Perceived quality of nursing education from a health systems perspective: a cross-sectional study of two universities in Albania

Nursing students’ perceptions of educational quality – particularly the clinical learning environment (CLE) – are an early indicator of whether programs are producing graduates who feel ready for practice. This study aimed to describe nursing students’ perceived educational quality and clinical learning environment (CLE) in two Albanian universities, and to identify factors independently associated with low perceived preparedness for practice. In May 2025, a cross-sectional questionnaire was administered to 367 students at the department of medical technical sciences, University “Aleksandër Moisiu” of Durrës and the University “Eqrem Çabej” of Gjirokastra. Items covered staff availability, teaching quality and clinical skills, preparedness for practice, teaching approaches, and placement conditions. Domain scales were created (Cronbach’s α ≥0.70) and low preparedness was defined as a preparedness score below the sample median. In multivariable binary and ordinal logistic regression, limited availability of clinical supervisors/preceptors, poorer overall CLE quality, and lower exposure to simulation-based teaching were independently associated with low preparedness. Descriptively, around half of respondents reported that key CLE domains need improvement, including distance to clinical practice sites (52.0%), transportation (49.6%), availability of equipment and supplies (50.1%), quality of supervision (50.1%), and student assessment (51.0%). Clinical supervisors/preceptors were often available for 31.9% of students. Only 23.4% rated clinical supervisors/preceptors’ teaching quality as good. Simulation and role-play were among the least frequently used teaching approaches. Students’ responses indicate systematic gaps in clinical supervision capacity, placement logistics, and clinical learning infrastructure. Strengthening structured preceptorship, clinical site agreements, and skills-lab/simulation capacity are practical targets for quality improvement.