Clinical education is a central element in nursing education, with clinical placements preparing students for clinical practice and enabling students to apply knowledge and skills learned in the classroom to real-world practice (Flott and Linden, 2016, Younas et al., 2022).

The initial clinical placement is of particular significance, as it is the first time students undertake professional tasks as nurses and apply the skills they learned in the clinical environment under the supervision of clinical instructors. Students learn to cope with the complexity of practice, the stressful work environment and the need to interact with patients, families and healthcare teams (McKenna et al., 2019‏; Shatto and Lutz, 2017; Younas et al., 2022). Therefore, their initial clinical placement is a critical turning point for students. While some experience change and growth, others feel distressed and fearful and decide to leave the profession (Levett-Jones et al., 2015, Flott and Linden, 2016, Younas et al., 2022).

A few studies have examined differences in stress levels among nursing students over the years of study and found significantly higher levels of perceived stress among students experiencing their initial clinical placement versus stress levels among senior students (Admi et al., 2018, Ching et al., 2020). Excessive stress may not only negatively affect nursing students’ physical and mental state but may also negatively affect their clinical learning (Rafati et al., 2017, Zheng et al., 2022) and their satisfaction with their clinical placement (Bodys-Cupak et al., 2022, Levett-Jones et al., 2015, Mazalová et al., 2022). Dissatisfaction with clinical placement has been found to influence students’ learning process and intention to continue their studies (Boyd-Turner et al., 2016, Gruppen et al., 2018, Jack et al., 2018). In this context, it is important to mention the inverted U theory, also known as the ‘Yerkes and Dodson law’ (Yerkes and Dodson, 1908). According to this theory, peak performance is achieved when the level of pressure experienced is appropriate for the work done. When an individual is under too much or too little pressure, performance declines, sometimes severely. For students, high stress levels can negatively affect their learning process and lead to dissatisfaction with their learning experiences.

Social support has consistently been associated with lower stress levels and acts to moderate stress (McLean et al., 2022, Poots and Cassidy, 2020, Yıldırım et al., 2017). Moreover, studies conducted among various cohorts of students have indicated that the level of stress experienced by students was significantly predicted by levels of perceived social support (McLean et al., 2022‏; Naylor et al., 2018; Poots and Cassidy, 2020; Yıldırım et al., 2017). Yet, the associations and contributions of perceived stress and social support to students’ satisfaction with their initial clinical placement have been poorly explored to date. Although, they may provide new and significant insights into the training and retention of nursing students in their early stages in the profession.

The current study was conducted in Israel among nursing students enrolled in a four-year undergraduate program at a university in central Israel. The nursing curriculum in Israel resembles that in the United States. It aims to train professionals with a unique body of professional knowledge, highly skilled in personal and professional proficiencies. In their first year, students learn basic sciences, which is the foundation for internal-surgical nursing. Students primarily learn theoretical-practical subjects in the classroom and in simulation settings during that year. In their second year students begin their clinical placements, with the initial placement beginning in the first semester of Year 2 for six weeks, mostly in internal and surgical units, at one of the six medical centers affiliated with the university, where for the next three years, students integrate theoretical and clinical studies. During clinical placements, students mainly experience the application of clinical skills with patients and families Altogether, the program grants 233 academic credits.