The Journey from Screen to Practice: Nursing Graduates’ Lived Experiences

The Journey from Screen to Practice: Nursing Graduates’ Lived Experiences | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Journey from Screen to Practice: Nursing Graduates’ Lived Experiences Radhwan Hussein Ibrahim, Sahir Mallaah Mohammad Ali, Abdulhakeem Jamil Ahmed, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7543142/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background: The COVID-19 pandemic forced nursing education worldwide to shift from traditional classrooms and clinical laboratories to online learning. While this ensured continuity, it raised concerns about the readiness of nursing graduates to transition into clinical practice, particularly in resource-limited and post-conflict settings such as Mosul, Iraq. Objective: This study aimed to explore the lived experiences of nursing graduates as they transitioned from online learning to clinical practice in Mosul. Methods: A qualitative phenomenological design was employed. Purposive sampling was used to recruit nursing graduates who had completed most of their education online and were currently practicing in hospitals in Mosul. Data was collected through semi-structured in-depth interviews, transcribed verbatim, and analyzed using Colaizzi’s seven-step method. Trustworthiness was ensured through credibility, dependability, transferability, and confirmability. Results: Five major themes emerged: (1) From virtual confidence to clinical uncertainty —Many participants reported feeling academically prepared yet clinically unready; (2) Struggling to translate theory into practice —limited practical exposure forced reliance on trial-and-error learning; (3) Emotional turbulence —Several participants described experiencing anxiety, fear of errors, and self-doubt before gradually adjusting; (4) Navigating support and mentorship —peer solidarity and guidance from senior staff were critical, though structured orientation was lacking; and (5) Building professional identity amid systemic challenges —graduates adapted to resource-limited environments and developed pride in their nursing role. Conclusion: Transitioning from online learning to clinical practice posed significant challenges for Mosul’s nursing graduates, characterized by skill gaps, emotional distress, and reliance on informal support. Despite these difficulties, graduates demonstrated resilience and developed a strong professional identity. The findings suggest a need for greater emphasis on blended education, structured transition programs, and supportive policies in Iraq to better prepare and support novice nurses. Further research is needed to test the effectiveness of such interventions. nursing graduates online learning clinical practice phenomenology transition experience Iraq Mosul Introduction The COVID-19 pandemic transformed nursing education worldwide, forcing an abrupt transition from traditional classroom and clinical settings to online platforms( 1 , 2 ). Nursing students, who typically rely on experiential learning and hands-on practice, were particularly affected( 3 , 4 ). While online modalities provided continuity of education, they also created challenges in developing clinical competencies, professional identity, and confidence in real patient care environments( 5 , 6 ). Globally, research has highlighted issues such as limited skill acquisition, anxiety regarding clinical readiness, and difficulties bridging theoretical knowledge with practice( 7 , 8 ). Transitioning from online learning back to clinical practice represents a critical juncture in the professional journey of new nursing graduates, making it an area of increasing scholarly attention( 9 , 10 ). In Iraq, nursing education is evolving within the context of systemic healthcare challenges( 11 ). Public sector healthcare is provided free of charge, yet it suffers from underfunding, resource constraints, and a shortage of trained nurses( 12 ). The demand for competent nursing professionals continues to rise, particularly in critical care and maternal-child health( 13 ). The sudden move to online education during the pandemic further strained the preparedness of nursing graduates entering practice( 14 , 15 ). In the city of Mosul, which has faced conflict, displacement, and reconstruction, the nursing workforce plays a pivotal role in rebuilding the healthcare system( 16 ). Nursing graduates from Mosul’s universities often encounter limited resources, overcrowded hospitals, and high patient acuity, which amplify the challenges of transitioning from academic settings to real-world practice( 17 ). The reliance on online learning during the pandemic intensified concerns about whether graduates are adequately equipped with the practical skills, professional confidence, and resilience needed in such a demanding environment. Although international studies have examined the impact of online learning on nursing students, there is a scarcity of research exploring the lived experiences of graduates who transitioned directly from predominantly online education into the complexities of clinical practice—particularly in conflict-affected and resource-limited contexts like Iraq. No published phenomenological research has specifically captured the voices of nursing graduates in Mosul, where unique socio-cultural, educational, and healthcare challenges shape their professional development. Understanding these experiences is significant for several reasons: It provides insights into the preparedness and challenges of new nurses. It informs nursing education reforms to strengthen clinical readiness. It highlights the contextual realities of nursing in Mosul, contributing to local and regional policy. It fills a critical gap in Middle Eastern nursing research, where limited qualitative studies focus on the online-to-clinical transition. Aim of the Study This study aims to explore the lived experiences of nursing graduates transitioning from online learning to clinical practice in Mosul, Iraq, through a phenomenological lens. By uncovering the challenges, coping strategies, and professional growth encountered during this transition, the study seeks to provide evidence that can guide nursing educators, policymakers, and healthcare institutions in enhancing nursing education and supporting graduates’ integration into clinical practice. Methods Research Design This study employed a qualitative research design using a phenomenological approach. Phenomenology was chosen as it seeks to explore and describe the lived experiences of individuals regarding a particular phenomenon. In this study, the phenomenon under investigation was the transition of nursing graduates from online learning during their undergraduate education to clinical practice in hospital settings. This design allowed the researchers to capture the depth, meaning, and essence of the participants’ experiences in their own words. Research Instrument The primary research instrument was the researcher, who acted as the key data collection tool. The semi-structured interview guide was designed specifically for the present study to explore nursing graduates’ transition experiences. It was informed by existing literature (e.g., Casey et al., 2021)(18), focusing on domains such as: · Preparedness for clinical practice after learning online. · Challenges faced during the transition from theory to practice. · Emotional, professional, and social experiences in clinical settings. · Coping strategies and sources of support. The guide was flexible, allowing participants to freely share their experiences while ensuring consistency across interviews. Field notes and reflective journaling were also maintained to capture non-verbal cues and researcher observations. Data Gathering Procedure Participants were purposively selected from nursing graduates of Mosul City who had completed their final years of study primarily through online learning during the COVID-19 pandemic and who were currently working in hospitals. Recruitment was facilitated through coordination with nursing colleges and hospital administration. Interviews were conducted face-to-face or virtually (depending on availability and participants’ preference) and lasted between 45 to 60 minutes. Each interview was audio-recorded with permission, and verbatim transcription was performed. Data collection continued until saturation was reached—when no new themes or insights emerged. Data Analysis Data were analyzed using Colaizzi’s phenomenological method(19), which involves seven systematic steps: 1. Reading all participants’ descriptions to obtain a general sense. 2. Extracting significant statements related to the phenomenon. 3. Formulating meanings from these significant statements. 4. Organizing formulated meanings into theme clusters. 5. Developing an exhaustive description of the phenomenon. 6. Identifying the fundamental structure of the experience. 7. Validating findings by returning to participants (member checking). This method ensured that analysis remained grounded in the participants’ actual experiences while allowing the emergence of themes that conveyed the essence of their transition. Trustworthiness of the Study To ensure rigor, Lincoln and Guba’s (1985) criteria for trustworthiness were applied: · Credibility: achieved through prolonged engagement with participants, member checking, and triangulation of data (interviews, field notes, reflective journals). · Transferability: ensured by providing thick descriptions of the research context, participants, and findings. · Dependability: addressed through an audit trail documenting research steps, coding processes, and decisions. · Confirmability: supported by reflexive journaling and peer debriefing to minimize researcher bias. Results A total of nursing graduates from Mosul participated in the study. They had completed most of their senior coursework through online learning and had recently transitioned into clinical practice. Thematic analysis of the interviews, guided by Colaizzi’s method, revealed five major themes and corresponding subthemes that encapsulated the essence of their lived experiences. These themes and subthemes are summarized in Table 1 . Theme 1: From Virtual Confidence to Clinical Uncertainty · Subtheme 1.1: Feeling Competent Online but Inadequate in Practice Many graduates expressed that while they had performed well academically in online settings, this confidence diminished upon entering the hospital environment. “I passed all my exams online, but when I faced a real patient, I felt like I was starting from zero.” · Subtheme 1.2: The Shock of Clinical Reality Participants described a “reality gap” between theoretical knowledge gained online and the unpredictable demands of patient care. Theme 2: Struggling to Translate Theory into Hands-On Skills · Subtheme 2.1: Limited Exposure to Practical Training Students reported minimal opportunities for practicing skills such as IV insertion, vital signs monitoring, and patient communication before graduation. “We watched videos about procedures, but in the hospital, my hands were shaking the first time I tried.” · Subtheme 2.2: Learning Through Trial and Error Graduates felt they were “catching up” by observing senior nurses and making mistakes. Theme 3: Emotional Turbulence During Transition · Subtheme 3.1: Anxiety and Fear of Making Errors Entering the wards brought high stress and fear of harming patients. “The first night shift, I couldn’t sleep… I kept thinking, what if I make a mistake?” · Subtheme 3.2: Loss of Confidence and Self-Doubt Many questioned whether online learning had truly prepared them. · Subtheme 3.3: Resilience and Gradual Adjustment Over time, some participants gained confidence as they repeated procedures and received informal support. Theme 4: Navigating Support and Mentorship · Subtheme 4.1: The Role of Senior Nurses and Doctors Graduates highlighted the importance of supportive senior staff in easing their transition. “When the head nurse guided me step by step, I felt less scared.” · Subtheme 4.2: Peer Solidarity Cohorts of new graduates leaned on each other to share learning and encouragement. · Subtheme 4.3: Lack of Structured Orientation Several participants lamented the absence of formal hospital transition programs. Theme 5: Building Professional Identity Amid Systemic Challenges · Subtheme 5.1: Adapting to Resource-Limited Environments Mosul hospitals, still recovering from conflict, lacked sufficient equipment and staffing, adding pressure on new nurses. · Subtheme 5.2: Finding Purpose and Pride Despite challenges, participants described a growing sense of responsibility and identity as frontline caregivers. “Even with all the difficulties, I feel proud to serve my people as a nurse in Mosul.” Summary of Themes The findings suggest that nursing graduates’ transition from online learning to clinical practice is characterized by a gap between theoretical readiness and clinical competence , emotional struggle , dependence on informal mentorship , and the gradual building of professional identity within a resource-constrained system . These themes reflect both the universal challenges of the online-to-practice shift and the unique contextual realities of Mosul. Table 1 Themes and Subthemes Identified from Participants’ Narratives Theme Subthemes 1. From Virtual Confidence to Clinical Uncertainty - Feeling competent online but inadequate in practice - The shock of clinical reality 2. Struggling to Translate Theory into Hands-On Skills - Limited exposure to practical training - Learning through trial and error 3. Emotional Turbulence During Transition - Anxiety and fear of making errors - Loss of confidence and self-doubt - Resilience and gradual adjustment 4. Navigating Support and Mentorship - Supportive senior nurses and doctors - Peer solidarity - Lack of structured orientation 5. Building Professional Identity Amid Systemic Challenges - Adapting to resource-limited environments - Finding purpose and pride in nursing Note. Themes and subthemes were developed using Colaizzi’s phenomenological method of data analysis. Discussion This study explored the lived experiences of nursing graduates in Mosul as they transitioned from online learning environments to clinical practice. The findings revealed five overarching themes: from virtual confidence to clinical uncertainty, struggling to translate theory into practice, emotional turbulence, navigating support and mentorship, and building professional identity amid systemic challenges. These themes provide valuable insights into the challenges and growth trajectories of new nurses in a post-pandemic, resource-constrained context. Bridging the Theory–Practice Gap The results highlight a significant gap between theoretical knowledge acquired online and the practical skills required in clinical settings. Graduates reported feeling academically prepared but clinically unready a finding echoed in previous research, where online nursing education was associated with diminished hands-on competency (Bao et al., 2022; Oducado & Estoque, 2021). This “shock of clinical reality” underscores the importance of blended and simulation-based approaches to ensure that students can transfer theoretical learning into practice effectively. In Iraq, where simulation laboratories are limited, the reliance on online modalities further widened this gap. Emotional Challenges in Transition Graduates described anxiety, fear, and self-doubt during their early weeks in practice. These experiences align with Benner’s Novice to Expert theory (1984), which emphasizes the vulnerability of new nurses at the novice stage. Similar studies have documented that online learning during the pandemic amplified emotional distress and reduced confidence in clinical readiness (Murray et al., 2021). In Mosul, where hospital settings are often overcrowded and under-resourced, these emotional challenges were intensified, making resilience-building a critical component of future nursing curricula. Support Systems as a Buffer Support from senior nurses, peers, and supervisors emerged as a key factor in easing graduates’ transition. Consistent with international literature, mentorship and structured orientation are recognized as essential for developing competence and reducing turnover among novice nurses (Chachula et al., 2015; Rush et al., 2019). However, participants in this study emphasized the absence of structured transition programs in Iraqi hospitals, leaving them reliant on informal peer networks. This gap calls for the development of systematic mentorship and residency programs in Iraqi nursing practice. Professional Identity Formation Despite challenges, participants described a growing sense of pride and professional identity. Serving in Mosul’s recovering healthcare system gave their work meaning, reflecting the resilience of nurses in conflict-affected contexts. This is consistent with studies showing that adversity can foster stronger professional commitment (Ten Hoeve et al., 2014). Importantly, the findings suggest that beyond skill acquisition, supporting graduates’ identity formation should be prioritized in nursing education and policy. Unique Context of Mosul and Iraq While many of the challenges mirror global experiences of online-to-practice transitions, the situation in Mosul is uniquely shaped by years of conflict, resource limitations, and the urgent need for skilled nurses. The lack of adequate infrastructure, limited mentorship, and heavy workloads amplify the stress of new graduates. These findings contribute region-specific insights to the global discourse on nursing education and practice, offering a Middle Eastern perspective that has been underrepresented in the literature. Implications for Nursing Education and Practice Educational Reform : Nursing colleges in Iraq should integrate more simulation-based training, hybrid learning models, and early clinical exposure. Hospital Orientation Programs : Structured residency and mentorship programs are needed to support novice nurses during transition. Policy Development : Ministries of Health and Higher Education should collaborate to align curricula with clinical needs, ensuring that graduates are practice-ready. Psychological Support : Programs promoting resilience, stress management, and professional identity formation should be incorporated into both nursing education and hospital practice. Study Contributions and Limitations The study has several limitations. First, findings are based on a small purposive sample of graduates from one city, which limits generalizability to other Iraqi or international contexts. Second, as interviews relied on self-report, responses may have been subject to recall or social desirability bias. Finally, the unique sociopolitical context of Mosul—a post-conflict city with resource-limited healthcare—may have influenced participants’ experiences in ways not transferable to other regions. Conclusion This study illuminated the lived experiences of nursing graduates in Mosul as they transitioned from online learning to clinical practice. The findings revealed a profound theory–practice gap, heightened emotional struggles, reliance on informal support networks, and the eventual development of professional identity amid systemic challenges. While the global nursing community faced similar disruptions due to the pandemic, the context of Mosul—with its resource-limited healthcare system and post-conflict recovery—intensified the difficulties faced by new nurses. Despite these challenges, participants demonstrated resilience and adaptability, underscoring the potential for growth when appropriate support structures are in place. The study highlights the urgent need for reforms in nursing education and hospital orientation programs in Iraq to ensure graduates are practice-ready, confident, and supported during their transition into professional roles. Implications for Future Research Building on these findings, several avenues for future research are recommended: 1. Longitudinal Studies o Future studies should track nursing graduates over time to examine how their confidence, competence, and professional identity evolve during the first years of practice. 2. Interventional Research o Research is needed to evaluate the effectiveness of structured mentorship, residency programs, and resilience-building interventions in supporting new graduates in Iraq and similar contexts. 3. Comparative Studies o Comparative investigations across different regions of Iraq, and between Iraq and other countries, could provide deeper insights into how sociopolitical and cultural contexts shape transition experiences. 4. Quantitative and Mixed-Methods Approaches o While this phenomenological inquiry captured rich qualitative insights, future research could employ quantitative tools (e.g., surveys measuring stress, resilience, or professional identity) alongside interviews to triangulate findings. 5. Policy-Oriented Research o Studies exploring how educational policy, accreditation standards, and hospital regulations impact the preparedness and retention of new nurses are essential to inform systemic reforms. By addressing these directions, future research can contribute to strengthening nursing education, enhancing the transition-to-practice experience, and ultimately improving patient care outcomes in Iraq and beyond. Declarations Acknowledgements The authors would like to express their gratitude to the nursing graduates who generously shared their experiences, as well as to the hospital administrators and staff in Mosul for their support during data collection. Author Contributions RHI : Conceptualization, supervision, methodology, manuscript revision. SMA : Data collection, analysis, drafting of the manuscript. AJA : Data collection, literature review, drafting support. SHA : Critical review, editing, and validation of findings. All authors read and approved of the final manuscript. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Clinical trial number not applicable. Ethics Approval and Consent to Participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki (1964, and its later amendments) . Ethical approval was obtained from Collegiate Committee for Medical Research Ethics, University of Mosul-Iraq ( Approval No: Reference: CCMRE-Nur-23-9, dated November 8, 2024 ). Written informed consent was obtained from all participants prior to data collection. Consent for Publication Not applicable, as no identifiable personal data are included in this manuscript. Competing Interests The authors declare no competing interests. References Abou Hashish EA, Alnajjar H, Rawas H. Voices on academic accreditation: lived experiences of nurse educators, administrators, students, and alumni in nursing education. BMC Medical Education. 2025;25(1) https://doi.org/10.1186/s12909-025-06657-2 Zhao X, Yu L, Bonnamy J, Brand G, Kovach N, Huang M. 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12:45:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1457957,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7543142/v1/78aa9e13-4078-49c7-aa78-b3ea0f9e4364.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Journey from Screen to Practice: Nursing Graduates’ Lived Experiences","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe COVID-19 pandemic transformed nursing education worldwide, forcing an abrupt transition from traditional classroom and clinical settings to online platforms(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e). Nursing students, who typically rely on experiential learning and hands-on practice, were particularly affected(\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). While online modalities provided continuity of education, they also created challenges in developing clinical competencies, professional identity, and confidence in real patient care environments(\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e). Globally, research has highlighted issues such as limited skill acquisition, anxiety regarding clinical readiness, and difficulties bridging theoretical knowledge with practice(\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e). Transitioning from online learning back to clinical practice represents a critical juncture in the professional journey of new nursing graduates, making it an area of increasing scholarly attention(\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn Iraq, nursing education is evolving within the context of systemic healthcare challenges(\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e). Public sector healthcare is provided free of charge, yet it suffers from underfunding, resource constraints, and a shortage of trained nurses(\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e). The demand for competent nursing professionals continues to rise, particularly in critical care and maternal-child health(\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e). The sudden move to online education during the pandemic further strained the preparedness of nursing graduates entering practice(\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn the city of Mosul, which has faced conflict, displacement, and reconstruction, the nursing workforce plays a pivotal role in rebuilding the healthcare system(\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e). Nursing graduates from Mosul\u0026rsquo;s universities often encounter limited resources, overcrowded hospitals, and high patient acuity, which amplify the challenges of transitioning from academic settings to real-world practice(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). The reliance on online learning during the pandemic intensified concerns about whether graduates are adequately equipped with the practical skills, professional confidence, and resilience needed in such a demanding environment.\u003c/p\u003e\n\u003cp\u003eAlthough international studies have examined the impact of online learning on nursing students, there is a scarcity of research exploring the lived experiences of graduates who transitioned directly from predominantly online education into the complexities of clinical practice\u0026mdash;particularly in conflict-affected and resource-limited contexts like Iraq. No published phenomenological research has specifically captured the voices of nursing graduates in Mosul, where unique socio-cultural, educational, and healthcare challenges shape their professional development.\u003c/p\u003e\n\u003cp\u003eUnderstanding these experiences is significant for several reasons:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eIt provides insights into the preparedness and challenges of new nurses.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eIt informs nursing education reforms to strengthen clinical readiness.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eIt highlights the contextual realities of nursing in Mosul, contributing to local and regional policy.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eIt fills a critical gap in Middle Eastern nursing research, where limited qualitative studies focus on the online-to-clinical transition.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003eAim of the Study\u003c/h3\u003e\n\u003cp\u003eThis study aims to explore the lived experiences of nursing graduates transitioning from online learning to clinical practice in Mosul, Iraq, through a phenomenological lens. By uncovering the challenges, coping strategies, and professional growth encountered during this transition, the study seeks to provide evidence that can guide nursing educators, policymakers, and healthcare institutions in enhancing nursing education and supporting graduates\u0026rsquo; integration into clinical practice.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eResearch Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a qualitative research design using a phenomenological approach. Phenomenology was chosen as it seeks to explore and describe the lived experiences of individuals regarding a particular phenomenon. In this study, the phenomenon under investigation was the transition of nursing graduates from online learning during their undergraduate education to clinical practice in hospital settings. This design allowed the researchers to capture the depth, meaning, and essence of the participants’ experiences in their own words.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Instrument\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary research instrument was the researcher, who acted as the key data collection tool. The semi-structured interview guide was designed specifically for the present study to explore nursing graduates’ transition experiences. It was informed by existing literature (e.g., Casey et al., 2021)(18), focusing on domains such as:\u003c/p\u003e\n\u003cp\u003e· Preparedness for clinical practice after learning online.\u003c/p\u003e\n\u003cp\u003e· Challenges faced during the transition from theory to practice.\u003c/p\u003e\n\u003cp\u003e· Emotional, professional, and social experiences in clinical settings.\u003c/p\u003e\n\u003cp\u003e· Coping strategies and sources of support.\u003c/p\u003e\n\u003cp\u003eThe guide was flexible, allowing participants to freely share their experiences while ensuring consistency across interviews. Field notes and reflective journaling were also maintained to capture non-verbal cues and researcher observations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Gathering Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were purposively selected from nursing graduates of Mosul City who had completed their final years of study primarily through online learning during the COVID-19 pandemic and who were currently working in hospitals. Recruitment was facilitated through coordination with nursing colleges and hospital administration.\u003c/p\u003e\n\u003cp\u003eInterviews were conducted face-to-face or virtually (depending on availability and participants’ preference) and lasted between 45 to 60 minutes. Each interview was audio-recorded with permission, and verbatim transcription was performed. Data collection continued until saturation was reached—when no new themes or insights emerged.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using Colaizzi’s phenomenological method(19), which involves seven systematic steps:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Reading all participants’ descriptions to obtain a general sense.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Extracting significant statements related to the phenomenon.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Formulating meanings from these significant statements.\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp;Organizing formulated meanings into theme clusters.\u003c/p\u003e\n\u003cp\u003e5.\u0026nbsp; \u0026nbsp;Developing an exhaustive description of the phenomenon.\u003c/p\u003e\n\u003cp\u003e6.\u0026nbsp; \u0026nbsp;Identifying the fundamental structure of the experience.\u003c/p\u003e\n\u003cp\u003e7.\u0026nbsp; \u0026nbsp;Validating findings by returning to participants (member checking).\u003c/p\u003e\n\u003cp\u003eThis method ensured that analysis remained grounded in the participants’ actual experiences while allowing the emergence of themes that conveyed the essence of their transition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrustworthiness of the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure rigor, Lincoln and Guba’s (1985) criteria for trustworthiness were applied:\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eCredibility:\u003c/strong\u003e achieved through prolonged engagement with participants, member checking, and triangulation of data (interviews, field notes, reflective journals).\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eTransferability:\u003c/strong\u003e ensured by providing thick descriptions of the research context, participants, and findings.\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eDependability:\u003c/strong\u003e addressed through an audit trail documenting research steps, coding processes, and decisions.\u003c/p\u003e\n\u003cp\u003e· \u003cstrong\u003eConfirmability:\u003c/strong\u003e supported by reflexive journaling and peer debriefing to minimize researcher bias.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of nursing graduates from Mosul participated in the study. They had completed most of their senior coursework through online learning and had recently transitioned into clinical practice. Thematic analysis of the interviews, guided by Colaizzi\u0026rsquo;s method, revealed \u003cstrong\u003efive major themes\u003c/strong\u003e and corresponding subthemes that encapsulated the essence of their lived experiences. These themes and subthemes are summarized in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: From Virtual Confidence to Clinical Uncertainty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 1.1: Feeling Competent Online but Inadequate in Practice\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Many graduates expressed that while they had performed well academically in online settings, this confidence diminished upon entering the hospital environment.\u003cbr\u003e\u003cem\u003e\u0026ldquo;I passed all my exams online, but when I faced a real patient, I felt like I was starting from zero.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 1.2: The Shock of Clinical Reality\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Participants described a \u0026ldquo;reality gap\u0026rdquo; between theoretical knowledge gained online and the unpredictable demands of patient care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: Struggling to Translate Theory into Hands-On Skills\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 2.1: Limited Exposure to Practical Training\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Students reported minimal opportunities for practicing skills such as IV insertion, vital signs monitoring, and patient communication before graduation.\u003cbr\u003e\u003cem\u003e\u0026ldquo;We watched videos about procedures, but in the hospital, my hands were shaking the first time I tried.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 2.2: Learning Through Trial and Error\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Graduates felt they were \u0026ldquo;catching up\u0026rdquo; by observing senior nurses and making mistakes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: Emotional Turbulence During Transition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 3.1: Anxiety and Fear of Making Errors\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Entering the wards brought high stress and fear of harming patients.\u003cbr\u003e\u003cem\u003e\u0026ldquo;The first night shift, I couldn\u0026rsquo;t sleep\u0026hellip; I kept thinking, what if I make a mistake?\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 3.2: Loss of Confidence and Self-Doubt\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Many questioned whether online learning had truly prepared them.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 3.3: Resilience and Gradual Adjustment\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Over time, some participants gained confidence as they repeated procedures and received informal support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4: Navigating Support and Mentorship\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 4.1: The Role of Senior Nurses and Doctors\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Graduates highlighted the importance of supportive senior staff in easing their transition.\u003cbr\u003e\u003cem\u003e\u0026ldquo;When the head nurse guided me step by step, I felt less scared.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 4.2: Peer Solidarity\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Cohorts of new graduates leaned on each other to share learning and encouragement.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 4.3: Lack of Structured Orientation\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Several participants lamented the absence of formal hospital transition programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 5: Building Professional Identity Amid Systemic Challenges\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 5.1: Adapting to Resource-Limited Environments\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Mosul hospitals, still recovering from conflict, lacked sufficient equipment and staffing, adding pressure on new nurses.\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u003cstrong\u003eSubtheme 5.2: Finding Purpose and Pride\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Despite challenges, participants described a growing sense of responsibility and identity as frontline caregivers.\u003cbr\u003e\u003cem\u003e\u0026ldquo;Even with all the difficulties, I feel proud to serve my people as a nurse in Mosul.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSummary of Themes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings suggest that nursing graduates\u0026rsquo; transition from online learning to clinical practice is characterized by \u003cstrong\u003ea gap between theoretical readiness and clinical competence\u003c/strong\u003e, \u003cstrong\u003eemotional struggle\u003c/strong\u003e, \u003cstrong\u003edependence on informal mentorship\u003c/strong\u003e, and \u003cstrong\u003ethe gradual building of professional identity within a resource-constrained system\u003c/strong\u003e. These themes reflect both the universal challenges of the online-to-practice shift and the unique contextual realities of Mosul.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eThemes and Subthemes Identified from Participants\u0026rsquo; Narratives\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"672\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubthemes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1. From Virtual Confidence to Clinical Uncertainty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e- Feeling competent online but inadequate in practice\u0026nbsp;\u003cbr\u003e\u0026nbsp;- The shock of clinical reality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2. Struggling to Translate Theory into Hands-On Skills\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e- Limited exposure to practical training\u0026nbsp;\u003cbr\u003e\u0026nbsp;- Learning through trial and error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3. Emotional Turbulence During Transition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e- Anxiety and fear of making errors\u0026nbsp;\u003cbr\u003e\u0026nbsp;- Loss of confidence and self-doubt\u0026nbsp;\u003cbr\u003e\u0026nbsp;- Resilience and gradual adjustment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4. Navigating Support and Mentorship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e- Supportive senior nurses and doctors\u0026nbsp;\u003cbr\u003e\u0026nbsp;- Peer solidarity\u0026nbsp;\u003cbr\u003e\u0026nbsp;- Lack of structured orientation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5. Building Professional Identity Amid Systemic Challenges\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e- Adapting to resource-limited environments\u0026nbsp;\u003cbr\u003e\u0026nbsp;- Finding purpose and pride in nursing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote. Themes and subthemes were developed using Colaizzi\u0026rsquo;s phenomenological method of data analysis.\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the lived experiences of nursing graduates in Mosul as they transitioned from online learning environments to clinical practice. The findings revealed five overarching themes: \u003cem\u003efrom virtual confidence to clinical uncertainty, struggling to translate theory into practice, emotional turbulence, navigating support and mentorship, and building professional identity amid systemic challenges.\u003c/em\u003e These themes provide valuable insights into the challenges and growth trajectories of new nurses in a post-pandemic, resource-constrained context.\u003c/p\u003e\n\u003ch3\u003eBridging the Theory–Practice Gap\u003c/h3\u003e\n\u003cp\u003eThe results highlight a significant gap between theoretical knowledge acquired online and the practical skills required in clinical settings. Graduates reported feeling academically prepared but clinically unready a finding echoed in previous research, where online nursing education was associated with diminished hands-on competency (Bao et al., 2022; Oducado \u0026amp; Estoque, 2021). This \u0026ldquo;shock of clinical reality\u0026rdquo; underscores the importance of blended and simulation-based approaches to ensure that students can transfer theoretical learning into practice effectively. In Iraq, where simulation laboratories are limited, the reliance on online modalities further widened this gap.\u003c/p\u003e\u003cdiv id=\"Sec30\" class=\"Section2\"\u003e\u003ch2\u003eEmotional Challenges in Transition\u003c/h2\u003e\u003cp\u003eGraduates described anxiety, fear, and self-doubt during their early weeks in practice. These experiences align with Benner\u0026rsquo;s \u003cem\u003eNovice to Expert\u003c/em\u003e theory (1984), which emphasizes the vulnerability of new nurses at the novice stage. Similar studies have documented that online learning during the pandemic amplified emotional distress and reduced confidence in clinical readiness (Murray et al., 2021). In Mosul, where hospital settings are often overcrowded and under-resourced, these emotional challenges were intensified, making resilience-building a critical component of future nursing curricula.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eSupport Systems as a Buffer\u003c/h2\u003e\u003cp\u003eSupport from senior nurses, peers, and supervisors emerged as a key factor in easing graduates\u0026rsquo; transition. Consistent with international literature, mentorship and structured orientation are recognized as essential for developing competence and reducing turnover among novice nurses (Chachula et al., 2015; Rush et al., 2019). However, participants in this study emphasized the absence of structured transition programs in Iraqi hospitals, leaving them reliant on informal peer networks. This gap calls for the development of systematic mentorship and residency programs in Iraqi nursing practice.\u003c/p\u003e\u003cdiv id=\"Sec32\" class=\"Section3\"\u003e\u003ch2\u003eProfessional Identity Formation\u003c/h2\u003e\u003cp\u003e Despite challenges, participants described a growing sense of pride and professional identity. Serving in Mosul\u0026rsquo;s recovering healthcare system gave their work meaning, reflecting the resilience of nurses in conflict-affected contexts. This is consistent with studies showing that adversity can foster stronger professional commitment (Ten Hoeve et al., 2014). Importantly, the findings suggest that beyond skill acquisition, supporting graduates\u0026rsquo; identity formation should be prioritized in nursing education and policy.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec33\" class=\"Section3\"\u003e\u003ch2\u003eUnique Context of Mosul and Iraq\u003c/h2\u003e\u003cp\u003eWhile many of the challenges mirror global experiences of online-to-practice transitions, the situation in Mosul is uniquely shaped by years of conflict, resource limitations, and the urgent need for skilled nurses. The lack of adequate infrastructure, limited mentorship, and heavy workloads amplify the stress of new graduates. These findings contribute region-specific insights to the global discourse on nursing education and practice, offering a Middle Eastern perspective that has been underrepresented in the literature.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eImplications for Nursing Education and Practice\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eEducational Reform\u003c/b\u003e: Nursing colleges in Iraq should integrate more simulation-based training, hybrid learning models, and early clinical exposure.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eHospital Orientation Programs\u003c/b\u003e: Structured residency and mentorship programs are needed to support novice nurses during transition.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePolicy Development\u003c/b\u003e: Ministries of Health and Higher Education should collaborate to align curricula with clinical needs, ensuring that graduates are practice-ready.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePsychological Support\u003c/b\u003e: Programs promoting resilience, stress management, and professional identity formation should be incorporated into both nursing education and hospital practice.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eStudy Contributions and Limitations\u003c/h3\u003e\n\u003cp\u003eThe study has several limitations. First, findings are based on a small purposive sample of graduates from one city, which limits generalizability to other Iraqi or international contexts. Second, as interviews relied on self-report, responses may have been subject to recall or social desirability bias. Finally, the unique sociopolitical context of Mosul\u0026mdash;a post-conflict city with resource-limited healthcare\u0026mdash;may have influenced participants\u0026rsquo; experiences in ways not transferable to other regions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study illuminated the lived experiences of nursing graduates in Mosul as they transitioned from online learning to clinical practice. The findings revealed a profound theory–practice gap, heightened emotional struggles, reliance on informal support networks, and the eventual development of professional identity amid systemic challenges. While the global nursing community faced similar disruptions due to the pandemic, the context of Mosul—with its resource-limited healthcare system and post-conflict recovery—intensified the difficulties faced by new nurses.\u003c/p\u003e\n\u003cp\u003eDespite these challenges, participants demonstrated resilience and adaptability, underscoring the potential for growth when appropriate support structures are in place. The study highlights the urgent need for reforms in nursing education and hospital orientation programs in Iraq to ensure graduates are practice-ready, confident, and supported during their transition into professional roles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Future Research\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBuilding on these findings, several avenues for future research are recommended:\u003c/p\u003e\n\u003cp\u003e1. \u003cstrong\u003eLongitudinal Studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eo Future studies should track nursing graduates over time to examine how their confidence, competence, and professional identity evolve during the first years of practice.\u003c/p\u003e\n\u003cp\u003e2. \u003cstrong\u003eInterventional Research\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eo Research is needed to evaluate the effectiveness of structured mentorship, residency programs, and resilience-building interventions in supporting new graduates in Iraq and similar contexts.\u003c/p\u003e\n\u003cp\u003e3. \u003cstrong\u003eComparative Studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eo Comparative investigations across different regions of Iraq, and between Iraq and other countries, could provide deeper insights into how sociopolitical and cultural contexts shape transition experiences.\u003c/p\u003e\n\u003cp\u003e4. \u003cstrong\u003eQuantitative and Mixed-Methods Approaches\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eo While this phenomenological inquiry captured rich qualitative insights, future research could employ quantitative tools (e.g., surveys measuring stress, resilience, or professional identity) alongside interviews to triangulate findings.\u003c/p\u003e\n\u003cp\u003e5. \u003cstrong\u003ePolicy-Oriented Research\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eo Studies exploring how educational policy, accreditation standards, and hospital regulations impact the preparedness and retention of new nurses are essential to inform systemic reforms.\u003c/p\u003e\n\u003cp\u003eBy addressing these directions, future research can contribute to strengthening nursing education, enhancing the transition-to-practice experience, and ultimately improving patient care outcomes in Iraq and beyond.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to the nursing graduates who generously shared their experiences, as well as to the hospital administrators and staff in Mosul for their support during data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRHI\u003c/strong\u003e: Conceptualization, supervision, methodology, manuscript revision. \u003cstrong\u003eSMA\u003c/strong\u003e: Data collection, analysis, drafting of the manuscript. \u003cstrong\u003eAJA\u003c/strong\u003e: Data collection, literature review, drafting support. \u003cstrong\u003eSHA\u003c/strong\u003e: Critical review, editing, and validation of findings. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles of the \u003cem\u003eDeclaration of Helsinki (1964, and its later amendments)\u003c/em\u003e. Ethical approval was obtained from Collegiate Committee for Medical Research Ethics, University of Mosul-Iraq (\u003cstrong\u003eApproval No: Reference: CCMRE-Nur-23-9, dated November 8, 2024\u003c/strong\u003e). Written informed consent was obtained from all participants prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable, as no identifiable personal data are included in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbou Hashish EA, Alnajjar H, Rawas H. Voices on academic accreditation: lived experiences of nurse educators, administrators, students, and alumni in nursing education. BMC Medical Education. 2025;25(1) https://doi.org/10.1186/s12909-025-06657-2\u003c/li\u003e\n\u003cli\u003eZhao X, Yu L, Bonnamy J, Brand G, Kovach N, Huang M. Challenges faced by international nursing students undertaking graduate research: Contemporary issues. Nurse Education Today. 2025;146 https://doi.org/10.1016/j.nedt.2024.106556\u003c/li\u003e\n\u003cli\u003eTowner EC, Lea J, East LS. Exploring Experiences of the New Graduate Registered Nurse in Caring for the Deteriorating Patient in Rural Areas: A Qualitative Study. Journal of Clinical Nursing. 2025;34(8):3316-29 https://doi.org/10.1111/jocn.17838\u003c/li\u003e\n\u003cli\u003eNorton D, Reeve S, Peacock A, Ward-Smith P. The Lived Experience of Newly Graduated Nurses\u0026apos; Transition to Practice: A Phenomenology Study. Journal for Nurses in Professional Development. 2025;41(2):68-74 https://doi.org/10.1097/NND.0000000000001103\u003c/li\u003e\n\u003cli\u003eGhimire A, Qiu Y. Beyond Borders: A Longitudinal Study of Nepali Nurses\u0026rsquo; Dreams, Realities, and the Pursuit of a Global Career. Policy, Politics, and Nursing Practice. 2025;26(3):163-76 https://doi.org/10.1177/15271544251322493\u003c/li\u003e\n\u003cli\u003eMurphy C, Connell S, Gantley M, Barrett T. Students\u0026rsquo; perspectives on the congruence and effectiveness of a problem-based learning approach to teach recovery-oriented practice: A mixed method study. Nurse Education in Practice. 2025;84 https://doi.org/10.1016/j.nepr.2025.104298\u003c/li\u003e\n\u003cli\u003eAl-Rjoub S. When Leadership Drives Nurses Away: Empirical Research Qualitative on High Turnover Rates Reasons. Nursing Open. 2025;12(7) https://doi.org/10.1002/nop2.70271\u003c/li\u003e\n\u003cli\u003eAli SM, Khalaf I, Hamdan-Mansour A. Leadership Lived Experiences Among Ph.D. Nursing Graduates: A Qualitative Study. International Journal of Innovative Research and Scientific Studies. 2025;8(3):244-54 https://doi.org/10.53894/ijirss.v8i3.6479\u003c/li\u003e\n\u003cli\u003eMetersky K, Al-Hamad A, Ruzgar NS, Tan V, Crasto G, Wong JPH. Exploring the Experiences and Perspectives of new Graduate Nurses on the Push-Pull Factors of Nursing Workforce Crisis Post COVID-19. Canadian Journal of Nursing Research. 2025;57(2):215-26 https://doi.org/10.1177/08445621241301953\u003c/li\u003e\n\u003cli\u003eCaponnetto V, Voltarel E, Masotta V, Lancia L, Petrucci C, Dante A. Unveiling the keys to success: Insights from a phenomenological study on recent nursing graduates. Nurse Education Today. 2025;144 https://doi.org/10.1016/j.nedt.2024.106465\u003c/li\u003e\n\u003cli\u003eYaas MH, Hamarash MQ, Almushhadany OI, Ibrahim RH, Jassim RS. Assessing the Effectiveness of Clinical Rotations in Preparing UndergraduateNursingStudentsforPractice:MixedStudy. Malaysian Journal of Nursing. 2023;15(2):87-99 https://doi.org/10.31674/mjn.2023.v15i02.010\u003c/li\u003e\n\u003cli\u003eQadir Hamarash M, Ibrahim RH, Yaas MH, Almushhadany OI, Al Mukhtar SH. Using Peer-Assisted Learning to Enhance Clinical Reasoning Skills in Undergraduate Nursing Students: A Study in Iraq. Advances in Medical Education and Practice. 2025;16:651-62 https://doi.org/10.2147/AMEP.S507996\u003c/li\u003e\n\u003cli\u003eAbdullah MK, Abdulghani MF, Ibrahim RH, Mahmood HJ, Mohsen OA, Jassim RS. Nurses\u0026apos; Attitudes, Knowledge, and Practices Concerning Evidence-BasedPractice:ACross-SectionalStudy. Malaysian Journal of Nursing. 2024;15(4):4-11 https://doi.org/10.31674/mjn.2024.v15i04.002\u003c/li\u003e\n\u003cli\u003eHamarash MQ, Ibrahim R, Yaas MH, Abdulghani MF, Al Mushhadany O. Comparative Effectiveness of Health Communication Strategies in Nursing: A Mixed Methods Study of Internet, mHealth, and Social Media Versus Traditional Methods. JMIR Nursing. 2024;7(1) https://doi.org/10.2196/55744\u003c/li\u003e\n\u003cli\u003eAlneama RMJ, Ibrahim RH. An integration of Benner\u0026rsquo;s theory to explore the learning styles and motivation as predictors of academic achievement among nursing students in Iraq. Journal of Holistic Nursing Science. 2025;12(1):95-104 https://doi.org/10.31603/nursing.v12i1.13324\u003c/li\u003e\n\u003cli\u003eHamarash MQ, Yaas MH, Almushhadany OI, Ibrahim RH. Preceptoring of Graduate Nursing Students in Iraq. Advances in Medical Education and Practice. 2023;14:1025-34 https://doi.org/10.2147/AMEP.S418824\u003c/li\u003e\n\u003cli\u003eAttia YK, Ibrahim RH. Difficulties experienced in clinical learning settings for nurses in Iraq: Perspectives of nursing administrators and nursing instructors. Informatics in Medicine Unlocked. 2023;38 https://doi.org/10.1016/j.imu.2023.101229\u003c/li\u003e\n\u003cli\u003eCasey K, Oja KJ, Makic MBF. The lived experiences of graduate nurses transitioning to professional practice during a pandemic. Nurs Outlook. 2021;69(6):1072-80 https://doi.org/10.1016/j.outlook.2021.06.006\u003c/li\u003e\n\u003cli\u003eZhao T, Ma Y, Hu S, Chen L, Lai AYK, Ma H. Perceptions and experiences of gratitude among patients with advanced cancer in China: A descriptive phenomenological study. Asia-Pacific Journal of Oncology Nursing. 2025;12 https://doi.org/10.1016/j.apjon.2025.100754\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"nursing graduates, online learning, clinical practice, phenomenology, transition experience, Iraq, Mosul","lastPublishedDoi":"10.21203/rs.3.rs-7543142/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7543142/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The COVID-19 pandemic forced nursing education worldwide to shift from traditional classrooms and clinical laboratories to online learning. While this ensured continuity, it raised concerns about the readiness of nursing graduates to transition into clinical practice, particularly in resource-limited and post-conflict settings such as Mosul, Iraq.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study aimed to explore the lived experiences of nursing graduates as they transitioned from online learning to clinical practice in Mosul.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A qualitative phenomenological design was employed. Purposive sampling was used to recruit nursing graduates who had completed most of their education online and were currently practicing in hospitals in Mosul. Data was collected through semi-structured in-depth interviews, transcribed verbatim, and analyzed using Colaizzi’s seven-step method. Trustworthiness was ensured through credibility, dependability, transferability, and confirmability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Five major themes emerged: (1) \u003cem\u003eFrom virtual confidence to clinical uncertainty\u003c/em\u003e—Many participants reported feeling academically prepared yet clinically unready; (2) \u003cem\u003eStruggling to translate theory into practice\u003c/em\u003e—limited practical exposure forced reliance on trial-and-error learning; (3) \u003cem\u003eEmotional turbulence\u003c/em\u003e—Several participants described experiencing anxiety, fear of errors, and self-doubt before gradually adjusting; (4) \u003cem\u003eNavigating support and mentorship\u003c/em\u003e—peer solidarity and guidance from senior staff were critical, though structured orientation was lacking; and (5) \u003cem\u003eBuilding professional identity amid systemic challenges\u003c/em\u003e—graduates adapted to resource-limited environments and developed pride in their nursing role.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Transitioning from online learning to clinical practice posed significant challenges for Mosul’s nursing graduates, characterized by skill gaps, emotional distress, and reliance on informal support. Despite these difficulties, graduates demonstrated resilience and developed a strong professional identity. The findings suggest a need for greater emphasis on blended education, structured transition programs, and supportive policies in Iraq to better prepare and support novice nurses. Further research is needed to test the effectiveness of such interventions.\u003c/p\u003e","manuscriptTitle":"The Journey from Screen to Practice: Nursing Graduates’ Lived Experiences","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 12:29:37","doi":"10.21203/rs.3.rs-7543142/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"55432705423622886005156843357397544782","date":"2025-10-09T17:36:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T11:18:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-08T02:59:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-17T10:07:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-17T09:25:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-09-12T11:08:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a9f86e2-d2cc-4a6f-a938-b3c1db4c4e21","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-23T12:29:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 12:29:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7543142","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7543142","identity":"rs-7543142","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}