Implementing a Framework to Support Nursing Competence

Wednesday, 24 July 2013: 10:30 AM

Sally E. Lima, MSN, GradDipAdvNsg, RN1
Mercy Thomas, MSN, CertTertTchg, RN2
Bernadette Twomey, MN (Hons), PgDipHSc (Mgmt), BHS (Ngs), ADN, RN3
Fiona H. Newall, PhD, MN, BSc (Nsg), RN1
Sharon B. Kinney, PhD, MN, PICU Nsg Cert, Cardiothoracic Cert, BN1
(1)Nursing Research, The Royal Children's Hospital, Melbourne VIC, Australia
(2)Nursing Education, The Royal Children's Hospital, Melbourne VIC, Australia
(3)Nursing Services, The Royal Children's Hospital, Melbourne VIC, Australia

Learning Objective 1: The learner will be able to discuss influences and elements that contribute to the attainment and development of competence in clinical practice

Learning Objective 2: The learner will be able to identify enablers and barriers in introducing a program for nursing competence


Quality care requires competent healthcare providers. The introduction of a Nursing Competency Framework (NCF) was evaluated, focusing on graduate nurses in their first year of practice. Core components within the NCF include supernumerary time, preceptorship, attainment of specified competencies and regular meetings with nurse educators and nurse managers.  The aims of the evaluation were to:

  • Ascertain the degree to which the core components required in the first ten weeks of employment as a graduate nurse were adhered to
  • Identify the enablers and barriers that supported the implementation of the NCF.


A combination of quantitative and qualitative data was collected through questionnaires, audit and focus groups. Participants included graduate nurses, preceptors, nurse educators, nurse managers and nursing directors.  


Findings demonstrated high adherence to some of the core components. All graduate nurses received supernumerary time. 90% of graduate nurses were allocated a preceptor. On average, 25 out of 30 specified competencies were completed within the expected time frame. Variable adherence was reported for components such as frequency of meetings with nurse educators and nurse managers. 

Three themes related to enablers and barriers were:

  • Standards included making expectations clear, facilitating identification of development needs for all nurses and the difficulties inherent in assessing competence;
  • Resources included both human resources such as access to effective preceptors, and material resources such as study days and access to procedures and guidelines;
  • Context was identified as central to the successful implementation of the NCF.  Contextual factors impacting on the implementation included time available for development and implementation, expectations creating pressure, opportunities, patient acuity and workload of preceptors.


Successes and opportunities for further development to ensure the NCF supports the development of excellence in clinical nursing practice have been identified. Sharing the findings will enable other organisations to consider implications for developing a competent nursing workforce.