Today's health care is rapidly changing due to issues such as complex changes of disease structures, diverse needs of people, aging populations, low birthrates, and technological developments (Fukada, 2018; Karami, Farokhzadian, & Foroughameri, 2017). These complex conditions are a challenge for health practitioners, including nurses. Regardless of work setting, nurses are expected to increase their competence in nursing practice to ensure patient safety and security, to maintain quality care, and to improve nursing outcomes in their unit (Fukada, 2018). It is unarguable that the clinical competence of registered nurses is a fundamental element in the delivery of nursing care. Although competence has been widely discussed in the literature, there is still a degree of ambiguity in its definition. The number of concept analyses demonstrates the complexity of the concept (Garside & Nhemachena, 2013; Smith, 2012; Valloze, 2009). The definition of competence varies in different countries. In the United Kingdom, competence refers to the ability to do tasks within an occupation (Audenaert, Vanderstraeten, Buyens, & Desmidt, 2014), while in the United States, competence is defined as the individual characteristics and behaviors needed to perform required activities (Spencer & Spencer, 2008).
