Nursing competence is a critical factor that is directly related to improved and positive patient outcomes. A major proposition in Benner’s from novice to expert model (Benner, 2001), competence is a continuous process of acquiring knowledge, skills, and experience. Although Benner’s model has made many significant contributions, it’s time to advance the model to a new theory. One major challenge is that nursing competence does not always increase in a linear fashion. Building on the work of Benner, this abstract describes a new theory, Rochester Nursing Competence (RNC) that examines the relationship between nursing competence during the course of a career and patient outcomes.
Methods:
The RNC theory, adapted from Raymond Vernon’s product life cycle theory (1966), as derived using Walker & Avant’s theory derivation strategies. Five steps were followed for the development of theory: 1) To become familiar with the topics related to nursing competence and patient outcome in the nursing literature by critically apprising studies published in the English language between 1980 to 2016; 2) To study widely in nursing and economic disciplines to determine the appropriateness of the derivation; 3) To select the product life cycle theory as a parent theory for derivation and exam similarity, and discrepancy between the parent and new theory, RNC; 4) To identify and modify the structure and statements of parent theory in the development of RNC theory; Finally, 5) to redefine new concepts and statements in forming RNC theory.
Results:
RNC theory presents a dynamic trajectory plotting a relationship between the two concepts of nursing competence and patient outcomes. Patient outcomes, on the y-axis ranging from low to high, reflect the effect of clinical nursing care and are driven by nursing competence. A higher level of patient outcomes refers to the patient with a higher quality of care and vice versa. Nursing competence, on the x-axis, refers to an increasing clinical capability over time in coping with various clinical situations by integrating knowledge, skills, and experience. Four stages of nursing competence reflect in a nurse’s lifelong career: the beginning, growth, maturation, and declination. Theoretically, increased nursing competence contributes to better patient outcomes in clinical practice and vice versa. In RNC theory, nursing competence, which is varied over the course of an individual’s career, enhances over time but may also plateau or decline after reaching the maturation stage. The plateau or decline results in a stagnant or decreasing effect on patient outcomes. RNC includes three proposed strategies, which are at three levels: individual, hospital system, and environment. These three strategies act as moderators to prevent or minimize any decline in nursing competence. In addition, three strategies are layered from inner to outer influencing each other.
Conclusion:
Understanding the trajectory of nursing competence is important for examining patient outcomes in clinical care. RNC theory proposes a pragmatic relation between nursing competence and patient outcomes and includes a career-long trajectory of nursing. RNC theory offers a practical framework for future studies of nursing competence as it evolves over time in clinical practice.