A Crisis in Competency: The Strategic and Ethical Imperative to Assessing New Graduate Nurses' Clinical Reasoning

Nurs Educ Perspect. 2017 Mar/Apr;38(2):57-62. doi: 10.1097/01.NEP.0000000000000112.


Aim: The aim of the study was to assess entry-level competency and practice readiness of newly graduated nurses.

Background: Literature on success of new graduates focuses primarily on National Council of State Boards of Nursing Licensure Examination (NCLEX-RN) pass rates, creating a false and incomplete picture of practice readiness.

Method: Posthire and prestart Performance-Based Development System assessments were administered to more than 5,000 newly graduated nurses at a large midwestern academic medical center between July 2010 and July 2015.

Results: Aggregate baseline data indicate that only 23 percent of newly graduated nurses demonstrate entry-level competencies and practice readiness.

Conclusion: New data suggest that we are losing ground in the quest for entry-level competency. Graduates often are underprepared to operate in the complex field of professional practice where increased patient acuity and decreased length of stay, coupled with a lack of deep learning in our academic nursing programs, have exacerbated a crisis in competency.

MeSH terms

  • Academic Medical Centers
  • Clinical Competence*
  • Clinical Decision-Making*
  • Employment*
  • Ethics, Nursing*
  • Humans
  • Ohio
  • Patient Safety
  • Problem Solving
  • Thinking*
  • United States