Abstract
Questions periodically arise regarding clinical competencies and students' ability to perform in the employment setting after graduating from a baccalaureate nursing (BSN) program. This article describes a collaborative project between a nurse administrator in an acute care facility and a nurse educator in a baccalaureate nursing program. The project was designed to evaluate whether expected competencies of BSN graduates were evident in the work setting. Skills and behaviors of BSN graduates were evaluated by 68 nurses in an acute care setting. The findings provide data for nurse administrators to assist with planning staff development and continuing education programs for nursing staff. The results also provide data for nurse educators to assist with evaluation of effectiveness of nursing programs.
In the rapidly changing healthcare environment, a comprehensive evaluation of performance is crucial. As expectations in the market place change, educators must respond accordingly (Wilkinson, 1996). Academic providers are charged with the increased responsibility to evaluate educational programs to ensure that graduates are prepared to meet expectations of employers, while healthcare providers are charged with the increased responsibility to ensure that all employees provide high-quality, cost-effective care.
To measure program success in academic settings, providers currently use such measures as pass rates on NCLEX exams, self-expressed satisfaction surveys, and employment rates of new graduates. In healthcare settings, the quality indicators of performance frequently used are based on the American Nurses Association's definitions of quality indicators. Such indicators include patient satisfaction, pain management, skin integrity, nosocomial infections, patient injury rate, and assessment and implementation of patient care requirements (Martin, 1997).
Current nursing literature emphasizes the importance of preparing nurses of the future to have a wide range of skills with ability to function in a variety of settings (Huston & Fox, 1998). In addition to possessing highly technical skills, competencies required in acute care settings in the future will include skills in negotiation and conflict resolution, analytical skills necessary to identify problems and set priorities, good oral and written communication skills, and the ability to collaborate across disciplines within the organization (Kenyon, Smith, Vig Hefty, McNeil, & Martaus, 1990). The effective nurse of the future will also be someone who is a patient advocate and has the ability to help patients and families choose wisely as they make decisions about their health and wellness (Moccia, 1993).
The most effective way to prepare nurses to meet the complex and diverse healthcare needs of society has been widely debated. Numerous research studies were conducted in the 1970s and 1980s to determine if basic educational preparation at the diploma, associate, or baccalaureate level resulted in different levels of theoretical knowledge and clinical proficiency (Giger & Davidhizar, 1990).
In 1990, Giger and Davidhizar conducted research to determine whether a relationship existed between types of basic education preparation and (1) conceptual and theoretical approaches to care, (2) nursing leadership, (3) the ability to make nursing diagnoses, and (4) implementation and evaluation of the nursing process. Findings suggested that baccalaureate graduates vary in conceptual and theoretical approaches to care in specific nursing care situations when uncontrolled variables have been controlled. The data indicated that baccalaureate respondents were more concerned with process-driven nursing tasks while associate degree respondents were more interested in content-driven nursing tasks. Findings also indicated that baccalaureate nurses were more knowledgeable than associate degree nurses in areas of nursing diagnosis, concept analysis, theoretical identification, and implementation of the nursing process. Results of the Giger and Davidhizar research were consistent with other studies in their literature review that supported the view that baccalaureate graduates tend to be more self-directed and independent and more proficient in use of research, leadership, theoretical, conceptual, and psychosocial assessment skills.
Nurse educators are currently challenged to design and restructure curricula as needed to prepare nurses to work in the 21st Century (Huston & Fox, 1998). Awareness of this challenge provided the rationale for expanding evaluation of the Clemson Nursing program to include a component in which graduates of the BSN program were evaluated by their peers to determine whether they were performing clinically and professionally at desired levels. Banta (1991) indicated that eliciting feedback from employers about job performance of graduates is a vital component of program assessment. The investigators of the current study shared the opinion that this type of assessment would provide valuable outcome data for program assessment that may not be obtained through other methods.
The study was a collaborative endeavor by a nurse administrator in an acute care facility and a nurse educator in a baccalaureate nursing program. The purpose of the study was to determine whether expected competencies of graduate nurses were evidenced in the work setting. Specific research questions addressed were:
1. What are the perceived competencies of BSN graduates, as evidenced by the mean ratings of performances in five categories: Clinical Skills, Organizational Skills, Interpersonal Skills, Professionalism, and General Knowledge?
2. What is the global assessment of Clemson BSN graduates as employees?
3. Are there differences in ratings between nurses with different levels of education?
4. Are there differences in ratings on the basis of clinical specialty?
5. Are there differences in ratings between staff nurses and nurses in a leadership position?