Factors Influencing the Clinical Competency among Nursing Students: A Cross-Sectional Study

Abstract

Introduction: 

This study aimed to identify the factors that influence clinical competency in nursing students.

Methods: 

A descriptive, cross-sectional approach was used among 178 nursing students who have already experienced clinical duty exposure in different areas of the hospital affiliation. The data were collected through a survey questionnaire between September and November 2020.

Results: 

The gender (B = 0.122; P = 0.12), age group (B = −0.107; P = 0.18), marital status (B = 0.124; P = 0.002), and course (B = 0.093; P ≤ 0.000) were found to predict nursing professional behaviors of student nurses. Moreover, skill competencies (general performance) was noted to have significant relationship with age (B = 0.092) and maritial status (B = 0.105; P = 0.004). Concerning skills core competencies, gender (B = 0.108; P = 0.11) and grade point average (GPA) (B = −0.129; P = 0.005) were found to be predictors. Finally, skills competencies (advanced nursing skills) dimensions were found to have a significant relationship with gender (B = −0.255; P < 0.000), age group (B = 0.223; P < 0.000), marital status (B = 0.148; P = 0.001), course (B = −0.113; P < 0.000), and GPA (B = −0.147; P = 0.009).

Conclusion: 

While the respondent’s perceived level of clinical behavior and skills competencies showed good knowledge in theory and competence in practice, it still needs hands-on supervision. These study results can be considered a tool for development developing using required programs at every level and across all settings.

INTRODUCTION

The competencies necessary for the nurse’s job include clinical nursing competency. For all nursing professionals, it is crucial to carry out their duties and responsibilities effectively and efficiently. Consequently, the nursing education curriculum’s base must be established by nursing competency.^[1] The key determinants are professional conduct and skill competencies, which include general performance, core competencies, and advanced nursing competencies. Nursing schools demand that student nurses have professional competence. Therefore, every nursing institution strives to promote high-quality academic programs to produce competent and successful nursing students.^[2] Hospitals and other clinical settings are the most in need of these qualified workers in the health-care delivery system.

The principal component analysis identified the four components of competence – professional nursing behaviors, fundamental nursing skills, general performance, and advanced nursing skills – demonstrating a high level of explanation for competency.^[3] This shows that the measure of perceived clinical competence has high reliability and validity, making it a valuable instrument for administering the self-evaluation of clinical performance by nursing students. As a result, it is the duty of nursing educators to mentor and oversee student nurses as they develop their professional behaviors and competencies to meet the demands of the constituency. Scholars such as Liou and Cheng^[3] found that the students felt confident in their clinical ability to a reasonable extent. Another study found that male nursing students perceive high competency in advanced and core nursing abilities, and nursing processes have been identified as the weakest area in advance.^[3] As their level of schooling rose, they were better equipped to practice safely in the clinical setting according to their perceptions of patient safety competence. The skills are continuously practiced by interacting with and directly caring for patients. Nursing students cannot practice safe nursing care based solely on their knowledge of patient safety competencies. They must continually practice knowing when to report negative situations.^[4] Patient monitoring from time to time provides safe care and competencies.^[5] Nursing competence is based on knowledge, and the curriculum taught in universities. The training program is essential in gaining nursing values and achieving educational goals. This knowledge and the skills acquired are valuable. This knowledge and the skills acquired are valuable which has an impact to their future career (or when they start working after graduation).^[6] Nursing graduates still take time to develop competency even after completing their academic nursing program. For this reason, clinical competency is something that requires ceaseless development.^[7]

This research is significant as it contributes to the quality of academic performances of every nursing school across the Kingdom. The clinical competency of the nursing students is the backbone of a nursing program that develops into highly skilled nursing professionals. Indeed, perceiving the clinical competency of nursing students improves their skills, which is very important in performing their tasks and identifying strengths and weaknesses. On the other hand, nursing students will become productive and competitive in their quest for academic excellence. Therefore, this study aimed to determine the predictive influencing factors to clinical competency among nursing students.

METHODS

Research design

This study employed a descriptive cross-sectional approach to determine the predictive influencing factors to clinical competency among nursing students.

Setting/participants

The study population included 178 nursing students who are already experienced clinical duty exposure in different areas in the hospital affiliation. Convenience sampling was used with the consideration of the inclusion criteria, which include (a) Age from 20 to 25 years, (b) Willingness to participate in the study and give their consent, and (b) Enrolled in both theoretical and practical courses. The participants were nursing students from level 5 to level 8. These academic levels had both theoretical and practical courses. This study was conducted at the University of Hail, the only University located in the Hail region. The data were gathered through a survey questionnaire between September and November 2020.

Instrument

Permission was obtained and adapted from the Clinical competencies questionnaire (CCQ) by Liou and Cheng^[3] for the data collection. The questionnaire was composed of sixteen nursing professional behaviors and three subscales: general nursing skills, core nursing skills, and advanced nursing skills. The CQC inventory consists of 31 questions, each scoring 5. The following is an approximate guide to interpreting the score: 1-Do not have a clue, 2-Know in theory, but not confident at all in practice, 3-Know in theory, can perform some parts in practice independently, and needs supervision to be readily available, 4-Know in theory, competent in practice, need contactable sources of supervision, 5-Know in theory, competent in practice without supervision. A higher score indicates an individual’s self-perception of a higher level of clinical competence.

The questionnaire had undergone content and cultural sensitivity testing at the University of Hail. Three nursing education specialists worked as validators. Two of them were credited with creating the nursing major’s curriculum, and the other is the dean of Nursing. Accordingly, all items were unanimously agreed to measure and are appropriate for the intended theme. The reliability of the instrument was evaluated after content validation using a pretest with 15 nursing students. An alpha coefficient of 0.80 was obtained from the reliability test.

Data gathering procedure

This research commenced after the clearance and approval from the Institutional Review board of the University of Hail. The participants were notified with a letter of permission attached to the questionnaire and a brief about the study’s aims and how to complete it. The consent form was acquired before the respondents’ participation was confirmed. An orientation was conducted with the participants explaining the procedure, the extent of their involvement, and their rights as participants. The participants were given at least 10–15 min to complete the questionnaire. Data gathering was conducted between September and November 2019.

Data analysis

SPSS 18 IBM Software Group, (Chicago, IL, USA) collected and analyzed the data. Descriptive statistics were performed, including frequency, percentage, mean, and standard deviation used to determine the perceived clinical competencies relationship between participants of the nursing students level as a self-assessment tool development. Regression analysis was used. The variables were introduced to the full multivariate model and the stepwise model to generate the best model explaining the highest possible level of the variance of the dependent variable.

RESULTS

Table 1 presents the demographic profile of the student nurses. The male (56.7%) participants were the majority, almost equal in the age group, primarily single (47.8%), and dominated by those who enrolled in critical care (19.75). Most students (50.6%) have a grade point average (GPA) of 2.01–3.0.

Table 1: Demographic profiles of the participants (n=178)

Table 2 presents the participants’ perceived level of clinical behaviors and skills competencies. Among all the dimensions, the students know in theory, competent in practice, need contactable sources of supervision in nursing professional behaviors (4.13 ± 0.228), skill competencies (general performance) (4.09 ± 0.220), skills competencies (core nursing skills) (4.08 ± 0.202), and skills competencies (advanced nursing skills) (3.98 ± 0.259).

Table 2: Perceived level of clinical behaviors and skills competencies of respondents

Table 3 presents the predictors of clinical competency of student nurses considering the four dimensions of clinical competency. The gender (B = 0.122; P = 0.12) shows female participants (4.14 ± 0.235 vs. 4.10 ± 0.213 [confidence interval [CI] = 0.027–0.218) have a higher perception than their male counterparts; the age group (B = −0.107; P = 0.18), showing older students of 23 years old (4.19 ± 0.200 [−0.196–0.018]) had perceived higher competency than the younger ones. Moreover, the marital status (B = 0.124; P = 0.002), specifically single (4.19 ± 0.217 [CI = −0.202–0.045]), perceived to have higher competencies and course (B = 0.093; P < 0.000), particularly nursing leadership and management (4.21 ± 0.177 [CI = 0.044–0.142]) were found to predict nursing professional behaviors of student nurses. The presented model was statistically significant (F(5,172) = 3.144, P = 0.010). The independent variables together explained approximately 84% of the variation in the dependent variable (adjusted-R² = 0.057, standard error of estimate [SEE] = 0.221).

Table 3: Predictors of clinical competency among student nurses based on its dimensions

Moreover, the skill competencies (general performance) found to have significant relationship with age (B = 0.092; P = 0.26) particularly 23 years of age group, and marital status (B = - 0.105; P = 0.004) primarily single. The independent variables together explained approximately 19% of the variation in the independent variable (adjusted R² = 0.167, SEE = 0.201).

Concerning skills core competencies, gender (B = 0.108; P = 0.11), particularly female (4.14 ± 0.223; CI [0.025–0.190]) and GPA (B = −0.129; P = 0.005) with 3.1–4.0 (4.13 ± 0.173, CI [−0.025–0.060]) were found to be predictors. This model was statistically significant (F[5,172 = 5.19; P < 0.000], explaining approximately 13% of the variation in the independent variable [adjusted R² = 0.106, SEE = 191]).

Finally, skills competencies (Advanced Nursing Skills) dimensions were found to have a significant relationship with gender (B = −0.255; P < 0.000), with females (4.03 ± 0.235, CI [−0.357–0.154]) perceivably more skillful. Furthermore, the age group (B = 0.223; P < 0.000) with older students (4.08 ± 152, CI [0.129–0.317) perceivably higher skills, and marital status (B = 0.148; P = 0.001) specially single (4.00 ± 0.235; CI [0.065–0.230]), course (B = −0.113; P < 0.000) in advanced health (4.11 ± 0.138]), and GPA (B = −0.147; P = 0.009) with 3.1–4.0 (4.11 ± 0.170; CI [−0.257–0.037]). The presented model was statistically significant (F(5,172) = 8.623, P < 0.000). The independent variables together explained approximately 20% of the variation in the dependent variable (adjusted-R² = 0.177, SEE = 0.235).

DISCUSSION

The primary purpose of this descriptive, cross-sectional approach is to determine the student nursing behaviors and skills performances that measure the perceived clinical competency. In general, the student nurse competencies in all the dimensions are commendable in that they know, in theory, competent in practice but need contactable sources of supervision. This implies that, in a secure and confidential setting, clinical management offers student nurses the opportunity to explore their own psychological and emotional responses to their clinical experience that reflect and challenge their practice. As a result, they received feedback on their skills; engage in professional growth and development. According to Kaphagawani and Useh^[8] supervised clinical practice is essential in nursing since it affects students’ clinical learning. As Chuan and Barnett^[9] supported, clinical performance improves if students are given the required assistance and supervision in the clinical setting. Furthermore, individualized management makes learning more accessible because it fosters the development of students’ self-assurance, professionalism, independence, and role socialization, all of which contribute to clinical competency.^[10] Such a result indicates that students require support and guidance from professional experts in the clinical setting for personal and professional growth.

This study found that female, older students 23 years of age, single, and those enrolled in nursing leadership and management were predictors in professional nursing behaviors and clinical competencies. Female nursing students reported having better competencies than their male counterparts, implying that men and women had quite different expectations for their careers as nurses; female students were more motivated by professional interests than male students. Men had more expectations of working in leadership roles and being employed in jobs outside of traditional nursing, while women had higher expectations of prioritizing time with family.^[11] This result is consistent with the study of Myklebust^[12] that when choosing nursing specialties where relationship skills are crucial, women may be seen as more caring than men as compared to female nursing students, males have reported a more significant desire to hold leadership positions.^[13] They also have lower aspirations of becoming staff nurses after schooling.^[14] Older students were found to predict clinical competencies, which implies that a sizable fraction of mature-aged students is enrolling in undergraduate nursing programs due to the shortage of nurses and the professional path available for progression for both enrolled nurses and nonlicensed personal carers. Older students performed better in baccalaureate and diploma courses than younger students.^[15] This current result agrees with Letyak and associates^[16] where more senior staff are typically thought to be more dependable, dedicated, resistant to change, and challenged by technology. In contrast, the younger team aims to strike a balance between work and leisure. As such, it can contribute to the understanding that there are disparities in older nursing students regarding clinical productivity and level of care.

Meanwhile, students who were enrolled in nursing leadership and management were found to have better competencies than those who enrolled in other courses. This means that while the students are moving higher to their managerial concepts in nursing, they, too, understand the meaning of acquiring skills needed in their role as managers in the future. Accordingly, as the students move to higher levels, they just as well place the learning outcomes in higher thinking order skills.^[17]

The student nurses’ skills competencies (general performance) were predicted only by older students and those who are single. This means that age and being single have been potent factors in the motivational differences between men and women, which is in line with the study finding of Hoffart et al.^[18] Such results follow their differences in productivity and quality of care competency in younger and older nursing students. Concerning skills core competencies, females and their GPAs were found as predictors.^[19] This means that to ensure that nursing education is improved in the right ways to produce nurses who will increase the number of human resources for health, a more thorough and systematic review of the variables that predict academic performance, success, and retention of undergraduate nursing students is necessary. According to Mthimunye and Daniels,^[20] the critical contextual indicators and defining elements of academic achievement in nursing education include age, gender, educational, and clinical performance. In context, the training program for males, females, and those with lower GPA’s critical in gaining nursing values and achieving educational goals.^[21] This knowledge and the skills acquired are valuable and directly affect the student’s future career immediately after graduation when they start working.

Nursing students require highly specialized competencies to decide on the patient’s condition and to predict and cope with problems that may occur during nursing care.^[22] Of note, skills competencies (advanced nursing skills) dimensions were found to have a significant relationship with gender, specifically female, which means they were more motivated to pursue a specialty by professional interest. According to Maurud et al.,^[11] female students were more driven and less likely to hold future leadership roles, prioritized their families more, and were more likely to pursue careers in the traditional nursing area. Depending on their gender, nursing students have different educational goals and expectations for their jobs. A nursing career is associated with the female gender role.^[12]

Moreover, older and single students have better skills, which means that age has been mentioned as a potential factor in the motivational differences between men and women.^[18] Students who have enrolled in advanced health with and GPA of 3.1–4.0 were found as predictors as well, which implies that nursing behavior and skills performances are integral and crucial for students in pursuit of academic achievements and quality education that prepares them to become future nurses competent, competitive, and productive individuals in society. Nursing education aims to develop the information, attitude, and abilities necessary to give needy people the nursing care they deserve. Therefore, students ought to understand the value of education and raise their professional standards. According to Kaliyaperumal et al.,^[21] the rating is essential for assessing the factors influencing students’ academic performance and increasing GPA. Furthermore, it is critical that nurse educators’ would encourage students to improve more.^[19] Overall, these current results contribute to the understanding that nursing schools, professional organizations, and health institutions have an essential responsibility to ensure that both nurses and student nurses are prepared for this role.

This study has suggested that while the respondent’s perceived level of clinical behavior and skills competencies are commendable, they still need hands-on supervision. In both theory and clinical, the nursing educator is the backbone and contributory factor for the students to reach their highest achievement, thus meeting their needs in their training ground.

Study limitation

This study limits the generalization of the results as it was conducted using the self-reported tool. As such, the results of this study must be complemented by another study integrating a qualitative type or mixed-method analysis in exploring the students’ perspectives on clinical competencies.

CONCLUSION

The gender, age group, marital status, and course were found to predict the professional nursing behaviors of student nurses. Moreover, skill competencies (general performance was found to have significnat relationship with age and marital status. Concerning skills core competencies, gender and GPA were found to be predictors. Finally, skills competencies (advanced nursing skills) dimensions are significantly related to gender, age group, marital status, course, and GPA. These study results can be used as a tool for developing quality nursing programs needed at every level and across all settings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.