The research team, led by Muna Alshammari and Bader Alwadaany of the College of Nursing at the Public Authority for Applied Education and Training, together with colleagues from Kuwait’s Ministry of Health and international collaborators, surveyed graduates across six general hospitals in Kuwait. Using purposive non-probability sampling, the team collected 357 participant records. After applying listwise deletion across the prespecified demographic variables, programme characteristics, and the full set of 25 five-point Likert-scale items, 310 complete cases remained for analysis. The statistical work was carried out in Python, a choice that reflects the growing role of open-source data science tools in health services research, and included descriptive statistics, 95 percent confidence intervals, reliability analysis, group comparisons, and multiple linear regression with heteroscedasticity-consistent standard errors.

The headline finding is broadly encouraging for Kuwait’s health authorities. Among the 310 complete cases, 230 participants, or 74.2 percent, reported completing a nine-month version of the rotation programme, making that duration the dominant model in the sample. The overall perception score averaged 3.81 on the five-point scale, with a standard deviation of 0.69 and a 95 percent confidence interval running from 3.73 to 3.88. The internal consistency of the survey instrument was exceptionally high, with a Cronbach’s alpha of 0.952, indicating that the 25 items held together as a coherent measure of programme perception. Scores of that reliability are uncommon in survey research and lend weight to the descriptive findings, even though the study design cannot establish causality.

Beneath the overall average, the domain-level results tell a more nuanced story. Knowledge and skills emerged as the strongest dimension of the programme, scoring 4.13 with a standard deviation of 0.73. Graduates clearly felt that the rotation gave them concrete clinical competencies and practical know-how that their academic preparation alone could not deliver. At the opposite end of the spectrum, the evaluation process received the lowest domain score of 3.34 with a standard deviation of 0.82, and that figure was calculated after reverse-scoring an item asking whether programme forms needed updating. In other words, the paperwork and feedback mechanisms of the programme were perceived as its weakest link, a pattern that echoes international literature on transition-to-practice schemes, where administrative evaluation often lags behind clinical content.

Two global questions sharpened this picture further. In the complete sample for the global items, which comprised 302 respondents, 279 graduates, or 92.4 percent, considered the programme useful, an overwhelming endorsement of its core purpose. Yet 245 of the same respondents, or 81.1 percent, stated that the programme required development. The combination is striking: nearly every graduate found value in the rotation, while more than four in five saw clear room for improvement. This is not a programme facing rejection but one facing expectations. New nurses in Kuwait appear to want the rotation to succeed and are simultaneously candid about where it falls short, particularly in the areas of supervision, feedback, and structured assessment.

The regression analysis added an unexpected twist. In the adjusted model covering all 310 participants, employment setting was the only characteristic independently associated with perception scores. Graduates who had moved into primary health care employment rated the programme significantly higher than those working in hospitals, with a regression coefficient of 0.56, a 95 percent confidence interval of 0.24 to 0.87, and a p-value of 0.001. None of the other included participant or programme characteristics showed an independent association with perception scores. The authors are careful to note that this is an observational, self-reported dataset, so the association between primary care employment and more favourable perceptions does not demonstrate that the rotation caused those attitudes, nor does it explain the mechanism behind them.

Why might primary care graduates view the same rotation more positively? The study does not answer that question directly, but several plausible interpretations deserve attention. Primary health care in Kuwait involves a different pace, patient mix, and degree of professional autonomy compared with acute hospital wards. Graduates who transitioned into primary care may have found that the broad, multi-department exposure of the rotation mapped more naturally onto the generalist demands of community practice, whereas hospital-based graduates may have measured the programme against the specialized, high-acuity expectations of ward work. Alternatively, differences in workplace culture, supervision density, or post-rotation support between the two settings could shape how graduates retrospectively judge their training. Disentangling these possibilities would require longitudinal and qualitative designs that the current study, by design, cannot provide.

The authors are explicit about the limits of their evidence. These are self-reported perceptions, not objective measures of clinical competence, patient outcomes, or retention. A favourable perception score does not establish that the programme objectively improves practice, and the cross-sectional design captures a single moment in time rather than change over the course of the transition. The use of purposive non-probability sampling also means the 310 complete cases cannot be assumed to represent all Kuwaiti nursing graduates, and the exclusion of 47 records through listwise deletion raises the possibility that incomplete respondents differed systematically from those with complete data. These caveats do not undermine the study’s value; they simply define what kind of claim the data can support.

Even so, the practical implications are concrete. The study recommends structured mentorship, trained preceptors, standardized competencies, regular feedback, and longitudinal objective evaluation as the priorities for reform. Each recommendation maps onto a specific weakness identified in the data. Trained preceptors and structured mentorship address the supervision gap that likely underlies the low evaluation-process score. Standardized competencies would give graduates and supervisors a shared yardstick for progress across departments. Regular feedback and longitudinal evaluation would replace the static, form-heavy assessment that graduates flagged as outdated with a dynamic system capable of tracking development over the full nine months and beyond. For a programme that already enjoys 92 percent perceived usefulness, these are refinements rather than rebuilds.

The broader significance of the study lies in its setting. Kuwait, like many countries in the region, faces persistent pressure to retain and develop its nursing workforce, and the transition from student to practitioner is a known point of attrition worldwide. By producing locally grounded, methodologically transparent evidence about how graduates experience the Ministry of Health rotation programme, the research team has given policymakers a baseline against which future reforms can be measured. The study received no external funding, was approved by the Ministry of Health Ethical Review Committee under approval number 2022/1942, and was conducted in accordance with the Declaration of Helsinki, with informed consent and anonymized data handling. Published open access, it invites replication and extension, ideally with longitudinal follow-up and objective outcome measures. For now, the message from Kuwait’s newest nurses is clear: the rotation works, and with sharper supervision and modernized evaluation, it could work considerably better.

Subject of Research: Nursing graduates' perceptions of the Kuwait Ministry of Health postgraduate rotation programme

Article Title: College of nursing graduates’ perceptions of Kuwait ministry of health rotation programme: a cross-sectional study

Article References: College of nursing graduates’ perceptions of Kuwait ministry of health rotation programme: a cross-sectional study. (n.d.). https://doi.org/10.1186/s12909-026-10443-z

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10443-z

Keywords: nursing education, new graduate nurses, transition to practice, rotation programme, clinical supervision, mentorship, preceptors, Kuwait, cross-sectional study, programme evaluation, primary health care, BMC Medical Education