Saturday, 9 January 2016

Becoming a competent nurse

Roger Watson, Editor-in-Chief

Are nurses ready to 'hit the ground running' when they graduate or does competence continue to develop once they enter clinical practice?  I have long suspected the latter and that was certainly my own experience in the transition from student to staff nurse.  If that is the case then it means that nurses are not fully prepared for practice when they graduate but that they develop after they start working.  Hopefully, they have a set of competencies that enable safe practice in most environments but as they specialise and settle down in one particular area of practice, they continue to learn.  This all seems very logical but it is hard to demonstrate and has recently been demonstrated in an Australian study by Lima et al. (2015) titled: 'Development of competence in the first year of graduate nursing practice: a longitudinal study' and published in JAN.  The study aimed to 'determine the extent to which competence develops in the first year of nursing practice' and this was carried out working with children.  The study is unique because, as identified by the authors: 'there have been few studies that have used a standardized tool to determine the development of professional nursing competence in the first year of practice'. I have to admit a special interest in this article due to my own work - some published in JAN - on competence which was cited in the article (Redfern et al. 2002, Watson et al. 2002, Chen & Watson 2011).

The study used the 73-item Nurse Competence Scale and administered it to 47 nurses entering practice with children at 3, 6 and 12 months after entry.  Using some very sophisticated statistical analysis involving mixed effects modelling - which takes into account baseline differences, missing data and time - the outcome of the study, in the words of the authors was that: 'Graduate nurses showed significant gains in competence in the first 6 months of transition from nursing students to Registered Nurses.'  There were gains after 6 months which were not statistically significant.  As the authors conclude: 'It is important to recognize the degree of competence of newly Registered Nurses and beyond. There must be support and professional development opportunities in place to facilitate ongoing development of competence, ensuring the safety of both the newly Registered Nurses and the patients for whom they care during this period of transition.'

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Reference

Chen Y, Watson R (2011) A review of clinical competence assessment in nursing Nurse Education Today 31, 832–836

Lima S, Newall F, Jordan HL, Hamilton B, Kinney S (2015) Development of competence in the first year of graduate nursing practice: a longitudinal study Journal of Advanced Nursing doi: 10.1111/jan.12874

Redfern S, Norman I, Calman L, Watson R, Murrells T.(2002) Assessing competence to practise in nursing: a review of the literature Research Papers in Education 17, 51–77

Watson R, Stimpson A, Topping A, Porock D (2002) Clinical competence assessment in nursing: a systematic review of the literature Journal of Advanced Nursing 39, 421–431

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