From Simulation to the Clinical Area: A Mixed-Methods Study Comparing Skills Laboratory Proficiency and Clinical Performance (RLE) Among Nursing Students in a Philippine University

Background: Skills laboratories play a vital role in nursing education by helping students develop procedural skills in a safe, controlled setting. Yet, it remains unclear how well these lab-based skills translate to real clinical performance (Related Learning Experience, RLE), especially within Philippine nursing programs. Aim: This study compares nursing students’ performance in skills lab return demonstrations and in real clinical settings (RLE), and explores how students perceive both environments. Methodology: A sequential explanatory mixed-methods approach was used. Quantitative data were obtained from the academic records of 138 randomly selected second-, third-, and fourth-year nursing students, comparing their skills lab and clinical (RLE) grades using descriptive statistics and a paired t -test. Qualitative insights were gathered from six focus group discussions and analyzed thematically. Results: Students received higher RLE grades than skills-lab grades (RLE: M = 84.88, SD = 2.01; skills lab: M = 82.60, SD = 5.96; mean difference = 2.28 points, 95% CI 1.29 to 3.27; t(137) = − 4.54, p < 0.001; Cohen’s dz = 0.39). Thematic analysis revealed four themes: (1) labs build foundational knowledge but can feel unrealistic; (2) clinical exposure and teamwork were perceived to strengthen performance and confidence; (3) memorization-heavy lab training was perceived to limit flexibility in real practice; and (4) emotional factors, such as anxiety and fear of mistakes, shaped students during the transition to patient care. Conclusion: Skills labs are essential for introducing core procedures and building initial confidence, but students’ clinical (RLE) grades were modestly higher than their skills lab grades. Students described gaps in realism and assessment alignment between settings, alongside transition anxiety. Enhancing simulation realism, emphasizing clinical reasoning in lab assessments, and strengthening lab–clinical coordination may better align training with clinical expectations and support students’ transition to practice. Keywords: nursing students, clinical performance, simulation training, clinical education, related learning experience, RLE, mixed methods research