Sustaining the nursing workforce - exploring enabling and motivating factors for the retention of returning nurses: a qualitative descriptive design.

BACKGROUND: The nursing shortage represents a persistent and urgent challenge within the healthcare industry. One of the most cost-effective and time-efficient solutions to address this issue is the recruitment of inactive nurses to rejoin the nursing workforce, while simultaneously ensuring the long-term sustainability of their careers following their return to work. The aim of this study is to explore the factors that facilitate the retention of nurses who have returned to work, from their perspective. METHODS: To achieve this aim, a qualitative descriptive design was employed. A total of 15 registered nurses who had not practiced nursing for a minimum of three years prior to their return to work, and had been working as nurses for at least three months following their return, were selected from seven healthcare institutions using convenience sampling. Face-to-face or online semi-structured interviews were conducted, and qualitative inductive analysis was employed to analyze the collected data. RESULTS: The analysis revealed five key themes, two of which were related to the enabling factors making it possible for the nurses to continue their work, while the remaining three pertained to the motivating factors driving the pursuit of professional careers. The two themes associated with enabling factors were identified as "Conditions and support that sustain work-life balance" and "A workplace that acknowledges my career, and encourages my growth as an experienced nurse". The three themes related to motivating factors were entitled "Pride in reconnecting with and contributing to society," "Cultivating confidence through incremental professional development and future envisioning," and "Enrichment of my own and my family's life". CONCLUSIONS: Returning nurses constitute a valuable asset for healthcare institutions. To effectively retain these nurses, it is crucial to implement multi-dimensional approaches that enable and motivate them to sustain and enrich their professional and personal lives while continuing their work in the nursing field.

Exploring nurses' clinical judgment concerning the relative importance of fall risk factors: A mixed method approach using the Q Methodology.

BACKGROUND: Nurses are pivotal in averting patient falls through their assessment of cues presented by patients and their environments, rendering clinical judgments regarding the risk of falling, and implementing tailored interventions. Despite the intricate cognitive processes entailed in nurses' judgment, no prior studies have explored their approach to assessing the risk of falling. OBJECTIVE: This study aimed to examine how nurses judge the risk of falling among patients with different conditions, whether there are differences in the importance of risk factors as judged by nurses, how they justify their judgments, and what attributes of the nurses influence their judgments. DESIGN: A mixed method approach using the Q Methodology was employed. SETTING(S): Three public and private hospitals in Japan. PARTICIPANTS: Eighteen nurses participated in the study. METHODS: Participants were tasked with ranking 36 patient scenarios, each featuring a distinct set of fall risk factors. Subsequently, post-sorting interviews were conducted to gather insights into their typical approach to assessing fall risk and the rationale behind their ranking decisions. A by-person principal component factor extraction was employed to examine differences in the rankings of the scenarios. The interview data were analyzed descriptively to elucidate the reasons behind these discrepancies. RESULTS: Nurses engage in complex cognitive manipulations when evaluating the risk of patient falls, drawing extensively from their wealth of experience while utilizing assessment tools to support their judgments. In essence, nurses identify patients' tendency to act alone without calling a nurse, impaired gait and cognition, sedative use, drains, and limited information sharing among healthcare professionals as key fall risks. In addition, nurses vary in the importance they attribute to certain risk factors, leading to the discrimination of three distinct judgment profiles. One group of nurses judges patients with cognitive impairment and acting alone as high risk. Another group of nurses considers patients with unstable gait and acting alone as high risk. The last group of nurses sees patients wearing slippers as high risk. The post-sorting interviews revealed that their judgments are closely related to the healthcare context and patient population. CONCLUSIONS: Nurses operate within diverse contexts, wherein they interact with patients of varying characteristics, collaborate with professionals from diverse disciplines, and have access to varying levels of human and physical resources. This nuanced understanding empowers the formulation of judgments that are finely attuned to the specific context at hand. STUDY REGISTRATION: Not registered.

Falls as the result of interplay between nurses, patient and the environment: Using text-mining to uncover how and why falls happen.

Objectives: This study aimed to explore, from the perspectives of nurses, how patients, the environment, and the practice of nurses interact with each other to contribute to patient falls. Methods: A retrospective review of incident reports on patient falls, registered by nurses between 2016 and 2020, was conducted. The incident reports were retrieved from the database set up for the project of the Japan Council for Quality Health Care. The text descriptions of the "background of falls" were extracted verbatim, and analyzed by using a text-mining approach. Results: A total of 4,176 incident reports on patient falls were analyzed. Of these falls, 79.0% were unwitnessed by nurses, and 8.7% occurred during direct nursing care. Document clustering identified 16 clusters. Four clusters were related to patients, such as the decline in their physiological/cognitive function, a loss of balance, and their use of hypnotic and psychotropic agents. Three clusters were related to nurses, and these included a lack of situation awareness, reliance on patient families, and insufficient implementation of the nursing process. Six clusters were concerned with patients and nurses, including the unproductive use of a bed alarm and call bells, the use of inappropriate footwear, the problematic use of walking aids and bedrails, and insufficient understanding of patients' activities of daily living. One cluster, chair-related falls, involved both patient and environmental factors. Finally, two clusters involved patient, nurse, and environmental factors, and these falls occurred when patients were bathing/showering or using a bedside commode. Conclusions: Falls were caused by a dynamic interplay between patients, nurses, and the environment. Since many of the patient factors are difficult to modify in a short time, the focus has to be placed on nursing and environmental factors to reduce falls. In particular, improving nurses' situation awareness is of foremost importance, as it influences their decisions and actions to prevent falls.

The relationships between the types of learning approaches used by undergraduate nursing students and their academic achievement: A systematic review and meta-analysis.

Identifying and promoting an appropriate learning approach among nursing students is important in nursing education. The objective of this study was to examine the relationship between undergraduate nursing students' approaches to learning and their academic achievement. A systematic review with a quantitative synthesis was conducted. Abstract searches of CINAHL, MEDLINE, PubMed, ERIC and Scopus were conducted in November 2020 to identify the relevant publications. In total, 11 studies involving 12 cohorts were identified as eligible for the meta-analysis. Based on nine studies with 10 cohorts (N = 1830), a significant positive relationship between the deep approach to learning and academic achievement was identified, with the summary effect size of r = 0.259 [95% CI: 0.184, 0.330]. In addition, based on 11 studies with 12 cohorts (N = 2138), a significant negative correlation between the surface approach to learning and academic achievement was found, with the summary effect size of r = -0.247 [95% CI: -0.318, -0.174]. Higher education institutions should encourage the use of the deep approach and discourage the surface approach to learning by utilising appropriate educational instructions and assessment methods.

Exploring factors that motivate nursing students to engage in skills practice in a laboratory setting: A descriptive qualitative design.

OBJECTIVES: The aim of this study was to explore factors that motivate students to engage in skills practice in a laboratory setting, and to identify their motivation types and the regulatory styles. METHODS: Semi-structured interviews were conducted with 23 nursing students from three universities between November 2017 and January 2018. A thematic analysis was used to identify factors associated with students' motivation to engage in skills practice in a laboratory. The types and the regulatory styles of student motivation were identified based on the self-determination theory. RESULTS: Seven motivating factors were identified. These factors included the students' desire "to acquire the skills necessary to work as a nurse", the "desire to improve skills in preparation for clinical practicum", and their felt "obligations to patients as a nurse". Moreover, "the impetus to study arising from the objective evaluation of oneself and others" and "wanting to pass the skills examination" motivated the students to engage in skills practice. A "learning environment that facilitates students' learning" and the "supportive involvement of educators" facilitated their learning. Based on the self-determination theory, the students were found to embrace extrinsic motivation with four regulatory styles of motivation, namely integrated, identified, introjected, and external regulation. CONCLUSIONS: Nurse educators should understand the motivating factors of students, and help students embrace a more internally controlled motivation by helping them envision their future careers as nurses, and by fostering their ethical duty to care for patients.

What educators could do to facilitate students' use of a deep approach to learning: A multisite cross-sectional design.

BACKGROUND: Despite the proliferation of diverse teaching methods, it is uncertain which teaching components have enhanced students' approach to learning and in what way these components have produced positive outcomes. OBJECTIVES: The aim of the study was to examine how the students' perceptions of learning activities, the acquisition of relevant knowledge, and educators' enthusiasm/supportive attitudes impact on the students' adoption of the deep approach to learning. DESIGN: A multisite cross-sectional design. SETTINGS: Two universities in Japan. PARTICIPANTS: Undergraduate nursing students (n = 154). METHODS: Questionnaires, which included the Teaching Approach Scale and the Japanese version of the Learning Approach Scale, were given to the students. Data were analysed by path analysis. RESULTS: The students' perceptions of learning activities were positively related to their use of a deep approach to learning. Moreover, this relationship was completely mediated by their perceptions of knowledge acquisition and educators' enthusiastic and supportive attitudes. CONCLUSIONS: The findings suggest that learning activities must be reinforced by appropriate educator support that enables students to acquire relevant knowledge and feel that learning is interesting and enjoyable. Without such support, interest and active engagement incurred by learning activities may quickly disappear, and learning activities may not lead to a change in the students' approach to learning.

Coping Strategies for Self-perceived Burden Among Advanced Cancer Patients.

BACKGROUND: Self-perceived burden (SPB) causes stress and negatively impacts the quality of life and mental health of patients. It is important to identify effective coping methods to reduce SPB when supporting advanced cancer patients. OBJECTIVE: To qualitatively elucidate advanced cancer patients' strategies for coping with SPB. METHODS: Eleven participants with advanced cancer were recruited from 2 palliative care units. The data were collected through semistructured interviews and analyzed by content analysis. RESULTS: One of the coping strategies that advanced cancer patients used to reduce their SPB was "making individual efforts to deal with their own circumstances." This category included subcategories: "making proactive action," "expressing their gratitude verbally," "suppressing their feelings," "searching for positive meanings," and "avoiding thinking about the burden on their families." Another coping strategy used was "exploring the solutions with their family," which consisted of one subcategory and indicated an open dialogue between patients and their families to reach acceptable and mutual decisions about patient care. CONCLUSION: Nurses should not only support patients' efforts to tackle the situation by themselves, but also help the family as a whole to tackle problems together. By facilitating meaningful dialogue between family members, patients' feelings of SPB can be alleviated. IMPLICATIONS FOR PRACTICE: Nurses should facilitate dialogue between patients and their family members in order to help them discover solutions to reduce their SPB and to find positive meanings in the caregiving-receiving situation.

Students' perceptions of teaching factors that demotivate their learning in lectures and laboratory-based skills practice.

OBJECTIVES: The objective of this paper is to report students' perceptions of factors that demotivated their learning in lectures and laboratory-based skills practice settings. METHODS: A total of 23 students were recruited from the Bachelor of Nursing courses at three Japanese universities, using purposive sampling. A semi-structured interview was conducted with each participant between November 2017 and January 2018 to elicit their perceptions about which aspects of the teaching context demotivated their engagement in learning. The results were analyzed using thematic analysis. RESULTS: Three themes were generated: a restrictive environment, discouraging attitudes and discouraging teaching approaches. CONCLUSIONS: To prevent students from experiencing demotivation, teachers in the nursing faculty need to manage learning resources more effectively, create a quiet and focused atmosphere to allow students to concentrate, and be enthusiastic about teaching. They also need to add value to their classes, help students to follow lectures, and ensure that the workload they give their students is appropriate.

The factors related to self-other agreement/disagreement in nursing competence assessment: Comparative and correlational study.

BACKGROUND: While assessment made by nurses of themselves (self-assessment) and assessment made of them by others (other-assessment) provide unique and valuable information as to individual nurses' competence, the subjective nature of both assessments often causes a disagreement between them. This is problematic when educational interventions to foster nurses' competence are designed. However, the question of what factors contribute to the self-other disagreement in competence assessment has rarely been investigated in nursing. OBJECTIVES: The aims of this study were to compare competence assessments made by nurses with that by others, and to investigate what types of demographic variables of nurses and others, and which personality traits of nurses were associated with the self-other agreement/disagreement in the competence assessment. DESIGN: A cross-sectional survey design. SETTINGS: Three hospitals in Japan. PARTICIPANTS: A total of 1167 registered nurses, who were practising in these three hospitals, were invited to participate in the study. The inclusion criteria of the participants were as follows: 1) currently working in an inpatient department, and 2) directly involved in patient care. METHODS: The survey package included two sets of questionnaires: one for self-assessment and the other for other-assessment, each of which was accompanied by an ID number for matching. Collected data were analysed using a Wilcoxon signed-rank test to compare the scores on competence assessed by nurses and others, and using multiple regression to examine the relationships between the demographics, personality traits, and the degree of self-other disagreement. RESULTS: A total of 207 matched questionnaires were obtained. The results showed that the scores on the assessment made by others were statistically significantly higher than those made by nurses of themselves. Moreover, regression analysis suggested that the age of nurses (i.e., younger nurses) and that of others (i.e., older evaluators), and nurses' personality traits of conscientiousness and extraversion were statistically significantly related to the agreement in self-other competence assessment. CONCLUSIONS: Nurse managers need to understand which factors contribute to self-other disagreement in competence assessment, and to identify a way to precipitate mutual agreement between them. By doing so, both nurses and managers can comprehend nurses' own strengths and weaknesses, and can determine educational needs and goals regarding nurses' competence development.

Effects of nurses' personality traits and their environmental characteristics on their workplace learning and nursing competence.

AIM: A good fit between an individual's personality traits and job characteristics motivates employees, and thus enhances their work behavior. However, how nurses' personality traits and their environmental characteristics relate to nurses' engagement in workplace learning, which improves their competence, has not been investigated. The aim of this study was to investigate how nurses' personality traits, environmental characteristics, and workplace learning were related to nursing competence. METHODS: A cross-sectional survey design was used. Questionnaires were distributed to 1167 Japanese registered nurses. Multiple regression analysis was used to examine the relationships between nurses' personality traits, the environmental characteristics, the nurses' engagement in workplace learning, and their competence. RESULTS: A total of 315 nurses returned questionnaires (i.e., a return rate of 27.0%). The results showed that both the personality traits (extraversion, conscientiousness, openness to experience) and environmental characteristics (autonomy at work and feedback given) were related to workplace learning and self-rated nursing competence. The results also showed that the relationship between extraversion (active, adventurous and ambitious dispositions of an individual) and self-rated nursing competence was moderated by environmental characteristics, and partially mediated by workplace learning. CONCLUSION: Positive personality traits, such as extraversion, conscientiousness, and openness to experience could enhance workplace learning and nursing competence. Moreover, environmental characteristics that allow nurses to express their personality traits have the potential to improve their learning and competence further.

Pregabalin reduces cisplatin-induced mechanical allodynia in rats.

Although cisplatin (CDDP) is a key drug in cancer chemotherapy, CDDP-induced peripheral neuropathy is a dose-limiting factor. We previously reported that CDDP-induced peripheral neuropathy, which progressed from allodynia to hypoalgesia, was ameliorated by the administration of CDDP to rats at a specific time. However, mechanical allodynia cannot be prevented therapeutically. Pregabalin (PGN) is used to suppress neuropathic pain from herpes zoster and diabetes. Therefore, we investigated the effects of PGN on CDDP-induced mechanical allodynia in rats. CDDP (4 mg/kg) was administered intravenously to male Sprague-Dawley rats at 5:00 once a week for 2 weeks, while saline was given to the control group. PGN (10 mg/kg/day) was administered orally twice a day at 8:00 and 20:00, and distilled water was given to the control group. The von Frey and hot-plate tests were performed to assess CDDP-induced peripheral neuropathy. Withdrawal thresholds were significantly greater than those in with the CDDP alone group when PGN was administered before and after the onset of CDDP-induced mechanical allodynia. Furthermore, CDDP-induced mechanical allodynia was suppressed by the administration of PGN only. These results demonstrate that PGN effectively ameliorates CDDP-induced mechanical allodynia during the administration of PGN.

Effects of Nurses' Perceptions of Actual and Demanded Competence on Turnover Intentions.

With the growing focus on continuous professional development, demands placed on nurses to uphold nursing competence have been increasing. This study examined how nurses with different lengths of clinical experience perceived the relationship between their actual competence and the competence they felt was demanded of them, and how this relationship was related to their turnover intentions. Survey questionnaires were distributed to 1,377 nurses, of whom 765 returned usable completed forms. The results showed that across all the groups of clinical experience, nurses perceived the demanded competence levels to be higher than their actual competence levels. However, turnover intentions were not related to nurses' perceptions of demanded competence and were negatively related to perceptions of actual competence. The levels of competence demanded should not be considered as threats for nurses. Improving nurses' competence may reduce their turnover intentions.

Development and examination of the psychometric properties of the Learning Experience Scale in nursing.

This paper examines the psychometric properties of the Learning Experience Scale. A survey method was used to collect data from a total of 502 nurses. Data were analyzed by factor analysis and the known-groups technique to examine the construct validity of the scale. In addition, internal consistency was evaluated by Cronbach's alpha, and stability was examined by test-retest correlation. Factor analysis showed that the Learning Experience Scale consisted of five factors: learning from practice, others, training, feedback, and reflection. The scale also had the power to discriminate between nurses with high and low levels of nursing competence. The internal consistency and the stability of the scale were also acceptable. The Learning Experience Scale is a valid and reliable instrument, and helps organizations to effectively design learning interventions for nurses.

Retaining the nursing workforce: factors contributing to the reduction of nurses' turnover intention in Japan.

AIM: The aim of this study was to investigate the effects of psychological contract fulfilment, perceived advancement opportunities and age on reducing the turnover intention of nurses in Japan. BACKGROUND: The factors that contribute to and mitigate the intentions of nurses to leave their organisations need to be investigated to understand the determinants of nurse turnover better. However, there is a paucity of studies identifying these mitigating factors. METHODS: Potential participants were 1337 registered nurses and midwives, of whom 766 participated in the study (a return rate of 57%). The data were analysed using a moderated regression analysis. RESULTS: Fulfilment of the psychological contract and perceived advancement opportunities independently and jointly contributed to a reduction in nurses' turnover intentions. The results also showed that nurses' ages were negatively correlated with their turnover intentions. CONCLUSIONS: Fulfilment of the psychological contract and advancement opportunities are important for reducing nurses' turnover intentions, especially among younger nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Clear guidelines/evaluations of contributions made by nurses and their organisations are needed to enhance the experience of nurses in terms of psychological contract fulfilment. Moreover, a structured advancement support system needs to be implemented to reduce nurses' turnover intentions.

The relationship between workplace learning and midwives' and nurses' self-reported competence: a cross-sectional survey.

BACKGROUND: Nurses have to maintain and improve their nursing competence in order to provide the best patient care possible. Workplace learning has the potential to improve nursing competence. Previous studies have examined the effect of training on competence development. However, the effects of other aspects of learning, such as learning from practice, feedback, reflection, and from others have not been investigated previously. Furthermore, it is uncertain what methods of learning nurses with different clinical experience adopt and how these learning methods relate to their self-reported competence. OBJECTIVES: The objectives of this study were to identify the methods of learning used by less and more experienced nurses, and to explore what methods of workplace learning would be associated with the self-reported competence of both groups of nurses. DESIGN: A cross-sectional survey design was utilised. SETTINGS: The study was conducted at two university-affiliated hospitals in Japan. PARTICIPANTS: A convenience sample of 954 nurses/midwives (hereafter referred to as nurses), who were involved in direct patient care, were recruited and 494 nurses returned usable questionnaires. METHODS: A survey method was used to collect data. The Holistic Nursing Competence Scale, the Learning Experience Scale and the Japanese version of Rosenberg's Self-esteem Scale, along with demographic questions, were included in the questionnaire. Hierarchical regression analysis was conducted to investigate the relationship between learning and nurses' self-evaluation of competence. This analysis was carried out for less experienced nurses (≤5 years of clinical experience) and experienced nurses (>5 years of experience). RESULTS: The results showed that learning was correlated with the levels of competence that nurses considered they had. When the specific types of learning were examined in relation to self-reported competence, there were a similarity and differences between less and more experienced nurses. For both groups of nurses, learning through reflection was found to relate to their self-reported competence. In addition, learning through practice and learning from others were positively correlated with the self-reported competence of less experienced nurses, while learning from feedback and training were positively associated with the self-reported competence of experienced nurses. CONCLUSION: Learning from reflection may be useful for both less and more experienced nurses by allowing them to embrace a positive view of their competence. Moreover, creating opportunities to experiment and observe others' practice can be profitable for less experienced nurses, while offering training opportunities and feedback can be beneficial for experienced nurses.

Investigating the adequacy of the Competence-Turnover Intention Model: how does nursing competence affect nurses' turnover intention?

AIMS AND OBJECTIVES: The aim of this study was to test the adequacy of the Competence-Turnover Intention Model, which was developed to identify how nursing competence could affect nurses' turnover intention (nurses' intention to voluntarily leave an organisation). BACKGROUND: Recent studies have suggested that the level of nursing competence is negatively related to nurses' intention to leave their jobs, suggesting that a lack of competence threatens both the quality and quantity of the nursing workforce. However, the mechanism of how nursing competence affects nurses' turnover intention has not been explored previously. DESIGN: A cross-sectional survey design was used. METHODS: Surveys were distributed to 1337 Japanese registered nurses/midwives in October, 2013. The adequacy of the model was analysed using structural equation modelling. RESULTS: In total, 766 questionnaires were returned, with a return rate of 57%. The model fitted well with the data. The results showed that the level of nursing competence was related positively to the quantity of organisational rewards they felt they had received, and negatively related to the level of exhaustion they experienced. Moreover, the perceived organisational rewards and exhaustion were correlated with nurses' turnover intention through affective commitment. CONCLUSIONS: The Competence-Turnover Intention Model is useful for explaining how nursing competence impacts on their turnover intention. RELEVANCE TO CLINICAL PRACTICE: Clinical implications derived from the findings are that: promoting nursing competence is key to improving not only the quality of care provided by nurses, but also to retaining the nursing workforce, and the model can be used to develop strategies that would mitigate their turnover intention.

Competence development as perceived by degree and non-degree graduates in Japan: a longitudinal study.

BACKGROUND: A degree programme is believed to prepare graduates with a higher level of competence than their diploma counterparts. However, there have been inconsistent findings reported as to whether or not degree-graduates outperformed those who take diplomas. OBJECTIVES: This study aimed to identify graduates' perceptions of competence development in their first year of employment, and to compare the competence levels of graduates with different educational backgrounds. DESIGN: This study adopted a longitudinal design. SETTINGS: This study has been performed in five hospitals in Japan. PARTICIPANTS: 122 Japanese graduates participated in this study. METHODS: The self-assessed competence of the graduates was collected in the 3rd, 6th, 9th, and 12th months of their employment using a survey method. The data were analysed using a linear mixed model. RESULTS: The results suggested that the graduates perceived their competence to be rapidly growing during the first half of the graduate year, and slowly later. The results also indicated that the graduates' perception of their competence showed a significant variation. The most striking finding of the study was that, on average, the non-degree graduates rated their competence higher than their degree counterparts. CONCLUSIONS: The current university orientation on emphasising intellectual and theoretical components of education, with less focus on practical components might have led to the development of lower competence among the BN graduates. A fine balance between theoretical and practical components needs to be established in a university curriculum.

Impact on perceived postnatal support, maternal anxiety and symptoms of depression in new mothers in Nepal when their husbands provide continuous support during labour.

BACKGROUND: when a husband provides continuous support during his wife's labour, his presence is considered effective in reducing her dissatisfaction with the childbirth process. The impact of this on the postnatal well-being of a new mother, however, is not clear. OBJECTIVE: to examine the impact on postnatal support, maternal anxiety and symptoms of depression experienced by new mothers in Nepal when their husband supported them continuously during labour. METHOD: the study involved 231 Nepali women, of whom 77 were supported continuously by their husbands, 75 by female friends, and 79 were not supported by any companion during childbirth. They were contacted at six to eight weeks post partum, when postpartum support questionnaires, a state-trait anxiety inventory and the Edinburgh postnatal depression scale were administered. Structural equation modelling was conducted. FINDINGS: observations showed that continuous support from a husband during his wife's labour was related to a greater degree of postnatal support than those who were not supported by their husband during labour (ß=0.23, p<0.001). Similarly, the more the women considered they were being supported, the less likely they were to experience maternal anxiety (ß=-0.52, p<0.001), which in turn was associated with a lower level of depression (ß=0.43, p<0.001). These findings were consistent, even after adjustments for the effect of female support during the postnatal period. CONCLUSION: the study suggests that continuous support from husbands during labour has a direct impact on the perceived postnatal support, and an indirect impact on anxiety and depression in new mothers in Nepal.

The relationship between the levels of nurses' competence and the length of their clinical experience: a tentative model for nursing competence development.

AIMS AND OBJECTIVES: To explore the relationship between the levels of nurses' competence and the length of their clinical experience, in order to provide a tentative model of the continuing competence of nurses. BACKGROUND: The professional development of employees has attracted great interest. This interest has led to the development of various models that illustrate how employees develop their competence throughout their careers. However, little is known of how nurses maintain and develop their competence throughout their career pathways. DESIGN: A cross-sectional design was used. METHODS: Using a survey method, five dimensions of self-assessed nursing competence and the length of the nurses' clinical practice were measured (n = 325). Each dimension of competence was plotted against the length of their clinical experience using locally weighted scatterplot smoothing. Then, the shapes of the plots were analysed by fractional polynomial regression analysis. RESULTS: Overall, the relationships between the levels of nursing competence and the length of clinical experience were illustrated by curves with a rapid increase in competence levels at the early stage of the nursing career and a slower increase later. These curves were modelled by either a logarithmic, square-root function or its reciprocal. The results supported the learning curve model. CONCLUSIONS: The competence development of nurses may be characterised by two distinctive periods: a rapid growth period followed by stable periods. However, the modality of the growth may be different depending on which dimension of nursing competence is in focus. RELEVANCE TO CLINICAL PRACTICE: The level of nursing competence directly affects the quality of care provided to patients. The findings of the study enable healthcare organisations to take proactive approaches to enhance nurses' competence by identifying when and how to assist nurses.