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A Crisis in Competency

The Strategic and Ethical Imperative to Assessing New Graduate Nurses’ Clinical Reasoning

Kavanagh, Joan M.; Szweda, Christine

doi: 10.1097/01.NEP.0000000000000112

AIM The aim of the study was to assess entry-level competency and practice readiness of newly graduated nurses.

BACKGROUND Literature on success of new graduates focuses primarily on National Council of State Boards of Nursing Licensure Examination (NCLEX-RN) pass rates, creating a false and incomplete picture of practice readiness.

METHOD Posthire and prestart Performance-Based Development System assessments were administered to more than 5,000 newly graduated nurses at a large midwestern academic medical center between July 2010 and July 2015.

RESULTS Aggregate baseline data indicate that only 23 percent of newly graduated nurses demonstrate entry-level competencies and practice readiness.

CONCLUSION New data suggest that we are losing ground in the quest for entry-level competency. Graduates often are underprepared to operate in the complex field of professional practice where increased patient acuity and decreased length of stay, coupled with a lack of deep learning in our academic nursing programs, have exacerbated a crisis in competency.

About the Authors Joan M. Kavanagh, MSN, RN, NEA-BC, is the associate chief nurse of nursing education and professional development, Cleveland Clinic Foundation, Cleveland, Ohio. Christine Szweda, MS, BSN, RN, is the senior director, operations of nursing education and professional development, Cleveland Clinic Foundation. For more information, contact Joan Kavanagh at

The authors declare no conflict of interest.

© 2017 Lippincott Williams & Wilkins, Inc.
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