Professional Recognition, Reality Shock and Nurses' Well-Being After the Bologna Reform in Spain: A Qualitative Study of Key Informants' Perspectives.

Background/

Objectives

The Bologna Process and the European Higher Education Area consolidated the transition of nursing education in Spain from diploma-level training to a university degree framework. Although previous research has examined newly graduated nurses' transition to practice, less attention has been paid to how key informants involved in educational reform interpret its long-term professional implications, including their potential relevance for nurses' well-being. This study explored key informants' perspectives on the implications of the Bologna Process and the Nursing White Paper on nursing education and professional development in Spain.

Methods

An exploratory qualitative study was conducted using in-depth semi-structured interviews with six key informants involved in nursing educational reform in Spain. Interviews were conducted between June and November 2025, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis.

Results

Three main themes were identified: (1) academic professionalization and the generation of professional expectations; (2) structural misalignment between university-based professionalization and clinical practice; and (3) Reality Shock, professional identity and nurses' well-being.

Conclusions

From the perspective of key informants, Reality Shock may be understood not only as an individual transition difficulty, but also as a possible expression of structural misalignment between academic professionalization and healthcare organizations. These findings suggest that strengthening nurses' well-being may require organizational strategies that translate educational reform into professional recognition, autonomy, leadership opportunities, and coherent career development.