In regard to the self-reported level of “clinical knowledge”, 44% of the Graduate nurse intern reported that they tend to agree, 20% agree and 4% strongly agree that they have adequate clinical knowledge that is required at the time of entry of practice. On the other hand, 20% mentioned that they tend to disagree, 8% disagree and 4% strongly disagree. (Fig:1)

The competencies focused under the domain clinical knowledge areunderstanding of the principles of evidence-based practice, which 60% of them tend to agree and 40% agreed that they have the said competency. The level of competencies ranges from 20% to 80% for the skills like knowledge of pathophysiology of patient conditions, knowledge of pharmacological implications of medications, interpretation of physician and interprofessional orders, andcompliance with legal / regulatory issues relevant to nursing practice. (Table:1)

In regard to the self-reported perceived level of competency related to the technical skills, 34.3% of the Graduate nurse intern reported that they tend to agree and also, 34.3% of them tend to disagree that they have good technical skills, 8.6% agree and 2.9% strongly agree that have adequate technical skills, on the other hand, 17.1% disagree and none of the graduates 0% mentioned that they strongly disagree that they have adequate technical skills that is required at the time of entry of practice. (Fig:2)

The competencies focused under the domain “technical skills” are understanding of quality improvement methodologies, conducting patient assessments (including history, physical exam, vital signs), documentation of patient assessment data, performing clinical procedures e.g., sterile dressing iv therapy, etc.),utilization of clinical technologies (e.g., iv smart pumps, medical monitors, etc.), administration of medication, utilization of Information Technologies (e.g., computers, EMRs, etc.).(Table: 1)

The recognition of changes in patient status. ability to anticipate risk, interpretation of assessment data (e.g., history, exam, lab testing, etc.), decision making based on the nursing process, recognition of when to ask for assistance and recognition of unsafe practices by self and others are the competencies expected to be present for the graduate nurse interns. The self-reported data indicates that 100% of the graduates that they are not confident in applying the nursing process in caring for the patients. And majority of them (i.e.) 60% tend to agree that they have the mentioned competencies of critical thinking. But none of them strongly agreed that they have the said competencies. (Fig 3)

In regard to the self-reported perceived level of competency related to communication, 33.3% and 26.7% of the Graduate nurse intern reported that they tend to agree and agree respectively, that they have good communication skills which includes specific competencies like rapport with patients and families, communication with interprofessional team, communication with physicians, patient education, conflict resolution, patient advocacy. Overall 20% to 60% of the new graduates tend to agree and agree that they have good communication skills in the mentioned competencies. (Fig 4)

In regard to the self-reported perceived level of competency related to the professionalism, 36.7% and 40% of the Graduate nurse intern reported that they tend to agree and agree respectively that are trained to practice professionalism. 16.7% tend to disagree, 3.3 % disagree & 3.3% strongly disagree respectively.

The competencies focused under the domain “professionalism” areability to work independently where 60% tend to agree and 20% agree for the same, 40% and 60% of the graduate nurse interns mentioned that they tend to agree and agree respectively that they have the ability to work as part of a team .In regard to ability to accept constructive criticism, 20 % of the graduates mentioned that they disagree, tend to disagree and equally 20% agree for the same. 80 % mentioned that they have respect for diverse cultural perspectives. (Fig: 5)

In regard to the Management of responsibilities, self-reported perceived level of competency indicates that 40% of the Graduate nurse intern reported that they tend to agree and 30% of them tend to disagree that they have the competency of management of responsibilities. (Fig: 6)

The competencies focused under the same domain areability to keep track of multiple responsibilities, ability to prioritize, delegation of tasks, completion of individual tasks within expected time frame, ability to take initiative, conducting appropriate follow-up. In that the notable data is that, 40 % to 60% of the graduates mentioned that they have the mentioned competencies. (Table: 1)

Fig. 1 Self-reported perception of graduate nurse interns regarding competencies of clinical knowledge

Fig. 2 Self-reported perception of graduate nurse interns regarding competencies of technical skills

Fig. 3 Self-reported perception of graduate nurse interns regarding competencies of critical thinking

Fig. 4 Self-reported perception of graduate nurse interns regarding competencies of communication.

Fig 5 Self-reported perception of graduate nurse interns regarding competencies of professionalism.

Fig.6 Self-reported perception of graduate nurse interns regarding competencies of management of responsibilities

Table 1: Summary of Self- reported level of competency preparedness by graduate nurse interns

On the whole, the nursing new graduate intern agree that they have competencies like knowledge of pharmacological implications of medications, compliance with legal / regulatory issues relevant to nursing practice, understanding of quality improvement methodologies, utilization of clinical technologies (e.g., iv smart pumps, medical monitors, etc.), administration of medication, utilization of information technologies (e.g., computers, electronic medical roads, etc.), ability to anticipate risk, decision making based on the nursing process, recognition of when to ask for assistance, communication with physicians, ability to work as part of a team, respect for diverse, cultural perspectives, ability to prioritize, delegation of tasks and ability to take initiative. They reported that they disagree that they have the competencies like understanding the principles of evidence-based practice, knowledge of pathophysiology of patient conditions, interpretation of physician and interprofessional orders, conducting patient assessments (including history, physical exam, vital signs), documentation of patient assessment data, performing clinical procedures e.g., sterile dressing iv therapy, etc.), recognition of changes in patient status, interpretation of assessment data (e.g., history, exam, lab testing, etc), recognition of unsafe practices by self and others, rapport with patients and families, communication with interprofessional team, patient education, conflict resolution, patient advocacy, ability to work independently, ability to accept constructive criticism, customer service, accountability for actions, ability to keep track of multiple responsibilities, completion of individual tasks within expected time frame and conducting appropriate follow-up. (Table 1).

The limitations of the study that was identified, recognized and acknowledged are, the study was conducted in one hospital and the fresh graduates of one particular year only was studied, which may limit the generalizability of the study to a certain extent. Also, the topic that is undertaken for the study focuses of obtaining the practice preparedness. The stake holders of nursing education are the nursing graduates, nursing academic faculty, hospital managers and the patient. In this study the perception of preparation of the graduate interns only are explored, the academic faculty, hospital nursing personnel and the patient, who is ultimately is to receive the care, are not included due to the extensiveness of the study.

As the study was an initiative to bridge the theory and practice gap. It is recommended that the academic institutions focus on the areas which is mentioned by the graduate nurse interns as being deficient. This can guide the academicians so that, the future batches of the graduates can be benefited by being practice ready. The results of the study can also be utilized by the hospital Nurse leaders to design the orientation program during the internship period to focus on the competencies that is mentioned that the graduate nurse interns perceived they are not competent. This study can be taken as an overall need assessment for the fresh nurse graduate so that further training programs can be planned based on the identified needs. This in turn will directly and indirectly decrease the turnover rate and also the number of graduates leaving the profession due to reality shock at the time of internship period, where the performance is not able to meet the demand in the service sector of the hospitals.