How competent are they? Graduate nurses self-assessment of competence at the start of their careers.

For many decades there has been ongoing debate about what it means to be competent and how competence develops and is assessed. A particular target in the debate has been graduate nurses. Despite the extent of competence of graduate nurses being questioned, very little research has examined graduate nurse competence at the time of commencing employment. This study sought to redress this gap. Forty-seven graduate nurses starting a graduate nurse programme in a large paediatric hospital were invited to participate in a study investigating the development of competence. All graduate nurses agreed to participate and completed the Nurse Competence Scale, a 73 item questionnaire across seven domains related to nurse competence: helping role, teaching-coaching, diagnostic functions, managing situations, therapeutic interventions, ensuring quality and work role. Each item is scored along a Visual Analogue Scale (0-100) where 0 is very low and 100 is very high. For descriptive purposes levels of competence are separated as low (0-25), rather good (> 25-50), good (> 50-75) and very good (> 75-100). Graduate nurses self-assessed their competence as rather good for overall competence and each of the domains. They indicated most competence in the domain of ensuring quality and least for teaching-coaching. Across all domains graduate nurses self-assessed a lower level of competence than in other studies using the NCS with nurses with more experience. The self-assessed level of competence in ensuring quality found in this study may reflect the emphasis on critical thinking and utilisation of evidence in practice in undergraduate studies. The findings of this study suggest graduate nurses have a lower level of self-assessed competence at time of commencing practice than nurses with more experience. Future research is warranted to understand to what extent, when, why and how competence develops in this population.