Study On Competency–Based Grading System Of Clinical Nurses In Unattended Wards

Objective:To investigate the correlative state of nurse ability grades, and to describe thenecessity and feasibility to design a competency-based grading system for nurse employedin unattended wards, providing reference for constructing such a system.To develop a framework of competency-based grading system for nurses, and set upentering criteria，competency criteria and the corresponding work for nurses in each level.Methods:A total of580nurses with different work seniority, degree and title in unattendedwards from6tertiary general hospitals in Shandong Province were investigated with aquestionnaire about the work items, work proportion, work time, work stress andself-evaluation. The questionnaire’s Cronbach’s α was0.82and the CVI was0.91.Nine nursing specialists and twelve clinical nurses were participated in semi-structured interviews. The data were analyzed by Claizzi’s phenomenological procedures.Twenty eight nursing experts were purposefully selected from five tertiary generalhospitals and one nursing colleges to participate in a Delphi survey on classificationframework, entering criteria，competency criteria and the corresponding work for nurses.Results:The correlative state of nurse ability grades:①S cheduling mode composedmainly ofthe continuous scheduling mode (72.40%), and flexible shifts accounted for34.84%，APNwas the main scheduling mode.②All of the nurses were engaged in all of different worktime, except vice-director nurse, the nurses with length of service less than a year and morethan20years, and the nurses with master degree, vice-director nurse and length of servicemore than20years, were mainly engaged in the daywork and8-4class work. Clinicalnursing work was completed mainly by associate degree nurses, primary professional titlenurses and length of service1～3years nurses in wards without Caregivers. Night nursingwork was also completed mainly by them.③The work items in which various levels of nurses engaged were significantly different (P＜0.01), but all clinical nurses in differentprofessional titles were engaged in all work items. Fundamental nursing care andtherapeutic nursing care were nurses’ most prominent tasks, accounting for23.81%and22.00%respectively; clinical teaching and research accounted for the smallest proportionof nurses’ working hours, with the ratios being8.17%and2.51%respectively.④Thevarious levels of nurses’ pressure was significantly different (P＜0.05), and the title andseniority were the main factors affecting stress.⑤The score of self-evaluation ofinvestigated nurses was (12.01±1.579).⑥The score of capability and job fit recognitionwas (18.97±2.747).It was necessary and feasible to construct a competency-based grading system fornurses employed in unattended wards; competency of clinical practice was the mostimportant criteria for grading; the grading system contained four grades: assistant nurse,registered nurse, specialized nurse and clinical nursing specialist.Positive coefficient of three expert consultation of the classification framework,admittance standard and identified competence respectively were93.33%,96.55%,100%.The mean of expert authority coefficient were0.779,0.801,0.818respectively. The meanof Kendall coefficient were0.170,0.206,0.275respectively, they were significantlydifferent(P＜0.05). Positive coefficient of three expert consultation of the work duty anditems for two rounds were90.32%and100%respectively. The mean of expert authoritycoefficient were0.864and0.897respectively. And the grading system of nursing staff inunattended wards was developed.Conclusion:The standards and responsibilities of various levels of nurses were not clear. Thiskind of nursing human resource use current situation, considerably affected the workenthusiasm and efficiency of nursing staff. It was suggested that managers should constructa scientific and practicable competency-based grading system for nurses, which should bedesigned to combine our country’s nurse title system and competency of clinical practice,and should be guided by the grading structure, so as to make full use of a nursing staffmaximum potential and improve the quality of nursing service.The experts agreed with the competency-based grading system with high degree ofresponses. It can be more comprehensively and objectively assess the ability of nurses,embodied capability and position fit, as well as provided the theoretical basis for healthgovernment’s policy.