What Clinical Competencies Are Essential for New Nurses?

Grant Ely, PhD, MBA, RN

Innovation:

We started ReadyRNs.com to help hospitals, clinics, and nursing programs identify and prioritize the clinical content and competencies needed for new nurses and students to become ready to practice at their organization. As a result, residencies and curricula can be customized and streamlined, thousands of dollars can be saved on training, and nurses can be at patients' bedsides faster, providing high-quality care.

For the largest health care system in Washington state, we identified over 13,000 competencies that nurses use to care for patients in their medical-surgical units. We organized and ranked these competencies and presented the findings to the system’s medical-surgical experts. They concluded that new nurses would only need to master 421 specific nursing competencies (of the 13,000+) to be trusted with typical patient assignments in any of their medical-surgical units. This health care system can now focus its medical-surgical residencies on those specific competencies, creating highly effective student-centric training and assessments to ensure each new nurse is ready to independently and safely practice. Leaders and educators can utilize the other competencies to develop advanced training and continuing education for their experienced nurses.

Background:

After graduating, I landed my dream nursing job in an intensive care unit, but uneasiness and self-doubt about my clinical competency drove me to resign from the ICU within a year. As I have worked as a nurse and health care leader since that time, I observed that many new nurses feel underprepared, unsafe, and overwhelmed. My concern for new nurses motivated me to leave my leadership position and work on this solution to ensure that students are intellectually, technically, and emotionally prepared to care for patients before graduating. It has been my experience that how we perceive our nursing abilities is a large part of our self-worth as nurses. Therefore, we can contribute to nurses’ emotional wellness in part by focusing on improving student and new nurse intellectual and technical preparation.

The education-practice gap is still a leading issue in nursing. A five-year study of 5,000 newly graduated nursing students showed that only 23% could demonstrate entry-level competency and basic readiness to care for patients.¹ Through COVID, that number decreased to 9%.² The American Association of Colleges of Nursing concluded that nursing education needs new thinking and approaches to prepare students to be work-ready by graduation.³ Without this preparation, new nurses can experience high stress and commit practice errors, affecting patient health outcomes.⁴ Around 25% of new nurses quit during their first year on the job, which significantly affects patient care access and quality, and increases the burden for the nurses who remain behind.⁴

The first step toward practice readiness is determining what nurses must know and do clinically. By collaborating with hospitals and clinics, we can gather the diagnoses, surgeries, medications, labs, procedures, and nursing skills for each nurse specialty and practice setting. This collaboration will allow organizations to create innovative nursing residencies and curricula based on actual clinical data and update them regularly with the latest health care changes.

With a clear focus on what nurses need to know and do, organizations can implement competency-based education that reflects real-life nursing and assesses relevant competencies to ensure graduates are ready to care for patients. As a result of these changes, we expect nurse retention and patient care to significantly improve as new, well-trained nurses reinforce health care’s frontlines.

We can provide nursing students and new nurses with the preparation they need to become practice-ready. They need our help, and sooner or later, we will need theirs.

To My Fellow Nurse Innovators:

My advice to other nurse innovators is to realize your worth. You have invested your career in caring for others. Nurses are experts in what works well in health care because we spend more time with patients than probably any other discipline. Utilize that experience, intuition, and insight to address the gaps we encounter as we care for our patients. If you can think of your innovative idea like your patient, there is a high likelihood that you will figure out what you need to do to bring your vision to a healthy reality. That’s just what nurses do.

References:

1. Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses’ clinical reasoning. Nursing Education Perspectives, 38(2), 57‒62. https://doi.org/10.1097/01.nep.0000000000000112
2. Kavanagh, J., & Sharpnack, P. (2021). Crisis in competency: A defining moment in nursing education. OJIN: The Online Journal of Issues in Nursing, 26(1). https://doi.org/10.3912/ojin.vol26no01man02
3. American Association of Colleges of Nursing. (2021). The Essentials: Core competencies for professional nursing education. Retrieved October 6, 2021, from https://www.aacnnursing.org/AACN-Essentials
4. National Council of State Boards of Nursing. (2022). Transition to practice. NCSBN.org. Retrieved August 5, 2022, from https://www.ncsbn.org/transition-to-practice.htm