The aims of the study were to describe which of the 47 Tuning competences were assessed during the qualification exam for the Degree in Nursing, the level of performance, the clinical area and setting in which they were contextualised, and which types of tests were used for their evaluation.
In both cognitive and psychomotor tests, the competences most frequently requested during the qualification exam were those associated with nursing practice and clinical decision-making (scope 2), which coincide with core competences in nursing outlined by different scholars [15, 20].
The competence most in demand in both tests was number 14: demonstrates the ability to appropriately use a range of nurse skills, medical devices and interventions/activities to provide optimum care. This is in line with that expressed by Italian scholars, who believe that nursing degree courses should provide students with preparation that would allow them to make clinical decisions independently with their knowledge, technical competences, and attitudes [20–21]. Students must be able to provide quality nursing care with proven effectiveness [15, 22].
Among the competences most investigated, especially in psychomotor tests, there was number 17: Using nursing skills, medical devices and interventions/activities to provide optimum care, demonstrates the ability to safely administer medicines and other therapies. This data consolidates the welfare aspect linked to the ‘medical paradigm’ , according to which nurses guarantee the correct application of diagnostic–therapeutic prescriptions. This confirms the opinion of Italian academics that include this competence in the shortlist of those deemed core .
In the literature, there are differing opinions of scholars and students with respect to the ability of recent graduates to manage drugs safely. Indeed, if, in some studies, it is asserted that the hours of teaching in pharmacology are sufficient to prepare students for the correct and safe management of drugs [24, 25], in other studies, the authors state exactly the opposite .
In this research, the least-frequently required competences in both tests were related to communicative and interpersonal aspects, including communication technologies (domain 4) and leadership competences and group dynamics management (domain 5). The competences of leadership, management, and group dynamics are considered ‘core’ to be acquired in the second cycle of studies . This suggests that Italian nursing education interprets post-basic training as a process of ‘additional training.’ According to the Bologna Process, however, postgraduate courses should include a ‘deepening of training’ of all competences already acquired in the first cycle of studies .
Regarding ‘Performance Levels’, only one level of performance is provided for psychomotor tests: autonomous, effective, and safe execution of simple procedures and the ability to provide information, communication, and/or a therapeutic relationship. In this study, in the 3 likely levels of cognitive tests, the most required was ‘autonomy of judgement’. This outcome is consistent with Lewallen and Van Horn (2019) , who state that at the end of the training course, it is expected that the student can critically assess decisions that were employed [28, 8].
Concerning the clinical area, the most-frequently investigated competences were to be found mainly in the field of chronic non-communicable diseases. Chronic non-communicable diseases are the main causes of death worldwide .
Regarding the setting, the most-investigated competences dealt with the adult patient, treated mainly in hospital rather than outside of it. These results show that the educational process remains anchored to the hospital-centred approach . It would be appropriate to redesign educational programmes to train nurses who will deal with home care .
Compared to the types of tests used for the assessment of competences, the field mainly evaluated was the cognitive one. The test most used in cognitive evaluations was the discussion of a clinical case, even if it required a notable commitment from the assessors, both in its elaboration and in its correction.
This finding matches with opinions expressed by Italian academics  urging further investigation of the cognitive sphere. This also depends on the logistical difficulty of organising a complex test able to evaluate all nursing competences, such as the test on the bed , which, in this study, was the least used. Indeed, even if the test on the bed allows the evaluation of all nursing competences, it is not frequently used because it is costly and requires the use of sizable close human, instrumental, and structural resources. Furthermore, this could be the reason for the lower demand for communicative, leadership, and management competences , since they imply a real relationship between the student, the patient, and other health professionals . However, these tests are organised based on the availability of the operational units and the planning of their activities and are difficult to recreate during the examination session. The least-used test in cognitive assessment was the open- or closed-response test. This is probably because it entails considerable efforts by educators in the structuring and correction of the test, especially if it is open-ended .
The most suitable tests for the evaluation of psychomotor competences were the practical tests on the simulated case and on the bed , which, in this study, however, were the least used. The reason that the simulated case practical test was little used can be explained by the difficulty in applying the Objective Structured Clinical Examination (OSCE) .
Considering the results obtained, there are many differences with respect to how the licensure exam is regulated in the various universities and the methods used during the exam to assess the competences [15, 3].
Limitations and future implications
The study was conducted in a single geographical area, and it focused only on the process of evaluating competences during the examination for qualification as a newly registered nurse.
There was a high degree of discrepancy in the types of tests used from site to university, the choice of which is influenced by the number of students and the structural resources available, elements which lead teachers to essentially choose the tests that explore the cognitive sphere.
A radical cultural change is expected, involving all the actors responsible for nursing education to reorientate themselves and to adopt a single model for evaluation in the licensure exam.
It is also strongly desirable to conduct a longitudinal study to collect data on the methods of assessing competences throughout the nursing degree courses in the various areas of the country.