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How competent are they? Graduate nurses self-assessment of competence at the start of their careers
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Collegian (2013) xxx, xxx—xxx
Available online at www.sciencedirect.com
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How competent are they? Graduate nurses self-assessment of competence at the start of their careers Sally Lima, MN, Grad Dip Adv Nsg, BN, RN a,b,c,∗, Fiona Newall, PhD, MN, BSc (Nsg), RN a,c,d, Sharon Kinney, PhD, MN, BN, PICU Nursing Cert., Cardiothoracic Cert. a,b, Helen L. Jordan, PhD, DipEd, BSc(Hons) e, Bridget Hamilton, PhD, BN (Hons), RN b a
Nursing Research, The Royal Children’s Hospital Melbourne, Australia Department of Nursing, School of Health Sciences, The University of Melbourne, Australia c Murdoch Children’s Research Institute, Australia d Departments of Nursing and Paediatrics, The University of Melbourne, Australia e Melbourne School of Population and Global Health, The University of Melbourne, Australia b
Received 15 April 2013 ; received in revised form 2 July 2013; accepted 5 September 2013
KEYWORDS Competence; Graduate nurse; Transition; Nurse Competence Scale
Summary For many decades there has been ongoing debate about what it means to be competent and how competence develops and is assessed. A particular target in the debate has been graduate nurses. Despite the extent of competence of graduate nurses being questioned, very little research has examined graduate nurse competence at the time of commencing employment. This study sought to redress this gap. Forty-seven graduate nurses starting a graduate nurse programme in a large paediatric hospital were invited to participate in a study investigating the development of competence. All graduate nurses agreed to participate and completed the Nurse Competence Scale, a 73 item questionnaire across seven domains related to nurse competence: helping role, teaching—coaching, diagnostic functions, managing situations, therapeutic interventions, ensuring quality and work role. Each item is scored along a Visual Analogue Scale (0—100) where 0 is very low and 100 is very high. For descriptive purposes levels of competence are separated as low (0—25), rather good (>25—50), good (>50—75) and very good (>75—100). Graduate nurses self-assessed their competence as rather good for overall competence and each of the domains. They indicated most competence in the domain of ensuring quality and least for teaching—coaching. Across all domains graduate nurses self-assessed a lower level of
∗
Corresponding author at: Nursing Research, The Royal Children’s Hospital Melbourne, Flemington Road, Parkville VIC 3052, Australia. Tel.: +61 3 9345 4210. E-mail address: [email protected] (S. Lima). 1322-7696/$ — see front matter © 2013 Australian College of Nursing Ltd. Published by Elsevier Ltd.
http://dx.doi.org/10.1016/j.colegn.2013.09.001
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S. Lima et al. competence than in other studies using the NCS with nurses with more experience. The selfassessed level of competence in ensuring quality found in this study may reflect the emphasis on critical thinking and utilisation of evidence in practice in undergraduate studies. The findings of this study suggest graduate nurses have a lower level of self-assessed competence at time of commencing practice than nurses with more experience. Future research is warranted to understand to what extent, when, why and how competence develops in this population. © 2013 Australian College of Nursing Ltd. Published by Elsevier Ltd.
Background The environment within which healthcare is provided by nurses continues to change rapidly. The care provided has become more complex and the variety of settings within which nurses practice has expanded. Increased financial constraints and a continuing shortage of nurses have created additional demands (Wolff, Pesut, & Regan, 2010). A combination of factors has contributed to some concerns regarding nursing care (Mid Staffordshire NHS Foundation Trust, 2013). Within this context there are strong societal and professional expectations that nurses will be competent to provide safe and effective care (McGrath et al., 2006). Despite the importance of the topic, the most effective means through which competence develops and is assessed remains elusive. There is an abundance of literature related to competence in the health professions. This includes some research and extensive commentary. Chen and Watson (2011) suggest that the definition of competence is obscure, contradictory and lacking consensus. Potential barriers to a clear understanding of competence include whether it is best understood as: behaviourist, attribute-based or holistic (Heywood, Gonczi, & Hager, 1992); actual or potential (While, 1994); knowledge and/or skills and/or personal attributes (Fernandez et al., 2012); permanent or temporary (Epstein & Hundert, 2002); evolutionary or static (Benner, 2001; Salisbury & Frankel, 2012); and transferable or contextual (Eraut, 1998). Reaching consensus is challenged by the vast number of stakeholders engaged in the debate. Employers, universities, governments, accreditation agencies, professional associations, industrial bodies, recipients of healthcare and healthcare professionals are amongst those who hold particular views and have a vested interest (Aretz, 2011; Moriarty, Manthorpe, Stevens, & Hussein, 2011; Wolff et al., 2010). Eraut (1998) proposes that the most worthwhile discussions related to competence occur when there is clarity around why the word is being used, the issues that are being addressed and the assumptions that are being made. The word competence is obligatory in nursing, as evidenced by the competency based approach to nursing registration in Australia and internationally (McGrath et al., 2006). In Australia, the Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse provide, among other things, a framework for nurses to selfassess competence; the national licensing board’s means to assess competence as part of the annual renewal of registration; and universities with a guide for developing curricula (Australian Nursing & Midwifery Council, 2006). The issue being addressed in this paper is the extent of competence of graduate nurses at the time of commencing
a graduate nurse programme (GNP). Each year approximately 11,000 students graduate from nursing and midwifery courses in Australia (Department of Health, 2012). All states in Australia offer GNPs (Levett-Jones & FitzGerald, 2005). While not compulsory, GNPs are recommended as the means through which graduate nurses can consolidate and further develop their competence (Oates, 2012). Perhaps there is no more significant time when the competence of nurses is challenged or debated than at the time of initial registration (Bradshaw & Merriman, 2008; Burns & Poster, 2008). Education providers argue graduate nurses are practice ready; they are professionally competent (Wolff et al., 2010). From this point of view competence develops along a trajectory whereby graduate nurses have foundation competencies transferable across situations. Then they require time, support and opportunities to develop competence in specific settings (Wolff et al., 2010). Conversely employers state graduate nurses are not practice ready; they are not competent (Moriarty et al., 2011). From this perspective competence is viewed as either/or. There is no time for competence to develop and graduate nurses need to have the skills to be able to ‘‘hit the floor running’’ (Wolff et al., 2010, p. 189). The assumption being made in this study is that the extent to which nurses are competent can be questioned. Many outcomes have been studied in relation to the first year of nursing practice. Yet published studies exploring graduate nurse competence as a primary focus have been relatively limited. In the UK studies have focused on competence from a perspective of educational preparation. Bartlett, Simonite, Westcott, and Taylor (2000) compared the competence of graduates and diplomates using the Nursing Competencies Questionnaire (NCQ), a tool designed for that study. In a similar study comparing the competence of graduates and diplomates Clinton, Murrells, and Robinson (2005) used a modified version of the NCQ. Although the NCQ was used in both studies to investigate competence post registration, it was developed and tested with the intent to investigate competence of student nurses (Norman, Watson, Murrells, Calman, & Redfern, 2002). Some studies have explored competence as an issue in wider investigation of GNP. This has been particularly evident in the USA where the Casey Fink Graduate Nurse Experience Survey (Casey, Fink, Krugman, & Propst, 2004) has been widely used in combination with other measures (Goode, Lynn, McElroy, Bednash, & Murray, 2013; Kowalski & Cross, 2010; Thomson, 2011; Ulrich et al., 2010). In an Australian context, exploration of graduate nurse competence has been investigated in conjunction with self-concept and retention (Cowin & Hengstberger-Sims, 2006), strengths and weaknesses of GNPs (Evans, Boxer, & Sanber, 2008),
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Self-assessed level of competence of graduate nurses clinical performance (Fisher & Parolin, 2000), expectations and experience (Goh & Watt, 2003; Roberts & Farrell, 2003) and graduates’ understanding of what competence means (Ramritu & Barnard, 2001). In studies with competence as the primary focus, the Nurse Competence Scale (NCS) features prominently. The NCS was developed in Finland (Meretoja, Isoaho, & LeinoKilpi, 2004) based on the work of Benner (2001). The NCS has been validated and used in a number of studies internationally (Bahreini et al., 2011; Cowin et al., 2008; Dellai, Mortari, & Meretoja, 2009; Hengstberger-Sims et al., 2008; Istomina et al., 2011; Meretoja & Koponen, 2011; Meretoja & Leino-Kilpi, 2003; Meretoja, Leino-Kilpi, & Kaira, 2004; O’Leary, 2012; Salonen, Kaunonen, Meretoja, & Tarkka, 2007; Wangensteen, Johansson, Bjorkstrom, & Nordstrom, 2012). Two studies utilising the NCS have focused on graduate nurses. Wangensteen et al. (2012) investigated the competence of recent graduate nurses, four to ten months post-graduation in Norway. Cowin et al. (2008) investigated competence of graduate nurses in the last two months of a GNP, testing convergent validity of an earlier version of the ANMC standards with the NCS. The outcomes of that study related to the competence component were reported by Hengstberger-Sims et al. (2008). No studies to date have investigated the competence of graduate nurses at the time of commencing employment, with competence as the primary focus. This paper reports one phase of a larger study investigating processes that contribute to the development of competence as the primary outcome measure. Within this study, a cohort of newly registered nurses in a GNP was asked to self-assess their level of competence at the time of commencing employment.
Design Aim The aim of this study was to determine the self-assessed level of competence of graduate nurses at the start of a GNP.
Sample and setting The study was conducted in a tertiary paediatric hospital in a large metropolitan area. Each year the hospital offers a GNP to between 40 and 50 recently registered nurses, to support their transition to professional nursing practice. In 2013, 47 nurses were to commence in the GNP and all graduate nurses were invited to participate.
Ethics The Human Research and Ethics Committee at the hospital where the study was being conducted approved the study. All potential participants were sent a letter and information statement. On commencing employment the principal investigator met with potential participants to describe the study and invite participation. The principal investigator had no formal association with the GNP.
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Questionnaire The questionnaire distributed to participants consisted of two parts. The first part collected the information related to age and experience, including paediatric clinical placements during undergraduate courses and previous employment as enrolled nurses (EN). The second part of the questionnaire consisted of the NCS (Meretoja, Isoaho, et al., 2004). Permission was obtained from the copyright holder and developer to use the NCS. The NCS includes 73 items across seven domains related to nurse competence: helping role (7 items), teaching—coaching (16 items), diagnostic functions (6 items), managing situations (8 items), therapeutic interventions (10 items), ensuring quality (6 items) and work role (19 items). The domains are derived from the work of Benner (2001). Respondents are asked to assess competence for each item with a visual analogue scale (VAS) (0—100 mm) where 0 is very low and 100 is very high. For descriptive purposes Meretoja, Isoaho, et al. (2004) propose levels of competence are separated as low (0—25), rather good (>25—50), good (>50—75) and very good (>75—100). Respondents are also asked to nominate the frequency of use of the competency items in clinical practice. For this a 4 point Likert type scale is used where 0 = not applicable in my work, 1 = used very seldom, 2 = used occasionally and 3 = used very often.
Data collection and analysis Data collection was carried out on two separate occasions in January and February 2013 due to graduate nurses commencing the GNP as two distinct groups. The principal investigator met with the graduate nurses on their second day of employment to discuss the study and invite questions and participation. Those who consented to participate were provided with the questionnaire to complete and return in a sealed addressed envelope. All data were entered and analysed in SPSS Version 21 for Windows. The data were analysed using descriptive statistics (frequencies, percentages, means and standard deviations). Sum variables were formed for each of the seven domains. An individual’s mean VAS score for a domain was calculated by adding the VAS scores for all items in a domain then dividing the overall by the number of items in that domain. An overall self-assessed competence score was calculated by adding the mean scores of the domains then dividing by the number of domains. To test for reliability Cronbach alpha was calculated for domains and overall competence scores.
Results All potential participants agreed to take part in the study and completed the questionnaire (n = 47). The average age of participants was 26 years. 32% (n = 15) of participants were aged 21 or 22 years. 60% (n = 28) of participants had completed a paediatric clinical placement as part of their undergraduate studies and 23% (n = 11) had previously worked as an EN. The average length of paediatric placement was 6.8 weeks and average length of employment as an EN was almost 3 years (35.7 months).
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S. Lima et al. Table 1
Level of competence and frequency of use. Level of competence
Helping role Teaching—coaching Diagnostic functions Managing situations Therapeutic interventions Ensuring quality Work role Overall competence
Frequency of use (occasionally or very often)
˛
M
SD
%
0.85 0.95 0.84 0.61 0.87 0.79 0.86 0.96
45.5 35.0 43.0 42.3 35.9 47.5 39.9 40.1
13.1 14.3 13.6 14.9 13.5 14.6 11.4 10.5
74.5 42.6 66.0 57.4 44.7 57.4 34.0 38.3
The Cronbach alpha, means and standard deviations for the domains and overall competence and percentage indicating frequency of use as occasionally or very often are presented in Table 1. In describing the psychometric testing of the NCS, Meretoja, Isoaho, et al. (2004) identified the Cronbach alpha ranged from 0.79 to 0.91. In this study the Cronbach alpha for the overall competence score was 0.96 and across the domains ranged from 0.61 for managing situations to 0.95 for teaching—coaching. The results revealed that the mean for self-assessed overall competence was 40.1 (±10.5). Within the domains, means ranged from 35.0 (±14.3) for the teaching—coaching domain to 47.5 (±14.6) for ensuring quality. In looking at frequency of use the helping role was most frequently used (74%) while the work role was least used (34%). There was a strong pattern that items related to coaching, mentoring, guiding or supporting other health professionals, including students, had a low mean competence score. For example the item with the lowest mean was ‘‘coordinating student nurse mentoring on my unit’’ (M = 12.6 ± 19.1) with ‘‘developing orientation programmes for nurses new to my unit’’ also having a mean less than 13 (M = 12.9 ± 17.7). Individual items with higher means tended to relate to recognising the needs of patients and families, and being aware of own limitations and need for professional development.
Discussion The purpose of this study was to ascertain the level of competence of nurses commencing a GNP as determined by self-assessment. Self-assessment is advocated as one important means through which competence is evaluated (EdCan, 2008; Edwards, Hawker, Carrier, & Rees, 2011; FitzGerald, 2001). Indeed self-declaration of competence is one of the key factors in renewal of registration for nurses with regulators (Australian Nursing & Midwifery Council, 2006). The NCS was chosen as it has been validated and used in a number of studies internationally including Australia, where the study being reported was conducted. While some studies using the NCS have incorporated the perspectives of others such as managers or preceptors, all published studies related to the NCS have included self-assessment (Bahreini et al., 2011; Cowin et al., 2008; Dellai et al., 2009; Hengstberger-Sims et al., 2008; Istomina et al., 2011;
Meretoja & Koponen, 2011; Meretoja & Leino-Kilpi, 2003; Meretoja, Leino-Kilpi, et al., 2004; O’Leary, 2012; Salonen et al., 2007; Wangensteen et al., 2012). No published studies using the NCS have explored the level of competence at the time of commencing a GNP. In the current study graduate nurses self-assessed their competence across each of the domains and overall as being rather good (>25—50). In all other published studies using the NCS, and with more experienced nurses results have demonstrated the level of overall competence as being at least good (>50—75). With the exception of one study where the domains of ensuring quality and therapeutic interventions had means in the rather good range (Salonen et al., 2007), all other studies have demonstrated means for the domains as being at least good. Several interesting patterns emerged when the findings of the current study were compared with other studies that have used the NCS. In the current study graduate nurses selfassessed their level of competence in the domain of ensuring quality higher than in any other domain (M = 47.5). In other studies using the NCS, nurses rated ensuring quality as the domain in which they were either the least or second least competent. Nurses in the current study identified lowest perceptions of competence in the domains of therapeutic interventions (M = 35.9) and teaching—coaching (M = 35.0). In other studies, competency in the domain of therapeutic interventions was often rated lower than other domains. The domain in which graduate nurses in the current study indicated the second highest level of competence, helping role (M = 45.5), was consistent with that reported in other published studies. These findings and comparisons prompt one to ask why the perceived level of competence across the domains is distinctive from previous studies with groups other than new graduates. Many items within the domain of ensuring quality relate to research, evaluation, critical thinking and philosophy of care. Much emphasis in undergraduate curriculum is placed on developing nurses who think critically and are capable of generating and utilising evidence in practice. The fact that graduate nurses in this study ranked this domain the highest perhaps reflects the focus of their undergraduate nursing studies. If the results of other studies are used to consider possible trajectories for this domain it is possible that over time the participants of the current study would see stability in competence in ensuring quality whilst there is development in other domains. Exploration
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Self-assessed level of competence of graduate nurses of structure and content of GNPs, ongoing professional development and context might contribute to understanding why there are different trajectories for each domain. When consideration is turned to overall self-assessed competence, 40.1 was the mean in the current study. Using the work of Wangensteen et al. (2012) and HengstbergerSims et al. (2008) as comparisons, mean overall competence in those studies were 62.5 and 59.5, respectively. Although the nurses in those studies were still within the first year of practice, by the time they self-assessed their level of competence (between four and ten months post registration) the means were approximately 20 points above that of the graduate nurses in the current study. While it is difficult to draw any inferences regarding these different means given the assorted settings and contexts, the work of Benner (2001) is helpful in suggesting meaning. Benner (2001) proposed nursing competence moves along a continuum from novice, through advanced beginner, competent and proficient to expert. Novices are nurses who have had no experience in the situations they are expected to practice in. Advanced beginners have coped with enough real situations (often with support of a mentor) to note recurring patterns and demonstrate marginally acceptable performance. Competent nurses have usually been in the same job or situation for two to three years. The findings from this study support the notion that competence develops along a continuum. The graduate nurses in this study self-assessed their competence at an earlier stage in their career than anyone else using the NCS has. The graduate nurses in this study self-assessed their level of competence as lower than participants in any other study using the NCS. More work is required to understand to what extent, when, why and how competence develops.
Limitations A limitation of this study is the sample size (N = 47). This was the entire graduate nurse population available for a year. The fact that the study was conducted in a paediatric hospital may limit the generalisability to paediatric settings. There would be benefit to conducting further research across a range of settings to increase the sample size and generalisability. Using self-assessment as a measure is open to more subjective interpretations. However self-assessment of competence is accepted by registering bodies as a means to renew license to practice and is widely reported in the literature.
Conclusion The graduate nurses who participated in this study at the start of a GNP indicated a lower level of competence than that reported in other studies using the same tool with nurses with more experience. The issue of competence is of paramount importance for nursing and healthcare. Many stakeholders have a vested interest in what competence means, how it develops and is assessed. The recipients of healthcare have a right to expect that care will be provided by nurses who are competent. Nursing care is increasingly complex as knowledge and treatment options evolve at a rapid pace. With an ageing population, limited resources
5 due to financial constraints and an ongoing nursing shortage, the expectations and demands placed on graduate nurses will continue to increase. It is therefore imperative that further research identifies the level of competence of nurses at varying points along the career trajectory and most effective ways to support ongoing development of competence in this population.
References Aretz, H. T. (2011). Some thoughts about creating healthcare professionals that match what societies need. Medical Teacher, 33(8), 608—613. http://dx.doi.org/10.3109/0142159x.2011.590389 Australian Nursing & Midwifery Council. (2006). National competency standards for the registered nurse (4th ed.). Canberra: Australian Nursing & Midwifery Council. Bahreini, M., Moattari, M., Ahmadi, F., Kaveh, M. H., Hayatdavoudy, P., & Mirzaei, M. (2011). Comparison of head nurses and practicing nurses in nurse competence assessment. Iranian Journal Of Nursing And Midwifery Research, 16(3), 227—234. Bartlett, H. P., Simonite, V., Westcott, E., & Taylor, H. R. (2000). A comparison of the nursing competence of graduates and diplomates from UK nursing programmes. Journal of Clinical Nursing, 9(3), 369—379. Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice (commemorative ed.). Upper Saddle River, NJ: Prentice Hall. Bradshaw, A., & Merriman, C. (2008). Nursing competence 10 years on: Fit for practice and purpose yet? Journal of Clinical Nursing, 17(10), 1263—1269. Burns, P., & Poster, E. C. (2008). Competency development in new registered nurse graduates: Closing the gap between education and practice. Journal of Continuing Education in Nursing, 39(2), 67—73. Casey, K., Fink, R., Krugman, M., & Propst, J. (2004). The graduate nurse experience. Journal of Nursing Administration, 34(6), 303—311. Chen, Y., & Watson, R. (2011). A review of clinical competence assessment in nursing. Nurse Education Today, 31(8), 832—836. Clinton, M., Murrells, T., & Robinson, S. (2005). Assessing competency in nursing: A comparison of nurses prepared through degree and diploma programmes. Journal of Clinical Nursing, 14(1), 82—94. Cowin, L. S., & Hengstberger-Sims, C. (2006). New graduate nurse self-concept and retention: A longitudinal survey. International Journal of Nursing Studies, 43, 59—70. Cowin, L. S., Hengstberger-Sims, C., Eagar, S. C., Gregory, L., Andrew, S., & Rolley, J. (2008). Competency measurements: Testing convergent validity for two measures. Journal of Advanced Nursing, 64(3), 272—277. Dellai, M., Mortari, L., & Meretoja, R. (2009). Self-assessment of nursing competencies — Validation of the Finnish NCS instrument with Italian nurses. Scandinavian Journal of Caring Sciences, 23(4), 783—791. Department of Health. (2012). Nurse and midwife graduate handbook 2012. Melbourne: Victorian Government. Retrieved from http://www.health.vic.gov.au/ data/assets/pdf file/0007/ 656053/1205021 Nurse-and-midwife-graduate-handbook-2012WEB.pdf EdCan. (2008). Competency Assessment in Nursing. In A summary of the literature published since 2000. Retrieved from http:// www.edcan.org/pdf/EdCancompetenciesliteraturereview FINAL.pdf Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2011). The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse. Adelaide:
Please cite this article in press as: Lima, S., et al. How competent are they? Graduate nurses self-assessment of competence at the start of their careers. Collegian (2013), http://dx.doi.org/10.1016/j.colegn.2013.09.001
+Model COLEGN-222; No. of Pages 6
ARTICLE IN PRESS
6
S. Lima et al.
Joanna Briggs Institute for Evidence Based Nursing and Midwifery. Epstein, R. M., & Hundert, E. M. (2002). Defining and assessing professional competence. JAMA: Journal of the American Medical Association, 287(2), 226. Eraut, M. (1998). Concepts of Competence, 12. Evans, J., Boxer, E., & Sanber, S. (2008). The strengths and weaknesses of transitional support programs for newly registered nurses. Australian Journal of Advanced Nursing, 25(4), 16—22. Fernandez, N., Dory, V., Ste-Marie, L.-G., Chaput, M., Charlin, B., & Boucher, A. (2012). Varying conceptions of competence: An analysis of how health sciences educators define competence. Medical Education, 46(4), 357—365. http://dx.doi.org/10.1111/j.1365-2923.2011.04183.x Fisher, M., & Parolin, M. (2000). The reliability of measuring nursing clinical performance using a competency based assessment tool: A pilot study. Collegian, 7(3), 21—27. FitzGerald, M. (2001). An integrative systematic review of indicators of competence for practice & protocol for validation of indicators of competence queensland nursing council. Adelaide, South Australia: Department of Clinical Nursing, Adelaide University in conjunction with the Joanna Briggs Institute for Evidence Based Nursing and Midwifery. Goh, K., & Watt, E. (2003). From ‘dependent on’ to ‘depended on’: The experience of transition from student to registered nurse in a private hospital graduate program. Australian Journal of Advanced Nursing, 21(1), 14—20. Goode, C. J., Lynn, M. R., McElroy, D., Bednash, G. D., & Murray, B. (2013). Lessons learned from 10 years of research on a post-baccalaureate nurse residency program. Journal of Nursing Administration, 43(2), 73—79. Hengstberger-Sims, C., Cowin, L. S., Eagar, S. C., Gregory, L., Andrew, S., & Rolley, J. (2008). Relating new graduate nurse competence to frequency of use. Collegian, 15, 69—76. Heywood, L., Gonczi, A., & Hager, P. (1992). A guide to development of competency standards for professions. Canberra: Australian Government Publishing Service. Istomina, N., Suominen, T., Razbadauskas, A., Martinkenas, A., Meretoja, R., & Leino-Kilpi, H. (2011). Competence of nurses and factors associated with it. Medicina-Lithuania, 47(4), 230—237. Kowalski, S., & Cross, C. L. (2010). Preliminary outcomes of a local residency programme for new graduate registered nurses. Journal of Nursing Management, 18(1), 96—104. Levett-Jones, T., & FitzGerald, M. (2005). A review of graduate nurse transition programs in Australia. Australian Journal of Advanced Nursing, 23(2), 40—45. McGrath, P., Anastasi, J., Fox-Young, S., Gorman, D., Moxham, L., & Tollefson, J. (2006). Collaborative voices: Ongoing reflections on nursing competencies. Contemporary Nurse: A Journal for the Australian Nursing Profession, 22(1), 46—58. Meretoja, R., & Koponen, L. (2011). A systematic model to compare nurses’ optimal and actual competencies in the clinical setting. Journal of Advanced Nursing, 68(2), 414—422. Meretoja, R., & Leino-Kilpi, H. (2003). Comparison of competence assessments made by nurse managers and practising nurses. Journal of Nursing Management, 11(6), 404—409.
Meretoja, R., Isoaho, H., & Leino-Kilpi, H. (2004). Nurse Competence Scale: Development and psychometric testing. Journal of Advanced Nursing, 47(2), 124—133. Meretoja, R., Leino-Kilpi, H., & Kaira, A. (2004). Comparison of nurse competence in different hospital work environments. Journal of Nursing Management, 12(5), 329—336. Mid Staffordshire NHS Foundation Trust. (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive summary. Retrieved June 24, 2013, from http://www. official-documents.gov.uk/document/hc1213/hc09/0947/ 0947.pdf Moriarty, J., Manthorpe, J., Stevens, M., & Hussein, S. (2011). Making the transition: Comparing research on newly qualified social workers with other professions. British Journal of Social Work, 41(7), 1340—1356. http://dx.doi.org/10.1093/bjsw/bcr031 Norman, I. J., Watson, R., Murrells, T., Calman, L., & Redfern, S. (2002). The validity and reliability of methods to assess the competence to practise of pre-registration nursing and midwifery students. International Journal of Nursing Studies, 39(2), 133—145. Oates, A. (2012, June). Early graduate nursing and midwifery program. Retrieved March 1, 2013, from http://www.health.vic.gov.au/nursing/furthering/graduate O’Leary, J. (2012). Comparison of self-assessed competence and experience among critical care nurses. Journal of Nursing Management, 20(5), 607—614. Ramritu, P. L., & Barnard, A. (2001). New nurse graduates’ understanding of competence. International Nursing Review, 48(1), 47—57. Roberts, K., & Farrell, G. (2003). Expectations and perceptions of graduates’ performance at the start and at the end of their graduate year. Collegian, 10(2), 13—18. Salisbury, E., & Frankel, A. (2012). Just how prepared can we expect new medical graduates to be. Postgraduate Medical Journal, 88(1041), 363—364. Salonen, A. H., Kaunonen, M., Meretoja, R., & Tarkka, M. T. (2007). Competence profiles of recently registered nurses working in intensive and emergency settings. Journal of Nursing Management, 15(8), 792—800. Thomson, S. (2011). Transition into practice: A comparison of outcomes between associate- and baccalaureate-prepared nurses participating in a nurse residency program. Journal for Nurses in Staff Development, 27(6), 266—271. Ulrich, B., Krozek, C., Early, S., Ashlock, C. H., Africa, L. M., & Carman, M. L. (2010). Improving retention, confidence, and competence of new graduate nurses: Results from a 10-year longitudinal database. Nursing Economics, 28(6), 363—375. Wangensteen, S., Johansson, I. S., Bjorkstrom, M. E., & Nordstrom, G. U. N. (2012). Newly graduated nurses’ perception of competence and possible predictors: A cross-sectional survey. Journal of Professional Nursing, 28(3), 170—181. While, A. E. (1994). Competence versus performance: Which is more important? Journal of Advanced Nursing, 20(3), 525—531. http://dx.doi.org/10.1111/j.1365-2648.1994.tb02391.x Wolff, A. C., Pesut, B., & Regan, S. (2010). New graduate nurse practice readiness: Perspectives on the context shaping our understanding and expectations. Nurse Education Today, 30(2), 187—191.
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Collegian (2013) xxx, xxx—xxx
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How competent are they? Graduate nurses self-assessment of competence at the start of their careers Sally Lima, MN, Grad Dip Adv Nsg, BN, RN a,b,c,∗, Fiona Newall, PhD, MN, BSc (Nsg), RN a,c,d, Sharon Kinney, PhD, MN, BN, PICU Nursing Cert., Cardiothoracic Cert. a,b, Helen L. Jordan, PhD, DipEd, BSc(Hons) e, Bridget Hamilton, PhD, BN (Hons), RN b a
Nursing Research, The Royal Children’s Hospital Melbourne, Australia Department of Nursing, School of Health Sciences, The University of Melbourne, Australia c Murdoch Children’s Research Institute, Australia d Departments of Nursing and Paediatrics, The University of Melbourne, Australia e Melbourne School of Population and Global Health, The University of Melbourne, Australia b
Received 15 April 2013 ; received in revised form 2 July 2013; accepted 5 September 2013
KEYWORDS Competence; Graduate nurse; Transition; Nurse Competence Scale
Summary For many decades there has been ongoing debate about what it means to be competent and how competence develops and is assessed. A particular target in the debate has been graduate nurses. Despite the extent of competence of graduate nurses being questioned, very little research has examined graduate nurse competence at the time of commencing employment. This study sought to redress this gap. Forty-seven graduate nurses starting a graduate nurse programme in a large paediatric hospital were invited to participate in a study investigating the development of competence. All graduate nurses agreed to participate and completed the Nurse Competence Scale, a 73 item questionnaire across seven domains related to nurse competence: helping role, teaching—coaching, diagnostic functions, managing situations, therapeutic interventions, ensuring quality and work role. Each item is scored along a Visual Analogue Scale (0—100) where 0 is very low and 100 is very high. For descriptive purposes levels of competence are separated as low (0—25), rather good (>25—50), good (>50—75) and very good (>75—100). Graduate nurses self-assessed their competence as rather good for overall competence and each of the domains. They indicated most competence in the domain of ensuring quality and least for teaching—coaching. Across all domains graduate nurses self-assessed a lower level of
∗
Corresponding author at: Nursing Research, The Royal Children’s Hospital Melbourne, Flemington Road, Parkville VIC 3052, Australia. Tel.: +61 3 9345 4210. E-mail address: [email protected] (S. Lima). 1322-7696/$ — see front matter © 2013 Australian College of Nursing Ltd. Published by Elsevier Ltd.
http://dx.doi.org/10.1016/j.colegn.2013.09.001
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S. Lima et al. competence than in other studies using the NCS with nurses with more experience. The selfassessed level of competence in ensuring quality found in this study may reflect the emphasis on critical thinking and utilisation of evidence in practice in undergraduate studies. The findings of this study suggest graduate nurses have a lower level of self-assessed competence at time of commencing practice than nurses with more experience. Future research is warranted to understand to what extent, when, why and how competence develops in this population. © 2013 Australian College of Nursing Ltd. Published by Elsevier Ltd.
Background The environment within which healthcare is provided by nurses continues to change rapidly. The care provided has become more complex and the variety of settings within which nurses practice has expanded. Increased financial constraints and a continuing shortage of nurses have created additional demands (Wolff, Pesut, & Regan, 2010). A combination of factors has contributed to some concerns regarding nursing care (Mid Staffordshire NHS Foundation Trust, 2013). Within this context there are strong societal and professional expectations that nurses will be competent to provide safe and effective care (McGrath et al., 2006). Despite the importance of the topic, the most effective means through which competence develops and is assessed remains elusive. There is an abundance of literature related to competence in the health professions. This includes some research and extensive commentary. Chen and Watson (2011) suggest that the definition of competence is obscure, contradictory and lacking consensus. Potential barriers to a clear understanding of competence include whether it is best understood as: behaviourist, attribute-based or holistic (Heywood, Gonczi, & Hager, 1992); actual or potential (While, 1994); knowledge and/or skills and/or personal attributes (Fernandez et al., 2012); permanent or temporary (Epstein & Hundert, 2002); evolutionary or static (Benner, 2001; Salisbury & Frankel, 2012); and transferable or contextual (Eraut, 1998). Reaching consensus is challenged by the vast number of stakeholders engaged in the debate. Employers, universities, governments, accreditation agencies, professional associations, industrial bodies, recipients of healthcare and healthcare professionals are amongst those who hold particular views and have a vested interest (Aretz, 2011; Moriarty, Manthorpe, Stevens, & Hussein, 2011; Wolff et al., 2010). Eraut (1998) proposes that the most worthwhile discussions related to competence occur when there is clarity around why the word is being used, the issues that are being addressed and the assumptions that are being made. The word competence is obligatory in nursing, as evidenced by the competency based approach to nursing registration in Australia and internationally (McGrath et al., 2006). In Australia, the Australian Nursing and Midwifery Council National Competency Standards for the Registered Nurse provide, among other things, a framework for nurses to selfassess competence; the national licensing board’s means to assess competence as part of the annual renewal of registration; and universities with a guide for developing curricula (Australian Nursing & Midwifery Council, 2006). The issue being addressed in this paper is the extent of competence of graduate nurses at the time of commencing
a graduate nurse programme (GNP). Each year approximately 11,000 students graduate from nursing and midwifery courses in Australia (Department of Health, 2012). All states in Australia offer GNPs (Levett-Jones & FitzGerald, 2005). While not compulsory, GNPs are recommended as the means through which graduate nurses can consolidate and further develop their competence (Oates, 2012). Perhaps there is no more significant time when the competence of nurses is challenged or debated than at the time of initial registration (Bradshaw & Merriman, 2008; Burns & Poster, 2008). Education providers argue graduate nurses are practice ready; they are professionally competent (Wolff et al., 2010). From this point of view competence develops along a trajectory whereby graduate nurses have foundation competencies transferable across situations. Then they require time, support and opportunities to develop competence in specific settings (Wolff et al., 2010). Conversely employers state graduate nurses are not practice ready; they are not competent (Moriarty et al., 2011). From this perspective competence is viewed as either/or. There is no time for competence to develop and graduate nurses need to have the skills to be able to ‘‘hit the floor running’’ (Wolff et al., 2010, p. 189). The assumption being made in this study is that the extent to which nurses are competent can be questioned. Many outcomes have been studied in relation to the first year of nursing practice. Yet published studies exploring graduate nurse competence as a primary focus have been relatively limited. In the UK studies have focused on competence from a perspective of educational preparation. Bartlett, Simonite, Westcott, and Taylor (2000) compared the competence of graduates and diplomates using the Nursing Competencies Questionnaire (NCQ), a tool designed for that study. In a similar study comparing the competence of graduates and diplomates Clinton, Murrells, and Robinson (2005) used a modified version of the NCQ. Although the NCQ was used in both studies to investigate competence post registration, it was developed and tested with the intent to investigate competence of student nurses (Norman, Watson, Murrells, Calman, & Redfern, 2002). Some studies have explored competence as an issue in wider investigation of GNP. This has been particularly evident in the USA where the Casey Fink Graduate Nurse Experience Survey (Casey, Fink, Krugman, & Propst, 2004) has been widely used in combination with other measures (Goode, Lynn, McElroy, Bednash, & Murray, 2013; Kowalski & Cross, 2010; Thomson, 2011; Ulrich et al., 2010). In an Australian context, exploration of graduate nurse competence has been investigated in conjunction with self-concept and retention (Cowin & Hengstberger-Sims, 2006), strengths and weaknesses of GNPs (Evans, Boxer, & Sanber, 2008),
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Self-assessed level of competence of graduate nurses clinical performance (Fisher & Parolin, 2000), expectations and experience (Goh & Watt, 2003; Roberts & Farrell, 2003) and graduates’ understanding of what competence means (Ramritu & Barnard, 2001). In studies with competence as the primary focus, the Nurse Competence Scale (NCS) features prominently. The NCS was developed in Finland (Meretoja, Isoaho, & LeinoKilpi, 2004) based on the work of Benner (2001). The NCS has been validated and used in a number of studies internationally (Bahreini et al., 2011; Cowin et al., 2008; Dellai, Mortari, & Meretoja, 2009; Hengstberger-Sims et al., 2008; Istomina et al., 2011; Meretoja & Koponen, 2011; Meretoja & Leino-Kilpi, 2003; Meretoja, Leino-Kilpi, & Kaira, 2004; O’Leary, 2012; Salonen, Kaunonen, Meretoja, & Tarkka, 2007; Wangensteen, Johansson, Bjorkstrom, & Nordstrom, 2012). Two studies utilising the NCS have focused on graduate nurses. Wangensteen et al. (2012) investigated the competence of recent graduate nurses, four to ten months post-graduation in Norway. Cowin et al. (2008) investigated competence of graduate nurses in the last two months of a GNP, testing convergent validity of an earlier version of the ANMC standards with the NCS. The outcomes of that study related to the competence component were reported by Hengstberger-Sims et al. (2008). No studies to date have investigated the competence of graduate nurses at the time of commencing employment, with competence as the primary focus. This paper reports one phase of a larger study investigating processes that contribute to the development of competence as the primary outcome measure. Within this study, a cohort of newly registered nurses in a GNP was asked to self-assess their level of competence at the time of commencing employment.
Design Aim The aim of this study was to determine the self-assessed level of competence of graduate nurses at the start of a GNP.
Sample and setting The study was conducted in a tertiary paediatric hospital in a large metropolitan area. Each year the hospital offers a GNP to between 40 and 50 recently registered nurses, to support their transition to professional nursing practice. In 2013, 47 nurses were to commence in the GNP and all graduate nurses were invited to participate.
Ethics The Human Research and Ethics Committee at the hospital where the study was being conducted approved the study. All potential participants were sent a letter and information statement. On commencing employment the principal investigator met with potential participants to describe the study and invite participation. The principal investigator had no formal association with the GNP.
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Questionnaire The questionnaire distributed to participants consisted of two parts. The first part collected the information related to age and experience, including paediatric clinical placements during undergraduate courses and previous employment as enrolled nurses (EN). The second part of the questionnaire consisted of the NCS (Meretoja, Isoaho, et al., 2004). Permission was obtained from the copyright holder and developer to use the NCS. The NCS includes 73 items across seven domains related to nurse competence: helping role (7 items), teaching—coaching (16 items), diagnostic functions (6 items), managing situations (8 items), therapeutic interventions (10 items), ensuring quality (6 items) and work role (19 items). The domains are derived from the work of Benner (2001). Respondents are asked to assess competence for each item with a visual analogue scale (VAS) (0—100 mm) where 0 is very low and 100 is very high. For descriptive purposes Meretoja, Isoaho, et al. (2004) propose levels of competence are separated as low (0—25), rather good (>25—50), good (>50—75) and very good (>75—100). Respondents are also asked to nominate the frequency of use of the competency items in clinical practice. For this a 4 point Likert type scale is used where 0 = not applicable in my work, 1 = used very seldom, 2 = used occasionally and 3 = used very often.
Data collection and analysis Data collection was carried out on two separate occasions in January and February 2013 due to graduate nurses commencing the GNP as two distinct groups. The principal investigator met with the graduate nurses on their second day of employment to discuss the study and invite questions and participation. Those who consented to participate were provided with the questionnaire to complete and return in a sealed addressed envelope. All data were entered and analysed in SPSS Version 21 for Windows. The data were analysed using descriptive statistics (frequencies, percentages, means and standard deviations). Sum variables were formed for each of the seven domains. An individual’s mean VAS score for a domain was calculated by adding the VAS scores for all items in a domain then dividing the overall by the number of items in that domain. An overall self-assessed competence score was calculated by adding the mean scores of the domains then dividing by the number of domains. To test for reliability Cronbach alpha was calculated for domains and overall competence scores.
Results All potential participants agreed to take part in the study and completed the questionnaire (n = 47). The average age of participants was 26 years. 32% (n = 15) of participants were aged 21 or 22 years. 60% (n = 28) of participants had completed a paediatric clinical placement as part of their undergraduate studies and 23% (n = 11) had previously worked as an EN. The average length of paediatric placement was 6.8 weeks and average length of employment as an EN was almost 3 years (35.7 months).
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S. Lima et al. Table 1
Level of competence and frequency of use. Level of competence
Helping role Teaching—coaching Diagnostic functions Managing situations Therapeutic interventions Ensuring quality Work role Overall competence
Frequency of use (occasionally or very often)
˛
M
SD
%
0.85 0.95 0.84 0.61 0.87 0.79 0.86 0.96
45.5 35.0 43.0 42.3 35.9 47.5 39.9 40.1
13.1 14.3 13.6 14.9 13.5 14.6 11.4 10.5
74.5 42.6 66.0 57.4 44.7 57.4 34.0 38.3
The Cronbach alpha, means and standard deviations for the domains and overall competence and percentage indicating frequency of use as occasionally or very often are presented in Table 1. In describing the psychometric testing of the NCS, Meretoja, Isoaho, et al. (2004) identified the Cronbach alpha ranged from 0.79 to 0.91. In this study the Cronbach alpha for the overall competence score was 0.96 and across the domains ranged from 0.61 for managing situations to 0.95 for teaching—coaching. The results revealed that the mean for self-assessed overall competence was 40.1 (±10.5). Within the domains, means ranged from 35.0 (±14.3) for the teaching—coaching domain to 47.5 (±14.6) for ensuring quality. In looking at frequency of use the helping role was most frequently used (74%) while the work role was least used (34%). There was a strong pattern that items related to coaching, mentoring, guiding or supporting other health professionals, including students, had a low mean competence score. For example the item with the lowest mean was ‘‘coordinating student nurse mentoring on my unit’’ (M = 12.6 ± 19.1) with ‘‘developing orientation programmes for nurses new to my unit’’ also having a mean less than 13 (M = 12.9 ± 17.7). Individual items with higher means tended to relate to recognising the needs of patients and families, and being aware of own limitations and need for professional development.
Discussion The purpose of this study was to ascertain the level of competence of nurses commencing a GNP as determined by self-assessment. Self-assessment is advocated as one important means through which competence is evaluated (EdCan, 2008; Edwards, Hawker, Carrier, & Rees, 2011; FitzGerald, 2001). Indeed self-declaration of competence is one of the key factors in renewal of registration for nurses with regulators (Australian Nursing & Midwifery Council, 2006). The NCS was chosen as it has been validated and used in a number of studies internationally including Australia, where the study being reported was conducted. While some studies using the NCS have incorporated the perspectives of others such as managers or preceptors, all published studies related to the NCS have included self-assessment (Bahreini et al., 2011; Cowin et al., 2008; Dellai et al., 2009; Hengstberger-Sims et al., 2008; Istomina et al., 2011;
Meretoja & Koponen, 2011; Meretoja & Leino-Kilpi, 2003; Meretoja, Leino-Kilpi, et al., 2004; O’Leary, 2012; Salonen et al., 2007; Wangensteen et al., 2012). No published studies using the NCS have explored the level of competence at the time of commencing a GNP. In the current study graduate nurses self-assessed their competence across each of the domains and overall as being rather good (>25—50). In all other published studies using the NCS, and with more experienced nurses results have demonstrated the level of overall competence as being at least good (>50—75). With the exception of one study where the domains of ensuring quality and therapeutic interventions had means in the rather good range (Salonen et al., 2007), all other studies have demonstrated means for the domains as being at least good. Several interesting patterns emerged when the findings of the current study were compared with other studies that have used the NCS. In the current study graduate nurses selfassessed their level of competence in the domain of ensuring quality higher than in any other domain (M = 47.5). In other studies using the NCS, nurses rated ensuring quality as the domain in which they were either the least or second least competent. Nurses in the current study identified lowest perceptions of competence in the domains of therapeutic interventions (M = 35.9) and teaching—coaching (M = 35.0). In other studies, competency in the domain of therapeutic interventions was often rated lower than other domains. The domain in which graduate nurses in the current study indicated the second highest level of competence, helping role (M = 45.5), was consistent with that reported in other published studies. These findings and comparisons prompt one to ask why the perceived level of competence across the domains is distinctive from previous studies with groups other than new graduates. Many items within the domain of ensuring quality relate to research, evaluation, critical thinking and philosophy of care. Much emphasis in undergraduate curriculum is placed on developing nurses who think critically and are capable of generating and utilising evidence in practice. The fact that graduate nurses in this study ranked this domain the highest perhaps reflects the focus of their undergraduate nursing studies. If the results of other studies are used to consider possible trajectories for this domain it is possible that over time the participants of the current study would see stability in competence in ensuring quality whilst there is development in other domains. Exploration
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Self-assessed level of competence of graduate nurses of structure and content of GNPs, ongoing professional development and context might contribute to understanding why there are different trajectories for each domain. When consideration is turned to overall self-assessed competence, 40.1 was the mean in the current study. Using the work of Wangensteen et al. (2012) and HengstbergerSims et al. (2008) as comparisons, mean overall competence in those studies were 62.5 and 59.5, respectively. Although the nurses in those studies were still within the first year of practice, by the time they self-assessed their level of competence (between four and ten months post registration) the means were approximately 20 points above that of the graduate nurses in the current study. While it is difficult to draw any inferences regarding these different means given the assorted settings and contexts, the work of Benner (2001) is helpful in suggesting meaning. Benner (2001) proposed nursing competence moves along a continuum from novice, through advanced beginner, competent and proficient to expert. Novices are nurses who have had no experience in the situations they are expected to practice in. Advanced beginners have coped with enough real situations (often with support of a mentor) to note recurring patterns and demonstrate marginally acceptable performance. Competent nurses have usually been in the same job or situation for two to three years. The findings from this study support the notion that competence develops along a continuum. The graduate nurses in this study self-assessed their competence at an earlier stage in their career than anyone else using the NCS has. The graduate nurses in this study self-assessed their level of competence as lower than participants in any other study using the NCS. More work is required to understand to what extent, when, why and how competence develops.
Limitations A limitation of this study is the sample size (N = 47). This was the entire graduate nurse population available for a year. The fact that the study was conducted in a paediatric hospital may limit the generalisability to paediatric settings. There would be benefit to conducting further research across a range of settings to increase the sample size and generalisability. Using self-assessment as a measure is open to more subjective interpretations. However self-assessment of competence is accepted by registering bodies as a means to renew license to practice and is widely reported in the literature.
Conclusion The graduate nurses who participated in this study at the start of a GNP indicated a lower level of competence than that reported in other studies using the same tool with nurses with more experience. The issue of competence is of paramount importance for nursing and healthcare. Many stakeholders have a vested interest in what competence means, how it develops and is assessed. The recipients of healthcare have a right to expect that care will be provided by nurses who are competent. Nursing care is increasingly complex as knowledge and treatment options evolve at a rapid pace. With an ageing population, limited resources
5 due to financial constraints and an ongoing nursing shortage, the expectations and demands placed on graduate nurses will continue to increase. It is therefore imperative that further research identifies the level of competence of nurses at varying points along the career trajectory and most effective ways to support ongoing development of competence in this population.
References Aretz, H. T. (2011). Some thoughts about creating healthcare professionals that match what societies need. Medical Teacher, 33(8), 608—613. http://dx.doi.org/10.3109/0142159x.2011.590389 Australian Nursing & Midwifery Council. (2006). National competency standards for the registered nurse (4th ed.). Canberra: Australian Nursing & Midwifery Council. Bahreini, M., Moattari, M., Ahmadi, F., Kaveh, M. H., Hayatdavoudy, P., & Mirzaei, M. (2011). Comparison of head nurses and practicing nurses in nurse competence assessment. Iranian Journal Of Nursing And Midwifery Research, 16(3), 227—234. Bartlett, H. P., Simonite, V., Westcott, E., & Taylor, H. R. (2000). A comparison of the nursing competence of graduates and diplomates from UK nursing programmes. Journal of Clinical Nursing, 9(3), 369—379. Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice (commemorative ed.). Upper Saddle River, NJ: Prentice Hall. Bradshaw, A., & Merriman, C. (2008). Nursing competence 10 years on: Fit for practice and purpose yet? Journal of Clinical Nursing, 17(10), 1263—1269. Burns, P., & Poster, E. C. (2008). Competency development in new registered nurse graduates: Closing the gap between education and practice. Journal of Continuing Education in Nursing, 39(2), 67—73. Casey, K., Fink, R., Krugman, M., & Propst, J. (2004). The graduate nurse experience. Journal of Nursing Administration, 34(6), 303—311. Chen, Y., & Watson, R. (2011). A review of clinical competence assessment in nursing. Nurse Education Today, 31(8), 832—836. Clinton, M., Murrells, T., & Robinson, S. (2005). Assessing competency in nursing: A comparison of nurses prepared through degree and diploma programmes. Journal of Clinical Nursing, 14(1), 82—94. Cowin, L. S., & Hengstberger-Sims, C. (2006). New graduate nurse self-concept and retention: A longitudinal survey. International Journal of Nursing Studies, 43, 59—70. Cowin, L. S., Hengstberger-Sims, C., Eagar, S. C., Gregory, L., Andrew, S., & Rolley, J. (2008). Competency measurements: Testing convergent validity for two measures. Journal of Advanced Nursing, 64(3), 272—277. Dellai, M., Mortari, L., & Meretoja, R. (2009). Self-assessment of nursing competencies — Validation of the Finnish NCS instrument with Italian nurses. Scandinavian Journal of Caring Sciences, 23(4), 783—791. Department of Health. (2012). Nurse and midwife graduate handbook 2012. Melbourne: Victorian Government. Retrieved from http://www.health.vic.gov.au/ data/assets/pdf file/0007/ 656053/1205021 Nurse-and-midwife-graduate-handbook-2012WEB.pdf EdCan. (2008). Competency Assessment in Nursing. In A summary of the literature published since 2000. Retrieved from http:// www.edcan.org/pdf/EdCancompetenciesliteraturereview FINAL.pdf Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2011). The effectiveness of strategies and interventions that aim to assist the transition from student to newly qualified nurse. Adelaide:
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Joanna Briggs Institute for Evidence Based Nursing and Midwifery. Epstein, R. M., & Hundert, E. M. (2002). Defining and assessing professional competence. JAMA: Journal of the American Medical Association, 287(2), 226. Eraut, M. (1998). Concepts of Competence, 12. Evans, J., Boxer, E., & Sanber, S. (2008). The strengths and weaknesses of transitional support programs for newly registered nurses. Australian Journal of Advanced Nursing, 25(4), 16—22. Fernandez, N., Dory, V., Ste-Marie, L.-G., Chaput, M., Charlin, B., & Boucher, A. (2012). Varying conceptions of competence: An analysis of how health sciences educators define competence. Medical Education, 46(4), 357—365. http://dx.doi.org/10.1111/j.1365-2923.2011.04183.x Fisher, M., & Parolin, M. (2000). The reliability of measuring nursing clinical performance using a competency based assessment tool: A pilot study. Collegian, 7(3), 21—27. FitzGerald, M. (2001). An integrative systematic review of indicators of competence for practice & protocol for validation of indicators of competence queensland nursing council. Adelaide, South Australia: Department of Clinical Nursing, Adelaide University in conjunction with the Joanna Briggs Institute for Evidence Based Nursing and Midwifery. Goh, K., & Watt, E. (2003). From ‘dependent on’ to ‘depended on’: The experience of transition from student to registered nurse in a private hospital graduate program. Australian Journal of Advanced Nursing, 21(1), 14—20. Goode, C. J., Lynn, M. R., McElroy, D., Bednash, G. D., & Murray, B. (2013). Lessons learned from 10 years of research on a post-baccalaureate nurse residency program. Journal of Nursing Administration, 43(2), 73—79. Hengstberger-Sims, C., Cowin, L. S., Eagar, S. C., Gregory, L., Andrew, S., & Rolley, J. (2008). Relating new graduate nurse competence to frequency of use. Collegian, 15, 69—76. Heywood, L., Gonczi, A., & Hager, P. (1992). A guide to development of competency standards for professions. Canberra: Australian Government Publishing Service. Istomina, N., Suominen, T., Razbadauskas, A., Martinkenas, A., Meretoja, R., & Leino-Kilpi, H. (2011). Competence of nurses and factors associated with it. Medicina-Lithuania, 47(4), 230—237. Kowalski, S., & Cross, C. L. (2010). Preliminary outcomes of a local residency programme for new graduate registered nurses. Journal of Nursing Management, 18(1), 96—104. Levett-Jones, T., & FitzGerald, M. (2005). A review of graduate nurse transition programs in Australia. Australian Journal of Advanced Nursing, 23(2), 40—45. McGrath, P., Anastasi, J., Fox-Young, S., Gorman, D., Moxham, L., & Tollefson, J. (2006). Collaborative voices: Ongoing reflections on nursing competencies. Contemporary Nurse: A Journal for the Australian Nursing Profession, 22(1), 46—58. Meretoja, R., & Koponen, L. (2011). A systematic model to compare nurses’ optimal and actual competencies in the clinical setting. Journal of Advanced Nursing, 68(2), 414—422. Meretoja, R., & Leino-Kilpi, H. (2003). Comparison of competence assessments made by nurse managers and practising nurses. Journal of Nursing Management, 11(6), 404—409.
Meretoja, R., Isoaho, H., & Leino-Kilpi, H. (2004). Nurse Competence Scale: Development and psychometric testing. Journal of Advanced Nursing, 47(2), 124—133. Meretoja, R., Leino-Kilpi, H., & Kaira, A. (2004). Comparison of nurse competence in different hospital work environments. Journal of Nursing Management, 12(5), 329—336. Mid Staffordshire NHS Foundation Trust. (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive summary. Retrieved June 24, 2013, from http://www. official-documents.gov.uk/document/hc1213/hc09/0947/ 0947.pdf Moriarty, J., Manthorpe, J., Stevens, M., & Hussein, S. (2011). Making the transition: Comparing research on newly qualified social workers with other professions. British Journal of Social Work, 41(7), 1340—1356. http://dx.doi.org/10.1093/bjsw/bcr031 Norman, I. J., Watson, R., Murrells, T., Calman, L., & Redfern, S. (2002). The validity and reliability of methods to assess the competence to practise of pre-registration nursing and midwifery students. International Journal of Nursing Studies, 39(2), 133—145. Oates, A. (2012, June). Early graduate nursing and midwifery program. Retrieved March 1, 2013, from http://www.health.vic.gov.au/nursing/furthering/graduate O’Leary, J. (2012). Comparison of self-assessed competence and experience among critical care nurses. Journal of Nursing Management, 20(5), 607—614. Ramritu, P. L., & Barnard, A. (2001). New nurse graduates’ understanding of competence. International Nursing Review, 48(1), 47—57. Roberts, K., & Farrell, G. (2003). Expectations and perceptions of graduates’ performance at the start and at the end of their graduate year. Collegian, 10(2), 13—18. Salisbury, E., & Frankel, A. (2012). Just how prepared can we expect new medical graduates to be. Postgraduate Medical Journal, 88(1041), 363—364. Salonen, A. H., Kaunonen, M., Meretoja, R., & Tarkka, M. T. (2007). Competence profiles of recently registered nurses working in intensive and emergency settings. Journal of Nursing Management, 15(8), 792—800. Thomson, S. (2011). Transition into practice: A comparison of outcomes between associate- and baccalaureate-prepared nurses participating in a nurse residency program. Journal for Nurses in Staff Development, 27(6), 266—271. Ulrich, B., Krozek, C., Early, S., Ashlock, C. H., Africa, L. M., & Carman, M. L. (2010). Improving retention, confidence, and competence of new graduate nurses: Results from a 10-year longitudinal database. Nursing Economics, 28(6), 363—375. Wangensteen, S., Johansson, I. S., Bjorkstrom, M. E., & Nordstrom, G. U. N. (2012). Newly graduated nurses’ perception of competence and possible predictors: A cross-sectional survey. Journal of Professional Nursing, 28(3), 170—181. While, A. E. (1994). Competence versus performance: Which is more important? Journal of Advanced Nursing, 20(3), 525—531. http://dx.doi.org/10.1111/j.1365-2648.1994.tb02391.x Wolff, A. C., Pesut, B., & Regan, S. (2010). New graduate nurse practice readiness: Perspectives on the context shaping our understanding and expectations. Nurse Education Today, 30(2), 187—191.
Please cite this article in press as: Lima, S., et al. How competent are they? Graduate nurses self-assessment of competence at the start of their careers. Collegian (2013), http://dx.doi.org/10.1016/j.colegn.2013.09.001