Anxiety directly affects individual learning effectiveness and self-reflection with insight in a school simulation laboratory.

Self-reflection and learning effectiveness further influence the first 2 months of nursing competence in an actual clinical setting.

Following the first 2 months of clinical practice, nursing competence has the strongest direct effect at the 4-month mark of clinical nursing competence.

Although anxiety does not have a direct impact on clinical performance, during 4 months of clinical practice, it does have a direct impact on students’ self-reflection, which, in turn, affects students’ clinical nursing competence.