A New Competence Standard Improves Nurses’ Confidence in Readiness to Practice

Background An evidence-informed competence framework, with measurable performance outcomes and knowledge, skills, and abilities metrics, and an implementation toolkit were developed and beta tested to determine nurse readiness for transitioning from orientation to autonomous practice. Objective To evaluate satisfaction and toolkit implementation and impact, and to identify opportunities for improvement. Methods Sites replaced their orientation methods with the competence framework, and beta testing took place over a 1-year period. Surveys before and after implementation measured orientee and nurse leader confidence in orientees’ ability to recognize a change in stability, intervene for a change in stability, advocate on behalf of the patient, and provide safe patient care. Comparisons of length of orientation, satisfaction, and opportunities for improvement were assessed. Nurse retention at 1 year was determined. Results Thirteen progressive care and critical care units with 49 orientees completed the beta test; 24 orientees completed the before and after surveys. After beta testing, orientees reported increased confidence levels in all polled performance outcomes compared with before orientation. Most (92%) orientees reported the framework performance outcomes and knowledge, skills, and abilities metrics were moderately to completely effective in preparing them to work with minimal supervision. Most (88%) nurse leaders, educators, and preceptors rated these same outcomes and metrics as moderately to completely effective. Nurse retention at 1 year was 90%. Conclusion The beta test demonstrated improvement in confidence in all polled areas, and 1-year retention outperformed the national average. The competence framework is effective in answering the question, How do leaders know when the nurse is ready to transition from orientation to more independent practice?