Instruments for measuring head nurses’ competencies in a hospital setting: a scoping review

Head nurses have diverse job content, including operational management, human resources management, patient care, and unit-level policy development. They act as leaders, coordinators, managers, monitors, liaisons, and negotiators, and thus require broad competencies. Measuring these competencies is challenging because of the absence of integrated instruments that measure multiple intertwined competencies. This study aimed to identify and map existing instruments used to measure head nurses’ competencies and analyze the specific competencies they address. A scoping review according to the five-stage framework of Arksey and O’Malley was conducted. Articles focusing on developing and psychometrically testing instruments to measure the competencies of head nurses with 24-hour first-line organizational and hierarchical responsibility for one or two units in a hospital setting were included. An electronic search was conducted via PubMed, Embase, and CINAHL. The Journal of Nursing Administration, Journal of Nursing Management, Journal of Healthcare Management, International Journal of Healthcare Management, Nursing Management, Nursing Administration Quarterly, and Nursing Outlook were screened manually to identify additional articles. This study included twelve articles published between 2006 and 2024. A total of 477 head nurse competencies were identified across 12 measurement instruments. Thematic analysis revealed four key competency areas, encompassing 20 related subthemes. First, strategic management competencies involve systemic thinking, research and evidence-based practices, change management, creative thinking, external liaison, and possessing an organizational view and political savviness. Second, operational management competencies focus on quality and safety management, process management, technology and information management, financial management, resource management, and staff planning. Third, clinical competencies encompass direct patient care, case management, customer service commitment, and diversity and ethical practices. Finally, human resources competencies include communication and interpersonal competencies, general staff management, professional development, and individual staff management. Nine instruments permitted self-assessment, two facilitated 360° assessment, and one enabled assessment by the head nurses’ superiors. This study highlights inconsistencies in the terminology and descriptions of the head nurse position, as well as the competencies outlined in instruments, leading to ambiguity. To address this, clearer and more standardized definitions are needed, ensuring that competencies can be effectively measured in practice.