Navigating Iran's National Nursing Internship Program: A Qualitative Study of Structural, Psychosocial, and Managerial Barriers from Students' Perspectives

The journey from nursing student to professional nurse is one of the most demanding transitions in any healthcare career. It is a period where young people must shift from learning theories in a classroom to making real decisions that affect human lives in a hospital ward. This transition is critical because the environment where students learn to practice is not just a place for training; it is the foundation of their professional identity. If the support systems around them fail, or if the environment is hostile, students can suffer from a profound sense of shock and anxiety. This can lead to high rates of people leaving the profession before they even start, and it can compromise the safety of the patients they are trying to help. In Iran, a specific national program was introduced to manage this transition, placing final-year students into hospitals to work full shifts alongside experienced staff. While the intention was to bridge the gap between school and work, the actual experience of the students involved in this program had not been systematically studied until recently.

Researchers at Jahrom University of Medical Sciences set out to understand what was really happening inside these hospitals. They conducted a qualitative study, which means they focused on listening to the personal stories and lived experiences of the people involved rather than just counting statistics. Between January and April 2026, the team interviewed eleven final-year nursing students, five men and six women, who were currently working through this internship program. The researchers asked them to describe their days, their struggles, and their feelings in detail. The interviews lasted between 45 and 65 minutes, allowing the students to speak freely about their challenges. By analyzing these conversations, the researchers identified three major areas where the system was failing the students: a lack of preparation, severe psychosocial difficulties, and a failure in how the program was managed.

The first major finding was that students were entering the hospital completely unprepared. This lack of readiness came from two directions. On the student side, many did not understand what they were supposed to do or what the goals of the internship were. They felt a deep sense of anxiety and doubt about their own abilities, often feeling like they were being thrown into deep water without knowing how to swim. Many admitted they did not know how to use essential medical equipment or how to communicate effectively with patients. On the other side, the hospitals themselves were often unprepared to receive them. Students reported that some wards did not provide basic welfare facilities like food, and because the nursing staff were already overwhelmed with their own workloads, they had no time or patience to guide the students. The environment was not set up to teach; it was set up to survive.

The second and perhaps most distressing finding was the psychosocial toll on the students. The study revealed a widespread lack of support from both the university faculty and the hospital staff. Students felt abandoned, with faculty members acting only as administrators who sent them to the hospital and then disappeared, while hospital staff often viewed them as a burden rather than learners. This isolation led to a disturbing pattern of professional misconduct. Ten out of the eleven students reported being treated poorly. They described being exploited, given workloads equivalent to full-time staff, and forced to perform tasks that were not part of their training, such as running errands or organizing paperwork. Beyond the unfair workload, they faced inappropriate behavior, including humiliation and verbal harassment. Some students recounted being told in front of patients and staff that they were not cut out for nursing, or being scolded aggressively for minor mistakes. This created a climate of fear where students felt they had no one to turn to for help.

The third theme uncovered was a fundamental failure in the management and planning of the program itself. There was a clear disconnect between the university and the hospitals. The two sides did not seem to be talking to each other about what the students were supposed to be doing or how they should be evaluated. This lack of coordination meant that students were sometimes placed in hospital wards before they had even finished the necessary training courses for those specific areas. It was as if they were being asked to drive a car before they had learned how to start the engine. The researchers found that the program lacked a logical structure, with no clear rules about the students' roles, no formal mechanism for them to report problems, and no structured way to ensure their safety or learning.

The study concludes that these three issues are deeply interconnected. The poor management of the program creates the conditions where students are unprepared, and that lack of preparation makes them vulnerable to the psychosocial abuse they face in the hospital. The researchers suggest that fixing this requires more than just telling students to be more resilient. They recommend that policymakers and hospital managers create structured orientation workshops to explain the program's goals clearly before students start. They also call for formal agreements between universities and hospitals to ensure that staff are trained to support students and that there are clear policies against harassment and exploitation. Without these structural changes, the internship program risks continuing to push students away from the profession they are trying to join, rather than guiding them into it.