Career Pathways
Clinical reasoning perceptions among differently educated registered nurses: A cross-sectional study
Justin Fontenot PhD, DNP, RN, NEA-BC
Anna Valdez PhD, RN, PHN, CEN, CFRN, FAEN, FAADN
Michael Hebert DNP, MDiv, MSN, BA, RN
Patrick McMurray MSN, RN
July 2, 2026 at 8:24:12 AM

Abstract
Background
Clinical reasoning is a critical skill for nursing practice, yet its development is influenced by educational preparation, years of experience, and professional variables. Limited research has explored the differences in perceptions of clinical reasoning competence among graduates of Associate Degree in Nursing and Bachelor of Science in Nursing programs.
Aim
To investigate differences in perceived clinical reasoning competence based on educational preparation and other variables.
Methods
This cross-sectional quantitative study surveyed newly graduated nurses using the Nurses Clinical Reasoning Scale. Independent samples t-tests, one-way Analysis of Variance, and Multivariate Analysis of Variance were conducted to analyze differences across variables.
Results
No statistically significant differences in perceived clinical reasoning competence were observed between Associate Degree in Nursing and Bachelor of Science in Nursing graduates or across years of licensure. Multivariate analyses also revealed insignificant results.
Conclusions
Despite its small sample size, this study provides preliminary evidence that perceptions of clinical reasoning ability are comparable across educational pathways and early licensure stages. These findings underscore the need for broader research and Bayesian analysis. This work establishes priors for future, more extensive studies using Bayesian analysis.
Keywords
ADN
BSN
Clinical reasoning
Educational preparation
Nursing education
New Research Paper out with my academic family Dr. Justin Fontenot, Ph.D., DNP, RN, NEA-BC and Dr Anna María Valdez, PhD, RN, CEN, CFRN, FADLN, FAADN, FAEN
So proud of this work! I hope this bring some insight and nuance about the assumptions we make about ADN vs BSN conversations.
