5 competencies needed by new baccalaureate graduates

As nurse educators prepare new graduates for practice, part of the challenge is to ensure that these nurses are capable of functioning in a broad continuum of care with increased responsibilities. To identify competencies needed by new baccalaureate graduates in today's health care environment and determine whether these competencies fall into particular dimensions, a cross-sectional survey design was used to query 363 nurse administrators from three health care settings. Nurse administrators rated the importance of 45 nursing competencies. Factor analysis was conducted on the competency items, and factor scores were calculated to determine the importance ratings by work setting groups. Findings revealed a simple six-factor competency structure (Health Promotion Competency, Supervision Competency, Interpersonal Communication Competency, Direct Care Competency, Computer Competency, and Caseload Management Competency). MANOVA indicated significant differences in the importance of these competence factors by work setting. The findings are an important beginning for evidence-based decision-making about nursing curriculum reform, both in the classroom and clinical practice areas. The study also provides a foundation for further measurement of nursing competencies.     

Preliminary clinical nursing leadership competency model: a qualitative study from Thailand

This qualitative study explored the clinical nursing leadership competency perspectives of Thai nurses working in a university hospital. To collect data, in-depth interviews were undertaken with 23 nurse administrators, and focus groups were used with 31 registered nurses. Data were analyzed using content analysis, and theory development was guided by the Iceberg model. Nurses' clinical leadership competencies emerged, comprising hidden characteristics and surface characteristics. The hidden characteristics composed three elements: motive (respect from the nursing and healthcare team and being secure in life), self-concept (representing positive attitudes and values), and traits (personal qualities necessary for leadership). The surface characteristics comprised specific knowledge of nurse leaders about clinical leadership, management and nursing informatics, and clinical skills, such as coordination, effective communication, problem solving, and clinical decision-making. The study findings help nursing to gain greater knowledge of the essence of clinical nursing leadership competencies, a matter critical for theory development in leadership. This study's results later led to the instigation of a training program for registered nurse leaders at the study site, and the formation of a preliminary clinical nursing leadership competency model.     

The training needs of Korean intensive care unit nurses regarding delirium

ObjectivesThe aim of this study was to investigate high-priority training needs by analysing the perceived importance and self-reported performance of nurses’ delirium care competency.DesignA cross-sectional survey with a convenience sample of 255 Korean intensive care units nurses.SettingIntensive care units in the Republic of Korea.Main outcome measuresIntensive care unit nurses’ delirium care competency.ResultsExploratory factor analysis of the Nurse Delirium Care Competency Scale showed a six-factor structure, which accounted for 67.51% of the variance in nurses’ delirium care competency: management algorithm, prevention, communication, nursing management, assessment, and collaboration. The self-reported performance scores of all six factors were significantly lower than their perceived importance scores. The delirium assessment factor was identified as a high training priority on the importance-performance matrix for new graduate nurses.ConclusionTraining programmes should be developed considering the six delirium care competency factors identified in this study. Further, nurse educators must adopt active educational modalities such as case-based small group learning and simulation-based learning to improve nurse competency in recognising and managing delirium.     

Relating new graduate nurse competence to frequency of use

The healthcare workplace can be a stress-laden environment for new graduates and job performance indicators are an important sign of developing confidence and expertise that will lead to improved patient outcomes. What is not evident from nursing studies is whether new graduate nurse competencies relate to the frequency of their use. This study sought to determine the relationship between perceived nursing competence and self-assessed frequency of use by new graduate nurses. Three cohorts (n = 116) of new graduate nurses undertaking year-long transition to graduate practice programs responded to a questionnaire that utilised the 2001 ANCI competencies and the Nurse Competency Scale and a Visual Analogue scale to self assess their perceived competence and the relative frequency of use for specific competence items. Results indicate that a relationship exists between perceived competence and frequency of use and that research competency scores are substantially lower than all other categories of competency. Implications for education and practice indicate that assessment of nurse competency for the new graduate nurse should focus on the development of generic nursing competencies rather than current expectation of advanced and workplace specific nurse competencies.     

Development of competency inventory for registered nurses in the People's Republic of China: scale development

BACKGROUND: Literature review indicated there is no existing nursing competency framework or instrument for Chinese registered nurses. By virtue of its global leadership role in nursing, the International Council of Nurses (ICN) developed an ICN Framework of Competencies for the Generalist Nurses in 2003. On the basis of the ICN's framework, a qualitative study was conducted to explore the expectations of Chinese nurse professionals on nursing competency in the previous study. A competency framework for Chinese registered nurses was formed. This paper describes the development and testing of the Competency Inventory for Registered Nurses (CIRN). METHODS: A methodological study design was used, consisting of two phases with six steps. A review of literature generated 112 items, which were evaluated by six experts followed by field testing in a purposive sample of 815 Chinese clinical registered nurses. Factor analysis and item analysis were applied to establish the scale's construct validity and reliability. RESULTS: The final scale consists of seven dimensions with 58 items. The overall scale reliability had a Cronbach's alpha of 0.89; the dimensions Cronbach's alpha ranged from 0.79 to 0.86. In addition, evidence for two other kinds of validity was obtained, which included criterion-related validity (r=0.44, p=0.04) and contrasted-group validity (p<0.001). CONCLUSION: The CIRN has demonstrated evidence of internal consistency reliability, content validity, and construct validity, and it provides an objective tool for assessing registered nurse competencies in the various areas of clinical practice.     

Caring and competency

The long-term crisis in nursing, particularly in acute care hospitals, is demonstrated in studies on negligence by the Institute of Medicine in To Err is Human: Building a Safer Health System1 and Crossing the Quality Chasm: A New Health System for the 21st Century.2 A review of the nursing literature reflects unclear definitions of competency and its component caring, and no single theory of competency has been adopted from the literature and used in the education of nurses. The American Nurses 2001 Code of Ethics does not resolve this confusion, because it does not correct the individual acts of nursing incompetencies in acute care hospitals. The author defines caring and competency by providing examples of what they are not in examining 200 actual cases of hospital nursing acts of incompetence by nursing discipline. None of these examples of imputed negligence was reported to the National Practitioner Data Bank because the "corporate shield" protected the nurses by not being named in the complaint nor named as part of the settlement against the hospital.A new model of the hospitalist, the nurse hospitalist, is presented to act as a daily teacher and facilitator for hospital nurses based on a curriculum of day-to-day examples of substandard patient care. This nurse specialist is an inpatient generalist advanced practice nurse who is employed by the hospital and reports to the chief nurse executive. The author proposes that this new model of the nurse hospitalist be devoted entirely to collaborating with nurse leaders, educators, charge nurses, and floor nurses throughout disciplines in advancing the competency of nursing. This daily proactive and prospective model of improving nursing performance in a facultative manner offers strategies to mitigate the limitations of the retrospective model of quality control. Total quality improvement practiced retroactively is ineffective. The author recommends no structural change in the institution but an educational agenda by the nurse hospitalist, with hospital administration to assist nurses in a new learning environment.     

Nursing work in Jordan: an example of nursing work in the Middle East

Aim. The study aimed to investigate Jordanian nurses’ perceptions of their role in clinical practice. Background. The lack of regulation of nursing practice by the profession across the Middle East until now has led to each institution setting its own policies regarding the role of the nurse and the practice of nursing. No study to date has examined the role of the nurse working in the acute hospital environment nor explored the practice of nursing in this region. Design and methods. A cross‐sectional questionnaire survey was conducted using a quota sample. A total of 348 medical‐surgical staff nurses and practical nurses from the three healthcare sectors in Jordan participated in the study with a response rate of 77%. The results were analysed by constructing multiple response tables, chi‐square test, anova and log‐linear analysis. Results. Staff nurses in Jordan were expected to carry out the majority of nursing care activities. The role of the practical nurse was limited to the physical and professional domains of nursing care. Activities requiring higher levels of emotional or intellectual labour and interdisciplinary communication were attributed only to the staff nurse. The majority of the respondents reported nursing had not been their first choice of career. Male nurses had a higher intention to leave the nursing profession. The predominant method of care delivery used by nurses was task‐oriented. Conclusion. There was a general consensus regarding what constituted the nurse's work in the clinical area across the three healthcare sectors in Jordan. Role delineation between the two levels of nurses was also clear. There is a need to move from task‐oriented to patient‐centred care to promote quality patient care. Relevance to clinical practice. This study explores the role of the nurse working in the acute hospital environment in Jordan.     

A European survey of general nurses' self assessment of competence

Policy initiatives have prompted examination of the deployment and mobility of the nursing workforce within the European Union (EU). The European Health Care Training and Accreditation Network [EHTAN, 2005. Available from: ] project aims to improve the transparency of nursing qualifications, working practices, skills and experience, thus facilitating nurse workforce mobility, through compilation of a competency matrix [Cowan, D.T., Norman I.J., Coopamah, V.P., 2005a. European healthcare training and accreditation network. British Journal of Nursing 14, 613-617; EHTAN, 2005. Available from: ]. This paper reports on a survey across five EU countries in which the EHTAN nurse competence self-assessment tool was utilised. The purpose is to describe migrant nurses perception of their competence in: (a) the country where they trained and qualified and (b) the new country in which they are working and (c) to compare non-migrant nurses perception of their competence across different EU countries.     

手术室护士胜任特征的研究

目的了解手术室护士的胜任特征。方法按配对原则要求将20名手术室护士分为绩优组和绩平组各10名。以《基本胜任特征词典》为基础,运用文献分析法、问卷调查法及小组讨论法编制《手术室护士胜任特征词典》,运用行为事件访谈,并根据编制的词典对访谈结果进行编码处理与统计学分析。结果两组手术室护士访谈时问与字数的比较差异无统计学意义（P〉0．05）;两组护士的专业知识与技能、团队协作精神、道德责任感、主动积极等17项胜任特征差异具有统计学意义（P〈0．05）。结论经分析整理及小组讨论得到,手术室护士胜任特征包括4个因素15个具体项目。     

Sustained nurse home visiting in early childhood: exploring Australian nursing competencies

Abstract There is strong evidence that a comprehensive model of sustained nurse home visiting (SNHV) in early childhood can improve child and family outcomes for vulnerable and at-risk families. There is also evidence that nurse home visitors experience challenges in delivering SNHV. This article aims to identify the nursing competencies needed for delivering a comprehensive model of SNHV and highlight the areas where further competency development is required. Qualitative analysis compared the content and language of published registered generalist and child and family nursing competency statements for Australian nurses with the work experiences of a team of community-based nurses delivering SNHV. Development of competencies is needed in the areas of (a) enhanced knowledge of child development, social determinants of health, and broader outcomes for individuals and populations; (b) advanced skills in fine observation, anticipatory guidance, negotiating, modelling and experimentation, holistic case management, and working in interdisciplinary teams; and (c) attitudinal competency for working "with" and supporting risk taking. The current published competencies for general and child and family nurses do not encompass the different and advanced competencies required for performing SNHV. Competency development and associated nurse training and support are needed for delivery of quality SHNV services.     

Dimensions of nurse work time: Progress in instrumentation

Because the work of health care is embedded in time, understanding nursing time‐allocation practices is essential for identifying nurse staffing and workflow patterns that optimize healthcare cost and quality outcomes. The interdependent nature of nursing care requires that nurses share time with other members of their work group. Shared time, also known as social or organizational time, requires careful negotiation of workflows within healthcare teams. Evaluation of negotiated workflows is contingent upon valid and reliable measures of sociological nursing time. In this study, we evaluated the psychometric properties of a newly adapted instrument for measuring sociological nursing time and describe the experience of sociological time among hospital‐employed nurses. Using a cross‐sectional survey design with a convenience sample of nurses (n = 359), we identified nine reliable components of sociological nursing time: insufficient time allocation; strict adherence to schedules; increased time awareness; value of quality over speed; fast and unpredictable pace changes; predictable job duties punctuated with unpredictable job demands; expectations for a fast work pace; inconsistent work‐hour expectations across departments; and high expectations for punctuality.     

Perinatal nursing education for single-room maternity care: an evaluation of a competency-based model

Aims and objectives. To evaluate the success of a competency‐based nursing orientation programme for a single‐room maternity care unit by measuring improvement in self‐reported competency after six months. Background. Single‐room maternity care has challenged obstetrical nurses to provide comprehensive nursing care during all phases of the in‐hospital birth experience. In this model, nurses provide intrapartum, postpartum and newborn care in one room. To date, an evaluation of nursing education for single‐room maternity care has not been published. Design. A prospective cohort design comparing self‐reported competencies prior to starting work in the single‐room maternity care and six months after. Methods. Nurses completed a competency‐based education programme in which they could select from a menu of learning methods and content areas according to their individual needs. Learning methods included classroom lectures, self‐paced learning packages, and preceptorships in the clinical area. Competencies were measured by a standardized perinatal self‐efficacy tool and a tool developed by the authors for this study, the Single‐Room Maternity Care Competency Tool. A paired analysis was undertaken to take into account the paired (before and after) nature of the design. Results. Scores on the perinatal self‐efficacy scale and the single‐room maternity care competency tool were improved. These differences were statistically significant. Conclusions. Improvements in perinatal and single‐room maternity care‐specific competencies suggest that our education programme was successful in preparing nurses for their new role in the single‐room maternity care setting. This conclusion is supported by reported increases in nursing and patient satisfaction in the single‐room maternity care compared with the traditional labour/delivery and postpartum settings. Relevance to clinical practice. An education programme tailored to the learning needs of experienced clinical nurses contributes to improvements in nursing competencies and patient care.     

住院病人对临床护士核心胜任力要求的现状调查

护士核心胜任力是护士的一般特质,是护理工作的基础。通过对住院3 d以上的病人进行问卷调查,了解住院病人对临床护士核心胜任力的要求和临床护士的实际情况,找出其中的差距,为提升护士的核心胜任力做好充分的准备。     

济南市三级医院护士核心能力的现状调查

目的调查济南市三级医院注册护士核心能力现状,分析人口学变量对护士核心能力的影响,为护士培训提供依据。方法应用一般资料调查表和注册护士核心能力量表,对济南市5所三级医院的513名护士进行问卷调查。结果护士核心能力总均分为(2.79±0.58)分。在各个维度中,评判性思维和科研得分最低,伦理和法律实践得分最高。工作年限、职称、工作满意度、婚姻状况、自评健康状况是其主要影响因素。结论济南市三级医院护士核心能力处于中等偏上水平,在护士培训中需注重评判性思维和科研能力的培养,并加强对年轻、未婚护士的培养,以提升护士的核心能力。     

Development of the public health nursing competency instrument

This paper describes the development and initial testing of an instrument to measure population-based public health nursing competencies. Although multiple lists of public health competencies exist, literature review did not elicit a valid instrument that could measure changes in public health nursing competency over time. The public health nursing competency instrument, consisting of 195 measurable activities organized in the framework of the nursing process, was developed. Competency scores of practicing public health nurses significantly increased after a continuing education series, and the instrument was confirmed by experts to be a valid reflection of public health nursing practice. The time required for instrument development exceeded expectations because of the multiple stages of delineating competencies and validating data with national experts.     

Bedside nurses’ roles in discharge collaboration in general internal medicine: Disconnected,disempowered and devalued?

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals’ roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses’ interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in‐depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty‐five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses’ absence from morning rounds, one‐way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision‐making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse–physician interactions and the current context of nursing care.     

Competency measurements: testing convergent validity for two measures

Title. Competency measurements: testing convergent validity for two measures Aim. This paper is a report of a study to investigate whether the Australian National Competency Standards for Registered Nurses demonstrate correlations with the Finnish Nurse Competency Scale. Background. Competency assessment has become popular as a key regulatory requirement and performance indicator. The term competency, however, does not have a globally accepted definition and this has the potential to create controversy, ambiguity and confusion. Variations in meaning and definitions adopted in workplaces and educational settings will affect the interpretation of research findings and have implications for the nursing profession. Method. A non‐experimental cross‐sectional survey design was used with a convenience sample of 116 new graduate nurses in 2005. The second version of the Australian National Competency Standards and the Nurse Competency Scale was used to elicit responses to self‐assessed competency in the transitional year (first year as a Registered Nurse). Findings. Correlational analysis of self‐assessed levels of competence revealed a relationship between the Australian National Competency Standards (ANCI) and the Nurse Competency Scale (NCS). The correlational relation between ANCI domains and NCS factors suggests that these scales are indeed used to measure related dimensions. A statistically significant relationship (r = 0·75) was found between the two competency measures. Conclusion. Although the finding of convergent validity is insufficient to establish construct validity for competency as used in both measures in this study, it is an important step towards this goal. Future studies on relationships between competencies must take into account the validity and reliability of the tools.