Evidence-informed policymaking: Modelling nurses' career pathway from registered nurse to advanced practice nurse.

AIM: To formulate, validate, and disseminate policy, modelling nurses' career pathway from registered to advanced practice nurse. METHOD: The evidence-informed policy and practice pathway framework was utilized. Multiple methods were used, including scoping review of literature, consultation of key informants, survey study, and expert group round-table discussions during 5-year project between 2013 and 2018. RESULTS: Through (a) sourcing, (b) using, and (c) implementing the evidence, the expert group worked systematically to formulate a policy on a career pathway from registered to advanced practice nurse. The formulated career pathway includes three competence levels: registered nurse, specialized nurse, and advanced practice nurse, which includes the roles of nurse practitioner and clinical nurse specialist. In addition, validation and dissemination of the policy, as well as its effective implementation and the process of integrating it into practice, were examined. CONCLUSION: Evidence-informed policymaking is an effective, interactive way to work collaboratively in achieving consensus and translating knowledge into practice. The formulated policy will contribute to the increased awareness, acknowledgement, and implementation of the registered nurses' traditional and new roles within health care environments. Implementing and integrating the policy in national health care policy, legislation, education, and organizations across the country is a work in progress.

Students' Self-assessed Competence Levels during Nursing Education Continuum - A Cross-sectional Survey.

During nursing education, nursing students are required to develop their competence to be able to fulfill their duties safely as Registered Nurses. The aims of this study were to explore 1) nursing students' self-assessed competence levels during education 2) the relationship with competence and frequency at which competencies are utilized in clinical practice, and 3) factors related to competence levels. 841 (response rate 67.6 %) nursing students responded to the Nurse Competence Scale in a cross-sectional study. The self-assessed overall competence levels were improving during the education continuum (VAS-means 1st 56.6; 2nd 58.3; 3rd 59.8 and 3.5th -year students 68.4). Every group revealed a significant positive correlation with competence and frequency at which competencies are utilized in clinical practice in clinical placement. Risk factors for low competence were also identified. Systematic multimethod competence evaluations with longitudinal designs are needed to monitor outcomes of nursing education.

Effectiveness of nursing interventions among patients with cancer: An overview of systematic reviews.

AIMS AND OBJECTIVES: To explore nursing interventions used among patients with cancer and summarise the results of their effectiveness. The ultimate goal was to improve the quality of care and provide best evidence for clinicians to refer to while developing effective nursing interventions. BACKGROUND: Nursing interventions refer to actions that nurses take with the aim of improving the well-being of people with cancer-related health and care needs. A plethora of systematic reviews has been conducted in this research area, although with scattered results. We conducted a comprehensive review to identify and summarise the existing evidence. METHODS: This overview of systematic reviews adheres to the PRISMA guidelines. The PubMed, CINAHL, MEDLINE and Scopus databases were searched. Nine reviews reporting findings from 112 original studies published 2007-2017 met the selection criteria. The results of intervention effectiveness were analysed using descriptive quantification and a narrative summary of the quantitative data. RESULTS: The effectiveness of educational nursing interventions was inconsistent on quality of life (QoL), attitudes, anxiety and distress, but positive on level of knowledge, symptom severity, sleep and uncertainty. Psychosocial nursing interventions had a significant effect on spiritual well-being, meaning of life, fatigue and sleep. Psychological nursing interventions reduced cancer-related fatigue. Nursing interventions supporting patients' coping had a significant impact on anxiety, distress, fatigue, sleep, dyspnoea and functional ability. Activity-based interventions may prevent cancer-related fatigue. CONCLUSIONS: Nursing interventions achieved significant physical and psychological effects on the lives of patients with cancer. Multidimensional nature of interventions by combining different elements reinforces the effect. Priorities for future research include identifying the most beneficial components of these interventions. RELEVANCE TO CLINICAL PRACTICE: Implementation of these nursing interventions into clinical practice is important to improve patients' knowledge and QoL as well as reducing various symptoms and side effects related to cancer and its treatment.

Effectiveness of mobile cooperation intervention on students' clinical learning outcomes: A randomized controlled trial.

AIMS: The aim of this study was to evaluate the effectiveness of the mobile cooperation intervention in improving the competence and self-efficacy of students and the quality of the clinical learning environment. BACKGROUND: For students, the clinical practicum is challenging as such and moreover the student - teacher cooperation, which supports the clinical learning of the students, has become complicated. Mobile applications have potential but their role in facilitating this cooperation remains unknown. DESIGN: A parallel-group randomized controlled trial. METHODS: Data were collected between January-March 2015 in Finland. The nursing students were randomly allocated to an intervention group (N = 52) or control group (N = 50). The intervention group used a mobile application to cooperate with the teacher during the clinical practicum. The control group engaged in standard cooperation. The primary outcome was competence. The secondary outcomes comprised self-efficacy and the quality of the clinical learning environment. Nurse Competence Scale, Self-efficacy in Clinical Performance instrument and the Clinical Learning Environment, Supervision and Nurse Teacher scale were used for student self-assessments. For the main analysis, hierarchical linear mixed models were used with the intention-to-treat principle. RESULTS: Competence and self-efficacy showed no significant between-group differences in mean improvements, but significant improvements in both groups were detected over the 5 weeks. Satisfaction with the clinical learning environment showed no significant between-group differences, however, the role of the nurse teacher subscale, especially regarding cooperation, showed significant group differences. CONCLUSION: The mobile cooperation intervention was not significantly effective in improving individual outcomes, but did seem to improve significantly some aspects of the contextual outcomes. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02635295.

Constructing content validity of clinical nurse specialist core competencies: exploratory sequential mixed-method study.

RATIONAL: The demand to increase nursing competence is brought on by the requirement of safe, accessible and more effective use of healthcare provider expertise. Clinical nurse specialist competency development dates back to the late 20th century; however, an examination of the literature reveals a lack of research and discussion to support the competency development. OBJECTIVES: To describe the formulation and validation process of the clinical nurse specialist core competencies. DESIGN: Exploratory sequential mixed-method design. METHODS: This mixed-method study, conducted between 2013 and 2017 in Finland, involved four phases: I) a Policy Delphi study (n = 25, n = 22, n = 19); II) cross-mapping of preliminary competency criteria against international competency sets; III) content validity study of expanded competency criteria (n = 7, n = 10); and IV) verification of competency criteria with practicing CNSs (n = 16). Data were analysed by both qualitative and quantitative analysis methods. RESULTS: Seventy-four preliminary clinical nurse competency criteria were formulated in the first phase of the study. Through cross-mapping the competencies against the US and Canadian clinical nurse specialist competency sets, they were further concised to 61 criteria. The examination of Content Validity Indexes and experts' comments led to the clarification and consequent inclusion of 50 criteria to the final scale, with Scale Content Validity Index Average of 0.94. The competency criteria were evaluated to be a solid set with potential to clarify and uniform the clinical nurse specialist roles. CONCLUSIONS: Through a rigorous research process, validated clinical nurse specialist competency criteria were formed with a high Scale Content Validity Index Average. The results allude to the potential of formulating international competency criteria to support global role clarity and understanding. However, further research is needed to validate the content and construct of the formulated competencies with a larger population across countries.

Preceptors' perceptions of the elements of a successful and an unsuccessful orientation period for newly graduated nurses.

AIM: To identify existing orientation patterns and to find elements that may enhance or impede successful orientation of newly graduated nurses. BACKGROUND: Preceptors have first-hand information concerning orientation and their opinions should not be forgotten when organisations develop their orientation processes. METHOD: An open-ended questionnaire was undertaken to collect data from preceptors (n = 172) about the current orientation patterns. Data were analysed by using deductive content analysis and by quantifying the phrases. RESULTS: Communal commitment to the orientation process, strong professional orientation know-how and supportive leadership were the enhancing elements of successful orientation. Complex interpersonal relationship problems during orientation, inadequate orientation resources and the organisation's structural and functional problems were the impeding elements of successful orientation. CONCLUSIONS: With the elements of successful orientation we ensure a supportive transition to practice for newly graduate nurses and possibilities to focus on good orientation practices for preceptors. IMPLICATION FOR NURSING MANAGEMENT: Nurse leaders play an important part in ensuring newly graduated nurses have a safe nursing career starting point and, for preceptors, opportunities to provide orientation that is as good as possible. Supportive leadership, sufficient resources and good interpersonal relationships should be the leading principles during newly graduated nurses' orientation period.

Nurse Competence Scale: a systematic and psychometric review.

AIM: The aim of this study was to report a systematic and psychometric review. BACKGROUND: The Nurse Competence Scale is currently the most widely used generic instrument to measure Registered Nurses' competence in different phases of their careers. Based on a decade of research, this review provides a summary of the existing evidence. DESIGN: A systematic literature review of research evidence and psychometric properties. DATA SOURCES: Nine databases from 2004 - October 2015. REVIEW METHODS: We retrieved scientific publications in English and Finnish. Two researchers performed data selection and appraised the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist. RESULTS: A total of 30 studies reported in 43 publications were included. These consisted of over 11,000 competence assessments. Twenty studies were from Europe and 10 from outside Europe. In addition to experienced nurses, the Nurse Competence Scale has been used for the competence assessment of newly graduated nurses and nursing students, mainly in hospital settings. Length of work experience, age, higher education, permanent employment and participation in educational programmes correlated positively with competence. Variables including empowerment, commitment, practice environment, quality of care and critical thinking were also associated with higher competence. The Nurse Competence Scale has demonstrated good content validity and appropriate internal consistency. CONCLUSION: The value of Nurse Competence Scale has been confirmed in determining relationships between background variables and competence. The instrument has been widely used with experienced and newly graduated nurses and their managers. Cross-cultural validation must be continued using rigorous methods.

Competence Assessment Instruments in Perianesthesia Nursing Care: A Scoping Review of the Literature.

PURPOSE: To identify competence assessment instruments in perianesthesia nursing care and to describe the validity and reliability of the instruments. DESIGN: A scoping review in a systematic manner. METHODS: A search in CINAHL, MEDLINE, and ERIC was carried out to identify empirical studies from 1994 to 2015. A narrative synthesis approach was undertaken to analyze the data. FINDINGS: Nine competence assessment instruments in perianesthesia nursing care were identified. The instruments used three types of data collection methods: Self-report, observation, and written examinations. The most commonly reported validity method was content validity involving expert panels and reliability tests for internal consistency and inter-rater's consistency. CONCLUSIONS: Integrating more than one data collection method may give support to overcoming some of the limitations, such as lack of objectivity and misinterpretation of the assessment results. In an ever-changing environment, perianesthesia nursing competence requires constant reassessment from the perspective of content validity, scoring methods, and reliability.

Newly graduated nurses' occupational commitment and its associations with professional competence and work-related factors.

AIMS AND OBJECTIVES: To explore newly graduated nurses' occupational commitment and its associations with their self-assessed professional competence and other work-related factors. BACKGROUND: As a factor affecting nurse turnover, newly graduated nurses' occupational commitment and its associations with work-related factors needs exploring to retain adequate workforce. Nurses' commitment has mainly been studied as organisational commitment, but newly graduated nurses' occupational commitment and its association with work-related factors needs further studying. DESIGN: This study used descriptive, cross-sectional, correlation design. METHODS: A convenience sample of 318 newly graduated nurses in Finland participated responding to an electronic questionnaire. Statistical software, NCSS version 9, was used in data analysis. Frequencies, percentages, ranges, means and standard deviations summarised the data. Multivariate Analyses of Variance estimated associations between occupational commitment and work-related variables. IBM SPSS Amos version 22 estimated the model fit of Occupational Commitment Scale and Nurse Competence Scale. RESULTS: Newly graduated nurses' occupational commitment was good, affective commitment reaching the highest mean score. There was a significant difference between the nurse groups in favour of nurses at higher competence levels in all subscales except in limited alternatives occupational commitment. Multivariate analyses revealed significant associations between subscales of commitment and competence, turnover intentions, job satisfaction, earlier professional education and work sector, competence counting only through affective dimension. CONCLUSION: The association between occupational commitment and low turnover intentions and satisfaction with nursing occupation was strong. Higher general competence indicated higher overall occupational commitment. RELEVANCE TO CLINICAL PRACTICE: Managers' recognition of the influence of all dimensions of occupational commitment in newly graduated nurses' professional development is important. Follow-up studies of newly graduated nurses' commitment, its relationship with quality care, managers' role in enhancing commitment and evaluation of the impact of interventions on improving commitment need further studying.

Evaluating clinical competence during nursing education: A comprehensive integrative literature review.

This paper explored concepts, definitions and theoretical perspectives evaluating clinical competence during nursing education. The questions were: (i) How is clinical competence evaluated? and (ii) What is evaluated? An integrative review of 19 original research articles from 2009 to 2013 was performed. Results showed that evaluation tools were used in 14, observations in 2 and reflecting writing in 3 studies. The students participated in all but one evaluation alone or together with peers, faculty members or preceptors. Three themes were found: (i) professional practice with a caring perspective; (ii) clinical skills and reflective practice; and (iii) cognitive, affective and psychomotor skills both with a nursing perspective. This review shows an emphasis on structured methods with a risk reducing nursing to tasks and skills why combinations with qualitative evaluations are recommended. A holistic view of competence dominated and in designing evaluations, explicit perspectives and operationalized definitions of clinical competence became evident.

Newly graduated nurses' empowerment regarding professional competence and other work-related factors.

BACKGROUND: Although both nurse empowerment and competence are fundamental concepts of describing newly graduated nurses' professional development and job satisfaction, only few studies exist on the relationship between these concepts. Therefore, the purpose of this study was to determine how newly graduated nurses assess their empowerment and to clarify professional competence compared to other work-related factors. METHODS: A descriptive, cross-sectional and correlational design was applied. The sample comprised newly graduated nurses (n = 318) in Finland. Empowerment was measured using the 19-item Qualities of an Empowered Nurse scale and the Nurse Competence Scale measured nurses' self-assessed generic competence. In addition to demographic data, the background data included employment sector (public/private), job satisfaction, intent to change/leave job, work schedule (shifts/business hours) and assessments of the quality of care in the workplace. The data were analysed statistically by using Spearman's correlation coefficient as well as the One-Way and Multivariate Analysis of Variance. Cronbach's alpha coefficient was used to estimate the internal consistency. RESULTS: Newly graduated nurses perceived their level of empowerment and competence fairly high. The association between nurse empowerment and professional competence was statistically significant. Other variables correlating positively to empowerment included employment sector, age, job satisfaction, intent to change job, work schedule, and satisfaction with the quality of care in the work unit. The study indicates competence had the strongest effect on newly graduated nurses' empowerment. CONCLUSIONS: New graduates need support and career opportunities. In the future, nurses' further education and nurse managers' resources for supporting and empowering nurses should respond to the newly graduated nurses' requisites for attractive and meaningful work.

Practice environment and its association with professional competence and work-related factors: perception of newly graduated nurses.

AIM: To explore newly graduated nurses' (NGN) perception of their practice environment and its association with their self-assessed competence, turnover intentions and job satisfaction as work-related factors. BACKGROUND: The impact of practice environment on nurses' work is important. Positive practice environments are associated with positive organisational, nurse and patient outcomes. How this applies to NGNs needs further exploration. METHOD: A cross-sectional descriptive correlation design was used. Data were collected with PES-NWI and NCS instruments from 318 Finnish registered nurses, and analysed statistically. RESULTS: Newly graduated nurses' perception of their practice environment was mainly positive. Most positive perceptions related to collegial nurse-physician relations, and the least positive to staffing and resource adequacy. Positive perceptions were also associated with higher professional competence, higher perceptions of quality of care and lower intentions to leave the job or profession. CONCLUSION: The findings revealed strong and significant associations between practice environment and work-related factors. Practice environment is an important element in supporting NGNs' competence, retention and job satisfaction. Nursing management should pay attention to NGNs' perceptions of their practice environment. IMPLICATIONS FOR NURSING MANAGEMENT: Management's ability to create and maintain positive practice environments can foster NGNs' professional development and job satisfaction, and consequently retain them in the workforce.

The future of the clinical nurse specialist role in Finland.

PURPOSE: To identify and examine the expert panelists' visions on the future implementation of the clinical nurse specialist (CNS) role in Finland. DESIGN AND METHODS: A policy Delphi design was conducted in 2013. A purposive sampling method was used to recognize expert panelists in the areas of advanced practice nursing (APN), healthcare management, and advanced practice nurse education. Three iterative Web-based survey rounds were conducted (n = 25, n = 22, n = 19). Both qualitative and quantitative methods were used to analyze the data. FINDINGS: The expert panelists envisioned the future of the CNS role in Finland. This study portrayed the CNS role in Finland as generally consistent with the international role. CNS have comprehensive skills and knowledge that they use to guide and develop nursing practice; however, several threats may affect their role achievement. The existing national consensus, contradiction, and ambivalence related to CNS roles were revealed through the examination of the results, thus pointing out the areas for consideration when further developing these roles and role policies. CONCLUSIONS: This is the first national study to examine the implementation of the CNS role in Finland. Expert panelists' views regarding the CNS role will be valuable in the forthcoming national policy formulation process. Although the policy Delphi design is not often utilized, this study reveals that it is very well suited to guide and inform national and international APN policy development. CLINICAL RELEVANCE: This study contributes to CNS role development and describes the methods facilitating the essential policy formulation process.

Newly Graduated Nurses' Competence and Individual and Organizational Factors: A Multivariate Analysis.

OBJECTIVE: To study the relationships between newly graduated nurses' (NGNs') perceptions of their professional competence, and individual and organizational work-related factors. METHODS: A multivariate, quantitative, descriptive, correlation design was applied. Data collection took place in November 2012 with a national convenience sample of 318 NGNs representing all main healthcare settings in Finland. Five instruments measured NGNs' perceptions of their professional competence, occupational commitment, empowerment, practice environment, and its ethical climate, with additional questions on turnover intentions, job satisfaction, and demographics. Descriptive statistics summarized the demographic data, and inferential statistics multivariate path analysis modeling estimated the relationships between the variables. RESULTS: The strongest relationship was found between professional competence and empowerment, competence explaining 20% of the variance of empowerment. The explanatory power of competence regarding practice environment, ethical climate of the work unit, and occupational commitment, and competence's associations with turnover intentions, job satisfaction, and age, were statistically significant but considerably weaker. Higher competence and satisfaction with quality of care were associated with more positive perceptions of practice environment and its ethical climate as well as higher empowerment and occupational commitment. CONCLUSIONS: Apart from its association with empowerment, competence seems to be a rather independent factor in relation to the measured work-related factors. Further exploration would deepen the knowledge of this relationship, providing support for planning educational and developmental programs. Research on other individual and organizational factors is warranted to shed light on factors associated with professional competence in providing high-quality and safe care as well as retaining new nurses in the workforce. CLINICAL RELEVANCE: The study sheds light on the strength and direction of the significantly associated work-related factors. Nursing professional bodies, managers, and supervisors can use the findings in planning orientation programs and other occupational interventions for NGNs.

Nurse competence between three generational nurse cohorts: A cross-sectional study.

Research indicates significant differences between nurse cohorts in many work-related factors. This study compared nurse competence between three generational cohorts comprising the current nursing workforce. The Nurse Competence Scale was used to collect data for this cross-sectional study from 2052 nurses in a university hospital in Finland. Data were analysed statistically. Significant differences were found between nurse cohorts in their competence. The length of work experience had a significant impact on the development of competence. The oldest cohort, with the longest work experience, had the highest competence scores (70.1 on a visual analogue scale), and the youngest had the lowest (59.0). All cohorts were most competent in patient-related nursing tasks, in maintenance of professional competence and in ethical care. Nurses were weakest in the development of nursing practice and the use of evidence-based knowledge. Targeted interventions in teaching-coaching for different nurse generations are needed to ensure the maintenance of nurse competence and high-quality patient care.

Ethical climate and nurse competence - newly graduated nurses' perceptions.

BACKGROUND: Nursing practice takes place in a social framework, in which environmental elements and interpersonal relations interact. Ethical climate of the work unit is an important element affecting nurses' professional and ethical practice. Nevertheless, whatever the environmental circumstances, nurses are expected to be professionally competent providing high-quality care ethically and clinically. AIM: This study examined newly graduated nurses' perception of the ethical climate of their work environment and its association with their self-assessed professional competence, turnover intentions and job satisfaction. METHOD: Descriptive, cross-sectional, correlational research design was applied. Participants consisted of 318 newly graduated nurses. Data were collected electronically and analysed statistically. ETHICAL CONSIDERATIONS: Ethical approval and permissions to use instruments and conduct the study were obtained according to required procedures. Data were rendered anonymous to protect participant confidentiality. Completing the questionnaire was interpreted as consent to participate. FINDINGS: Nurses' overall perception of the ethical climate was positive. More positive perceptions related to peers, patients and physicians, and less positive to hospitals and managers. Strong associations were found between perceived ethical climate and self-assessed competence, turnover intentions in terms of changing job, and job satisfaction in terms of quality of care. Nurses at a higher competence level with positive views of job satisfaction and low turnover intentions perceived the climate significantly more positively. CONCLUSION: Nursing management responsible for and having the power to implement changes should understand their contribution in ethical leadership, as well as the multidimensional nature of nurses' work environment and the interaction between work-related factors in planning developmental measures. Future research should focus on issues in nurse managers' ethical leadership in creating ethical work environments. There is also a need for knowledge of newly graduated nurses' views of factors which act as enhancers or barriers to positive ethical climates to develop. Interventions, continuing education courses, and discussions designed to promote positive ethical climates should be developed for managers, nurses, and multi-professional teams.

Do educational outcomes correspond with the requirements of nursing practice: educators' and managers' assessments of novice nurses' professional competence.

OBJECTIVE: This study evaluated weather educational outcomes of nurse education meet the requirements of nursing practice by exploring the correspondence between nurse educators' and nurse managers' assessments of novice nurses' professional competence. The purpose was to find competence areas contributing to the acknowledged practice-theory gap. DESIGN: A cross-sectional, comparative design using the Nurse Competence Scale was applied. SUBJECTS: The sample comprised nurse educators (n = 86) and nurse managers (n = 141). METHODS: Descriptive and inferential statistics were used in the data analysis. MAIN OUTCOME MEASURES: Educators assessed novice nurses' competence to a significantly higher level than managers in all competence areas (p < 0.001). The biggest correspondence between educators' and mangers' assessments were in competencies related to immediate patient care, commitment to ethical values, maintaining professional skills and nurses' care of the self. The biggest differences were in competencies related to developmental and evaluation tasks, coaching activities, use of evidence-based knowledge and in activities which required mastering a comprehensive view of care situations. However, differences between educators' and managers' assessments were strongly associated with their age and work experience. Active and improved collaboration should be focused on areas in which the differences between educators' and managers' assessments greatly differ in ensuring novice nurses' fitness for practice.

Professional competence of practising nurses.

AIMS AND OBJECTIVES: To compare nurse competence in terms of its quality and frequency of action in medical, surgical, paediatric/obstetric/gynaecological and psychiatric clinical fields. BACKGROUND: One challenge of current health care is to target practising nurses' competencies to optimal use. Therefore, a systematic assessment of nurse competence is justified. Studies using the Nurse Competence Scale have found that nurses' competence is on a good or very good level and it increases with age and work experience. DESIGN: A cross-sectional comparative survey using the Nurse Competence Scale. METHODS: A purposive sample of 2083 nurses in a major University Hospital in Finland participated in this study in 2007-2008. Descriptive statistics and inferential statistics' anova with Bonferroni correction, and Pearson/Spearman correlation coefficients were used to analyse the data. RESULTS: The overall level of competence of nurses was good, and the quality of action correlated positively with the frequency of action. Nurses in the psychiatric field reached somewhat higher overall mean scores than nurses in other clinical fields. On item level, nurses seemed to be the most competent in actions related to immediate individualised patient care, the maintenance of their own professional competence and commitment to nursing ethics. Age and particularly work experience were positively correlated with the competence. CONCLUSION: Findings from this large data corroborate previous study results on the category level assessment of nurse competence using the Nurse Competence Scale indicating a good level of competence. On item level, findings revealed more detailed themes of nurse competence, which complements earlier knowledge retrieved from the category level analysis and could be used to target nurses' competencies to even more optimal use. RELEVANCE TO CLINICAL PRACTICE: Competence assessment and targeted interventions are recommended as tools for the management for planning nurses' career development and continuing education to ensure competent and motivated work force and high-quality care.

A systematic model to compare nurses' optimal and actual competencies in the clinical setting.

AIM: This paper is a report of a study to develop a model to compare nurses' optimal and actual competencies in the clinical setting. BACKGROUND: Although future challenge is to focus the developmental and educational targets in health care, limited information is available on methods for how to predict optimal competencies. METHOD: A multidisciplinary group of 24 experts on perioperative care were recruited to this study. They anticipated the effects of future challenges on perioperative care and specified the level of optimal competencies by using the Nurse Competence Scale before and after group discussions. The expert group consensus discussions were held to achieve the highest possible agreement on the overall level of optimal competencies. Registered Nurses (n = 87) and their nurse managers from five different units conducted assessments of the actual level of nurse competence with the Nurse Competence Scale instrument. Data were collected in 2006-2007. RESULTS: Group consensus discussions solidified experts' anticipations about the optimal competence level. This optimal competence level was significantly higher than the nurses' self-reported actual or nurse managers' assessed level of actual competence. The study revealed some competence items that were seen as key challenges for future education of professional nursing practice. CONCLUSION: It is important that the multidisciplinary experts in a particular care context develop a share understanding of the future competency requirements of patient care. Combining optimal competence profiles to systematic competence assessments contribute to targeted continual learning and educational interventions.

Evidence of clinical competence.

This cross-sectional research used a qualitative questionnaire to explore clinical competence in nursing. The aim was to look for evidence of how clinical competence showed itself in practice. In the research, the views from both education and working life are combined to broadly explore and describe clinical competence from the perspective of students, clinical preceptors and teachers. The questions were formulated on how clinical competence is characterised and experienced, what contributes to it and how it is maintained, and on the relation between clinical competence and evidence-based care. The answers were analysed by inductive content analysis. The results showed that clinical competence in practice is encountering, knowing, performing, maturing and improving. Clinical competence is an ongoing process, rather than a state and manifests itself in an ontological and a contextual dimension.