The respondents were between 22 and 67 years old (mean 33), including 234 (88 %) females and 32 (12 %) males with a mean experience as an RN of 6 years (0-44) (Table 1). All respondents worked in hospital somatic medical and surgical contexts. The total mean score for self-assessed competence (A-scale) was 7.59 (median 8, range 8) of a possible 10 points, and the total mean score for the need for further training (B-scale) was 5.6 (median 6, range 9) of a possible 10 points.
Table 1. Demographic variables (n = 266)
|
N (%)
|
Mean (SD)
|
Median (min-max)
|
Female
Male
|
234 (88)
32 (12)
|
|
|
Age, years
|
|
33.3 (11.5)
|
28 (22-67)
|
Educational level
Registered nurse
Specialist nurse
|
235 (88)
31 (12)
|
|
|
Years as RN
≤ 0.5 year
> 0.5 - 5 years
≥ 6 years
|
129 (48.5)
61 (22.9)
76 (28.6)
|
6 (10.3)
|
0.75 (0-44)
|
Self-assessed competence
The RNs assessed their competence highest in statements related to cooperation with other health professionals, taking full responsibility, and acting ethically (Table 2). The respondents assessed their competence lowest for statements related to assessing patients’ health needs by telephone (mean 4.50), giving health promotion advice and recommendations to patients by telephone (mean 4.73), and improving a creative learning environment for staff at the workplace (mean 5.58).
Table 2. Self-assessment of competence (A scale) = top 10 items
|
Item
|
Content
|
Mean
|
SD
|
1
|
37
|
I consult other professional experts when required
|
9.37
|
1.066
|
2
|
32
|
I take full responsibility for my own actions
|
9.24**
|
1.222
|
3
|
24
|
I act ethically when caring for patients
|
9.05
|
1.069
|
4
|
28
|
I maintain an ethical approach towards my colleagues
|
8.98
|
1.117
|
5
|
39
|
I am cognisant of when my medical knowledge is insufficient when assessing patients’ health conditions
|
8.95
|
1.365
|
6
|
23
|
I take patients’ physical health needs (illness, pain, disabilities, etc.) into account when assessing and planning for the health and life situation of patients
|
8.83
|
1.185
|
7
|
38
|
I cooperate actively with other health professionals when coordinating patients’ nursing, care and treatment
|
8.62
|
1.493
|
8
|
34
|
I understand the consequences my decisions may have for patients
|
8.61*
|
1.479
|
9
|
10
|
I utilise medical equipment in an appropriate and accurate manner
|
8.53*
|
1.404
|
10
|
29
|
I take active responsibility for creating a good working environment
|
8.42*
|
1.730
|
Items in bold – significant differences between length of professional experience (ANOVA)
*p < 0.05
** p < 0.01
Splitting the sample in RNs with a) ≤ 0.5 year (Group A), b) >0.5-5 years (Group B), and c) ≥ 6 years (Group C) experience, the analyses of variance demonstrated statistically significant differences in self-assessed competence (A-scale) for 35 out of the 50 items (Table 3). Looking further into differences between the groups the post hoc test of these 35 items demonstrated statistically significant differences between all three groups for four items (statements related to medication and treatment, quality development and routine improvement), between group A/C and B/C, for 14 items, between group A/B and A/C for one item, and between group A/C for 16 items (Table 3). RNs with ≥ 6 years of experience assessed their competence higher than group A and B for all 35 items. RNs with >0.5-5 years’ experience assessed their competence higher than RNs in group A in five items (statements related to medication and treatment, quality development, routine improvement and making own decisions). The level of self-assessed competence increased with increased years of experience.
Table 3. Self-assessment of competence (A-scale). Statistical significant differences between groups based on experience as a nurse. ANOVA and post hoc Tukey.
Item
|
Significant differences between groups
|
Mean difference
|
p
|
1
|
I am independently responsible for health assessment (systematic physical examination), examinations and treatment of patients with complicated medical conditions +
|
+++
|
A/C: -1.447
B/C: -1.011
|
A/C: .000
B/C: .001
|
2
|
I am independently responsible for health assessment (systematic physical examination), examinations and treatment of patients with uncomplicated medical conditions
|
+++
|
A/C:-1.146
B/C: -.667
|
A/C: .000
B/C: .024
|
3
|
I plan and prioritise nursing and medical interventions
|
+
|
A/C: -.633
|
A/C: .005
|
4
|
I identify patients’ health problems
|
+++
|
A/C: -1.110
B/C: -.849
|
A/C: .000
B/C: .004
|
5
|
I assess patients’ symptoms
|
+++
|
A/C: -.904
B/C: -.586
|
A/C: .000
B/C: .034
|
6
|
I evaluate and modify patients’ medical treatment
|
+++
|
A/C: -1.127
B/C: -.670
|
A/C: .000
B/C: .031
|
7
|
I exclude differential diagnoses when assessing patients’ health conditions
|
+++
|
A/C: -1.318
B/C: -.914
|
A/C: .000
B/C: .012
|
8
|
I interpret, analyse and reach alternative conclusions about patients’ health conditions after a detailed mapping of health history and health assessment (physical examination)
|
+++
|
A/C: -.979
B/C: -1.030
|
A/C: .000
B/C: .001
|
9
|
I apply both subjective and objective methods when examining, treating and caring for patients
|
+
|
A/C: -.981
|
A/C: .000
|
10
|
I utilise medical equipment in an appropriate and accurate manner
|
+
|
A/C: -.648
|
A/C: .004
|
11
|
I have knowledge of the effects of medication and treatment for the patients I am responsible for
|
++++
|
A/B: -.905
B/C: -.805
A/C: -1.711
|
A/B: .003
B/C: .022
A/C: .000
|
12
|
I identify changes in patients’ health and medical conditions
|
+++
|
A/C: -.969
B/C: -.729
|
A/C: .000
B/C: .013
|
14
|
I systematically gather information from each patient about her/his health resources
|
+
|
A/C: -.668
|
A/C: .017
|
15
|
I have knowledge of the interactions of various types of medication and what side-effects they may cause for the patients I am responsible for
|
++++
|
A/B: -1.347
B/C: -.874
A/C: -2.221
|
A/B: .000
B/C: .036
A/C: .000
|
16
|
I generate a creative learning environment for staff at my workplace
|
+++
|
A/C: -1.775
B/C: -1.129
|
A/C: .000
B/C: .015
|
17
|
I participate in quality development at my workplace
|
++++
|
A/B: -1.552
B/C: -1.236
A/C: -2.788
|
A/B: .000
B/C: .012
A/C: .000
|
18
|
I take responsibility for competence development at my workplace
|
+
|
A/C: -.700
|
A/C: .016
|
19
|
I improve routines/systems that fail to meet the needs of patients at my workplace
|
++++
|
A/B: -1.414
B/C: -1.057
A/C: -2.471
|
A/B: .000
B/C: .027
A/C: .000
|
20
|
I am actively responsible for my own professional development
|
+
|
A/C: -.785
|
A/C: .009
|
27
|
I support and guide patients in mastering their illnesses and health problems
|
+
|
A/C: -.597
|
A/C: .035
|
29
|
I take active responsibility for creating a good working environment
|
+
|
A/C: -.803
|
A/C: .004
|
31
|
I make my own decisions in my work
|
++
|
A/B: -.646
A/C: -1.203
|
A/B: .032
A/C: .000
|
32
|
I take full responsibility for my own actions
|
+
|
A/C: -.705
|
A/C: .000
|
33
|
I am correct and accurate in speech and writing
|
+++
|
A/C: -1.099
B/C: -.851
|
A/C: .000
B/C: .012
|
34
|
I understand the consequences my decisions may have for patients
|
+
|
A/C: -.577
|
A/C: .019
|
35
|
I experience a division of responsibility between the physician and me as a nurse
|
+++
|
A/C: -1.211
B/C: -1.221
|
A/C: .000
B/C: .003
|
36
|
I cooperate well with the physician
|
+++
|
A/C: -.715
B/C: -.824
|
A/C: .010
B/C: .013
|
40
|
I document the steps taken in assessing patients’ needs for nursing, care and treatment
|
+
|
A/C: -.746
|
A/C: .001
|
41
|
I reflect on my actions
|
+
|
A/C: -.633
|
A/C: .005
|
43
|
I perceive opportunities and have visions for how nursing and clinical paths for patients can be developed
|
+
|
A/C: -1.016
|
A/C: .002
|
44
|
I have a vision of how nursing should be developed at my workplace
|
+
|
A/C: -1.234
|
A/C: .000
|
45
|
I assess patients’ health needs by telephone
|
+++
|
A/C: -1.815
B/C: -1.651
|
A/C: .000
B/C: .003
|
46
|
I give health promotion advice and recommendations to patients by telephone
|
+++
|
A/C: -2.103
B/C: -1.964
|
A/C: .000
B/C: .000
|
47
|
I give health promotion and illness preventive recommendations in accordance with national guidelines to patients
|
+
|
A/C: -1.153
|
A/C: .004
|
50
|
I report all incidents in accordance with the actual patient safety system
|
+
|
A/C: -1.873
|
A/C: .000
|
Groups based on experience as a nurse: Group A: ≤ 0.5 years, Group B: > 0.5 - 5 years, Group C: ≥ 6 years
+Significant differences between group A/C
++Significant differences between group A/B and A/C
+++Significant differences between group A/C and group B/C
++++Significant differences between all groups (i.e. A/C, A/B, B/C)
Need for further training
Regarding the need for further training, the highest mean scores were found for statements related to medications competence; illness and preventive recommendations to patients; and giving health promotion advice by telephone (Table 4). The lowest mean scores (i.e. competence they needed the least) were found in statements related to cooperation (mean 4.02), acting ethically (mean 4.18), and taking full responsibility (mean 4.25).
Table 4. Self-assessment of need for further training (B scale) = top 10 items (i.e. competence needed most)
|
Item
|
Content
|
Mean
|
SD
|
1
|
15
|
I have knowledge of the interactions of various types of medication and what side-effects they may cause for the patients I am responsible for
|
7.29**
|
2.336
|
2
|
47
|
I give health promotion and illness preventive recommendations in accordance with national guidelines to patients
|
6.83*
|
2.496
|
3
|
46
|
I give health promotion advice and recommendations to patients by telephone
|
6.76**
|
2.782
|
4
|
7
|
I exclude differential diagnoses when assessing patients’ health conditions
|
6.73**
|
2.342
|
5
|
11
|
I have knowledge of the effects of medication and treatment for the patients I am responsible for
|
6.69**
|
2.620
|
6
|
45
|
I assess patients’ health needs by telephone, e-mail or other electronic devices
|
6.64**
|
2.856
|
7
|
8
|
I interpret, analyse and reach alternative conclusions about patients’ health conditions after a detailed mapping of health history and health assessment (physical examination)
|
6.54**
|
2.277
|
8
|
19
|
I improve routines/systems that fail to meet the needs of patients at my workplace
|
6.43**
|
2.486
|
9
|
1
|
I am independently responsible for health assessment (systematic physical examination), examinations and treatment of patients with complicated medical conditions
|
6.34**
|
2.390
|
10
|
16
|
I generate a creative learning environment for staff at my workplace
|
6.33**
|
2.593
|
Items in bold – significant differences between length of professional experience (ANOVA)
*p < 0.05
** p < 0.01
Splitting the sample in RNs with a) ≤ 0.5 year (Group A), b) >0.5-5 years (Group B), and c) ≥ 6 years (Group C) experience, the analyses of variance demonstrated statistically significant differences for self-assessed need for further training for 46 out of the 50 items. The two items where no significant differences were found either for the A-scale or B-scale contains statements related to having an ethical approach. Looking further into the differences between the groups the post hoc test of the 46 items demonstrated statistically significant differences between all three groups for six items (statements related to health assessment, medical treatment, examinations, differential diagnoses, and incident reports), between group A/C and B/C for nine items, between group A/B and A/C for 19 items; and between group A/C for 12 items (Table 5). RNs with ≥ 6 years of experience assessed their needs for further training lower than group A and B for all 46 items. RNs with >0.5-5 years’ experience assessed their needs for further training lower than RNs in group A in 25 items (table 5). The self-assessed need for further training decreased with increased years of experience.
Table 5. Need for further learning (B-scale). Statistical significant differences between groups based on experience as a nurse. ANOVA and post hoc Tukey.
Item
|
Significant differences between groups
|
Mean difference
|
P
|
1
|
I am independently responsible for health assessment (systematic physical examination), examinations and treatment of patients with complicated medical conditions
|
+++
|
A/C: 1.715
B/C: 1.109
|
A/C: .000
B/C: .016
|
2
|
I am independently responsible for health assessment (systematic physical examination), examinations and treatment of patients with uncomplicated medical conditions
|
++++
|
A/B: 1.063
B/C: 1.023
A/C: 2.086
|
A/B: .013
B/C: .039
A/C: .000
|
3
|
I plan and prioritise nursing and medical interventions
|
++
|
A/B: 1.411
A/C: 1.984
|
A/B: .001
A/C: .000
|
4
|
I identify patients’ health problems
|
++
|
A/B: 1.390
A/C: 2.161
|
A/B: .001
A/C: .000
|
5
|
I assess patients’ symptoms
|
++
|
A/B: 1.311
A/C: 2.056
|
A/C: .002
B/C: .000
|
6
|
I evaluate and modify patients’ medical treatment
|
++++
|
A/B: 1.107
B/C: 1.052
A/C: 2.159
|
A/B: .012
B/C: .038
A/C: .000
|
7
|
I exclude differential diagnoses when assessing patients’ health conditions
|
++++
|
A/B: .810
B/C: 1.216
A/C: 2.026
|
A/B: .049
B/C: .005
A/C: .000
|
8
|
I interpret, analyse and reach alternative conclusions about patients’ health conditions after a detailed mapping of health history and health assessment (physical examination)
|
+++
|
A/C: 1.593
B/C: 1.016
|
A/C: .000
B/C: .022
|
9
|
I apply both subjective and objective methods when examining, treating and caring for patients
|
++++
|
A/B: .996
B/C: 1.024
A/C: 2.020
|
A/B: .013
B/C: .023
A/C: .000
|
10
|
I utilise medical equipment in an appropriate and accurate manner
|
+
|
A/C: 1.115
|
A/C: .014
|
11
|
I have knowledge of the effects of medication and treatment for the patients I am responsible for
|
++
|
A/B: 1.613
A/C: 2.249
|
A/B: .000
A/C: .000
|
12
|
I identify changes in patients’ health and medical conditions
|
++++
|
A/B: .944
B/C: 1.228
A/C: 2.172
|
A/B: .029
B/C: .008
A/C: .000
|
13
|
I develop and administer health-promoting and illness-preventive actions for patients
|
+++
|
A/C: 1.811
B/C: .993
|
A/C: .000
B/C: .046
|
14
|
I systematically gather information from each patient about her/his health resources
|
++
|
A/B: 1.266
A/C: 1.707
|
A/B: .002
A/C: .000
|
15
|
I have knowledge of the interactions of various types of medication and what side-effects they may cause for the patients I am responsible for
|
++
|
A/B: 1.466
A/C: 2.045
|
A/B: .000
A/C: .000
|
16
|
I generate a creative learning environment for staff at my workplace
|
+
|
A/C: 1.542
|
A/C: .000
|
17
|
I participate in quality development at my workplace
|
+
|
A/C: 1.408
|
A/C: .001
|
19
|
I improve routines/systems that fail to meet the needs of patients at my workplace
|
+++
|
A/C: 1.794
B/C: 1.187
|
A/C: .000
B/C: .015
|
21
|
I take patients’ mental health needs (mood swings, feelings of hopelessness, depression, etc.) into account when assessing and planning for the health and life situation of patients
|
++
|
A/B: 1.168
A/C: 1.454
|
A/B: .009
A/C: .000
|
22
|
I take patients’ spiritual health needs (feelings of meaninglessness, existential needs, beliefs, fear of death, etc.) into account when assessing and planning for the health and life situation of patients
|
++
|
A/B: 1.007
A/C: 1.634
|
A/B: .036
A/C: .000
|
23
|
I take patients’ physical health needs (illness, pain, disabilities, etc.) into account when assessing and planning for the health and life situation of patients
|
++
|
A/B: 1.096
A/C: 1.012
|
A/B: .025
A/C: .029
|
25
|
I identify and assume responsibility for patients’ own health resources in planning nursing care
|
+
|
A/C: 1.149
|
A/C: .007
|
26
|
I take patients’ social health needs (leisure activities, friends, financial situation, etc.) into account when assessing and planning for the health and life situation of patients
|
+++
|
A/C: 1.927
B/C: 1.110
|
A/C: .000
B/C: .031
|
27
|
I support and guide patients in mastering their illnesses and health problems
|
+
|
A/C: 1.590
|
A/C: .000
|
29
|
I take active responsibility for creating a good working environment
|
+
|
A/C: 1.132
|
A/C: .014
|
30
|
I put emphasis on patients’ own wishes when assessing and planning for nursing care and medical treatment
|
++
|
A/B: 1.007
A/C: 1.380
|
A/B: .048
A/C: .002
|
31
|
I make my own decisions in my work
|
++
|
A/B: 1.359
A/C: 2.450
|
A/B: .006
A/C: .000
|
32
|
I take full responsibility for my own actions
|
++
|
A/B: 1.547
A/C: 2.137
|
A/B: .002
A/C: .000
|
33
|
I am correct and accurate in speech and writing
|
+
|
A/C: 2.111
|
A/C: .000
|
34
|
I understand the consequences my decisions may have for patients
|
++
|
A/B: 1.367
A/C: 2.322
|
A/B: .006
A/C: .000
|
35
|
I experience a division of responsibility between the physician and me as a nurse
|
+++
|
A/C: 2.503
B/C: 1.626
|
A/C: .000
B/C: .003
|
36
|
I cooperate well with the physician
|
+++
|
A/C: 1.948
B/C: 1.392
|
A/C: .000
B/C: .011
|
37
|
I consult other professional experts when required
|
++
|
A/B: 1.123
A/C: 1.504
|
A/B: .033
A/C: .001
|
38
|
I cooperate actively with other health professionals when coordinating patients’ nursing, care and treatment
|
++
|
A/B: 1.571
A/C: 1.681
|
A/B: .001
A/C: .000
|
39
|
I am cognisant of when my medical knowledge is insufficient when assessing patients’ health conditions
|
+
|
A/C: 1.420
|
A/C: .004
|
40
|
I document the steps taken in assessing patients’ needs for nursing, care and treatment
|
++
|
A/B: 1.468
A/C: 1.714
|
A/B: .003
A/C: .000
|
41
|
I reflect on my actions
|
++
|
A/B: 1.238
A/C: 1.681
|
A/B: .011
A/C: .000
|
42
|
I analyse and evaluate my work continuously
|
+
|
A/C: 1.676
|
A/C: .000
|
43
|
I perceive opportunities and have visions for how nursing and clinical paths for patients can be developed
|
+
|
A/C: 1.716
|
A/C: .000
|
44
|
I have a vision of how nursing should be developed at my workplace
|
+
|
A/C: 1.541
|
A/C: .000
|
45
|
I assess patients’ health needs by telephone
|
+++
|
A/C: 1.702
B/C: 1.657
|
A/C: .000
B/C: .004
|
46
|
I give health promotion advice and recommendations to patients by telephone
|
+++
|
A/C: 1.901
B/C: 1.989
|
A/C: .000
B/C: .000
|
47
|
I give health promotion and illness preventive recommendations in accordance with national guidelines to patients
|
+
|
A/C: 1.082
|
A/C: .015
|
48
|
I have a supportive ongoing dialogue with patients about their needs and wishes
|
++
|
A/B: 1.295
A/C: 1.869
|
A/B: .005
A/C: .000
|
49
|
I focus on relatives’ need for support and guidance
|
++
|
A/B: 1.045 A/C: 1.989
|
A/B: .035
A/C: .000
|
50
|
I report all incidents in accordance with the actual patient safety system
|
++++
|
A/B: 1.681
B/C: 1.294
A/C: 2.975
|
A/B: .000
B/C: .020 A/C: .000
|
Groups based on experience as a nurse: Group A: ≤ 0.5 years, Group B: > 0.5 - 5 years, Group C: ≥ 6 years
+Significant differences between group A/C
++Significant differences between group A/B and A/C
+++Significant differences between group A/C and group B/C
++++Significant differences between all groups (i.e. A/C, A/B, B/C)
Concurrence between self-assessed competence and need for further training
Seven of the top 10 items regarding highest need for further training (Table 4) were found among the ten items with lowest self-assessed competence. In the same way, seven of the top 10 items assessed with lowest need for further training were found among the ten items with highest self-assessed competence (Table 2). Statistically significant differences between group A (≤ 0.5 year) and group B (>0.5-5 years) were seen in two items: “I have knowledge of the interactions of various types of medication and what side-effects they may cause for the patients I am responsible for” (item 15), and “I make my own decisions in my work” (item 31) in both the A-scale and the B-scale. Statistically significant differences between group B (>0.5-5 years) and group C (≥ 6 years) were seen in 18 and 15 items for self-assessed competence and need for further training respectively. Eleven of these items were found in both the A-scale and the B-scale (1-2, 6-8, 12, 19, 25, 36, 45-46) (Table 3 and 5). For most items there was no concurrence between self-assessed competence and the need for further training regarding statistically significant differences between the groups.