Development of clinical competence – a longitudinal survey of nurse practitioner students

Abstract

Background In order to achieve a sustainable standard of advanced clinical competence for nurse practitioners leading to a credible role, it is important to investigate the development of clinical competence among nurse practitioner students. Aim The aim of the present study is to analyse the development of nurse practitioner students’ self-assessed clinical competence from the beginning of their education to after completion of their clinical studies. Design The study involved the application of a longitudinal survey design adhering to STROBE guidelines. Methods The participants consisted of 36 registered nurses from a nurse practitioner programme at a Norwegian university. The Professional Nurse Self-Assessment Scale II was used for data collection during the period August 2015 to May 2020. Results The students developed their clinical competence the most for direct clinical practice. Our findings are inconclusive in terms of whether the students developed clinical competence regarding consultation, coaching and guidance, and collaboration. However, they do indicate a lack of development in some aspects of clinical leadership. The students with the lowest level of clinical competence developed their clinical competence regarding direct clinical practice significantly more than the students with the highest level of clinical competence. The differences between students with high and low levels of clinical competence were levelled out during their education. Thus, the students as a whole became a more homogenous group after completion of their clinical studies. Previous work experience in primary healthcare was a statistically significant, yet minor, predictor of the development of clinical competence. Conclusion Our findings indicate that the students developed their clinical competence for direct clinical practice in accordance with the intended learning outcomes of the university’s Master’s programme and international standards for nurse practitioners. It is imperative that the clinical field supports nurse practitioners by facilitating extended work-task fits that are appropriate to their newly developed clinical competence. We refrain from concluding with a recommendation that prior clinical work experience should be an entry requirement for nurse practitioner programmes. However, we recommend an evaluation of the nurse practitioner education programme with the aim of investigating whether the curriculum meets the academic standards of clinical leadership expected in advanced level of nursing.

Exploring the Impact of Virtual Reflection Groups on Advanced Practice Nurse Students During the COVID-19 Pandemic: Focus Group Study With Master’s Students

“…Another study found that the greatest development of competence was in relation to direct clinical practice. Although the students entered the program with different levels of competence, this was largely equalized during their education in the master’s program [ 26 ]. The data from the focus group in our study showed that the learning outcomes from the VRGs strengthened the students’ critical thinking skills in the process of developing their competence, in particular by taking increased responsibility for leading professional discussions.…”

“…APN students also need to learn medical subjects while maintaining a holistic approach that includes providing patient-centered care, which is the foundation of nursing [ 7 ]. Developing clinical decision-making is another important aspect of clinical competence [ 26 , 27 ]. APNs are experts in nursing who have extended their medical knowledge while retaining their unique nursing character [ 7 ].…”

Clinical learning opportunity in public academic hospitals: A concept analysis

“…The problem that drove the research study was the ambiguous and unclear meaning of clinical learning opportunity that created challenges and uncertainties for nurse educators, CETU personnel and operational managers in the clinical areas. The student nurses were not provided with sufficient CLOs and practical experiences to meet their clinical learning goals (Mothiba et al 2020;Motsaanaka et al 2020;Taylor et al 2021). The uncertainties and challenges led to the poor professional development of the student nurses (Berhe & Gebretensaye 2021).…”

“…Furthermore, student nurses became despondent and demotivated, leading to frustration, increased absenteeism and prolonged length of study due to inadequate CLOs (Berhe & Gebretensaye 2021;Motsaanaka et al 2020). Exposure to real-life practice settings, experiences and clinical activities provides opportunities that will facilitate clinical learning to bridge the gap between theory and practice and prepare the student nurses to develop the qualifications of a clinically competent, independent, professional nurse practitioner (Taylor et al 2021;Zulu, Du Plessis & Koen 2021). Motsaanaka et al (2020) also report that clinical exposure to learning opportunities will develop the student nurses' clinical competencies in higher-order thinking skills (HOTS).…”

“…Despite the critical discussions on the importance and various applications of CLOs in literature, there is a lack of clarity in its definition and understanding as a concept (Stoffels et al 2021;Walker & Avant 2019). A lack of clear definition and misunderstanding of the concept created challenges for nursing educators, clinical education and training unit (CETU) personnel, and operational managers in providing student nurses with adequate exposure to clinical teaching, learning and positive practical experiences (Taylor et al 2021). The ambiguous and abstract nature of the concept of CLOs was defined and clarified to capture its contextual intricacies and to help improve the global standards of professional clinical education in the practice-based profession (Baker, Cary & Bento 2021;Shaterjalali et al 2018;WHO 2020).…”