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Challenges and support for working nurses preparing for graduate school: A qualitative study guided by Bronfenbrenner's ecological systems theory
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DOI：10.1016/j.nepr.2026.104809.png)
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Abstract
En 中文
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.
Keywords:
Education
Nursing
Professional development
Graduate
Ecological systems theory
Qualitative research
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