Self-assessed level of competence of graduating nursing students and factors related to it

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Summary

Background

The transition from a nursing student to a professional nurse is both challenging and stressful. Competence of graduating nursing students is related to patient safety and there is a need for assessment of competence. However, there is a lack of research on the level of competence at the moment of graduation.

Objectives

To describe the level of competence of graduating nursing students based on students' self-assessments and to identify possible related factors.

Design

Cross-sectional survey design.

Methods

The data were collected using an on-line survey (the Nurse Competence Scale) in 2011 and administered to 302 graduating nursing students in Finland practicing in their final clinical placement in university hospitals. The sample contained 154 students (response rate 51%). The data were analyzed statistically.

Results

The self-assessed overall competence was on good level (66.7, VAS 0-100). The competence was highest in helping role and in diagnostic functions, being slightly lower in therapeutic interventions and work role. Pedagogical atmosphere during the final clinical placement had a statistically significantly positive correlation with the overall level of competence.

Conclusions

Graduating nursing students have good competence at the moment of graduation based on their self-assessments. Self-assessment is a basis for competence development, and systematic self-assessments should be used during the education. Teacher and supervisor assessments and knowledge-tests could be used alongside with self-assessments of competence to give a wider picture of the competence.

Introduction

Upon graduating, nursing students are expected to have adequate competence to be able to fulfill their duties safely and effectively. The competence of graduating nursing students (hereafter students) is related to professional standards, patient safety and the quality of nursing care, and there is a need for assessment of competence in health care (WHO, 2008). In the literature, there are studies concerning nurses' level of competence (e.g. Meretoja et al., 2004a, Cowan et al., 2007, Andrew et al., 2008), but only few studies report the level of competence near the moment of graduation (e.g. Bartlett et al., 2000, Hengstberger-Sims et al., 2008, Wangensteen et al., 2012).

The transition from a nursing student to a professional nurse is both challenging and stressful (Clare and van Loon, 2003, Mooney, 2007). The term “reality shock” by Kramer (1974) describes the transition from student to qualified nurse by three phases, as well as the conflict between the qualification expectations and the actual reality of work. According to previous studies, 13% to 30% of new nurses have changed jobs after the first year (Bowles and Candela, 2005, Kovner et al., 2007), and this trend is in evidence throughout Europe (Flinkman et al., 2008, Aiken et al., 2012). The awareness of nurse responsibility differs between students and graduated nurses (Wangensteen et al., 2008), and recently registered nurses are not prepared for this responsibility (Ross and Clifford, 2002).

The aim of this study was to describe the level of competence of students at the moment of graduation based on students' self-assessments and to identify possible factors related to competence. The verification of the level of competence of students at the moment of graduation is part of quality assurance of nursing education. The results of this study are useful for developing the curricula of nursing education and new nurses' practical work orientation and mentorship programs aimed to reduce intentions to leave nursing.

Section snippets

Background

The concept of competence in nursing is multidimensional (Meretoja et al., 2002, Watson et al., 2002, Cowan et al., 2005). In the literature, competence in general has been defined in terms of “the ability to perform the task with desirable outcomes under the varied circumstances of the real world” (Benner, 1982, p. 304). In this study, competence is defined in terms of functional adequacy and the capacity to integrate knowledge, skills, attitudes and values in specific contextual situations of

Aim

The aim of this study was to describe the level of competence of students at the moment of graduation based on students' self-assessments and to identify possible factors related to competence. Two research questions were answered:

  • 1)

    What is the level of competence of students based on their self-assessments?

  • 2)

    What factors are related to the level of competence?

Design

The study design was a cross-sectional survey design using a structured questionnaire.

Sample

This study was conducted in Finland, where nurse

Sample Characteristics

A total of 154 students participated in this study. The age of the respondents ranged from 21 to 49 years (mean = 25.5 years, SD 5.1), and 90% of the participants were female (Table 2).

Level of Competence of Students

The level of competence ranged from 59.4 to 75.6 and the mean was 66.7 (Table 3). Over half (62.9%) of the students assessed their level of competence as good (VAS > 50–75) and 25.8% as very good (VAS > 75–100). The highest assessments were in the helping role (VAS 75.6) and the lowest assessments were in work role (VAS

Discussion of Results

Overall, the students assessed their competence on good level. The level is somewhat higher than reported on the competence of practicing nurses (Salonen et al., 2007, Hengstberger-Sims et al., 2008, Wangensteen et al., 2012) (Table 3). These scores suggest that, as far as students' perceptions of their level of competence are concerned, the curricula of nursing education meet their objectives. However, it has to be borne in mind that during their clinical placements, students are practicing

Conclusion

This knowledge from students, in addition to recently graduated nurses, nurses with work experience and nurse managers, could contribute to discussion as to how to develop new nurses' competence and how to support them during the orientation process. The pedagogical atmosphere in the clinical learning environment was seen to be an important factor relating to the level of competence. During the final clinical placement students prepare for the transition into independent practice. Systematic

Conflict of Interest

None of the authors have personal or financial relationships that influence the study.

Acknowledgments

We would like to thank all the graduating nursing students who participated in this study and the contact teachers in all polytechnics in Finland who kindly helped with the data collection.

The study was supported by the Finnish Nurses Association and the Finnish Concordia Fund and Sairaanhoitajien koulutussäätiö.

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