Clinical competency: perceptions of nursing interns and clinical mentors
Article Category: Original article
Publicado en línea: 26 mar 2024
Páginas: 105 - 110
Recibido: 12 abr 2023
Aceptado: 04 sept 2023
DOI: https://doi.org/10.2478/fon-2024-0011
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© 2024 Jackline Prathibha et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Competence is an important aspect of nursing care that has a major impact on the quality of nursing services given.1 Owing to the ongoing shortage of nurses and increasing patient acuity, there is a requirement for novice nurses to speedily master critical-thinking and psychomotor skills.2 When it comes to hiring nurses, one of the most common concerns healthcare administrators have is whether entry-level nurses are competent and ready to work in clinical settings. According to the World Health Organization (WHO), there is a global shortfall of over 4.3 million midwives and nurses.3 India is short of 1.94 million nurses.4 The previous study reports that newly hired nurses lack the clinical competency to operate in a clinical context, but they are also perceived by their clinical nurse mentors as nursing interns lacking in competency in clinical skills. In a survey conducted among 57,000 nurse supervisors, only 25% of supervisors were fully satisfied with the performance of novice nurses. The healthcare system wants newly hired nurses to develop quickly from a novice to a competent level, where they can work autonomously, due to the rising demand for excellent nursing care and nurse retention.5 Thus, student nurses need to be assessed for their ability to perform the required skills before they start working in the healthcare setting.6
Entry-level nurses will have restrictions to use technical skills and also may lack the skills to provide comprehensive patient care. They may also be stressed out as a result of reality shock caused by the gap between theory and practice. The demands placed by the physician and nursing superiors are high on newly joined nurses, and this causes emotional stress and strain affecting their physical well-being. If they are unsatisfied with their employment, burnout and excessive stress levels can result in them considering quitting their jobs. As a result, all the money spent on nursing training will be of naught.7 A study conducted among graduate nurses, who were about to complete their graduation, reveals that the existing evidence indicates a gap between theory and practice in achieving higher levels of clinical competency.8
During the process of transition, the unpreparedness of newly joined nurses for their professional role can be a broad consequence for the healthcare system and other nurses, which can lead to reduced-quality patient care.9 Authors in this study felt the need to understand the perception of clinical competency among nursing interns as well as consider the observations of clinical nurse mentors regarding the clinical competency of their respective nursing interns.
The study was conducted among nursing interns and clinical nurse mentors. The study aimed to assess the clinical competency of nursing interns and the perception of clinical nurse mentors toward student nurses’ clinical competency. A cross-sectional survey design was used for the study. A quantitative approach by using a cross-sectional survey design was used to collect the data from both nursing interns and clinical nurse mentors. Using an open-ended questionnaire, the data were collected from the clinical nurse mentors to assess the perception of nursing interns’ competency. The data were summarized descriptively.
The students who are in their final year of BSc and Diploma Nursing course, doing their 6 months of internship under registered nurses, and performing a variety of clinical and health-related duties in hospitals and other healthcare facilities were considered. Students and clinical nurse mentors were selected from a nursing academic institution located in the southern part of India. This academic institution provides education in Diploma Nursing, Baccalaureate in Nursing, Post Basic Nursing, Master in Nursing, and the Nurse practitioner course.
Students who are in their internship clinical posting during their course of nursing and the mentors who are involved with the intern students’ supervision are included in the study. All the nursing interns who were available during the data-collection period and who fulfilled the inclusion criteria were included in the study.
A purposive sampling method was used to select a total of 104 nursing interns, who work under registered nurses and performed a variety of clinical and healthrelated duties in the hospital, and 26 internship clinical nurse mentors of nursing institutions, who are involved in the supervision of nursing interns. All nursing interns and clinical nurse mentors available between January 2021, and April 2021, are included in the study.
Data collection tools were prepared separately for both nursing interns and clinical nurse mentors.
Items included in the sociodemographic
The demographic
Before data collection, a validation report from the experts for the survey instrument was collected, and the Cumulative Validity Index (CVI) was found to be 0.96. After administering the tool to 20 nursing interns, a reliability of 0.9 was established for the self-rated clinical competency tool using Cronbach’s alpha.
After obtaining informed consent, 104 participants were recruited for the study. The self-reported structured clinical competency tool was administered along with the demographic
Open-ended questions on the perception of clinical nurse mentors toward student nurses’ clinical competency were administered to 26 clinical nurse mentors of nursing interns using Google forms.
The Statistical Package for Social Sciences (SPSS Version 16.0, IBM Corporation, Armonk, New York, United States) was used for data storage, tabulation, and the generation of descriptive statistics. Participants’ demographic data and the self-reported clinical competency among nursing interns were presented as frequency and percentage. Data from the clinical nurse mentors were collected through Google forms using an open-ended questionnaire and were analyzed as per their opinions.
Consent and permission were obtained from the institutional ethical committee (IEC Number: 40/2019) and also from the head of the nursing institution. The CTRI registration was done—REF/2019/02/017875.
The number of nursing interns approached was 104; all of them filled the tool with a response rate of 100%.
Out of the 104 participants, 94 (90.4%) were females and 10 (9.6%) were males. Approximately 97% were under 22 years of age. Among the 104 nursing interns, 78 (75%) were graduates and 26 (25%) were diploma holders. All the participants (104, 100%) had exposure to different areas of nursing like Medical-Surgical, Pediatrics, Psychiatric, Obstetrics, and Community Health (Table 1).
Sociodemographic characteristics of the nursing interns (
| Characteristics | Frequency | Percentage (%) |
|---|---|---|
| Male | 10 | 9.6 |
| Female | 94 | 90.4 |
| 20–22 | 97 | 93.3 |
| 23–26 | 7 | 6.7 |
| Diploma | 26 | 25.0 |
| Graduates | 78 | 75.0 |
This tool included 5 major aspects of nursing practice, which included nursing assessment, IPR, nursing intervention, professional competency, and ethical consideration (Table 2).
Self-reported competency assessment of nurses interns (
| Areas | Incompetent | Competent |
|---|---|---|
| Basic nursing care | 7.7 | 96.6 |
| IPR | 39.6 | 89.2 |
| Drug administration and patient safety | 7.5 | 89.6 |
| Professional competency/accountability | 24.9 | 86.2 |
| Ethical components | 12.2 | 88.3 |
Basic nursing care included components such as identifying the patients, independent assessment of the patient, patient care as per the protocol, following infection control, and biomedical waste management. In total, 96.6% of the nursing interns expressed competency in basic nursing care. The IPR had various aspects like showing respect to the patient, communication, sensitivity to the patient and family, maintaining good IPR with coworkers, and providing collaborative care to the patient assessed. In total, 89.2% of students expressed to have developed competency in the IPR aspect. Drug administration and patient safety included independent administration of medication, application of knowledge of pharmacology, handling hospital equipment as per the guidelines, and practicing safe measures. In total, 89.6% expressed having developed competency in drug administration and patient safety. Professional competency comprising understanding the hospital protocol, safe handling of medical records, demonstrating involvement in nursing education, coordinating with other healthcare teams, maintaining confidentiality, reporting errors, and performing timely documentation was assessed. In total, 86.2% of nursing interns expressed having developed professional competency and accountability to practice in nursing care. Ethical components included professional conduct, assertiveness, following ethical principles in practice, and providing evidence-based care. Totally, 88.3% of student nurses expressed competency in following the ethical aspects of care.
In total, 26 internship clinical nurse mentors consented to their participation; among them 23 (88.5%) were females and 3 (11.5%) were males.
These data were collected through Google forms using an open-ended questionnaire. A total of 5 open-ended questions areas concerning the present internship, expected competency of students, clinical performance, measures to improve clinical competency, and areas of competency and incompetency were addressed as per the observations of clinical nurse mentors (Table 3).
Perception regarding nursing interns’ clinical competency by the clinical nurse mentors (
| 1. Do you think the present internship is helping the student to become competent in their professional practice? |
| Faculty members expressed that the present internship is helping the student to become competent as they are getting enough time to learn through one-to-one teaching. The internship also allowed them to practice their skills in critical care units and other clinical areas and independently take care of all kinds of patients under minimum clinical supervision. However, students were required to take the initiative to learn by having effective communication with the staff nurses in the ward, which would help them to become competent in professional practice. The faculty suggested that having students completely posted in the hospital would help make them more accountable and learn better in professional practice. |
| 2. What are the clinical competencies you are expecting from the intern student nurses? |
| Clinical nurse mentors considered that students should also be able to effectively communicate with the patient, family, and healthcare personnel and thereby maintain good IPR. Interns should be able to handle the patient independently and provide comprehensive care to the clients by applying evidence-based practice. Students should be able to provide individualized care for the patients, which includes assessment and identification of the patient’s needs and providing need-based and holistic care. Efficient documentation, waste management, patient safety, infection control, and medication aspects have been reported as essential for providing comprehensive care and being competent enough to practice effectively as an independent nurse at the bedside after the 4-year bachelor’s program. Thus, clinical nurse mentors felt that internships do play a major role in the students’ further professional growth. |
| 3. What areas do you think most of the interns are competent in? |
| Most of the nursing interns are competent in monitoring vital signs and providing nursing care, communication, IPR, patient safety, infection control, medication administration, and waste management. But few of the clinical nurse mentors felt that interns need repeating the hands-on experience. To develop competency in the clinical area, they should even learn to take individual responsibility. Very few students are found to be competent in providing comprehensive care for patients. Students should show the right attitude toward providing care for patients. It should not be done by force or compulsion. |
| 4. What areas do you think most of the interns are incompetent in? |
| Some areas were found to be lacking like fluid calculation and ABG analysis, documentation and critical care, in-depth need assessment, and advanced nursing procedures, which includes assessment of toxic signs, drug reactions, and side effects. Most of the students do not show much interest in communication with patients and health professionals, assertiveness, and application of knowledge to practice. |
| 5. What can be done to improve the clinical competency of intern students? |
| Clinical nurse mentors expressed that student placement may be determined based on the interests of individual students and that if they are carefully overseen by ward nurses, their performance will improve. The key to practice is motivating pupils to participate actively in ward routines and teaching them about the importance of fluid calculation and ABG analysis. Evaluating nursing interns’ performance in the clinical area along with the in-charge nurses was expressed as an effective measure of standard competency. Patient assignment to nursing interns is to be done as a buddy system in both general and critical areas. Along with being a part of the ward routine, students are supposed to be equally responsible for handing it over. It would be better if nursing interns are paid for their clinical duty; then, it would be good motivation in holding them accountable in clinical practice. Coordination between nursing institutes, clinical nurse mentors, hospitals, and students will benefit in improving students’ learning and competency development. Participation in in-service education and other leadership activities are equally important factors in improving medical and nursing knowledge. Case discussion could also provide the continuous learning and confidence to perform patient assessments and help identify the need and progress, which will allow them to actively contribute during physician rounds. |
In the present study, clinical nurse mentors expressed their views that the intern students needed to take the initiative to learn by having effective communication with the staff nurses in the ward, which would help them becoming competent in professional practice. In addition, the key to practice is motivating students to participate actively in ward routines and learning. Teaching them about the importance of fluid calculation and Arterial Blood Gas (ABG) analysis is helpful. Evaluation of students’ performance, alongside the charge nurses, is expressed as an effective measure of standard competency.
Characterizing experiencing engagement, creating a mutual relationship, and professional development emerged as sub-themes in a qualitative study conducted among 18 on nursing students’ experiences of learning at a clinical education ward after their clinical practice at a university hospital in Sweden. In addition, caring for patients with an extensive need for nursing care helped the students to become patientcentered and overcome the threshold, experience engagement, and authenticity in learning the profession.10
However, some of the studies showed the opposite trend. A cross-sectional study that was conducted in two nursing schools in Ethiopia resulted in half of the study interns perceiving themselves as incompetent.8
In the present study, clinical nurse mentors felt that interns are incompetent in areas like fluid calculation and ABG analysis, documentation and critical care, in-depth need assessment, and advanced nursing procedures— which include assessment of toxic signs, drug reactions, and side effects. A qualitative exploratory descriptive study developed having 105 participants in Portugal reported errors in the execution of care; errors shown by the students included medication errors; errors in transversal competencies; errors in identifying needs; errors in care assessment; and errors in care planning.11
The undergraduate nursing students’ experiences with clinical supervision were explored to obtain information from the student’s viewpoints. The findings indicated that nursing interns at the institution perceived to have competency in clinical practice in the areas like nursing assessment, IPR, intervention, professional competency, and ethical considerations. It was found that most of the students reported having gained adequate competency in practice, indicating that the internship helped them to practice nursing with confidence and efficiency. Considering the opinion of the clinical nurse mentors, student teaching in areas like fluid calculations, ABG documentation, and critical care aspects can be incorporated and emphasized more before they could come for practice. Active collaboration with institutions, clinical nurse mentors, and staff nurses is an essential key component in providing the best learning opportunities for the internship. The findings of this study may help create an inclusive culture of teaching, continuous assessment, and environments that support diversity and inclusive excellence in nursing education. Further studies can be done to assess the intern nurses’ clinical competencies in the clinical area, and competencies can be compared to the score obtained in their internship.
Active collaboration with institutions, supervisors, and staff nurses is an essential key component in providing the best learning opportunities for the internship. The areas in clinical practice that require focus can be addressed during the early training period of the student nurses. Perceptions of the students have given a way to understand the outcomes of clinical exposure during the internship. Perception of clinical nurse mentors elicited expectations regarding the clinical learning plan and the outcome of clinical postings for nursing interns.
The purposive sampling technique was one possible flaw in the current study. Second, because the data came from a single university, the conclusions are not generalizable. Also, the study relied on students’ self-reported data, which might have resulted in bias as a result of the respondent’s interpretation of the questions or desire to express their feelings, thus increasing the prevalence of the problem.