Aim To assess self‐reported clinical competence and the need for further training among newly graduated registered nurses (NGRNs) working in Swedish acute care hospital settings. Background NGRNs are expected to take full responsibility for patients' nursing care in an increasingly complex clinical context, and professional nurses' clinical competence is critical in providing high‐quality and safe nursing care. Design A cross‐sectional design. Methods Data were collected using the 50‐item ProffNurse SAS II. A total of 85 NGRNs who had recently commenced working with direct patient care at three hospitals in central Sweden participated in the study. The response rate was 69%. The STROBE cross‐sectional reporting guidelines were used. Results The NGRNs assessed their clinical competence as being highest in areas relating to team collaboration and ethics and lowest in areas relating to professional development and direct clinical practice. The need for further training was greatest in areas such as direct clinical practice and patient safety and lowest in areas such as team collaborating and ethics. Conclusion The use of instruments to identify NGRNs' self‐assessed clinical competence is of value when designing and evaluating introductory programmes for NGRNs taking on positions in acute care hospital settings. The availability of experienced nurses from whom NGRNs can gain clinical competence and learn from is of importance, both from the perspective of the NGRNs themselves and patient safety. Relevance to clinical practice An understanding of NGRNs' clinical competence and their need for further training may assist in both planning and organising nursing programmes and in making clinical policy decisions when designing introduction programmes in acute care settings.

Aims and objectives To explore newly graduated registered nurses' experiences and how they manage complex patient situations. Background Newly graduated registered nurses' working in acute care hospital settings are challenged by managing complex patient situations in rapidly changing clinical contexts involving increased patient acuity, comorbidities and staffing shortages. Design Qualitative study design. Methods Data were collected using focus groups interviews of a total of 16 newly graduated registered nurses with clinical work experience of 6 months of direct patient care in an acute care hospital setting. Analyses were conducted using qualitative content analysis. COREQ reporting guidelines were used. Results The analysis resulted in the overarching theme “Not being sufficiently prepared and supported to meet responsibilities and demands.” The theme included three categories: “Responsibility is not in proportion to competence,” “Lack of medical competence and experience complicates patient safety” and “Strives for control to manage and organise nursing care.” Conclusion The results show that newly graduated registered nurses' are not sufficiently supported for the level of responsibility and the demands placed on them when providing nursing in complex patient situations in acute care hospital settings. If they are given sole responsibility for multiple complex patient situations, patient safety may be compromised. Relevance to practice Special attention need to be paid to NGRNs support to medical competence in the areas of assessing, planning, prioritizing, leading, and distributing nursing care in daily clinical settings for at least their first year of professional work.

Aim To explore and describe changes in self‐assessed clinical competence and the need for further training among newly graduated Registered Nurses during their first 15 months of professional work in acute care hospital settings. Design Quantitative longitudinal design. Methods The 50‐item Professional Nurse Self‐Assessment Scale of clinical core competencies II was used. A total of 45 newly graduated Registered Nurses answered the questionnaire at four different occasions. Data were collected after 2, 5, 9 and 15 months of working experience. Result The components “ethical decision‐making,” “cooperation and consultation” and “clinical leadership” were rated highest in clinical competence and lowest in need for further training. The components “professional development” and “critical thinking” were rated lowest in clinical competence and “direct clinical practice” rated highest in need for further training. The clinical competence increased significant between 9–15 months, with the exception of “critical thinking” and need for further training decreased significantly between 9–15 months, with the exception of “critical thinking.”

Older people with prolonged pain suffered from a low health-related quality of life. Pain interfered with their lives and contributed to diminished control in their daily lives. Nurses are essential for the identification and prevention of pain and should be aware of how pain affects older people's physical, mental and social health.

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