Abstract
The study under analysis used a previously existing data set to examine the outcomes of hospital-related aspects (practice environment, average nurse education, and average nurse experience) and personal characteristics (education and experience) on the level of clinical nursing proficiency. Although the findings of the study showed a positive association between the makeup of hospital nurses in terms of their cumulative level of education and nursing competence independent of factors such as personal level of education and expertise, it was not possible to prove the association between two contextual factors (professional practice environment and aggregate hospital experience) and nursing expertise. Consequently, the authors’ hypothesis that contextual factors are more important than personal characteristics in determining nursing clinical proficiency was not supported.
Introduction
The study under analysis was undertaken with the view to investigating how hospital contextual factors (practice environment, mean nurse education, and mean nurse experience) affect or influence clinical nursing proficiency. The authors acknowledged that, although clinical nursing proficiency is an important ingredient in the provision of quality patient care, a research gap existed as available studies focused on personal nurse characteristics (e.g., years of experience in employment and educational level) to the exclusion of hospital-related factors (McHugh & Lake, 2010). The authors used previous research studies to not only define independent and dependent variables, but also to demonstrate how the independent variables affect clinical nursing proficiency. Although the studies reviewed showed a direct relationship between personal variables and clinical expertise, it was determined that our comprehension of the association between hospital-related factors and clinical proficiency is limited, hence the need to undertake the study under review.
The study under analysis aimed to investigate “the effects of both hospital contextual factors and individual nurse education and experience on clinical nursing experience” (McHugh & Lake, 2010, p. 280). The authors hypothesized that “contextual factors affect expertise above and beyond individual factors” (McHugh & Lake, 2010, p. 277). Although personal nurse characteristics such as education level and skill have the capacity to influence the clinical proficiency of nursing professionals, the researchers felt that it was equally important to investigate the contextual factors in which a nurse practices as such knowledge may be instrumental in establishing a culture of professionalism that could be used to promote and progress the expertise level of nurses in hospital settings. The researchers predicted a strong relationship between hospital-level contextual factors (practice environment, mean nurse education, and mean nurse experience) and the development of personal clinical nursing proficiency.
Materials and Methods
The researchers undertook a cross-sectional analysis of a previously existing data set (N=8,611 registered nurses) to investigate the outcomes of hospital-related factors (practice environment, average nurse education, and average nurse know-how) and unique personal characteristics (education and experience) on the level of proficiency demonstrated by nurses in hospital settings. The dependent variable (nurse-reported level of expertise) was measured by asking nursing professionals to rank their proficiency level against several responses that included “Advanced Beginner, Competent, Proficient, or Expert” (McHugh & Lake, 2010, p. 280). The personal education level variable was assessed by dichotomizing BSN status (less than BSN = 0; BSN or higher = 1), while the personal level of nursing experience was assessed and explored using a continuous scale that factored the number of years in service.
The contextual factor of average level of education was assessed as the group average of a twofold (zero/one) variable signifying an individual nurse as having achieved the BSN status or higher, while that of mean experience was assessed by calculating the average number of years that nursing professionals had worked in the respective health institutions included in the sample. Finally, the Practice Environment Scale of the Nursing Work Index (PES-NWI) that utilizes a Lickert-type rating system was used to determine the characteristics of practice environments in the selected health institutions based on predetermined items that were categorized into five subscales to typify the spheres of professional environments for nursing practice (McHugh & Lake, 2010). The five subscales revolved around issues of nursing participation, hospital staffing levels and resource availability, adherence to the provision of quality care, ability of the nurse manager to involve nurses in the decision making process, as well as leadership and nursing support.
The independent variables described were measured to determine their level of influence on the nurse-reported level of expertise, which was the dependent or outcome variable. Descriptive statistics, bivariate analysis of relationships between variables and the strength of such relationships, Spearman’s rank-order correlations, and regression models were used to interpret data.
Results
The findings of the study showed a positive association between the makeup of nursing professionals in terms of their cumulative level of education and their accumulated proficiency independent of factors such as personal education level and individual experience in healthcare settings. The findings were also consistent with those of previous small-scale studies that showed personal level of education and years worked in healthcare settings as significant factors in determining clinical nursing expertise. However, the findings failed to prove a relationship between professional practice environments as assessed by the index used and nursing proficiency despite such a relationship being noted in previous quantitative and qualitative studies on the topic (McHugh & Lake, 2010). A possible explanation for this particular finding is that the index used to assess practice environments did not have the capacity to capture some of the aspects that are important in developing clinical nursing proficiency in practice settings.
The findings of the study also failed to prove a positive relationship between the contextual factor of aggregate hospital experience and clinical nursing expertise. Other previous studies have failed to demonstrate a relationship between aggregate hospital experience and patient care outcomes, though such findings are often reinforced by benchmarking experience on the basis of time as opposed to measuring actual situations through which a nursing professional is provided with the opportunity to refine, elaborate, or disconfirm knowledge (McHugh & Lake, 2010). The findings demonstrate that, although characteristics such as personal educational level and number of years worked in healthcare settings are of immense importance in influencing the nurse’s level of clinical proficiency, significant achievements in the possibility of an individual nurse becoming more proficient in care delivery can also be realized through encouraging nurses to pursue continuous education.
Conclusion
The study that has been analyzed was conducted to investigate the outcomes of hospital-related factors (practice environment, mean nurse education, and mean nurse experience) and personal characteristics (education level and years of experience) on the development of nurse proficiency in clinical settings. This paper has analyzed the main components of the study (e.g., aims, goals, hypothesis, literature review, materials and methods, as well as findings) to show if there is a strong relationship between hospital-level contextual factors and the development of nurse proficiency in clinical settings. Based on the findings of the study, it is evident that the authors’ proposition that hospital-related factors affect the development of nursing proficiency more than personal factors was not supported. Overall, however, the findings of the study under analysis can be used to develop strategies for use in deciding the optimal composition of nursing professionals in healthcare settings. Such strategies may include favoring individual characteristics (e.g., a BSN or more experience) in recruiting and retaining nurses, providing continuous education based on proficiency and skills, utilizing specialist nurses as clinical role models and mentors, and supporting nurses to complete their degree programs through tuition compensation.
Reference
McHugh, M.D., & Lake, E.T. (2010). Understanding clinical expertise: nurse education, experience, and the hospital context. Research in Nursing & Health, 33(4), 276-287.