Exploring the Influence of Clinical Placement Quality and Metacognitive Awareness on Clinical Competence in Nursing Students Through the Mediation of Learning Agility

Abstract

Background: Clinical competence is a core outcome of nursing education, yet students often experience a theory–practice gap driven by variability in clinical placements and differences in reflective self-regulation and adaptability. Objective: To examine the influence of clinical placement quality and metacognitive awareness on clinical competence in nursing students and to test learning agility as a mediating mechanism. Methods: A quantitative cross-sectional observational study was conducted among undergraduate nursing students at the University of Science and Technology, Lahore. Participants completed a structured Likert-scale questionnaire assessing clinical placement quality, metacognitive awareness, learning agility, and clinical competence. Analyses included descriptive statistics, reliability testing, Pearson correlations, multiple linear regression, and mediation analysis using PROCESS Model 4 with bootstrapped confidence intervals. Results: Data from 348 students were analyzed. All constructs demonstrated excellent internal consistency (Cronbach’s α range 0.93–0.96). Clinical placement quality, metacognitive awareness, and learning agility were positively associated with clinical competence (r = 0.469, 0.605, and 0.625, respectively; all p < 0.001). In multivariable regression, clinical placement quality (β = 0.238, p < 0.001) and metacognitive awareness (β = 0.531, p < 0.001) predicted competence (R² = 0.509). Learning agility strongly predicted competence (β = 0.728, p < 0.001) and partially mediated the effects of clinical placement quality (indirect β = 0.180, 95% CI 0.090–0.275) and metacognitive awareness (indirect β = 0.150, 95% CI 0.074–0.229). Conclusion: Clinical placement quality and metacognitive awareness enhance nursing students’ clinical competence both directly and through learning agility, supporting curricular strategies that strengthen reflective self-regulation and adaptive learning alongside high-quality clinical supervision.