Journal of Nursing Education

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Does the Baccalaureate Make a Difference?: Differentiating Nurse Performance by Education and Experience

Vivien DeBack, PhD, RN; Marcia Mentkowski, PhD

Abstract

ABSTRACT

The nursing profession continues to debate the question of whether level of education matters in performance once the nurse is oriented to a particular setting, or whether the assumed advantages of baccalaureate education can be substituted by on-the-job experience. In this study, nurses with a baccalaureate degree demonstrated more nursing competencies when compared with their associate degree or diploma colleagues. Results also suggest that education promotes a broader range of abilities than does experience.

Abstract

ABSTRACT

The nursing profession continues to debate the question of whether level of education matters in performance once the nurse is oriented to a particular setting, or whether the assumed advantages of baccalaureate education can be substituted by on-the-job experience. In this study, nurses with a baccalaureate degree demonstrated more nursing competencies when compared with their associate degree or diploma colleagues. Results also suggest that education promotes a broader range of abilities than does experience.

Introduction

The profession continues to debate the question of whether level of education matters in performance once the nurse is oriented to a particular setting, or whether the assumed advantages of baccalaureate education can be substituted by on-the-job experience. Nurse educators expect baccalaureate education to develop superior nurse practitioners, but are these expectations confirmed in demonstrations of nursing performance by experienced nurses?

Nursing professionals now can debate the question more effectively because the identification and measurement of nursing competence that defines effective clinical performance has recently received considerable attention. Some authors have focused on developing performance checklists (McCaffrey, 1978; Scott, 1979; Smania, McClelland & McClosky, 1978) or competence rating scales (Wandelt & Stewart, 1975), while others have developed competencies of graduates for use by nursing programs (Jacobs, Fivars, Edwards & Fitzpatrick, 1976; National League for Nursing, 1982; Report of Statewide Thsk Force, 1982). Nurse educators, practitioners, and administrators have all been involved in creating these sets of competencies, and all sets claim to be able to identify the skills, abilities, competencies, or expectations of the practicing nurse, and to more clearly describe differences in the practice of nurses with varying educational backgrounds.

The literature cited above assumes that curricula for preparing nurses are different and prepare two different kinds of nurse, one technical and one professional. But evidence is mixed as to whether baccalaureate graduates actually perform more and different abilities than associate degree or diploma graduates. Nelson (1978) found that as a group, baccalaureate, associate degree, and diploma graduates perceived their degree of competence differently. Supervisors of baccalaureate, associate degree, and diploma graduates also perceived the nursing graduates' degree of competence differently. Chamings and Teevan (1979) concluded that baccalaureate degree nursing educators do indeed have higher expectations of student performance than do associate degree educators, but neither Chamings and Teevan nor Nelson researched whether graduates of baccalaureate or associate programs performed differently.

Some studies find a difference in the nursing performance of graduates from technical vs. professional programs; some do not. McKenna (1971) found differences in function, knowledge and basic skills of nurses who graduated from baccalaureate programs when compared to nurses who graduated from associate degree and diploma programs. Although McKenna identifies elements of both professional and technical nursing practice for employers of nursing to use in hiring, McKenna claims there is little evidence in the literature concerning whether service agencies utilize graduates differently or whether graduates from different programs actually perform differently. Walters, Chater, and Viver (1972) studied baccalaureate and associate degree staff nurses. They found that directors of nursing consistently acknowledged differences between professional and technical nursing practices, while head nurses did not. Clearly, the question of level of education as a differentiating variable for nurse performance needs further study, and level of education needs to be considered in relation to years of experience.

But how do we define effective nurse performance in a way that has meaning for the nurse educator and administrator such that performance can be taught and assessed both in school and on the job? We believe a generic set of nursing competencies that are developmental, holistic, and descriptive of effective nurse performance can assess such abilities in school and in practice, provided the competencies actually measure differences between baccalaureate and associate degree nurses in practice and differentiate abilities more likely developed through education as distinct from experience.

Nurse performance is thus defined in this study as a set of broad competencies that can be developed in baccalaureate nursing programs and also observed in the practice of experienced nurses. An important consideration in deriving a competence model is developing a clear definition of the term competence or ability. For Alverno educators, a competence is a broad, generic ability, characteristic of the person, that transfers across settings and situations, and is not a set of discrete skills. A competence is ageneric ability that transfers because educators must define an ability in ways that enable them to teach and assess for it independent of the many future roles and settings in which graduates will practice. This transferability is critical because even experienced nurses continue to change positions, roles and responsibilities.

While a generic competence does not usually have a oneto-one correspondence with observable actions in performing a job, it represents underlying characteristics that can be applied to describe the successful integration of a variety of subtasks. Competencies also serve as constructs that both educators and practitioners can use to guide teaching, learning, and assessment of professional role behaviors. A competence is developmental, in that it can be defined in sequential descriptions or pedagogical, cumulative levels that describe increasingly complex elements or processes for teaching and assessing performance. A competence is also holistic in that it is an integrated, inseparable part of a person. A competence is made up of several integrated components: knowledge, skills, affect, motivation and selfperception. Competencies are outcomes of an educational process, and they also describe the kind of personal abilities most nurse educators are seeking to develop in students, and administrators are seeking to select for and develop on the job (Alverno College Faculty, 1976; Alverno College Nursing Faculty, 1985; Mentkowski & Doherty, 1984).

Competencies are defined in behavioral terms, and inferred from descriptions of effective and ineffective behaviors performed by professionals. This study differs from others cited in this article that nurses were asked not only to describe abilities they believe are necessary for effective practice, but in addition, each nurse was interviewed for six incidents of her own effective and ineffective performance and asked to describe her behavior in detail through a critical incident interview (Flanagan, 1954; Jacobs, Fivars, Edwards & Fitzpatrick, 1976; McClelland, 1978). The interview also collects information on the entire context in which the incident took place, distinguishes the nurses performance from that of others in the event, and elicits what the nurse was thinkng and feeling at the time. It also elicits the ultimate result of the behaviors so that an expert judge can determine the nurses effectiveness or ineffectiveness in each situation. The competencies for effective nursing performance were derived from the interviews (Mentkowski, DeBack, Bishop, Allen & Blanton, 1980). Subsequent to derivation of the competencies, performance data were related to the nurses' education, experience, position, and work setting.

The hypotheses tested were (1) baccalaureate graduate nurses perform more nursing competencies than associate degree or diploma nurses and (2) nurses with more nursing experience perform more nursing competencies.

Method

Sample: Three health care settings in a large midwestern metropolitan area were selected to participate: acute care, long-term care, and a community agency. They were selected for their excellent reputation in both lay and professional communities, so that more effective performance was more likely measured. Eighty-three female nurses were interviewed from a wide range of units in the three settings (Table 1). Nurses in both staff and supervisory positions were interviewed (Table 2).

Instruments: Job Competence Assessment (Boyatzis, 1982; Klemp, 1980; McClelland, 1976; Mentkowski, O'Brien, McEachern & Fowler, 1982), a methodology developed by McBer and Company, was selected to measure nurse performance because the method assumes that competencies as defined above manifest themselves in numerous specific job- related actions or behaviors, and that these instances represent the evidence of the presence of competence. This methodology consisted of administering four instruments: a peer nomination questionnaire to enable a comparison between "outstanding" and "good" nurses; a job element inventory of 120 behaviors to assess nurses' perceptions of behaviors critical for training, selection, and outstanding performance; and a biographical questionnaire to collect data on a number of variables including highest degree earned and number of years in practice (Mentkowski et al., 1980). McClelland's (1978) Behavioral Event Interview generated critical incidents to assess nursing performance. Researchers from McBer trained the interviewers in the technique. Data from the biographical questionnaire and interview were analyzed to test the two hypotheses advanced in this study.

Table

TABLE 1POPULATION OF NURSES EMPLOYED, PARTICIPATED, RETURNED QUESTIONNAIRE, INTERVIEWED, AND CRITICAL INCIDENTS COLLECTED PER SETTING

TABLE 1

POPULATION OF NURSES EMPLOYED, PARTICIPATED, RETURNED QUESTIONNAIRE, INTERVIEWED, AND CRITICAL INCIDENTS COLLECTED PER SETTING

Table

TABLE 2FREQUENCY OF NURSES IN THREE SETTINGS BY ORGANIZATIONAL POSITION

TABLE 2

FREQUENCY OF NURSES IN THREE SETTINGS BY ORGANIZATIONAL POSITION

Table

TABLE 3EDUCATIONAL BACKGROUND OF NURSES INTERVIEWED

TABLE 3

EDUCATIONAL BACKGROUND OF NURSES INTERVIEWED

Procedure: All nurses were assured of confidentiality on all instruments. Data collection began with the nomination procedure. The rationale for this procedure is to identify competencies that describe "outstanding" nurse performance. All nurses identified those nurses they believed were "outstanding" practitioners from all nurses in that setting. A panel of two social scientists and two professional nurse educators reviewed the distribution of nominations cast for nurses within each setting to differentiate the group of "outstanding" nurses, and then randomly selected a group of "outstanding" nurses (n = 45) and a comparable group of "good" nurses not nominated (n = 38). Nomination data analysis are not reported for the purposes of this study, but this variable neither differentiated "outstanding" nor "good" nurses, nor did this variable correlate with education and experience. In addition, nurses in both staff and supervisory positions across three settings (acute care, long-term care, community agency), were interviewed.

Table

TABLE 4YEARS OF EXPERIENCE OF NURSES INTERVIEWED

TABLE 4

YEARS OF EXPERIENCE OF NURSES INTERVIEWED

Each interviewee described three critical incidents in which the nurse felt effective and three critical incidents where she felt ineffective. For each incident, the interviewer elicited information about what happened, what led up to the incident, who was involved, what the nurse thought or felt at the time, what the nurse did, and what the outcome was. After describing six incidents, the participant described her own job responsibilities, and the characteristics needed to perform her role. Each interview lasted approximately one and a half hours. The interviews were taped with prior consent and written up in a standard format to aid analysis. Following the interview, the participant completed the biographical questionnaire, which generated the educational background of nurses (Table 3) and their nursing experience (Table 4). For the purpose of data analysis, the associate degree and diploma nurses (n = 38 ) were contrasted with baccalaureate and higher degreed (n = 45) nurses. Nurses with five or more years of experience (n = 29) were contrasted with nurses with less than five years of experience (n = 54).

Table

TABLE 5GENERIC COMPETENCE MODEL FOR EFFECTIVE NURSING PERFORMANCE: A CODEBOOK1

TABLE 5

GENERIC COMPETENCE MODEL FOR EFFECTIVE NURSING PERFORMANCE: A CODEBOOK1

Table

TABLE 5GENERIC COMPETENCE MODEL FOR EFFECTIVE NURSING PERFORMANCE: A CODEBOOK1

TABLE 5

GENERIC COMPETENCE MODEL FOR EFFECTIVE NURSING PERFORMANCE: A CODEBOOK1

Table

TABLE 5GENERIC COMPETENCE MODEL FOR EFFECTIVE NURSING PERFORMANCE: A CODEBOOK1

TABLE 5

GENERIC COMPETENCE MODEL FOR EFFECTIVE NURSING PERFORMANCE: A CODEBOOK1

Table

TABLE 6EDUCATION AND EXPERIENCE MAIN EFFECT MEANS AND STATISTICAL SIGNIFICANCE MEANS AND PROBABILITY VALUES

TABLE 6

EDUCATION AND EXPERIENCE MAIN EFFECT MEANS AND STATISTICAL SIGNIFICANCE MEANS AND PROBABILITY VALUES

Development and Use of the Codebook: A model of nurse competencies was derived from the interview data to describe behaviors and was then used as a codebook to score differences in nursing performance. The codebook derivation process was developed over one and one half years by Alverno researchers with initial assistance from David McClelland and George Klemp of McBer. Ten versions of the codebook were developed through a bootstrapping or hormeneutic enterprise. The final, eleventh version includes nine broad, generic competencies (Conceptualizing, Emotional Stamina, Ego Strength, Positive Expectations, Independence, Reflective Thinking, Helping, Influencing, Coaching) and behavioral descriptors that appeared to discriminate outstanding from good nurses across the 502 critical incidents coded from the three settings (Table 5); statistical analyses generally did not confirm discrimination by nomination.

Each aspect of the incident was crucial for the researchers in the analysis of the data since specific behaviors were considered the only scorable information. All incidents were scrutinized by each of three researchers for codable behaviors. The process for deriving competencies from the incidents focused on what occurred, on behaviors related to the outcome, and on what the nurse actually did.

While deriving competencies from the incidents, behavioral descriptors were used to further differentiate various aspects of the competencies and to describe their positive or negative value given the outcome. The codebook thus describes behaviors that could be coded positively or negatively. Positive categories were not used for negative coding.

After the codebook was completed, the 502 incidents from the three settings were scored using the codebook. Each of three coders (two nursing faculty and one sociologist) assigned scores to each critical incident. Each critical incident was coded only once for a given behavioral descriptor, even though it may have appeared more than once. Because agreement levels among the three coders did not reach acceptable levels for individual coding alone, discrepancies among the coders were resolved by consensus.

Results

Overall Frequency of Competencies: The nine competencies generated from the 502 incidents, ranked by frequency of positive occurrence across incidents, are: Helping, 224; Influencing, 171; Independence, 137; Coaching, 122; Conceptualizing, 56; Ego Strength, 27; Emotional Stamina, 17; Reflective Thinking, 14; and Positive Expectations, 6. Three of the five competencies that were negatively coded were infrequently observed. The negatively coded competencies ranked for frequency of negatively coded incidents are: Conceptualizing, 32; Independence, 20; Positive Expectations, 9; Ego Strength, 7; and Emotional Stamina, 3.

Relationships Among Competencies: Cluster analysis of the competencies examined the extent to which clusters of scores in the data confirmed the competencies as being independent abilities. Each nurse demonstrated a wide variety of competencies. Even at the 409c error level, clusters in the data do not appear. The competence model was developed with the intent that each competence should be an independent ability, and the cluster analysis supports that independence.

Further support for this finding of independence is found in the intercorrelation matrix1 for the positively coded competencies. This matrix showed seven of 81 significant intercorrelations from which we concluded that the competencies themselves are more likely independent. For positive competencies, absolute magnitude of correlation coefficients range from r = .00 to r = .35. The average for these correlations is r = .11. Consequently, each competence is treated separately in the analysis of education and experience.

Relationship of Education and Experience to Competencies

Overview: A 2 ? 2 (Education ? Experience) analysis of variance procedure for unequal n's yielded statistically significant Education main effects for six of the nine competencies and yielded statistically significant Experience main effects for three of the nine competencies (Table 6). Some additional Education and Experience main effects approached statistical significance (Table 6). In general, Education and Experience were associated with more competencies performed, but Helping was a notable exception.

Education: The behaviors of the more educated nurses exhibited more Independence and Ego Strength. Thus, the more educated nurses acted more independently, took responsibility for their judgment, or took an advocacy role for another, while at the same time they showed Ego Strength by acting responsibly even at the risk of incurring disapproval. Further, negatively coded Ego Strength marginally approached statistical significance, supporting the positive influence of education on Ego Strength. The more educated nurses not only performed more Influencing, which involved strategic attempts to refocus emotions or to change behaviors, but also exhibited more Coaching. Coaching goes beyond strategic influence by specifying that the direction of behavioral change is toward increasing the responsibility of others, and is a more complex behavior than Helping. The behaviors of the more educated nurses also exhibited less Helping.

The less educated nurses were more likely to demonstratively fail at Conceptualizing by not recognizing relevant relationships or by failing to guide their actions according to relevant higher order principles (they were coded more often for negative Conceptualizing). Conversely, the more educated nurses were more likely to be positively coded for Conceptualizing (although this latter finding only approached statistical significance). Another nearly significant main effect suggests that more educated nurses also exhibited more Reflective Thinking. In other words, more educated nurses tended to search for or find greater insights by reñecting on their own behavior, feelings, beliefs, and their consequences.

There was perhaps some tendency for the more educated nurses to exhibit more instances of emotions interfering with their performance, which are the behaviors negatively coded as Emotional Stamina, but this effect only marginally approached statistical significance.

Experience: The behaviors of the more experienced nurses exhibited more Influencing, which indicates that they used more proscriptive rationales, valid information, or alternative strategies to change behavior or else strategically attempted to refocus negative emotions more often. Behaviors of more experienced nurses also were more frequently positively coded for Conceptualizing, which indicates that experienced nurses more often supported their thought or action with a relationship between pieces of information, showed the creative use of resources, or recognized an abnormal pattern from data within normal limits. The behaviors of more experienced nurses exhibited less Helping, which includes less active listening, rapport, empathy, or the provision of information. Unlike the more educated nurses, less Helping was not accompanied by more Coaching, but was accompanied by more Influencing. Main effects that approach statistical significance suggest that (1) more experienced nurses were less likely to stereotype or see a person as incapable (negatively coded Positive Expectations), and that (2) the behaviors of less experienced nurses exhibited more instances of controlling anger or fear (Emotional Stamina). (3) There was also some tendency for the more experienced nurses to show more Reflective Thinking. (4) Finally, the more experienced nurses showed some tendency to demonstrate more Ego Strength.

Interaction Effects: One interaction between Education and Experience approached statistical significance, but does not qualify any of the above main effects. The interaction involves negatively coded Ego Strength, which describes behaviors where the nurse either abandons her responsibility because of an untested barrier or expected disapproval or else acts out of a need for approval or feelings of ineffectiveness. T-tests show that the nurses with the least education and experience demonstrated this lack of Ego Strength (M = .33) more than the more educated and/ or experienced nurses (Ms = .05, .05, and .07).

Extraneous Variables: Position and Setting

Education: The position of the nurse, supervisor versus staff, was not associated with her level of education, r = .11, ? >.16. However, level of education was associated with the setting where the nurse practiced, chi square 2 (2df) = 27.87, p<.001. At the community agency, 27 of 30 nurses interviewed had at least a baccalaureate, while only 14 of 43 nurses interviewed at the acute care setting had a bacalaureate or above. Within the acute care setting, where level of education showed more variance, education was associated with supervisory versus staff position, r = .28, p<.05.

Education was positively associated with Ego Strength, even within the acute care setting, F(1, 41) = 23.00, ? <.001. The tendency of the baccalaureate nurse to do less negative Conceptualizing also remains clear, even within the acute care setting, F(I, 41) = 5.71, g <.05. The tendency of the baccalaureate nurse to demonstrate more Coaching is also directionally evident even within the acute care setting, F(1, 41) = 3.54, ? <.08. In addition, the baccalaureate nurse appears to demonstrate Reflective Thinking equally in the community agency and acute care settings. However, the tendency of the baccalaureate nurse to demonstrate less Helping also appears in the acute care setting, F(I, 41) = 11.32, ? <.01.

The community agency nurses with a baccalaureate tended to exhibit more positively coded Ego Strength and Independence than their counterparts in the acute care setting, t(39) = 3.86, ? <.01 and t(39) = 2.30, ? <.05, respectively. The three coded instances of negative Emotional Stamina are all associated with baccalaureate nurses in the community agency. The baccalaureate nurses in the community agency exhibited more Helping than the baccalaureate nurses in the acute care setting, t(39) = 3.34, ? <.01. Baccalaureate nurses perhaps tend to demonstrate more Coaching in the community agency than in the acute care setting, but this difference only approaches statistical significance, t(39) = 1.70, ? <.10.

Experience: The amount of nursing experience did not differ across the three nursing settings, chi square 2 (2df)<l. Experience was, however, substantially associated with the position of supervisor as opposed to staff, r= .54, p<.001. Of the 29 nurses with less than five years of nursing experience, only two were supervisors.

Conceptualizing was positively associated with experience, even for nurses in a staff position, F(I, 44) = 6.05, ? <.05. If anything, however, it was the less experienced nurses who were most likely to show Ego Strength in a staff position, F(I, 44) = 3.59, ? <.07. Experience did not otherwise predict competencies of the nurses working as staff, all ? >.18.

Among the more experienced nurses, those in a supervisory position tended to be those most likely to demonstrate the competencies of Influencing and Ego Strength, F(I, 50) = 5.22, ? <.05 and F(I, 50) = 10.12, ? <.01, respectively. Experienced supervisors exhibited less Helping and tended to perhaps have less Emotional Stamina, F(I, 50) = 3.36, ? <.08, and F(I, 50) = 2.69, ? =.11, respectively.

Discussion

The findings of the present study suggest that education promotes a broader range of abilities than experience does. Moreover, the impact of education appears to be independent of the impact of experience. There was only one hint of an interaction between these two variables. The relative independence of nursing education effects from work experience may be the result of the experiential nature of nursing education. Indeed, nursing experience itself was also associated with some competencies.

The benefits of education, in general, do not appear to be due to the spurious association of education with type of setting. Even within the restricted sample of the acute care setting, baccalaureate nurses demonstrate more competencies. Baccalaureate nurses demonstrate more Ego Strength and Coaching, and are less likely to be caught exhibiting a lack of appropriate Conceptualizing, even within the acute care setting. The pattern of data also supports the greater Reflective Thinking of the baccalaureate nurse across setting.

In this study, Ego Strength is defined as an ability to withstand confrontation and disagreement or to persevere in one's judgment despite disapproval. Thus, the more educated nurse appeared as a confident and capable professional able to fulfill responsibilities even at the risk of incurring disapproval. The more highly educated nurse frequently demonstrated the competence of Coaching. We defined Coaching as a teaching behavior. This ability to instruct, encourage, and train is a commonly expected outcome of baccalaureate nursing education. The present data support this contention, as the baccalaureate nurses instructed and encouraged others to take more responsibilities.

The more highly educated nurse appears to be less likely to exhibit a failure to appropriately conceptualize a situation. The data suggest that both the more educated and/or more experienced nurse show more effective Conceptualizing of the nursing situations they confront. The more educated nurse seems to show more of a tendency to reflect upon her thoughts, feelings, actions, and their consequences.

Some of the other beneficial effects of education, such as Independence and, perhaps, Influencing, might be attributable to the community agency setting instead. Even if so, it is not clear whether this agency selectively chose baccalaureate nurses, who have greater Independence and Influencing behaviors or, alternatively, whether this agency provides a setting that elicits these competencies. Moreover, setting alone does not account for the greater Influencing of more educated nurses, because the trend for community agency based nurses to exhibit more Influencing does not approach conventional levels of statistical significance. Still, the nurses at the community agency, who were highly educated, demonstrated a higher degree of Independence. In other words, they demonstrated decisive action without external pressure to do so, accepted responsibility for their judgment, and adopted an advocacy role. These highly educated nurses described situations in which they actively followed problems to their conclusions, acted as a causal agent and sought information when necessary.

In addition to their tendency to show more positive Conceptualizing, more experienced nurses showed less tendency to stereotype or see persons as incapable. Although more experienced nurses also showed more Influencing through personal example, valid information, alternative strategy, and emotional refocusing, these more experienced nurses also tended to be in supervisory positions. Indeed, only those nurses who were both more experienced and in a supervisory position showed greater Influencing, and, since there were virtually no inexperienced nurses in a supervisory position, promotion to supervision alone may lead to these Influencing behaviors. Promotion to a supervisory position also seems associated with greater Ego Strength.

The more educated and experienced nurses showed less Helping described as active listening, rapport, empathy, and the provision of information. But the more educated nurse showed more Coaching, described as instructing or a more complex form of Influencing. Baccalaureate education encourages the development of self-help behavior. Educated and experienced nurses also showed some tendency toward having less Emotional Stamina. It should be noted that nurses in supervisory positions also exhibited less Helping and Emotional Stamina. The strong correlation between experience and position implies that supervision is the probable cause of these decreases for the more experienced nurses. The smaller correlation between education and position suggests that the decreased Helping and Emotional Stamina of the more educated nurse cannot entirely be attributed to their higher positions. Decreased Emotional Stamina of the more educated may be due to the stresses that executive nurses experience because they see the complexity and consequences of performing in many difficult situations which may be beyond their control. More educated and experienced nurses, because they conceptualize, understand, and are more likely to see consequences, may simply be reflecting reactions to situations which are indeed more realistically overwhelming than they are to the more naive nurse. In addition, the low relationship between level of education and promotion may be especially frustrating for these competent nurses. In fact, if education were more important in determining promotion then it apparently is among the nurses we studied, the nurses in supervisory positions might, we suspect, show greater Emotional Stamina.

Conclusions

Nurses with a baccalaureate degree demonstrated more nursing competencies compared with their associate degree or diploma colleagues. To date, the professional literature has been mixed as to whether baccalaureate nurses offer a different level of care than their associate degree or diploma colleagues. These results support McKenna's (1971) findings that baccalaureate nurses do perform differently when compared to associate degree or diploma graduates.

Many studies of nursing abilities have focused on new graduate nurses (Chamings & Teevan, 1979; McKenna, 1971; Nelson, 1978). This study offers new data because it studied the long-term impact of education on experienced nurses who have been "in the field" and are knowledgeable enough about their roles and institutions to apply theories of nursing to practice. In this study, nurses with five or more years of experience performed more competencies than those with less than five years. Although experience is also an important factor in the development of effective practitioners, level of education impacts a broader range of behaviors than years of experience.

Perhaps education had more of an impact because performance was measured by generic competencies. We think that the effects of education are observed because competencies are defined as holistic, broad abilities with multiple components that transfer across time, roles and settings; nursing performance is measured in this way. In this study, we researched not only specific behaviors, but we also considered the situation itself, who was involved, what motivations, dispositions, attitudes and self-perceptions the nurse was thinking or feeling at the time the behavior was performed, and what the results of the behaviors were. All these elements, taken together, allow the inference of a generic competence characteristic of the person that is causally-related to performance. Therefore, nursing performance is judged and linked to nursing theory not only by the skill observed, but by the entire context, sequence of events, thoughts and intentions of the nurse, and ultimate outcome.

These behaviorally defined competencies may be particularly useful because they apply across clinical settings and units. Within any given setting, generic abilities are applicable in numerous, specific, job-related actions. Indeed, study results on the impact of education and experience on competencies defined in this way held across position (staff, supervisory) and setting (acute, long-term, community agency).

Study results describe the more experienced, educated nurse as likely to demonstrate more Conceptualizing, Ego Strength, Independence, Influencing, and Coaching. These nurses also show more Reflective Thinking but less Emotional Stamina. These abilities, when taken together, seem to have an underlying component; that of an active, thinking, influential style, in which the nurse strives to assist the client to take on more responsibility for his or her own care. This study suggests that the more experienced, educated nurse, when given the opportunity, is likely to engage in an active, thinking role. Finally, there is no substitute for education. The competencies of Ego Strength, Coaching and Independence appear attributable to education alone. Experience alone accounts only for the positive aspects of Conceptualizing. Happily, education and experience in combination seem to provide the nurse with a greater ability to consider the total context of the nursing situation and what it requires as opposed to the simple reliance upon routine practice.

We believe that in-depth studies of this nature are necessary because of the way curriculum decisions have been made in nursing education. In the past, abilities needed by nurses were defined for curricula by nursing faculty, based on the faculty's knowledge and experience. Studies based on the performance of effective nurses are needed to support expert judgment of nursing faculty in the selection of abilities to be taught in baccalaureate curricula. This nursing competence model (Mentkowski et al., 1980), tested for the relative effects of education and experience, is being used to validate the Al verno nursing curriculum, and the examples of effective nurse performance will be used to improve instructional strategies and assessment techniques. The next step for nursing education is to develop instruments to assess these, and perhaps other competencies, and then to examine the extent to which students demonstrate them. These assessment techniques and an accompanying assessment center technology (Thornton & Byham, 1982) could also be used by nurse administrators to determine the effectiveness of practitioners and their potential for advancement.

That level of education is so influential is encouragement to nurse educators who support the baccalaureate degree as the minimum requirement for professional practice. Nurse administrators are encouraged to seek baccalaureate graduates because they will be the more effective and efficient practitioners. In this day of cost consciousness, the nurse educator needs assurance that more education has longterm benefits, and the nurse administrator needs tools to identify those nurses who perform the abilities needed for contemporary practice. This study suggests that baccalaureate nurses, given time to acquire experience, will be the most effective in professional job performance.

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TABLE 1

POPULATION OF NURSES EMPLOYED, PARTICIPATED, RETURNED QUESTIONNAIRE, INTERVIEWED, AND CRITICAL INCIDENTS COLLECTED PER SETTING

TABLE 2

FREQUENCY OF NURSES IN THREE SETTINGS BY ORGANIZATIONAL POSITION

TABLE 3

EDUCATIONAL BACKGROUND OF NURSES INTERVIEWED

TABLE 4

YEARS OF EXPERIENCE OF NURSES INTERVIEWED

TABLE 5

GENERIC COMPETENCE MODEL FOR EFFECTIVE NURSING PERFORMANCE: A CODEBOOK1

TABLE 5

GENERIC COMPETENCE MODEL FOR EFFECTIVE NURSING PERFORMANCE: A CODEBOOK1

TABLE 5

GENERIC COMPETENCE MODEL FOR EFFECTIVE NURSING PERFORMANCE: A CODEBOOK1

TABLE 6

EDUCATION AND EXPERIENCE MAIN EFFECT MEANS AND STATISTICAL SIGNIFICANCE MEANS AND PROBABILITY VALUES

10.3928/0148-4834-19860901-05

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