International Journal of Nursing Research (IJNR)

International Peer Reviewed Journal

Research Article

Assessing Clinical Competencies of Intern Nursing Students:

A Comparative Study in both Private and Governmental Health Sectors
Hayam El-Shrief, Marwa Ageiz
Department of Nursing Administration, Faculty of Nursing, Menoufia University, Egypt

ABSTRACT

Aim: This study aimed to assess the clinical competence of nursing intern students in both private and governmental health
sectors and then to compare the clinical competency of intern students in both sectors. Subjects and Methods: Descriptive
cross-sectional comparative research design was used. This study was conducted at two health sectors in Egypt, including
governmental sectors (Teaching Hospital and Menoufia University Hospital in Shebin El-Kom, Menoufia Governorate,
and Naser Institute) and private sector (El-Salam International Hospital, International Medical Center, and Omoma
Hospital). The participants of this study included all intern students (n = 105) enrolled in the internship program during
the academic year 2017–2018 at the Faculty of Nursing, Menoufia University. Tool: First tool: Self-Assessment Clinical
Competence Questionnaire was used to conduct this study. Second Tool: Clinical competence questionnaire was used
as an observational checklist to observe the actual clinical competence level of the intern students. Result: The highest
percentage of the studied sample achieved an excellent level of competence at both hospitals regarding all competency
domains. However, the general performance domain of competency had the highest score. Conclusions: There were
statistically significant differences between both hospitals (governmental and private) regarding all competency domains,
as the majority of intern students at the private hospitals achieved an expert competence level than intern students at the
governmental hospitals.

Keywords: Clinical competency, Nursing intern students, Private and governmental health sector

Address for Correspondence: Hayam El-Shrief, Department of Nursing Administration, Faculty of Nursing, Menoufia University,
Egypt. Email: [email protected]

Introduction The Nursing and Midwifery Council defined competence as

skills and capacity to practice safely and effectively while
Nursing agenda is greatly concerned with developing and there is no supervision. Clinical competency is outlined as the
accessing competence. Reviews of competence concluded that ability to unravel complex problems employing a combination
no single definition is accepted nationally; thus, competence of knowledge, attitude, and practical skills, and its goal is to
might represent potential to perform, not actual performance. assess practical capabilities of medical students in varied
fields so as to satisfy the requirements of public service.[1]
Access this article online To be a clinically competent clinician, one should have the
Website:www.innovationalpublishers.com/journal/ijnr e-ISSN: 2456-1320
ability to provide safe care and a capability to accurately
DOI: https://doi.org/10.31690/ijnr/65 assess and critically suppose through the most effective
This is an open access journal, and articles are distributed under the
choices for care using evidence-based practice. Furthermore,
terms of the Creative Commons Attribution Noncommercial Share clinically competent student/nurse has the ability to apply
Alike 4.0 License, which allows others to remix, tweak, and build upon metacognitive judgment through a demonstration of
the work non-commercially, as long as appropriate credit is given and
the new creations are licensed under the identical terms. understanding self-knowledge, applicable knowledge, and
self-evaluation, whereas incorporating attributes such as
How to cite this article: El-Shrief H, Ageiz M. Assessing Clinical Competencies
of Intern Nursing Students: A Comparative Study in both Private and Governmental effective communication, efficient time management, and
Health Sectors. Int J Nur Res. 2018; 4(4): 268-275. delegation in their clinical practice.[2]

268 © 2018 IJNR | Published by Innovational Publishers

 El-Shrief and Ageiz, IJNR, Vol 4 (4), 268-275, 2018

Nursing education should foster clinical competence as a areas of specialization that they are looking for, validating
fundamental goal which includes the ability to apply professional the nurse’s knowledge and demonstrating their initiative in
knowledge and skills, communication and social skills, and taking charge of their education.
advanced problem solving and decision-making skills.[3]
Assessing clinical competence that aimed to identify areas that The role of employers and the government
require improvement moreover determining the educational
needs of nurses should be taken into account because of the Promoting the nurse’s credentials of the knowledge, skills,
most vital responsibility of managers in clinical settings.[4] and personal attributes that they need in the nursing field is
Recently, attaining an entry level of clinical competency the responsibility of employers. Similarly, the government
through nursing education and paying attention to the conjointly plays a paramount role through organizing
clinical competence of nurses are a necessary foundation and retaining nursing programmers to support nurses in
of the nursing profession, due to the multiplied community reinforcing their clinical competencies.
awareness and expectations concerning receiving high-
quality services, paying attention to the clinical competence Significance
of nurses has become more paramount.[5] According to the
Australian Nursing Association, nursing students should Competency measurements that predict job performance
have enough consciousness concerning their professional could increase the probabilities that a remedial action will
qualifications when graduating and their attitudes toward be identified and will increase job performance of trainees
acquiring necessary competencies ought to be positive for who had low scores on end-of-training competency tests.[10]
their clinical performance to be effective.[6] Intern students during the internship program offered by
Health care is provided through public and private providers. the faculty of nursing are assigned to both private and
The private health sector provides varied services and governmental hospitals through which students were
distinctive learning opportunities thus contributing to clinical exposed to different practice environment that may affect
education and training of nursing intern students. There are their competency level. Consequently, the aim of that study
essential differences between the public and private hospital was to assess clinical competence of intern nursing students
sectors which produce valuable opportunities for education in both private and governmental health sectors and then to
and training.[7] Factors that affect the private sector’s compare the clinical competency of intern students in both
capacity to provide education and training include (a) the sectors, through the following objectives:
admitted patient profile and treatments provided, (b) the • Assessing intern students’ level of clinical competencies
staffing profile, and (c) funding models.[8] in private sectors.
• Assessing intern students’ level of clinical competencies
Four ways for nurses to maintain clinical competency[9] in governmental sectors.
• Comparing levels of clinical competencies of intern
Commit to lifelong learning students at private and governmental sectors.

The nursing career requires lifelong learning that motivates Theoretical framework: Stages of clinical competence
nurses to continuously demonstrate commitment to enhance acquisition[11]
their competence and to ensure that their competencies are
updated according to the current nursing practices. Benner’s application to nursing of the Dreyfus model of skill
acquisition
Attend conferences and seminars
Benner applied skill acquisition model to explain the nurse
The conferences provide nurses with the opportunity to progression level during their practice from novice to expert.
meet inspiring speakers, experts, and professionals from
different nursing specialties and backgrounds. The nurse Three Competency levels: Novice/advanced beginner
can further develop networks with other nurses and health-
care professionals, allowing them to exchange ideas and Novice/advanced beginner: (marginally acceptable
concepts and keep updated on the most recent innovations performance)
in nursing care and education. They start to spot clinical situations. They are unable to
possess a comprehensive view of a new clinical case and the
Get a certification in specialization absence of critical approach.
Competent
Being certificated in specialization provides patients with a They are attentive to all relevant aspects of a situation; they are
lot of trust within the skills and talents of a nurse who is ready to articulate their actions in the form of medium and long-
certified in their specialization. Employers will also be more range goals or plans. They have the competencies to critically,
persuaded to hire a nurse with a valid certificate within the consciously, and analytically grasp matters and to form plans.

© 2018 IJNR | Published by Innovational Publishers 269

 El-Shrief and Ageiz, IJNR, Vol 4 (4), 268-275, 2018

Proficient/expert intern students on an individualized basis with each nursing

Intuitive understanding of every scenario, they have the intern during their clinical practice in the clinical setting by
ability to provide the necessary intervention and evaluation the researcher.
in an accurate and rational manner on the health-care
problem; they possess a deep knowledge of the situation as Scoring system of the tool
a whole. Highly skilled, they use analytic tools when a new
situation presents itself. The original instrument ranged responses on a 5-point Likert
scale to measure the clinical competence level of upcoming
Subjects and Methods baccalaureate nursing graduates. The scale item response
scores range from 1 (do not have a clue) to 5 (known in
Study design theory, competent in practice without any supervision). Total
scores range from 47 to 235, with a higher score indicating
A descriptive, cross-sectional, comparative, quantitative a higher level of competence.
study design was employed. In this study, the researcher applied some modification to the
scale to become a 3-point Likert scale named as 1 (novice), 2
Study setting (competent), and 3 (expert), indicating that 1 referred to the
student require learning and development relating to most or
This study was conducted at two health sectors in Egypt, all aspect of this competence, 2 referred to the student require
including governmental sectors (Teaching Hospital and learning and development relating to some aspect of this
Menoufia University Hospital in Shebin El-Kom, Menoufia competence, and 3 referred that the student was confident
Governorate, and Naser Institute) and private sectors and can effectively demonstrate her/his knowledge, skills,
El-Salam International Hospital, International Medical and performance relating to this competence.
Center, and Omoma Hospital). Total score ranged from 47 to 141. The scoring system was
as follows: From 1 to 47 indicating the novice level, from
Study sample >47 to 94 referred to a competent level, and from >94 to 141
showed a competent level.
The participants of this study included all intern students
(n = 105) enrolled in the academic of internship program Validity and reliability of the tool
during the year 2017–2018 at the Faculty of Nursing,
Menoufia University. The validity and reliability of the study tool were evaluated
in a cross-sectional study by Liou and Ching,[12] who
Data collection tool found that the Cronbach’s alpha for the entire 47-item
Clinical Competence Questionnaire was 98. Tools were
First tool tested for content validity by a jury of five experts in the
field of nursing administration to ascertain relevance and
Self-assessment clinical competence questionnaire was completeness.
used to conduct this study that was developed according
to Patricia Benner’s “from novice to expert” model and Pilot study
provided a basis for interpreting our study results.
In this study, the questionnaire consisted of two parts, first Before actual data collection, a pilot study is conducted
part included sociodemographic data such as age, gender, by the researcher by distributing self-administered
marital status, residence, having periodic educational questionnaire on 10% of the study sample (12 students)
program, and having extra shifts and the second part from different clinical areas who were not included in the
contained four main competency components that delineated main study sample to fill out the questionnaire to ascertain
specific competencies required for nursing pre graduates: clarity and applicability of the study tool and to determine
(a) Nursing professional behaviors, which includes 16 obstacles that may be encountered during data collection.
competencies; (b) general performance, which includes
12 competencies; (c) core nursing skills, which includes Procedure
12 competencies; and (d) advanced nursing skills, which
includes 7 competencies consisting of 47 items. Actual data collection process started after 6 months of the
internship year from March 2018 to August 2018 to ensure
Second data collection tool that intern students overcame the reality shock that might
be experienced by them at the beginning of engaging in the
To ensure more validation to the collected data, the researcher clinical field and rotated on many clinical areas that might
used clinical competence questionnaire as an observational provide them with different clinical practice and impacted
checklist to observe the actual competency level of the their level of clinical competence.

270 © 2018 IJNR | Published by Innovational Publishers

 El-Shrief and Ageiz, IJNR, Vol 4 (4), 268-275, 2018

Data were collected by the researchers using two methods and Microsoft Excel Spreadsheet Package (Office 2010) for
result analysis of the study. Data were expressed as number
First and percentage (n and %) and analyzed by applying Chi-
square test. All these tests were used as tests of significance
Administering self assessment clinical competence at P < 0.05 in the current study.
questionnaire to the intern nursing students to be filled out
during their clinical practice. Results
Second Table 1 displays the distribution of sociodemographic
characteristics of the studied sample. As shown in Table 1, the
The nursing interns were instructed to deal with all clinical
highest percentage of the studied sample was between the age
situations freely without any tension and instructed to take
of 22 and 24 years in both governmental and private hospitals.
all care decisions as they used to do in the presence of the
Regarding gender, the highest percentage of the studied
researchers who observed the nursing intern students’ skills.
sample was female. In addition, the highest percentage of the
Each observation conducted at different times through
studied sample was single at the private hospitals. More than
different shifts.
half of the respondents were rural residence at both private
and governmental hospitals. The majority of respondents who
Ethical considerations
did not attend any periodic in-service training programs were
A letter of approval was secured from the Dean of the in the governmental hospitals. The highest percentage of the
Faculty of Nursing to the Head of the Hospitals, in which studied sample who worked overtime was in private hospitals.
the study was conducted. The participants were asked for Table 2 illustrates association between sociodemographic
the approval for their participation. The researchers clarified characteristics of the studied sample and their total level of
to the participants that their participation in the study is clinical competence. As indicated from Table 2, there was
optional and they are able to withdraw from the study at any a statistically significance between nursing intern students’
time. Furthermore, it was explained to the research subjects socio-demographic data such as (gender, marital status, and
that anonymity and confidentiality will be guaranteed and working overtime) and their level of clinical competence.
no names on the questionnaires will be written. Table 3 shows the frequency distribution of the studied sample
according to their total level of clinical competence. As
Data analysis revealed from Table 3, the highest percentage of studied sample
achieved an expert level of the general performance of clinical
The collected data was refined by the researcher for any competence regarding all clinical competency domains.
repeated or missed responses, then computerized, coded, Table 4 displays the frequency distribution of the clinical
analyzed, and tabulated. The researcher utilized Statistical competence level for the studied sample of both hospitals.
Packages for the Social Sciences, Version 20.0 for Windows, There were highly significant differences between both

Table 1: Distribution of sociodemographic characteristics of the studied sample (n=105)

Subjects’ characteristics Governmental (n=54) Private (n=51) P value
Age (years) n (%) n (%)
22–24 75.9 (41) 64.7 (33) 0.2
>24 24.1 (13) 35.3 (18)
Gender
Male 27.4 (14) 27.7 (15) 0.5
Female 72.6 (37) 72.2 (39)
Marital
Single 90.1 (46) 51.8 (28) 0.000
Married 9.9 (5) 48.2 (26)
Residence
Rural 54.9 (28) 53.7 (29) 0.9
Urban 45.1 (23) 46.2 (25)
Periodic in‑service training program
Yes 39.2 (20) 11.1 (6) 0.000
No 60.8 (31) 88.9 (48)
Working over time
Yes 70.5 (36) 27.7 (15) 0.000
No 29.5 (15) 72.3 (39)

© 2018 IJNR | Published by Innovational Publishers 271

 El-Shrief and Ageiz, IJNR, Vol 4 (4), 268-275, 2018

Table 2: Association between sociodemographic characteristics of studied sample and their total level of clinical
competence (n=105)
Items Novice competent Expert Chi P value
n (%) n (%) n (%)
Age (Years) 1.6 0.9
22–24 7 (6.7) 13 (12.4) 54 (51.4)
>24 3 (2.9) 6 (5.7) 22 (20.9)
Gender 13.1 0.001
Male 3 (2.9) 5 (4.7) 21 (20)
Female 7 (6.7) 14 (13.3) 55 (52.4)
Residence
Rural 5 (4.7) 10 (9.6) 42 (40) 0.1 0.9
Urban 5 (4.7) 9 (8.6) 34 (32.4)
Marital 13.1 0.001
Single 5 (4.7 11 (10.5) 58 (55.3)
Married 5 (4.7) 9 (8.6) 17 (16.2)
Periodic in‑service training program 6.4 0.04
Yes 0 (0) 8 (7.5) 18 (17.1)
No 10 (9.6) 11 (10.5) 58 (55.3)
Working over time 13.1 0.001
Yes 0 (0) 7 (6.7) 44 (41.9)
No 10 (9.6) 12 (11.4) 32 (30.4)

hospitals (governmental and private) regarding all clinical Table 3: Frequency distribution of studied sample according to
competency domains. their total level of clinical competence (n=105)
Table 5 shows correlation between total score of self- Items Novice Competent Expert
assessment questionnaire and observational checklist. As n (%) n (%) n (%)
revealed from Table 5, there was no statistical difference Nursing professional behavior 11 (10.5) 32 (30.5) 62 (59)
between total score of self-assessment questionnaire and General performance 11 (10.5) 22 (20.9) 72 (68.6)
observational checklist. Core nursing skills 19 (18.1) 23 (21.9) 63 (60)
Figure 1 shows the frequency distribution of the clinical Advanced nursing skills 37 (35.2) 13 (12.4) 55 (52.4)
competence level for the studied sample at both hospitals. Total 19 (18.1) 16 (15.2) 70 (66.7)
As presented in Figure 1, the majority of intern students at
the private hospitals achieved an expert level of competence
health sectors and then to compare the clinical competency
than intern students at the governmental hospitals.
of intern students in both sectors. It was once evident from
the results of this study that the highest percentage of the
Discussion
studied sample was between the ages 22 and 24. Most of the
Developing equipped and confident new graduate nurses participants were females that was parallel with the study by
who can commit to their health care organizations is a AL-Mahmoud[15] and Fathi and Anwar[16] who revealed that
significant challenge. Researchers attributed the nursing about two-thirds of participants (61.33%) had been in their
competency to the chemistry between the nurse and patient, early 20’s and most of them (77.33%) were females and that
and nursing students could achieve highly competence was contradicted with Bifftu et al.[17] who concluded that the
levels through their own interpersonal skills, knowledge, majority of the study individuals176 (75.2%) had been male.
and potential to rise upward using learned practical and As well, in the current study, the very best share of the studied
theoretical knowledge to enrich own experience as part of sample had been single that was in congruence with Bifftu et
care values.[13] Today, the healthcare needs of the population al.[17] where 224 (95.7%) of participants were single and that
are more varied and complex, requiring a differentiated and result was contradicted with Fathi and Anwar[16] who found that
focused response to the specific needs of each individual. greater than one-half of their studied sample (56.66%) were
Those needs which have changed drastically over time have married. In addition, more than half of the respondents in this
to be met through increasing competent authorities capable study were rural residence in both private and governmental
of playing an energetic role in the complex organizational hospitals, which supported by Fathi and Anwar[16] who found
context, of which they are a part.[14] that the majority of the subjects (74%) were from rural areas.
The aim of that study was to assess clinical competence of Regarding the relationship between the total level of
intern nursing students in both private and governmental clinical competence of intern nursing students and their

272 © 2018 IJNR | Published by Innovational Publishers

 El-Shrief and Ageiz, IJNR, Vol 4 (4), 268-275, 2018

Table 4: Frequency distribution of clinical competence level of studied sample at both hospitals (n=105)
Items Governmental Private Chi P value
n (%) n (%)
Nursing professional behavior
Novice 9 (16.6) 3 (5.9) 33.6 0.000
Competent 23 (42.5) 10 (19.6)
Expert 22 (40.7) 38 (74.5)
General performance
Novice 11 (20.3) 0 (0) 30.5 0.000
Competent 19 (35.1) 3 (5.9)
Expert 24 (44.4) 48 (94.1)
Core nursing skills
Novice 11 (20.3) 0 (0) 24.4 0.000
Competent 18 (33.3) 5 (9.8)
Expert 25 (46.2) 46 (90.2)
Advanced nursing skills
Novice 11 (20.3) 0 (0) 31.9 0.000
Competent 25 (46.2) 7 (13.7)
Expert 18 (33.3) 44 (86.3)
Total
Novice 10 (18.5) 0 (0) 28.1 0.000
Competent 17 (31.5) 2 (3.9)
Expert 27 (50) 49 (96.1)

Table 5: Correlation between total score of self-assessment questionnaire and observational checklist (n=105)
Items Novice Competent Expert X2 P value
n (%) n (%) n (%)
Self-assessment total score 10 (9.5) 19 (18.1) 76 (72.4)
5.5 0.06
Observation checklist total score 11 (10.5) 22 (20.9) 72 (68.6)

sociodemographic characteristics, the result of the present

study showed that there was a statistically significance
between nursing intern students’ socio-demographic data
such as (gender, marital status, and working overtime)
and their level of clinical competence and that result was
disagreed with AL-Mahmoud[15] who proven that there had
been no statistical relationships between studied respondents’
demographic traits (age, area and marital status) and their
scientific competence dimensions. Furthermore, Abbas
et al.[13] results confirmed that the clinical competence of
female nursing students was higher than male students.
However, Rheaume et al.[18] cited a statistical significance
between age and the total level of clinical competence.
These findings might be accounted for that male nursing Figure 1: Frequency distribution of clinical competence
students are more motivated to join the different clinical level of the studied sample at both hospitals
practice in the different hospital immediately after finishing
the second academic year in the faculty, so they might In addition, intern students in private hospitals were provided
enrich their clinical experiences and have early engaged with the opportunity of working overtime, thus exposing
in the clinical field which might contribute to raising their to a variety of clinical practices and achieving statistically
level of competence. In addition, single nursing students significant differences in their competency level than those
had the enthusiasm and motivation to enhance their clinical who did not have extra work shifts.
practice through engaging in different clinical settings and According to the frequency distribution of the studied sample
educational workshops than married students who might be according to their total level of competence, the result of the
overloaded by numerous social responsibilities. present study revealed that the highest percentage of the studied

© 2018 IJNR | Published by Innovational Publishers 273

 El-Shrief and Ageiz, IJNR, Vol 4 (4), 268-275, 2018

sample achieved an expert level of the general performance of in-service training opportunities, and continuing learning
clinical competence compared to other competency domains. experiences for new nurses.[25]
The result of a present study supported by the findings of However, in private hospitals, all clinicians must adhere to
Children’s National Medical Center[19] which mentioned standardized care protocols that guide their clinical practice
that the perfect percentage of the studied sample completed and contributed to quality patient care and nursing competence.
excellent level of the general performance of clinical In addition, the health-care delivery system in these hospitals
competence, in which the internship program presents the allowed for more autonomous practices. Intern nursing students
newbie nurse with the information base and talent set needed in private hospitals had extensive education and training
to transition to competence in clinical nursing practice. program before engaging in the internship programs which
Furthermore, that finding could be attributed to the fact that equip them with the necessary knowledge and skills that are
all items on the general performance level are frequently updated and evidence-based to ensure that they are clinically
practiced by the students during their clinical practice of competent to care for the diverse patient population. On the
previous academic years; thus, the majority of students in both other hand, governmental hospitals, which have essential role
private and public hospitals achieved an excellent level in that in teaching nursing students, limit the opportunity for them to
domain. This study result contradicted with AL-Mahmoud[15] acquire necessary knowledge and skills as in these hospitals
who tested that the very best mean rating is for interpersonal nursing intern students not allowed to practice autonomously
and communication skills dimension while general overall but as assistances to the nursing staff.
performance had the lowest suggest scores.
The result of the present study revealed that there were highly Conclusions
significant differences between both hospitals (governmental
and private) regarding all clinical competency domains In the light of the present study, it can be concluded that
which was in the identical line with AL-Mahmoud[15] who the highest percentage of the studied sample achieved an
situated that there was a notably statistically enormous excellent level of competence at both hospitals regarding all
correlation between all clinical competence dimensions. competency domains. However, the general performance
This finding out about result contradicted with Tzeng[20] domain of competence had the highest score. In addition,
who found that no statistically significant correlations are there were statistically significant differences between
documented between total clinical competence dimensions. both hospitals (governmental and private) regarding all
The result of the present study reported that the majority of competency domains, as the majority of intern students at
intern students at the private hospitals achieved an expert the private hospitals achieved an excellent competence level
level of competence than intern students at the governmental than intern students at the governmental hospitals.
hospitals. The result of the current study was similar to Arrigoni
et al.[21] who assessed the degree of clinical competency in Recommendation
two private quarters in contrast with the governmental area
and reported that the level of clinical competence in the non- According to the current study findings, the researcher
public quarter had an excessive degree of clinical competence recommended that:
than the governmental sector. In addition, that finding was 1. Further studies are recommended (qualitative and
constant with the results of the survey by Buchanan et al.[22] quantitative) to deeply assess factors that affect the
who showed that private hospitals play the main function in competence level of intern nursing students at both
education and coaching and see this investment as strategically governmental and private hospitals.
important and the private health centers invest in the existing 2. Adopt a clinical competency questionnaire as an
and the future health-care workforce. On the contrary, Shahla assessment tool for evaluating the clinical performance of
et al.[23] found that no statistical correlations were documented the intern nursing students during the internship program.
between non-public and governmental sectors according to 3. Provide various training opportunities at different private
intern students’ level of clinical competence. hospitals, thus contributing to boosting their practical
In Egypt, the rigorous accreditation and quality assurance performance and developing their competencies before
programs of the health-care system might account for that going out to the labor market.
result in both health-care sectors. Creating a professional 4. Provide the orientation program for new nursing
nursing practice work environment that allow nurses graduates at the government hospitals to improve their
to practice to their full potential, and according to their level of clinical learning experiences according to
expectation as professionals, may be a fruitful strategy for Benner’s “from novice to expert” model.
nurse managers and administrators to attract and retain 5. Participation in extra skills laboraaatories - especially
nurses, promote their commitment to the organization and during orientation period - through which students are
improve their outcomes.[24] required to master basic procedures before practicing on
Ensuring professional development of nurses in the patients, to develop confidence and build independence
professional practice environment is the ultimate goal which and competent professional skills.
can be achieved through providing orientation programs, 6. Simulations are also mandatory and are carried before

274 © 2018 IJNR | Published by Innovational Publishers

 El-Shrief and Ageiz, IJNR, Vol 4 (4), 268-275, 2018

each training period with the aim of training the 11. Benner P. From Novice to Expert: Excellence and
students’ for real-life situation. Power in Clinical Nursing Practice. Menlo Park:
Addison-Wesley; 1984. p. 13-34.
Acknowledgment 12. Liou MS, Ching Y. Developing and Validating the Clinical
Competence Questionnaire: A Self-Assessment Instrument
My great thanks submit to ALLAH who provided me with for Upcoming Baccalaureate Nursing Graduates School of
the ability to do this work. I would like to offer a special Nursing. Taiwan: Chang Gung University of Science and
thanks to nursing intern students for their participation and Technology at Chiayi Campus, Chiayi; 2014.
cooperation to complete this study. Finally, my deep thanks 13. Abbas E, Zeiad T, Marzieh P, Yaser S. Clinical
to my parents and colleagues for their assistance. competence among Msc students of critical care nursing
faculty of nursing. Baqiyatallah university of medical
Conflicts of Interest sciences. Iran J Med Edu 2015;14:3-20.
14. Benner P, Sutphen M, Leonard V, Day L. Educating
This study has some important limitations that should be kept Nurses: A Call for a Radical Transformation. San
in mind when interpreting the results. First, the cross-sectional Francisco: Jossey-Bass; 2016.
nature of the study design does not confirm definitive cause 15. AL-Mahmoud DS. Relationship between nurse interns’
and effect relationship. Second, the clinical environment is satisfaction regarding internship program and clinical
measured with one item that may not address the different competence. Med J Cairo Univ 2013;81:151-61.
dimensions of clinical environments that may lack an important 16. Fathi A, Anwar A. Clinical judgment among nursing
variable which can impact the competence of students. interns. Clin Nurs Stud 2018;6:3.
17. Bifftu S, Berihun M, Dachew BS, Netsanet H.
References Perceived clinical competence among undergraduate
nursing students in the university of Gondar and bahir
1. Elnicki DM, Alper EJ, Bost JE, Corbett EC, Fagan MJ, dar university. Northwest Ethiopia: A cross-sectional
Mechaber A, et al. Procedural and interpretive skills institution based study. Adv Nurs 2016;2016:7.
of medical students: Experiences and attitudes of third 18. Rheaume A, Clement L, Lebel N. Under-standing
year students. Acad Med 2006;81:48-51. intention to leave amongst new graduate Canadian
2. Meehan D. Description and Meaning of Clinical nurses: A repeated cross sectional survey. Int J Nurs
Competency: Perceptions of Nurse Managers and Stud 2011;48:490-500.
Baccalaureate Nurse Faculty. Master Thesis; 2016. 19. Children’s National Medical Center is the Nation’s
3. Hakimzadeh R, Karamdost N, Memarian R, Ghodrati A, Children’s Hospital. With More than 50 Pediatric
Mirmosavi J. Assessing nursing students’ clinical Sub-Specialties. Children’s National is a Non-Profit
competency: Self-assessment. Nurs Vis 2012;1:20-5. Organization. Residency Program. NW Washington:
4. Ghanadi K, Anbari K, Zendedel A. Clinical competency. Children’s National Medical Center 111 Michigan
Strides Dev Med Educ 2013;10:398-400. Avenue; 2013. p. 202-476-5000.
5. Nesami MB, Rafiee F, Parvizi S, Esmaeili R. Concept 20. Tzeng H. Nurses self-assessment of their nursing
analysis of competency in nursing: Qualitative research competencies, job demands and job performance in the
and delivery of a hybrid model. J Mazandaran Univ Taiwan hospital system. Int J Nurs Stud 2017;4:487-96.
2007;18:35-42. 21. Arrigoni C, Grugnetti AM, Caruso R, Gallotti ML,
6. Parsa-Yekta Z, Badr FR, Khaton A. Nursing students’ Borrelli P, Puci M, et al. Nursing students’ clinical
viewpoints about their clinical competencies and its competencies: A survey on clinical education objectives.
achievement level. Iran J Nurs Res 2007;3:7-14. Ann Ig 2017;29:179-88.
7. Australian Institute of Health and Welfare. Hospital 22. Buchanan J, Jenkins S, Scott L. Student Clinical
Resources-15: Australian Hospital Statistics. Health Education in Australia: A University of Sydney Scoping
Services Series No. 71. Cat. No. HSE 176.2016. Study. Sydney: University of Sydney; 2015.
Canberra: AIHW. 23. Shahla M, Shahnaz K, Fatemeh S. The relationship
8. Department of Health. Medical Training Review Panel: between clinical competence and clinical self-efficacy
Eighteenth Report. Canberra: Department of Health; among nursing and midwifery students. Isfahan Univ
2015b. Med Sci 2015;3:1117-23.
9. Azzida H. A competency transcript to assess and 24. WHO Regional Office for the Eastern Mediterranean.
personalize new graduate competency. J Nurs Adm Analysis of the Private Health Sector in Countries of the
2017;39:19-25. Eastern Mediterranean Region. Geneva: WHO; 2014.
10. Forsberg E, Ziegert K, Hult H, Fors U. Clinical 25. Hickey MT. Baccalaureate nursing graduates’
reasoning in nursing, a think-aloud study using virtual perceptions of their actual clinical instructional
patients-a base for an innovative assessment. Nurse experiences and preparation for practice. J Prof Nurs
Educ Today 2014;34:538-42. 2010;26:35-41.

© 2018 IJNR | Published by Innovational Publishers 275