New graduate nurses' clinical competence: A mixed methods systematic review.

AIM: To appraise and synthesize evidence of empirical studies reporting assessment of new graduate nurses' clinical competence in clinical settings. DESIGN: Mixed methods systematic review. DATA SOURCES: The search strategy included keywords relevant to: new graduate nurse; clinical competence; and competence assessment. The searched literature databases included CINAHL, MEDLINE, Embase, PsycINFO and Web of Science. The search was limited to full-text papers in English or French, published between 2010 -September 2019. REVIEW METHODS: Inclusion criteria were: 1) empirical studies; 2) detailed method and complete results sections; 3) competence assessment in clinical settings; and 4) new graduate nurses (≤24 months). Two independent reviewers screened eligible papers, extracted data and used the Mixed Methods Appraisal Tool framework for quality appraisal. Divergences were solved through discussion. RESULTS: About 42 papers were included in this review: quantitative (N = 31), qualitative (N = 7) and mixed methods (N = 4). Findings suggest that new graduate nurses exhibit a good or adequate level of competence. Longitudinal studies show a significant increase in competence from 0-6 months, but findings are inconsistent from 6-12 months. CONCLUSION: There are a multitude of quantitative tools available to measure clinical competence. This suggests a need for a review of their rigor. IMPACT: No recent reviews comprehensively synthesized the findings from new graduate nurses' clinical competence. This review has found that new graduate nurses' competence has been mostly assessed as good, despite the expectation that they should be more competent. Longitudinal studies did not always show a significant increase in competence. These findings can help nurse educators in providing more support to new graduate nurses throughout the transition period or design improved transition programme. This review also identified quantitative tools and qualitative methods that can be used for competence assessment.

Measurement properties of scales assessing new graduate nurses' clinical competence: A systematic review of psychometric properties.

BACKGROUND: New graduate nurses' competence is a concern for all healthcare organizations. Previous reports show heterogeneous levels of competency amongst them. As a positive association between competency and quality of care in clinical settings has been suggested, it is essential for researchers and clinicians to select valid, reliable, and responsive scales to assess new nurses' competence. However, a systematic evaluation of the measurement properties of scales measuring new nurses' competence had yet to be published. OBJECTIVE: To analyse, evaluate and synthesize the measurement properties of scales used to assess new nurses' clinical competence. DESIGN: A systematic psychometric review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methods. DATA SOURCES: The search strategy included a combination of keywords and thesaurus terms related to new graduate nurses, clinical competence, and competence assessment. Five databases were searched: Embase, CINAHL, MEDLINE, PsycINFO and Web of Science. The search was limited to full-text papers published in English or French, from 2010 to 2019. REVIEW METHODS: Two independent reviewers screened eligible papers, extracted data related to validity, reliability, and responsiveness of each scale, and evaluated the quality of their measurement properties as well as risk of bias in their psychometric evaluation. Divergences were solved through discussion. RESULTS: Ten scales were included: eight original scales, one culturally adapted and one modified. Of these scales, eight were developed or adapted in the 2010s decade and the other two scales were developed earlier. Most scales are divided into 6 to 8 subscales and use an adjectival scale with either 4, 5 or 7 points. The content validity study of all scales in this review was deemed to be doubtful or inadequate quality. Reliability was almost exclusively assessed by calculating the internal consistency with Cronbach's alpha coefficient which gives no information on equivalence or stability of the measure. Responsiveness was never properly assessed in the reviewed studies. CONCLUSIONS: There is little evidence on the measurement properties for each scale regarding their validity and reliability; responsiveness was not assessed for any scale. Every scale evaluated in this review had different characteristics (length, subscales, response options). Therefore, selection of the most appropriate scale depends on the context and purpose of the assessment. Prospero registration number: CRD42018109711 Tweetable Abstract: Systematic review of scales measuring new nurses' competence: we must do better and conduct more validity/reliability testing of existing scales.

Clinical nursing leadership educational intervention for first-year nursing students: A qualitative evaluation.

Clinical nursing leadership is critical for quality care. All nurses including students should receive clinical nursing leadership education. Research pertaining to educational strategies on clinical leadership for nursing students remains sparse. The aim of this paper is to report the qualitative evaluation of a co-constructed educational intervention on clinical nursing leadership, developed for 1st year preregistration nursing students. The research question was "what are the components of an educational intervention that support the development of clinical nursing leadership in 1st year nursing students?". The intervention included videos, brainstorming, journal entries on students' clinical leadership paired with the observation of a nurse's clinical leadership. A research and development model guided the study. Focus groups and individual interviews were conducted with 23 students and 6 educators who tested the intervention. Thematic analysis revealed three intervention components that supported learning: visual examples at the student's level, observation of role models and animated discussions in small groups. Visual examples and observation of role models supported learning by expanding student's initial views of nursing beyond a technical role to one that is embedded with clinical nursing leadership. Animated discussions in small groups helped students learn to speak up and be open to other's opinions.

Experiences of nursing students and educators during the co-construction of clinical nursing leadership learning activities: A qualitative research and development study.

BACKGROUND: Student voice posits that students' unique perspectives on teaching and learning can be used in conjunction with those of educators to create meaningful educational activities. OBJECTIVE: The study aimed to describe nursing students' and educators' experiences during the co-construction of educational activities involving clinical nursing leadership. DESIGN: Qualitative research and development model. SETTING: The study was conducted at a French-Canadian nursing faculty that provides a 3-year undergraduate program. PARTICIPANTS: Five undergraduate nursing students, four nursing educators, and the principal investigator formed the co-construction team. METHODS: Data collected included all documents (written and audio) related to the co-construction process: three 2-hour team meetings, PI's fieldnotes and a focus group discussion that occurred once the co-construction process was completed. Thematic analysis was performed guided by Paillé and Muchielli's (2010) method. RESULTS: Data analysis revealed two interrelated themes: (1) unique, purposeful collaboration and (2) change that makes a difference. A space described as safe, without hierarchy and that included the "right" people helped the team achieve their objective of creating new educational activities on clinical nursing leadership. The two new learning activities developed by the team were perceived as useful for future nursing students. At the individual level, team members appreciated how co-construction helped them understand teaching and learning from new perspectives. CONCLUSIONS: A structured, efficient co-construction process contributed to positive changes in the nursing program and participants. Additional research is required to enhance understanding of the factors that facilitate and hinder student-educator collaboration outside the classroom.

A cognitive learning model of clinical nursing leadership.

Cognitive modeling of competencies is important to facilitate learning and evaluation. Clinical nursing leadership is considered a competency, as it is a "complex know-act" that students and nurses develop for the quality of care of patients and their families. Previous research on clinical leadership describes the attributes and characteristics of leaders and leadership, but, to our knowledge, a cognitive learning model (CLM) has yet to be developed. The purpose of our research was to develop a CLM of the clinical nursing leadership competency, from the beginning of a nursing program to expertise. An interpretative phenomenological study design was used 1) to document the experience of learning and practicing clinical leadership, and 2) to identify critical-learning turning points. Data was gathered from interviews with 32 baccalaureate students and 21 nurses from two clinical settings. An inductive analysis of data was conducted to determine the learning stages experienced: awareness of clinical leadership in nursing; integration of clinical leadership in actions; active leadership with patient/family; active leadership with the team; and, embedded clinical leadership extended to organizational level and beyond. The resulting CLM could have significant impact on both basic and continuing nursing education.