Impact of Stress on Clinical Performance of Nursing Students: A Cross-Sectional Study

Abstract

Nursing students face multiple academic, clinical, and interpersonal challenges during their training, often resulting in elevated stress levels. Excessive stress can hinder skill acquisition, impair decision-making, and compromise patient care. Objective: To identify key stressors affecting nursing students during clinical practice and to evaluate the relationship between stress levels and clinical performance. Methods: A cross-sectional study was conducted among 107 nursing students at the College of Nursing, Children's Hospital, Lahore from December 2025 to May 2026., using a simple random sampling technique. The Perceived Stress Scale (PSS) was employed to assess stress levels, and a structured clinical performance questionnaire evaluated self-reported competence. Data were analyzed using SPSS version 26; the Chi-square test was used to determine associations between stress and categorical variables. Results: More than half of participants (51.4%) reported moderate stress, while 23.4% experienced high stress. Higher stress levels were significantly associated with lower confidence in basic procedures, poorer documentation, reduced infection-control adherence, weaker medication administration, less effective communication and teamwork, poorer decision-making, weaker professionalism and ethical practice, and poorer time management (p < 0.05 for all). Students aged 20-25 years and those in their 4th year of study reported significantly higher stress than their peers (p = 0.003 and p < 0.001, respectively), while clinical placement area showed no significant association. Conclusion: Stress is prevalent among nursing students and is closely linked to reduced clinical performance across nearly every domain examined. Integrating stress-management training, simulation-based learning, and structured mentorship into nursing curricula may enhance students' competence, confidence, and professional readiness.