Journal of Nursing Education

Comparison of Expected and Evidenced Baccalaureate Degree Competencies

Barbara Joyce-Nagata, PhD, RN; Rene Reeb, PhD, RN; Sharron Burch, MN, RN

Abstract

ABSTRACT

The defining of beginning competencies for the baccalaureate degree in nursing education has been an issue over the past decade. Many researchers have attempted to investigate the performance of graduates of the basic nursing preparation programs. At present, there is little that links education to practice.

The purposes of this study were to validate whether the competencies of graduates of baccalaureate degree nursing programs were as expected by nursing service administrators, and whether the expected competencies were evidenced in the work setting. A two-part questionnaire was administered to 142 directors of nursing in health-care settings in Mississippi. The research project requested an evaluation of the baccalaureate competency statement from two perspectives. On a five-point Likert scale, administrators were asked to evaluate if the competency should be expected of a baccalaureate graduate. The administrators then evaluated to what extent the competency statement was evidenced. Analysis of the data was done using descriptive statistics. A mean for each competency was calculated for expected and evidenced responses. A difference of 30% between the expected and evidenced responses was deemed to be significant. Conclusions were drawn and recommendations for further study made.

Abstract

ABSTRACT

The defining of beginning competencies for the baccalaureate degree in nursing education has been an issue over the past decade. Many researchers have attempted to investigate the performance of graduates of the basic nursing preparation programs. At present, there is little that links education to practice.

The purposes of this study were to validate whether the competencies of graduates of baccalaureate degree nursing programs were as expected by nursing service administrators, and whether the expected competencies were evidenced in the work setting. A two-part questionnaire was administered to 142 directors of nursing in health-care settings in Mississippi. The research project requested an evaluation of the baccalaureate competency statement from two perspectives. On a five-point Likert scale, administrators were asked to evaluate if the competency should be expected of a baccalaureate graduate. The administrators then evaluated to what extent the competency statement was evidenced. Analysis of the data was done using descriptive statistics. A mean for each competency was calculated for expected and evidenced responses. A difference of 30% between the expected and evidenced responses was deemed to be significant. Conclusions were drawn and recommendations for further study made.

Introduction

The denning of beginning competencies for the associate and baccalaureate degree in nursing education has been an issue over the past decade. Historically, psychomotor skills were thought to be the mainstay of nursing performance (NLN, 1977). Baccalaureate education in nursing provides a broad background in liberal arts, teaching-learning theory, leadership theory and knowledge of human behavior of both individuals and groups (Bottoms, 1984; Gabrielson, 1968; Reed, 1967). Competencies in nursing education have been categorized by various concepts: functions, knowledge, and practice (Field, Gallman, Nicholson, & Dreher, 1984; Johnston, 1982). Waters, Chater, Vivier, Urrea, and Wilson (1972) and Norris (1972) have delineated professional nursing competencies related to specific nursing functions. Both authors utilize the nursing process as a framework to outline functional roles of the professional nurse. Waters et al (1972) includes collaboration, coordination of care, determination of research problems, modification of standard approaches, and provision of continuing education in her set of professional nurse competencies.

Many researchers have attempted to investigate the performance of graduates of the basic nursing preparation programs (Chamings & Teevan, 1979; Gray, Murray, Ray, & Sawyer, 1977; Hogstel, 1977; Krueger, 1971; Meléis & Farrell, 1974). Studies show a lack of congruency between the skills taught in schools of nursing and the skills expected of nursing service administrators in the marketplace (Heater, 1984; Hoyter, 1971; Kohnke, 1973; Martin, 1981; Moore & Grams, 1980; Nelson, 1978; Sweeney, Regan, CVMalley, & Hedstrom, 1980; Wende, 1984; Wesco, 1972;). Nursing service administrators seem to place more emphasis on an expansive repertoire of nursing skills than do faculty or new graduates (Sweeney & Regan, 1982). There seem to be identified differences in the levels of preparation in the different types of nursing programs (Chamings & Tfeevan, 1979; Primm, 1986; Boggs, Baker, & Price, 1987); however, current evidence is inadequate to determine if different types of program graduates actually perform differently. There is little that links education to practice.

Background

In recent years there has been much discussion in nursing service and nursing education regarding clinical competencies of the new graduate. The literature supports that this discussion is generated by associate and baccalaureate degree educators. In March 1977, the Executive Committee of the Council of Associate Degree Programs of the National League of Nursing (NLN), following a mandate of the Council, began to develop an objective approach to the problem of differentiation of various levels of nursing. This resulted in a statement of competencies that would describe the graduate of the associate degree nursing program on entry into practice (NLN, 1979). At the same time, the NLN appointed ad hoc committees for diploma and baccalaureate degree levels to write statements of competencies that would describe their graduates.

In Mississippi, an ad hoc committee for each of the preparation levels of nursing was formed by the Deans and Directors Council. The associate degree competencies for the state of Mississippi were completed and published in October 1977. Competency statements were developed in Mississippi, Florida, and Texas. National competency statements were completed and approved in 1978 by the NLN. After the NLN competencies were accepted, the Mississippi competencies were reviewed and revised to meet national standards. Baccalaureate competencies were completed by March 1978. These documents were subjected to review and comparison by the Deans and Directors Council, after which they were issued to all schools of nursing in Mississippi; state, regional, and national nursing organizations; state health-related organizations; and nursing administrators.

Content of the competencies was reviewed by the health service representatives and nursing educators. Systematic efforts to evaluate content validity provided input regarding relevance and clarity of the statements. The initial draft was revised according to comments received. These competencies have been reviewed and revised regularly by a committee of competent educators appointed by the Deans and Directors Council.

The competencies have been incorporated into most nursing curricula throughout the state. Later, a separate committee was formed to develop a strategy to validate competencies within nursing service. This committee consisted of one representative each from associate, baccalaureate, and master's degree programs. A research consultant assisted the committee as needed. The intended outcome of the proposed project was to be able "to validate with health agencies that graduates are able to perform the nursing activities indicated by the respective competencies."

To accomplish this task, the committee planned a research study and developed a questionnaire composed of the competencies from each of the levels of nursing education. Approaches to curriculum design can either be heavily behavioristic or humanistic. The baccalaureate competencies depict nursing roles from a holistic perspective that attempts to incorporate elements of culture, personality, and community. Early in its endeavors, the ad hoc committee established a limitation regarding the differences in curriculum design and the specificity with which associate and baccalaureate competencies could be described. The dilemma could not be resolved. Attempts to consolidate associate and baccalaureate competencies into one survey were dismissed. The consensus was that differences do exist in the curriculum design, knowledge base, practice role, and application of nursing practice. The committee voted to pursue validation of the written competencies as developed for each type of program separately. No comparison between baccalaureate and associate degree competencies was made. This article will report the findings of the research related to the baccalaureate degree competencies.

Purpose

The purpose of this research was twofold: to validate whether the competencies of graduates of the baccalaureate degree nursing program were as expected by nursing service administrators; and to validate whether the expected competencies were evidenced in the work setting.

To accomplish the task of determining the relationship between expected and realized outcomes of nursing graduates, the following secondary purposes were identified: to describe demographic data of the respondent; to determine separate internal consistency estimates for expected and evidenced competency responses for each competency; to determine overall internal consistency estimates for the combined responses; and to summarily describe the responses to each competency relative to the anticipated expectation of the competency by nursing service administrators and the degree of demonstrated behaviors evidenced by the sample group.

Population and Sample

The population for the study was 142 directors of healthcare facilities in Mississippi. These names were secured through the cooperation of the Mississippi Hospital Association, the Mississippi State Health Department, and the Mississippi Health Care Commission.

Because hospitals employ the majority of the new graduates during the first year after graduation, it was decided that the questionnaires would be sent to each hospital in Mississippi. The nursing home and community health population were selected by a systematic random sampling method (Table 1).

Methodology and Instrument Development

A two-part questionnaire was developed that included the following:

1. A demographic data sheet that included:

a. age;

b. sex;

c. type of basic education;

Table

TABLE 1DATA REGARDING SAMPLE POPULATION

TABLE 1

DATA REGARDING SAMPLE POPULATION

d. highest educational degree;

e. practice position;

f. previous teaching experience;

g. type of practice setting (acute, other);

h. agency size;

i. agency classification (private, public);

j. number of RN's employed by the agency;

k. number of baccalaureate and associate degree graduates hired.

2. Baccalaureate degree competencies.

The research project requested an evaluation of each of the developed competency statements from two perspectives. On a five-point Likert scale, administrators were asked to evaluate if the competency should be expected of a graduate. Then the administrator evaluated to what extent was the competency exhibited by baccalaureate degree graduates. The tool was scored so that a five indicated strong agreement with the competency and a one indicated a strong disagreement with the statement.

The questionnaire required approximately an hour to complete. There were two mailings of the questionnaire. Eighty of the questionnaires were returned which was 56% of total mailout. Twenty-two questionnaires (28%) were rejected as incomplete and 58 questionnaires (73%) were usable for data analysis.

The survey for the baccalaureate competencies was developed by listing the baccalaureate competencies and the subconcepts. Table 2 illustrates the major baccalaureate competencies, the number of respective subcompetencies, and the number of related behaviors used to clarify the competency and subcompetency more specifically.

Competency 1 describes the conceptual framework of baccalaureate education as being reflective of philosophical and ethical points of view regarding man, health, and nursing. Subcompetencies identified for this category were recognition of values, worth and dignity, and recognition of contributing environmental factors.

Competency 2 describes the knowledge base of the baccalaureate graduate as being supported by experience in humanities and the biopsychosocial sciences. Subcompetencies describe the use of creative self-expression, critical thinking, ecological variables, verbal and written communication, and professional role behaviors in nursing practice.

Competency 3 describes the utilization of nursing process with individuals, families, groups, and communities toward goals of health promotion, maintenance, and/or restoration . Subcompetencies included the five components of the nursing process: assessment, analysis, planning, implementation, and evaluation. Each component was either further described or broken down to more specifically describe nursing behaviors related to the respective component of the nursing process. The behavior, although specific, was generally applied to all nursing care and was not restricted to any one speciality area or age group. For example, under the subcompetency of evaluation, evaluation is specifically described as monitoring progress of goals, determining effectiveness of nursing actions, modifying a plan of care based on reassessment, and informing clients and significant others regarding progress toward desired goals.

Competency 4 speaks to the baccalaureate students' contribution to nursing practice through the utilization of systematic inquiry. Subcompetencies describe use of research skills and application of research findings to client care.

Competency 5 describes the demonstration of the baccaluareate students' accountability in nursing practice. Subcompetencies include behaviors specific to demonstrating accountability for self, the client, nursing practice, and the profession. Specific behaviors are identified for each subcompetency. For example, the subcompetency of accountability to the profession is delineated as practicing in the professional organization and contributing to the continued development of nursing.

Competency 6 refers to collaboration with nurses, health professionals, and consumers for the improvement of health-care delivery. Subcompetencies include knowledge of and respect for others, awareness of trends and issues in health-care delivery, and the application of planned change strategies.

Competency 7 evaluates the baccalaureate students' contribution to the ongoing appraisal and definition of nursing as a maturing profession. Subcompetencies include recognizing the potential for expansion of nursing roles, contributing to role redefinition, and participating in maintaining the integrity of nursing.

The seven major competencies and their respective subconcepts totaled 67 competencies for the baccalaureate graduate. Of the 67 competencies, 23 were cognitive, 31 psychomotor, and 13 were affective (Oliva, 1988). Of the seven major competencies, two are cognitive (2 and 4), three are psychomotor (3, 5, and 6) and two are affective (1 and 7)(Table 2). The subcompetency of implementation addressed nursing skills under the specific behavior of "performs functional skills required to meet the clients' biophysiological needs." All baccalaureate degree nursing functional skills were evaluated by this one competency statement.

Table

TABLE 2BACCALAUREATE DEGREE COMPETENCIES

TABLE 2

BACCALAUREATE DEGREE COMPETENCIES

Internal consistency refers to the extent to which all items on a scale measure the same variable. Another explanation of internal consistency reliability is that it is based on the average correlation among items within a test and the number of items. Coefficient alpha developed by Cronbach is the basic formula for determining internal consistency reliability.

Overall internal consistency estimates for the combined responses using Cronbach's coefficient alpha were calculated. The Cronback alpha was 0.86 for the expected competency statement and 0.82 for the evidenced competency statements. The overall Cronbach alpha was 0.84.

Study Findings

Table 3 summarizes the demographic data of the respondents to the baccalaureate degree questionnaires.

The number of responses, range of responses, and mean for each competency statement were calculated for expected and evidenced responses. The respondents agreed or strongly agreed with all of the expected competencies (mean >3.0). Administrators disagreed that 16 competencies were not evidenced by the baccalaureate degree graduates (mean <3.0). These 16 competencies are listed in Table 4, which identifies the specific behavior not evidenced and the respective major competency and/or subcompetency of the behavior.

There were 18 baccalaureate competencies in which the mean was in the 90th percentile for receiving a response of "strongly agree" on the expected and evidenced categories of the survey. Table 5 illustrates the item, the respective major competency, and the category (expected or evidenced) in which the item was ranked in the 90th percentile of agreement. Fifteen baccalaureate competencies were rated "strongly agree" at or above the 90th percentile for the expected category. Of the 15 competencies highly expected, seven were also highly evidenced in practice. The three competencies highly evidenced (above the 90th percentile) were not in the strongly expected category.

Table

TABLE 3FREQUENCIES AND PERCENTAGES OF RESPONDENT CHARACTERISTICS FOR BACCALAUREATE DEGREE COMPETENCIES

TABLE 3

FREQUENCIES AND PERCENTAGES OF RESPONDENT CHARACTERISTICS FOR BACCALAUREATE DEGREE COMPETENCIES

In analyzing the data received, the strongly agree and agree categories were condensed into one response for the expected category as well as the evidenced category. The frequencies of the responses (expected and evidenced) for each competency were converted to percentages. For each baccalaureate competency, a percentage was documented indicating the number of participants who indicated the competency was expected. A percentage was documented for each competency indicating the percentage of participants indicating that the competency was evidenced in practice. A difference of 30% between the expected and evidenced responses was deemed to be significant. Of the 67 competencies, 34 had a difference of 30% or greater between expected and evidenced responses. In summary, more than half of the identified baccalaureate competencies that were expected by nursing administrators were not evidenced in nursing practice.

Table

TABLE 4BACCALAUREATE COMPETENCIES NOT EVIDENCED IN NURSING PRACTICE BY NURSING ADMINISTRATORS

TABLE 4

BACCALAUREATE COMPETENCIES NOT EVIDENCED IN NURSING PRACTICE BY NURSING ADMINISTRATORS

Conclusion

There is an increasing awareness among both nursing administrators and nursing educators to define competencies for the technical and professional levels of nursing care. This has been addressed at both state as well as national levels. The Deans and Directors Council, representing the associate and baccalaureate degree nursing programs for the state of Mississippi, had the foresight to appoint ad hoc committees of nurse educators that not only developed competency statements but also, over a span of several years and by using nurse educators, were able to establish face and content validity for these statements.

However, because of the gap between nursing education and nursing practice, nurse administrators were requested to respond to the competency statements in two ways: identify if the competency was expected of the baccalaureate graduate, and indicate whether the baccalaureate graduate evidenced the competency in the work environment. Thus, content validation from the perspective of both nurse educators and administrators would be determined, giving strong credence to the identified competencies. Internal consistency estimates for the researcherdeveloped instrument were calculated at r=.84 (r=.86 for the expected competency statements and r=.82 for the evidenced competency statements),

Table

TABLE 5TOP RANKED COMPETENCIES RATED "STRONGLY AGREE" BY EXPECTED AND EVIDENCED COMPETENCIES FOR BACCALAUREATE DEGREE GRADUATES

TABLE 5

TOP RANKED COMPETENCIES RATED "STRONGLY AGREE" BY EXPECTED AND EVIDENCED COMPETENCIES FOR BACCALAUREATE DEGREE GRADUATES

The following conclusions are based on the findings of this study:

* All of the baccalaureate competencies were expected by respondents of the study.

* Administrators disagreeed that 16 baccalaureate competencies were not evidenced by the baccalaureate graduates in the practice setting. Of the baccalaureate competencies not evidenced by the respondents, the predominant deficit seemed to be in the psychomotor domain and, more specifically, in the application of the nursing process.

* Other factors, such as respondent demographics variables (previous education, teaching experience, job position) that may influence judgment of leadership personnel related to expectations and observations of competencies. This study represents one state's leadership qualifications and resulting judgement.

The conclusions of this study have implications for nurse educators in Mississippi who purport to teach an entire curriculum according to nursing process. A concern is the contention that a baccalaureate nurse is socialized into the role of professional nursing via the nursing process.

Nursing curricula are in a continuous state of flux. Educators delete, integrate, and expand content. In fact, the most active dimension is extending course content based on what the educator holds to be meaningful in relation to a specialty area and practice setting. The validity of the decisions about what students need or are expected to know is a fundamental factor affecting practice. Further study of nursing curriculum in relation to activities and experiences that facilitate and enable students to meet competencies need to be investigated. Decisions about course content and experiences should be based on the depth and breadth of understanding of the longlasting relevance to the practice setting. The students ability to use knowledge in varying clinical settings beyond the influence of specific environments needs to be critiqued during curriculum evaluation and revision.

Attempts to increase communication between nursing education and practice have been initiated through the Mississippi Nurses Association (MNA) with the involvement of the special interest groups. The MNA Nursing Program Educators and Nursing Service Administrators special interest groups have joined to provide workshops with the major purpose of increasing communication and collaboration related to the education of student nurses. The workshops (Faculty Practice; Content, Competence, and Care; Preceptorships; and Working Together for Safe Practice) provided theory as well as opportunities for small group work related to increasing competence in the work place. Continuous communication related to the strengths and weaknesses of the new graduate must be planned and facilitated at local levels.

Identification of specific nursing behaviors or activities that reflect baccalaureate competencies need to be delineated. Delineation of nursing actions that reflect competence would increase reliability of administrator judgment. Inservice education provided in the workplace to facilitiate interpretation of competency statements and/or to identify specific nursing actions respective of each competency would increase reliability of respondent réponse.

Identification and validation of competencies may become more critical as the nursing shortage and entry into practice issues continue. It is proposed that this study be replicated in other states to gain further validation of the competencies and control for specific evaluator variables.

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TABLE 1

DATA REGARDING SAMPLE POPULATION

TABLE 2

BACCALAUREATE DEGREE COMPETENCIES

TABLE 3

FREQUENCIES AND PERCENTAGES OF RESPONDENT CHARACTERISTICS FOR BACCALAUREATE DEGREE COMPETENCIES

TABLE 4

BACCALAUREATE COMPETENCIES NOT EVIDENCED IN NURSING PRACTICE BY NURSING ADMINISTRATORS

TABLE 5

TOP RANKED COMPETENCIES RATED "STRONGLY AGREE" BY EXPECTED AND EVIDENCED COMPETENCIES FOR BACCALAUREATE DEGREE GRADUATES

10.3928/0148-4834-19890901-08

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