Exploring Clinical Experiences Among Third- and Fourth-year Students in Undergraduate Nursing Programme at Private Colleges in Karachi, Pakistan: An Exploratory Descriptive Study

Background Clinical placement is the cornerstone of nursing education, bridging the gap between theoretical knowledge and professional competence. In Low- and Middle-Income Countries (LMICs) like Pakistan, a structural disconnect exists where private nursing colleges often lack affiliated teaching hospitals. This forces students to complete clinical rotations in resource-constrained public tertiary care facilities, creating a complex and often hostile learning environment. This study aims to explore the clinical experiences, challenges, and coping strategies of third- and fourth-year undergraduate nursing students navigating this specific educational model. Methods An exploratory descriptive qualitative design was employed, underpinned by Benner’s from Novice to Expert theoretical framework. Data were collected through eight semi-structured focus group discussions (FGDs) with 59 Bachelor of Science in Nursing (BSN) students from three private nursing colleges in Karachi, Pakistan. Participants were selected using purposive maximum variation sampling to capture diverse experiences across varying hospital units. Data was analyzed using Braun and Clarke’s reflexive thematic analysis. Rigor was maintained through member checking, peer debriefing, and a reflexive audit trail. Results The analysis revealed a profound disconnect between academic preparation and clinical reality, encapsulated in five major themes: (1) Systemic and Environmental Deficiencies , characterized by institutional neglect and severe resource scarcity leading to unsafe practices; (2) A Culture of Supervisory Neglect and Hostility , where students felt abandoned by instructors and devalued by hospital staff; (3) The Pervasive Theory–Practice Chasm , marked by the cognitive dissonance of witnessing normalized unsafe protocols; (4) The Crucible of Confidence , detailing the psychological toll on students and their development of resilience and "digital mentorship" as survival mechanisms; and (5) A Call for Systemic Reform , outlining student-driven recommendations for accountability and improved supervision. Conclusions The current model of clinical education for private college students in public hospitals in Karachi is fraught with systemic failures that compromise patient safety and student well-being. Students’ progress toward competence not through structured mentorship, but through resilience developed in a harsh, unsupported environment. Urgent reforms in regulatory oversight, preceptor training, and resource allocation are required to bridge the theory-practice gap and ensure safe clinical learning environments.