education programs designed to develop the knowledge, skills, capabilities, or competency required for entry to nursing practice, and those providing perspectives on nursing knowledge and skills for entry-to-practice programs, published between 2015 and 2025, were included. Inductive thematic analysis was used to identify domains of foundational knowledge, which were then mapped to a knowledge framework derived from Barbara Carper's patterns of knowing to support the interpretation and conceptualisation of each domain.

Eighty-one articles were included in the review. Six domains of foundational knowledge and skills were identified: (1) scientific and disciplinary foundations of nursing practice; (2) clinical reasoning and technical competence; (3) person-centred, compassionate, and relational care; (4) professional self, reflection, and interpersonal capability; (5) ethical, legal, and culturally safe practice; and (6) social justice, health equity, and socio-political awareness. The foundational knowledge and skills required for nursing registration were broad, multidimensional, and complex. Areas related to socio-political awareness, health equity, system-level thinking, and digital health, were less consistently embedded in education programs and often addressed in a fragmented or superficial manner. The analysis revealed an important distinction within empirical knowing in nursing between conceptual and theoretical knowledge as well as its application in practice.

The findings suggest that curriculum design may benefit from supporting theoretical and conceptual integration and addressing emerging and underrepresented areas of practice, including socio-political awareness, health equity, health system literacy, and digital health. These domains may inform the preparation of nurses to meet current and future health needs. Entry-to-practice education programs should also strengthen the articulation of integrated foundational capabilities, ensuring that relational, interpersonal, and professional capabilities are embedded and assessed. These programs could also consider incorporating digital health and emerging technologies into core curriculum requirements, embedding health systems, policy analysis, and global health perspectives, while strengthening the emphasis on equity, cultural safety, and Indigenous health.