Using the Competence Scale for Senior Clinical Nurses to Examine Safe Staffing

Background: To achieve the intended outcome of healthy work environments, in the form of quality care, safe patient outcomes, and nurse recruitment and retention, attention must be directed to the invisible, cognitive work of nursing (i.e., work that promotes suitable work flow and care delivery), and to factors that support or complicate this invisible work ¹. Nurse staffing has always been a complex issue, but delivery of safe, quality, cost-effective patient care is important, along with the creation of a safe environment for patients and medical professionals.

The perception of adequacy of a staffing scale is a 6-item scale assessing the most common factors affected by nurses’ perceptions of adequate staffing ². One of the central themes was to develop the role of the Senior Charge Nurse (SCN) and equip these clinical leaders with the information and tools needed to monitor and improve quality in their areas ³.

We developed the Competence Scale for Senior Clinical Nurses (CS-SCN) ⁴as a concise scale to measure and evaluate the competence of senior clinical nurses. The CS-SCN comprises five factors: “Role accomplishment”, “Self-management”, “Research”, “Practice and coordination”, and “Work implementation” .Measuring competence is important to achieve safe and appropriate nurse staffing,

Objective: The aim of this study was to examine whether the CS-SCN is a useful marker of appropriate nurse staffing.

Methods: A cross-sectional questionnaire survey using the CS-SCN was undertaken at a hospital in Japan in 2013. Subjects comprised 219 senior clinical nurses (27 males, 191 females) defined as those with ³5 years of clinical experience. Total score for each factor was calculated by wards which were involved of internal medicine, surgery, ICU, ER, OR, obstetrics and gynecology, etc. We compared competence scores for each factor by ward. We tested whether differences in scores were statistically significant by Kruskal-Wallis test, and distributions were tested by box plot.

This study was approved by the research ethics committee of the authors’ institution.

Results: No competence scores showed significant differences, but distributions for the competence score of wards by box plot were different. With regard to the total score (range:22-88) of all factors, the highest level was 86, and the lowest level was 35. Score ranges were 7–28 for “Role accomplishment”, 2–8 for “Self-management”, 2–8 for “Research”, 5–20 for “Practice and coordination”, and 6–24 for “Work implementation”. Mean total score was 61.2 (range, 45–76) for highest-level ward and 49.5 (range, 42–61) for lowest-level ward.

Conclusions: The results suggest that CS-SCN offers useful scale for measuring safe nurse staffing.

Conflicts of interest: The authors declare no potential conflict of interest with respect to the research and authorship.

Acknowledgments: This work was supported by Japan Society for the Promotion of Science, the Ministry of Education,
Culture, Sports, Science, and Technology (KAKENHI grant No. 26463250), Japan.