How employment-based clinical experience during undergraduate education influences transition to practice: A qualitative systematic review

AIM: To synthesize qualitative evidence on the experiences of undergraduate nursing students and new graduate nurses engaged in formal paid employment models or health-related work during their undergraduate studies, to examine how these employment-based clinical experiences influence their transition to nursing practice, and to identify elements that facilitate or hinder this transition. DESIGN: Qualitative systematic review. METHODS: Searches were conducted in MEDLINE, Embase, Emcare (Ovid), CINAHL Complete (EBSCOhost), ERIC (ProQuest), and gray literature sources, including ProQuest Dissertations and Theses and Google Scholar. No date or country limits were applied, although only English-language studies were included. The review followed JBI methodology for qualitative evidence synthesis and adhered to PRISMA reporting guidelines. Two reviewers independently appraised methodological quality using the JBI Critical Appraisal Checklist, with disagreements resolved through discussion with a third reviewer. Findings were aggregated through meta-aggregation. RESULTS: Twelve studies met the inclusion criteria, contributing 92 findings categorized into 13 categories and three synthesized findings: 1) Developing professional identities while navigating role-related challenges; 2) Developing clinical competence and confidence; and 3) Gaining environmental familiarity and workplace socialisation while managing high expectations. Formal paid employment and health-related work provided students and new graduates with opportunities to enhance confidence, competence, and workplace readiness. However, they also encountered challenges related to role boundaries, supervision variability, and dual expectations, illustrating the complex influence of employment-based experiences on transition to practice. CONCLUSION: Additional clinical experience acquired through formal paid employment and health-related work contributes meaningfully to the transition to nursing practice by strengthening professional identity, clinical proficiency, and workplace socialization. Persistent challenges highlight the need for structured support, clear supervision, and defined scopes of practice within employment-based roles.