Exploring the core competencies of clinical nurses in Chinese tertiary hospitals: a qualitative content analysis

1. Background

Core competency is defined as the essential minimum set of attributes, such as applied knowledge, skills, and attitudes, that enable an individual to perform a set of tasks effectively and in accordance with appropriate standards[1]. Core competencies serve as a common language for all healthcare professions, defining what all people are expected to be able to do to the best of their abilities. There is currently no international standard for defining the concept of nursing core competency (NCC), the International Nurses Association and individual national nursing associations define core competencies for nurses differently based on nursing practice and nursing developments in their respective countries[2-7]. The NCC has been defined by international nursing associations and national nursing associations in accordance with national nursing practice and developments. As nurses struggle to adapt to standard definitions of competency, nursing practice and public expectations continue to change, and these factors make defining competencies in practice an ongoing challenge[8]. NCC, while defined differently, must be an integrated and dynamically evolving competency. It combines multiple competencies such as knowledge, skills, talents, and personal characteristics and should be updated as society, the healthcare environment, and the nursing profession change. Because of an aging population and changes in disease spectrum, the healthcare environment has changed dramatically. Simultaneously, as medical care improves, people's health needs and concepts evolve, and people are increasingly concerned not only with their own physical health, but also with spiritual, psychological, social, environmental, and other factors[9]. The demand for social health has contributed to the development of nursing competency. The health needs of society have contributed to the development of nursing competency while also raising the bar for the renewal and expansion of nursing competency and roles. Nurses are gradually moving from the subordinate role of physicians to independence[10], they are unstoppable forces shaping global healthcare, providing better care and attention to individuals and families all over the world. In China, nurses' attempts to enforce prescriptive authority are also enhancing nurses' abilities to “be at the table”, which is a significant step forward in the renewal of nurses' competency and roles[11]. Nursing services are being extended from institutions to communities and families through the development of new nursing service models such as "Internet + nursing services," with nurses playing an important role in providing professional care, health management, rehabilitation promotion, and other comprehensive nursing services. Nurse competency development must reflect the current state of health care[12] and in an ever-changing world, new competencies are required[13] . Some studies have shown that China has a chronic shortage of nursing human resources and that nurses' competencies vary, meeting the current social demand for high levels of care more difficult. Chinese nursing managers have long struggled with the issue of how to use effective methods to promote nurse competency development[14].In order to better seek ways and strategies to enhance nurses' competency, it is critical to understand the hierarchy of the nurse's competency needs. Competency models have been used in job analysis, performance management, and human resource training and development as an important tool in human resource development[15] .The Onion Model, a classic competency model, has been widely used in competency assessment and measurement. The Onion Model categorizes competence into three layers: the inner layer, the middle layer, and the outer layer. The inner layer consists of motivation and characteristics, the middle layer of attitudes, values, and self-image, and the outer layer of knowledge and skills[16] . The inner layer's competency is less likely to be trained, developed, and measured, whereas the outer layer's competency is more likely to be acquired and assessed through training. Although many core competency structures existed in China in the past, with the passage of time and the renewal of society's health needs, nurses have been assigned new roles and responsibilities in the new health development strategy, and the renewal and development of core competencies for nurses is an unavoidable trend[17]. Because of its rich hierarchical features, the Onion Model better explains the embodiment of nurses' core competencies at different levels. This study is based on the general layout of social health strategies and the actual needs of nurses, as well as a qualitative study based on the theoretical foundation of the Onion Model, which can provide rich theoretical guidance for future competency-based training (CBT) for nurses.

2. Methods

2.1 Design

From June to August 2022, semi-structured interviews with 20 clinical nurses and nursing managers (including nurse leaders and nursing department directors) in 11 Chinese provinces and cities were conducted using qualitative content analysis. The collected data were analyzed using content analysis, a design that provides contextual descriptions and explanations of social phenomena while also facilitating understanding of participants' voices, perspectives, and ideas[18] . The purpose of this qualitative study was to address issues concerning the current state of core competency and competency enhancement needs among nurses in Chinese tertiary hospitals. The report of this study is based on the Comprehensive Criteria for Qualitative Research Report (COREQ) checklist[19] .

2.2 Sample and Recruitment

To ensure the operationalization of the interview questions, we recruited the sample using purposive sampling based on the requirements of the qualitative studies[20]. Recruitment took place in 11 cities and provinces, including Beijing, Shanghai, Guangdong, Fujian, Hunan, Sichuan, Henan, Shandong, Shaanxi, Jilin, and Liaoning. In total, 20 people agreed to take part in our research. Nurses and nurse managers were among those recruited until saturation was reached (no additional information was obtained).

2.3 Data collection

We contacted the participants after obtaining permission from the appropriate institutions. Prior to the formal interviews, we explained to the participants the purpose, significance, and confidentiality of the study and assured them that they could withdraw at any time. Depending on the convenience of the participants and geographical constraints, formal interviews were scheduled via WeChat (a popular social media application in China) or face-to-face communication. All interviews were limited to 45-60 minutes, and participants' nonverbal expressions were recorded using field notes.

Following a literature review and group discussion, the initial interview outline was created. The literature on nurse core competencies and nurse competency enhancement needs was reviewed, and meaningful items were chosen as the basis for the interview outline using content analysis. An academic professor and two doctoral candidates participated in the group discussion. Furthermore, three experts with advanced titles and doctorates in clinical nursing and nursing administration were asked to revise the initial interview outline. The interview outline was then revised after three participants (both clinical nurses and nurse leaders) were recruited for pre-interviews. The interview outline for the participants is shown in Table1.

2.4 Data Analysis

The NVivo 12.0 software was used to analyze the records and create a synthetic description of the coding process. The data were analyzed using an inductive approach combined with a deductive approach, as well as qualitative content analysis techniques developed by Graneheim and Lundman[21]. Deductive methods were used to connect categories and subcategories to the Onion Model's three levels. The members of the research team read the text several times to gain a general understanding of the content, then outlined the meaning of relevant units and phrases, which were then subdivided into categories and subcategories based on the degree of similarity. Memos and reflective notes were used as important tools for data analysis immediately after the interviews, during data analysis, and during the literature comparison. Two researchers coded independently and discussed as a team to analyze the data.

2.5 Ethical considerations

This study was approved by the Research Ethics Committee of the First Affiliated Hospital of China Medical University (approval number: [2022]328). All participants were informed of the purpose of the study and signed a written informed consent form prior to data collection.

2.6 Rigor

Four major factors contribute to the credibility of qualitative research: credibility, resonance, originality, and usefulness[21]. The study was carried out by two researchers with prior experience in qualitative research. To ensure the study's rigor and credibility, two researchers with qualitative research experience completed the coding task at the same time and then negotiated coding differences through group discussions until consensus was reached, minimizing the influence of personal bias on coding. In terms of resonance, the text version formed after each coding session was spoken back to the interviewees for authenticity review. In terms of originality, the interview outline was developed based on nurses' own competency needs and nursing managers' requirements for nurses' core competencies under the new health development strategy, and it provided new insights into the enhancement of nurses' core competencies. Finally, in terms of utility, qualitative data analysis allows for the expansion of new conceptual categories to improve and complement the existing NCC model, as well as provide a theoretical foundation for the future competency-based training.

3. Results

3.1 Demographic characteristics of the participants

Table 2 and Figure 1 depicts the participants' demographic characteristics and geographical distribution, respectively. 20 clinical nurses and nursing managers (nurse leaders and nursing directors were included) from 11 recruited to participate in semi-structured interviews, including 4 males and 16 females, with an average age of (36.25 ± 9.70) and average working years of (13.00 ± 9.56) regarding.

3.2 The onion core competency model of tertiary hospitals nurses

The 27 core competencies were divided into three layers through qualitative data analysis: core elements, endogenous elements, and exogenous elements, resulting in the onion core competency model of tertiary hospitals (Figure 2) and the definition of concepts at each layer (Table 3).

3.2.1 Motivation and traits

The core layer of the onion core competency model is motivation and traits. Personal characteristics and intrinsic drivers and cores that drive nurses to develop their competency and provide quality care are referred to as motivation and traits. Accountability is the driving force that drives nurses to take on the important responsibility of safeguarding the lives of patients and practicing the important mission of "health related, life entrusted". Furthermore, enterprise, execution, and adaptability are necessary characteristics for nurses to perform high-quality clinical work.

N2: As nurses, we are first and foremost caregivers who must always be aware of our patients' status and be accountable for their safety.

N14: A nurse must be a motivated individual who is capable of continuous improvement. I believe we should know what we need to improve on and stick to our objectives.

NM11: In my experience as a manager, nurses are very good at execution, and execution allows them to carry out medical orders as well as complete their tasks on time.

N18: It is especially important to learn to adapt to the change in role and thinking during the transition from student to clinical nurse.

3.2.2 Professional philosophy and values

The middle layer of the onion core competency model is composed of professional philosophy and values, including career perception, professionalism and career development planning. Career perception refers to nurses' positive and correct perceptions and attitudes toward the nursing profession. Meanwhile, this study identified professionalism, which included empathy, self-restraint, prudence, and dedication.

NM17: Although there are some voices in society who believe nurses are subordinate to doctors, we cannot simply do what they say; we must make our own decisions.

NM13: In the workplace, empathy is essential. Although we have been emphasizing things like transposition and empathy, empathy is less likely to exist alongside our rational work in some process-oriented tasks.

N1: We must always take our work seriously, not just when the head nurse is present and then again when she leaves.

Career development planning is essential for controlling the development of nurses' competency and providing nurses with more clarity about their future direction.

N10: We must be very open and tolerant, accept new things, and recognize societal changes. For example, it is now clear that aging is a major issue. We need to understand what society is going through right now because only then will we be able to prepare and anticipate appropriately, and eventually realize what areas we need to improve.

3.2.3 Knowledge and skills

The outer layer is the knowledge and skills. Four main components: clinical nursing competency, management and leadership competency, humanistic practice competency, and professional development competency are highlighted in this layer.

3.2.3.1 Clinical nursing competency

The cornerstone of nurses' nursing jobs in the past, present, and future is excellent and skilled clinical knowledge and operational skills. Basic nursing knowledge and skills, specialty nursing knowledge and skills, and emergency response knowledge and skills were identified in the study. The aging of society, the rise in patients with chronic diseases, the persistence of the COVID-19 pandemic, and the emphasis on maternal and child health care as well as traditional Chinese medicine (TCM) rehabilitation in China's policies all contribute to the gradual need for nurses to have knowledge and skills about these specialties in addition to the fundamental nursing competencies that are required.

N20: With the application of TCM treatment in the treatment of COVID-19 pandemic, TCM is gradually gaining public recognition, and we should fully utilize the characteristics of "preventive disease treatment" in TCM care, as well as carry forward the functions of TCM rehabilitation and preventive health care.

N10: I believe we can do more in child health care. For example, in some countries, special people will go to the home to monitor the child's health, rather than waiting until the disease causes irreversible damage to the child to treat it. In the future, I believe we will need to invest more in preventive health care.

N2: The COVID-19 pandemic has caused us a lot of trouble, and the screening has been ineffective.

NM19: Nowadays, the majority of our patients in our department are elderly, and they all have multiple comorbidities. As a result, we must be familiar with the treatment of common conditions such as hypertension, diabetes, and cardiovascular disease, and these skills are essential.

3.2.3.2 Leadership and management competency

Leadership and management competencies, which include patient management, team leadership, and self-management, are equally important to clinical nurses and nursing managers. Patient management entails both condition and medication management. Team leadership entails both team building and team support coordination. Emotion regulation, life and work management are all aspects of self-management. Patient management is the foundation of nursing work, team leadership is the foundation of the entire team's common and coordinated development, and self-management is the guarantee of a good working environment. Nurses can provide high-quality care to patients by leading and managing these three areas of their work.

NM8: The emergence of advanced practice nurses (APNs) is a significant global trend, and efforts made in our country to provide nurses prescriptive authority are a crucial first step toward the creation of APNs. The nurses' expertise of drug administration, dosage, indications, side effects, etc. is crucial to this process. With this solid foundation, they may continue to manage patients more effectively.

It is worth noting that the professional specificity of nurses causes them to focus more on patients, resulting in self-emotion management being frequently neglected.

N3: Every day, I saw many critically ill patients who were in pain. When I first started working, I had dreams about being sick and being suctioned, and I was terrified of being sick.

3.2.3.3 Humanistic practice competency

Legal and ethical decision-making, humanistic care, and interpersonal communication are all examples of humanistic practice competency. Person-centered care and respect for the patient's feelings and needs as a "human" are more important in the new health development strategy. Thus, humanistic practice competencies are especially important in the new role of nurses.

N4: Due to the COVID-19 pandemic, hospitals are requiring patients to have a negative nucleic acid report before they can be admitted, but if it is an emergency admission that is too late for nucleic acid, then how to make the right choice needs to cause us to think.

The importance of communication in humanistic care cannot be overstated; however, good interpersonal communication in clinical situations necessitates a significant amount of effort, and empathy and patience may be an important way to achieve comfortable and acceptable communication.

NM15: Because our clinical work is so demanding, it can be difficult to keep our emotions in check. We may not be as attentive to patients who come for consultation at this time as we are when they are relatively free.

NM5: You can improve communication by thinking differently and empathizing more. Even if you don't empathize, you must learn to put yourself in the shoes of the patient in order to communicate and communicate more smoothly.

3.2.3.4 Professional development competency

Nursing research, evidence-based practice, critical thinking, and information use competencies were identified in the professional development competency area.

N3: Occasionally, I may encounter new problems or methods of care in the clinic that are inconsistent with what I was taught by my instructor, and I consider going home to look up the information, but I always put it off for various reasons. In the future, I believe I will need to be able to think deeply and solve problems.

NM6: Because times are changing and new technologies are emerging in the field of nursing, it is critical to continue learning and updating in order to avoid being obsolete.

4. Discussion

According to the “Hospital Grade Management Measures” promulgated by the National Health Commission of the People's Republic of China[22] , a tertiary hospital is one that can provide the highest level of medical and health care as well as higher education and research. Because tertiary hospitals have a significantly higher level of development than other levels of hospitals, nurses in tertiary hospitals frequently require higher quality and competence to undertake tasks within tertiary hospitals in order to capitalize on their strengths and play a leading role in the Healthy China strategy. The core competency needs of nurses in tertiary care hospitals were identified in this study as part of the new health development strategy. Meanwhile, the Onion Model categorizes different competencies into three levels based on the ease of competency formation, which aids in understanding the requirements of the various levels of competencies and provides a reference for future competency-based training (CBT).

Core competency need of nurses in tertiary hospitals

The most central level of need in the NCC is motivation and traits, which are the intrinsic, difficult-to-measure aspects of people that are the most difficult to uncover and change. It is undeniable that nurses' sense of responsibility for the safety of their patients' lives remains the nursing profession's most fundamental mission commitment. Nurses' competency to continually improve and develop is driven by enterprise, and both execution and adaptability are traits possessed by a highly qualified nurse.

Professional philosophy and values are both the foundation of nursing practice and the cornerstone of nurses' ability to provide high quality nursing care[23]. Perceptions of the nursing profession directly influence individual behavior and performance, and by being sensitive to changes and trends in the nursing field, they can have a clearer understanding of their career plans. Furthermore, some participants mentioned that choosing nursing is a choice of dedication. Dedication, as a professional spirit rooted in the nursing profession, is at the heart of a nurse's profession[24].

Clinical nursing competency, leadership and management competency, humanistic practice competency, and professional development competency are the most accessible and cultivated competencies. The majority of these related knowledge and skills are similar to the competencies in the previously developed core competency framework for nurses in China[25]. In this study, the real needs of nurses and reflections on competency development were included, and these differences and additions may reflect the new preferences and needs of nurses in the context of times and social developments that are shaped by the various values and strategic goals of society and the health care system. Nurses require a diverse set of skills to provide quality care to patients in an ever-changing clinical environment. Because of the development of nursing specialization in China, common knowledge and nursing skills in specialties such as hospice care, chronic disease management, TCM, and maternal and child health must be gradually learned and applied in addition to basic nursing knowledge and skills. In the same way, a multidisciplinary understanding of disease, such as anatomy, physiology, biochemistry and pathology, is better suited to providing quality patient care. Despite the fact that not all participants held leadership positions, the majority of participants mentioned this important competency. Leadership and management competency is not unique to nursing managers, in addition to administrative competencies, nurses' leadership can provide quality care to patients by infecting the surrounding healthcare professionals and patients through their own professional and personal charisma[26]. All nurses play an important role in leadership and are encouraged to learn more about it in the ever-changing healthcare field[27, 28] .

With the implementation of medical policies, patient experience and feelings are being prioritized, and humanistic practice competencies, which include legal and ethical, interpersonal communication, humanistic care, and other related competencies, are being raised by an increasing number of nurses. Surprisingly, almost all nurses mentioned the difficulty of communication. One of the causes of communication barriers could be a mismatch in information[29]. The question of how to communicate effectively with patients and colleagues in a high-stress clinical situation remains unanswered. The biomedical model, which focuses on diagnosis and treatment, continues to heavily influence how healthcare professionals view patient care in most clinical settings in China. Nurses are more likely to be concerned with the patient's physical condition and less concerned with psychological care, which contradicts the holistic nature of care to some extent[30, 31]. As a result, nurses must continue to improve their humanities-related skills in order to provide "person-centered" care in the future. Professional development skills are the knowledge and skills that nurses should have in order to improve and develop their clinical professionalism. It is not only a technical tool, but it is also the most effective method of obtaining scientific information, which is a necessary skill for nurses. Many nurses in research have suggested that the ability to use information is important. The rapid advancement of information technology is gradually transforming the medical and nursing care delivery model[32]. Nurses should fully utilize information technology tools to expand their service areas in order to adapt to this new model of care. Furthermore, the shift in mindset aids in the development of competencies and increases motivation for behavior change. As a result, the future focus and difficulty will be how to fully use critical thinking in nursing decision making and train the shift in mindset[33] .

Cultivation and development of core competencies of nurses in tertiary care hospitals

Both the "Healthy China 2030" Strategy and the 20th Communist Party of China (CPC) Report advocate for a people-centered approach to health maintenance in all aspects and cycles. In light of the people's growing health needs, the development of nursing capabilities must be integrated with the current social context, expanded the scope of nursing services, and integrated with the people's health needs. As patients' individual needs, disease complexity, and treatment modalities evolve, the development of nurses' core competencies must become more varied depending on the stage.

According to the findings of this study, the majority of nurses believe that their own competencies are still lacking in many ways and that they should constantly improve and update their professional knowledge and skills in order to meet the health needs of patients. The nurses' ability to integrate and apply their knowledge is limited, and they have a fixed mindset, making it difficult to apply their learning. This could be due to a mismatch between what nurses learn in school and in the clinic, as well as a gap between what they learn in training and clinical practice. Furthermore, the supervising teacher influences the working style and attitude of the new nurses and may have a significant impact on their professional perceptions[34]. Moreover, not all nurses consider their own competence development deeply, and they are frequently accustomed to accepting passive learning, settling for the status quo, and being less self-driven. In China, the Confucian educational ideology handed down through history, as well as the modern education system that mimics the former Soviet Union's classroom style, have severely limited the development of students' creative ways of thinking[35, 36], therefore, a change in the traditional educational model should be considered. Competency-based training for nurses may be an effective way to enhance the thinking and developmental skills of nurses[37] . CBT extends and expands theoretical and practical training content, which is closer to clinical practice and can effectively improve the ability of new nurses to solve difficult problems and make clinical judgments and decisions[38-40].

References

1. Albarqouni L, Hoffmann T, Straus S, Olsen NR, Young T, Ilic D et al.Core Competencies in Evidence-Based Practice for Health Professionals: Consensus Statement Based on a Systematic Review and Delphi Survey. JAMA NETW OPEN 2018, 1(2):e180281. https://doi.org/10.1001/jamanetworkopen.2018.0281.
2. CNA (Ed.): Advanced nursing practice: A national framework: Ottawa༚Canadian Nurse Association; 2008.
3. Andrew G.ERIC - EJ545609 - Future Directions for Vocational Education in Australian Secondary Schools., Australian and New Zealand Journal of Vocational Education Research, 1997. Australian and New Zealand Journal of Vocational Education Research 2001, 1(5):77–108.
4. Wells E.ANCI Competencies: An Investigation of Uniqueness and Importance. Australia‚Griffith University; 2003.
5. Lenburg CB.The Framework, Concepts and Methods of the Competency Outcomes and Performance Assessment (COPA) Model. Online Journal of Issues in Nursing 1999, 2(4).
6. Liu M, Yin L, Ma E, Lo S, Zeng L.Competency Inventory for Registered Nurses in Macao: instrument validation. J ADV NURS 2009, 65(4):893–900. https://doi.org/10.1111/j.1365-2648.2008.04936.x.
7. Implementation Tool Kit for AACN Essentials.2022.Available from https://www.aacnnursing.org/AACN-Essentials/Implementation-Tool-Kit.2022/4/11.
8. Church CD.Defining Competence in Nursing and Its Relevance to Quality Care. J NURSES PROF DEV 2016, 32(5):E9-E14. https://doi.org/10.1097/NND.0000000000000289.
9. Salmond SW, Echevarria M.Healthcare Transformation and Changing Roles for Nursing. Orthopedic nursing 2017, 36(1):12–25. https://doi.org/10.1097/NOR.0000000000000308.
10. Catton H.International Council of Nurses: putting nurses at the centre of the world's policymaking has benefits for us all. INT NURS REV 2019, 66(3):299–301. https://doi.org/10.1111/inr.12546.
11. Mengting X, Xingwei Z, Xuejiao Z, Chenyue Z.Research status and SWOT analysis of the nurse prescribing authority in China. Chinese Nursing Research 2022, 36(3):428–432. https://doi.org/10.12102/j.issn.1009-6493.2022.03.008.
12. Chan TE, Lockhart JS, Schreiber JB, Kronk R.Determining nurse practitioner core competencies using a Delphi approach. J AM ASSOC NURSE PRA 2020, 32(3):200–217. https://doi.org/10.1097/JXX.0000000000000384.
13. Lejonqvist G, Kajander-Unkuri S.Evaluating nursing competence with the Nurse Competence Scale from an ontological and contextual point of view: An integrative literature review. Nordic Journal of Nursing Research 2021, 42(1):7–17. https://doi.org/10.1177/20571585211000972.
14. Yunyun L, Jing B, Lanfeng Z.Research status quo of core competencies of nurses in China:a bibliometric analysis. Chinese Nursing Research 2018, 32(18):2897–2900. https://doi.org/10.12102/j.issn.1009-6493.2018.18.020.
15. Rissi JJ, Gelmon SB.Development, Implementation, and Assessment of a Competency Model for a Graduate Public Affairs Program in Health Administration. J PUBLIC AFF EDUC 2014, 20(3):335–352. https://doi.org/10.1080/15236803.2014.12001792.
16. Boyatzis RE.The competent manager: A model for effective performance|.*4*4. New York: Wiley; 1983.
17. Martin McKee, Sherry Merkur, Nigel Edwards, Nolte E.The Changing Role of the Hospital in European Health Systems.: Cambridge University Press; 2020.
18. Mohajan HK.Qualitative research methodology in social sciences and related subjects. Journal of Economic Development Environment and People 2018, 1(7):23–48.
19. Tong A, Sainsbury P, Craig J.Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International journal for quality in health care : journal of the International Society for Quality in Health Care 2007, 19(6):349–357.
20. Polit DF, Beck CT.Nursing Research: Generating and Assessing Evidence for Nursing Practice|.*2022*2022: Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.
21. Graneheim UH, Lundman B.Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. NURS EDUC TODAY 2004, 24(2):105–112.
22. Commission CHAW.Notice of the National Health and Wellness Commission on the Issuance of Accreditation Standards for Tertiary Hospitals (2020 Version).; 2020.
23. Poorchangizi B, Borhani F, Abbaszadeh A, Mirzaee M, Farokhzadian J.The importance of professional values from nursing students' perspective. BMC NURS 2019, 18:26. https://doi.org/10.1186/s12912-019-0351-1.
24. Jenaro C, Flores N, Orgaz MB, Cruz M.Vigour and dedication in nursing professionals: towards a better understanding of work engagement. J ADV NURS 2011, 67(4):865–875. https://doi.org/10.1111/j.1365-2648.2010.05526.x.
25. Liu M, Yin L, Ma E, Lo S, Zeng L.Competency Inventory for Registered Nurses in Macao: instrument validation. J ADV NURS 2009, 65(4):893–900. https://doi.org/10.1111/j.1365-2648.2008.04936.x.
26. Bianchi M, Bagnasco A, Bressan V, Barisone M, Timmins F, Rossi S et al.A review of the role of nurse leadership in promoting and sustaining evidence-based practice. J NURS MANAGE 2018, 26(8):918–932. https://doi.org/10.1111/jonm.12638.
27. Quinn B.Role of nursing leadership in providing compassionate care. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2017, 32(16–19):53–63. https://doi.org/10.7748/ns.2017.e11035.
28. Pattison N, Corser R.Compassionate, collective or transformational nursing leadership to ensure fundamentals of care are achieved: A new challenge or non-sequitur? J ADV NURS 2022. https://doi.org/10.1111/jan.15202.
29. Allenbaugh J, Corbelli J, Rack L, Rubio D, Spagnoletti C.A Brief Communication Curriculum Improves Resident and Nurse Communication Skills and Patient Satisfaction. J GEN INTERN MED 2019, 34(7):1167–1173. https://doi.org/10.1007/s11606-019-04951-6.
30. Chen X, Zhang Y, Zhang R, Shen G.'I Accelerate' model: A grounded theory on conceptual framework of patient experience with nursing care in China. J NURS MANAGE 2021, 29(5):1311–1319. https://doi.org/10.1111/jonm.13271.
31. Pype P, Pype K, Rowlands A, George R, Devisch I.COVID-19 and touch in medical encounters. PATIENT EDUC COUNS 2021, 104(3):464–466. https://doi.org/10.1016/j.pec.2020.10.023.
32. Su W, Hwang G, Chang C.Bibliometric analysis of core competencies associated nursing management publications. J NURS MANAGE 2022, 30(7):2869–2880. https://doi.org/10.1111/jonm.13795.
33. Crevacore C, Coventry L, Duffield C, Jacob E.Factors impacting delegation decision making by registered nurses to assistants in nursing in the acute care setting: A mixed method study. INT J NURS STUD 2022, 136:104366. https://doi.org/10.1016/j.ijnurstu.2022.104366.
34. Kukkonen P, Leino-Kilpi H, Koskinen S, Salminen L, Strandell-Laine C.Nurse managers' perceptions of the competence of newly graduated nurses: A scoping review. J NURS MANAGE 2020, 28(1):4–16. https://doi.org/10.1111/jonm.12891.
35. Yoon J.Development of emergency nursing care competency scale for school nurses. BMC NURS 2021, 20(1):63. https://doi.org/10.1186/s12912-021-00580-9.
36. D'Aoust RF, Brown KM, McIltrot K, Adamji JD, Johnson H, Seibert DC et al.A competency roadmap for advanced practice nursing education using PRIME-NP. NURS OUTLOOK 2022, 70(2):337–346. https://doi.org/10.1016/j.outlook.2021.10.009.
37. Chen S, Zhang C, Li W.The effects of competency-based training model in the training of new nurses: A meta-analysis and systematic review. PLOS ONE 2022, 17(11):e277484. https://doi.org/10.1371/journal.pone.0277484.
38. Moore J, Hawkins-Walsh E.Evaluating Nurse Practitioner Student Competencies: Application of Entrustable Professional Activities. The Journal of nursing education 2020, 59(12):714–720. https://doi.org/10.3928/01484834-20201118-11.
39. Engels C, Boutin E, Boussely F, Bourgeon-Ghittori I, Couturier B, Fromantin I et al.Use of Evidence-Based Practice Among Healthcare Professionals After the Implementation of a New Competency-Based Curriculum. WORLDV EVID-BASED NU 2020, 17(6):427–436. https://doi.org/10.1111/wvn.12474.
40. Chan TE, Lockhart JS, Thomas A, Kronk R, Schreiber JB.An integrative review of nurse practitioner practice and its relationship to the core competencies. Journal of professional nursing : official journal of the American Association of Colleges of Nursing 2020, 36(4):189–199. https://doi.org/10.1016/j.profnurs.2019.11.003.

Tables

Table 1. Interview outline of the participants

NO.	Questions
NO.	Clinical nurses	Nursing managers
1.	Please share your views on the current state of nursing competencies.	What do you think of nurses' roles and functions in the new era?
2.	What are the issues and deficiencies in your own competencies?	Which competencies do you believe nurses are currently lacking?
3.	What competencies you think nurses should to develop in the future? (e.g., knowledge, skills, attitudes)	What competencies do you think nurses should acquire in the future?(e.g., knowledge, skills, attitudes)
4.	How do you think current nursing competencies will fare in the next decade?	What are your thoughts on the existing core competency training for nurses?
5.	How do you feel about nursing competency training?(e.g., teachers, duration, frequency)

Table 2. Demographic characteristics of the participants

NO.	Gender	Age	Title	Position	Education level	Working years	Section
N1	Female	26	Nurse practitioner	Nurse	Master	2	Nursing department
N2	Female	25	Nurse practitioner	Nurse	Bachelor	4	Intensive care unit
N3	Male	26	Nurse practitioner	Nurse	Bachelor	5	Emergency
N4	Male	27	Nurse practitioner	Nurse	Bachelor	4	Operating room
NM5	Female	35	Associate senior nurse	Head Nurse	Doctoral	11	Cardiology
NM6	Female	53	Senior nurse	Chief of nursing department	Master	28	Nursing Department
NM7	Female	59	Senior nurse	Chief of nursing department	Doctoral	36	Nursing Department
NM8	Female	51	Senior nurse	Chief of nursing department	Master	30	Nursing d department
N9	Female	30	Nurse in charge	Nurse	Master	10	Intrarenal Dialysis
N10	Female	31	Nurse practitioner	Nurse	Master	6	Geriatric ward
NM11	Female	36	Nurse in charge	Head nurse	Doctoral	10	Operating room
NM12	Male	34	Nurse practitioner	Head nurse	Master	5	Intensive care unit
NM13	Female	38	Associate senior nurse	Deputy director of nursing department	Doctoral	15	Nursing department
NM14	Female	38	Associate senior nurse	Head nurse	Master	15	Pediatric general ward
NM15	Female	34	Nurse in charge	Head nurse	Master	13	Obstetrics and gynecology
NM16	Female	43	Nurse in charge	Head nurse	Master	13	Cardiology
NM17	Male	37	Nurse in charge	Head nurse	Bachelor	16	Operating room
N18	Female	29	Nurse practitioner	Nurse	Bachelor	8	Infection ward
NM19	Female	45	Associate senior nurse	Head Nurse	Bachelor	23	Cardiothoracic surgery
N20	Female	25	Nurse practitioner	Nurse	Bachelor	5	Emergency

* N=nurse, NM=nursing manager

Table 3. Definition of the concepts of core competencies for nurses in tertiary hospitals

Model element hierarchy	Theoretical element name	New element name	Definition
Exogenous elements	Knowledge, skills	Clinical nursing competency	The knowledge and operational skills necessary for nurses to perform clinical work.
		Management and leadership competency	The nurse's management and leadership of patients, team members and themselves .
		Humanities practice competency	The nurse's ability and skill in using humanistic knowledge as demonstrated in clinical nursing work is the external manifestation of the nurse's humanistic philosophy, knowledge and skills and other factors.
		Professional development competency	The knowledge and skills that nurses should have in order to enhance and develop their professionalism in their clinical work.
Endogenous elements	Self-concept, attitudes, values, social roles	Professional philosophy and values	Nurses' perceptions and attitudes toward the nursing profession.
Core elements	Motivation, traits	Motivation and traits	The personal attributes and intrinsic drivers that drive nurses to provide quality care.

Exploring the core competencies of clinical nurses in Chinese tertiary hospitals: a qualitative content analysis

Abstract

1. Background

2. Methods

3. Results

4. Discussion

Conclusion

Abbreviations

Declarations

References

Tables