Competency in Nursing Students: A Systematic Review

Document Type : Systematic Review


1 Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran

2 Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran


Introduction: Nursing students require highly specialized competencies to accurately determine patients' states and to predict and cope with problems that may occur during nursing care. This study explores the definition, domains, and levels of nursing students' competency.
Methods: This study was a systematic review of nursing students’ competencies in English (ISI, SCOPUS, Ovid, Proquest, Iranmedex, Google scholar, PubMed) and Persian (Scientific Information Database) databases (1985–2015), according to the University of York Center for Reviewers and Dissemination Guidance approach, 2008.
Results: From a total of 13,115 articles, 20 were retrieved in the final step. The individual experiences, dynamic process, and positive interactive social and beneficial changes in the equality of one’s professional life that cause meta-cognitive abilities, touch reality, motivation, decision making, job involvement, professional authority, self-confidence, knowledge and professional skills formulated the definition of nursing students' competency. Educational, cultural, individual, professional and inter-professional, research, clinical and practical domains were defined as belonging to nursing students' competency. Seven nursing student competency levels were identified.
Conclusion: Although the definitions of competency, its domains, and its levels vary by profession and country, this systematic review demonstrated the comprehensive ones in three scopes. However, more research is needed to examine the three scopes in the nursing student competency concept.


  1. Fan J-Y, Wang YH, Chao LF, Jane S-W, Hsu L-L. Performance evaluation of nursing students following competency-based education. Nurse Educ Today. 2015;35(1):97-103.
  2. Francis Mwale H. Attracting and retaining nurses to a rural hard to reach post in lesotho: A combination of financial incentives, preservice competency based curriculum and student rural clinical placements. Annals of Global Health. 2015;81(1):67.
  3. Jukema JS, Harps-Timmerman A, Stoopendaal A, Smits CHM. A care improvement program acting as a powerful learning environment to support nursing students learning facilitation competencies. Nurse Educ Pract. 2015;15(6):457-62.
  4. Kelton MF. Clinical Coaching–An innovative role to improve marginal nursing students' clinical practice. Nurse Educ Pract. 2014;14(6):709-13.
  5. Blažun H, Kokol P, Vošner J. Research literature production on nursing competences from 1981 till 2012: A bibliometric snapshot. Nurse Educ Today. 2015;35(5):673-9.
  6. Specialists NAoCN. Clinical nurse specialist core competencies: Executive summary 2006–2008. Retrieved September. 2010;14:2013.
  7. Ross L, Giske T, van Leeuwen R, Baldacchino D, McSherry W, Narayanasamy A, et al. Factors contributing to student nurses'/midwives' perceived competency in spiritual care. Nurse Educ Today. 2016;36:445-51.
  8. Khatiban M, Sangestani G. The effects of using problem-based learning in the clinical nursing education on the students' outcomes in Iran: A quasi-experimental study. Nurse Educ Pract. 2014;14(6):698-703.
  9. Park K, Ahn Y, Kang N, Sohn M. Development of a simulation-based assessment to evaluate the clinical competencies of Korean nursing students. Nurse Educ Today. 2016;36:337-41.
  10. Pereira J, Echeazarra L, Sanz-Santamaría S, Gutiérrez J. Student-generated online videos to develop cross-curricular and curricular competencies in Nursing Studies. Comput Human Behav. 2014;31:580-90.
  11. Mikšová Z, Šamaj M, Machálková L, Ivanová K. Fulfilling the competencies of members of a nursing team. Kontakt. 2014;16(2):e108-e18.
  12. Ruth-Sahd LA, Grab C. And this, too, has already changed in nursing. J Lancaster Gen Hosp. 2012;7(2):83-8.
  13. Anema M, McCoy J. Competency based nursing education: guide to achieving outstanding learner outcomes: Springer Publishing Company; 2009.
  14. Brown RA, Crookes PA. How do expert clinicians assess student nurses competency during workplace experience? A modified nominal group approach to devising a guidance package. Collegian.
  15. Forsberg E, Ziegert K, Hult H, Fors U. Clinical reasoning in nursing, a think-aloud study using virtual patients–A base for an innovative assessment. Nurse Educ Today. 2014;34(4):538-42.
  16. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: Wiley Online Library; 2008.
  17. Vahedian-Azimi A, Ebadi A, Saadat S, Ahmadi F. What is an Appropriate Nursing Care Model in Critical Care Units: Domestic or International Models. Int J Med Rev. 2014;1(2).
  18. Ebadi A, Tabanejad Z, Pazokian M. Clinical Competence among MSc Students of Critical Care Nursing. Iran J Med Educ. 2015;14(12):1030-9.
  19. Kim K, Han Y, Kwak Y, Kim J-s. Professional Quality of Life and Clinical Competencies among Korean Nurses. Asian Nurs Res. 2015.
  20. Khomeiran RT, Yekta Z, Kiger A, Ahmadi F. Professional competence: factors described by nurses as influencing their development. Int Nurs Rev. 2006;53(1):66-72.
  21. Wu F-q, Wang Y-l, Wu Y, Guo M. Application of nursing core competency standard education in the training of nursing undergraduates. Int J Nurs Sci. 2014;1(4):367-70.
  22. Hagbaghery MA, Salsali M, Ahmadi F. A qualitative study of Iranian nurses' understanding and experiences of professional power. Hum Resour Health. 2004;2(1):9.
  23. Ličen S, Plazar N. Identification of nursing competency assessment tools as possibility of their use in nursing education in Slovenia—A systematic literature review. Nurse Educ Today. 2015;35(4):602-8.
  24. Ääri R-L, Tarja S, Helena L-K. Competence in intensive and critical care nursing: A literature review. Intensive Crit Care Nurs. 2008;24(2):78-89.
  25. Wallace D, Boller J. New nurse practitioner competencies: Skill development and reflective writing rubrics. J Nurse Pract. 2014;10(7):e13-e21.
  26. Wilhelmsson M, Pelling S, Uhlin L, Owe Dahlgren L, Faresjö T, Forslund K. How to think about interprofessional competence: A metacognitive model. J Interprof Care. 2012;26(2):85-91.
  27. Hagbaghery MA, Salsali M, Ahmadi F. The factors facilitating and inhibiting effective clinical decision-making in nursing: a qualitative study. BMC Nurs. 2004;3(1):2.
  28. Olson DK. Competency to collaboration: an interactive process for cross-sectoral development. Lancet Glob Health. 2014;2:S39.
  29. Andreou C, Papastavrou E, Merkouris A. Learning styles and critical thinking relationship in baccalaureate nursing education: a systematic review. Nurse Educ Today. 2013.
  30. Ballangrud R, Hall-Lord ML, Persenius M, Hedelin B. Intensive care nurses’ perceptions of simulation-based team training for building patient safety in intensive care: A descriptive qualitative study. Intensive Crit Care Nurs. 2014;30(4):179-87.
  31. Vanaki Z, Memarian R. Professional ethics: beyond the clinical competency. J Prof Nurs. 2009;25(5):285-91.
  32. Niezen MG, Mathijssen JJ. Reframing professional boundaries in healthcare: A systematic review of facilitators and barriers to task reallocation from the domain of medicine to the nursing domain. Health Policy. 2014;117(2):151-69.
  33. Cassidy I, Butler MP, Quillinan B, Egan G, Mc Namara MC, Tuohy D, et al. Preceptors’ views of assessing nursing students using a competency based approach. Nurse Educ Pract. 2012;12(6):346-51.
  34. Cabaniss R. Faculty identification of competencies addressing quality and safety education in Alabama Associate Degree Nursing Education Programs. Teach Learn Nurs. 2014;9(4):181-92.
  35. McCready T. Portfolios and the assessment of competence in nursing: a literature review. Int J Nurs Stud. 2007;44(1):143-51.
  36. Dunn SV, Lawson D, Robertson S, Underwood M, Clark R, Valentine T, et al. The development of competency standards for specialist critical care nurses. J Adv Nurs. 2000;31(2):339-46.
  37. ten Cate O, Scheele F. Viewpoint: competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med. 2007;82(6):542-7.
  38. Evans A. Competency assessment in nursing-a summary of literature published since 2000. Autralia, EdCaN. 2008.
  39. Collaborative IE. Team-based competencies: building a shared foundation for education and clinical practice. Washington, DC: Interprofessional Education Collaborative. 2011.
  40. Paganini MC, Egry EY. The ethical component of professional competence in nursing: an analysis. Nurs Ethics. 2011:0969733011408041.
  41. Park YI, Kim JA, Ko J-K, Chung MS, Bang K-S, Choe M, et al. An identification study on core nursing competency. The Journal of Korean Academic Society of Nursing Education. 2013;19(4):663-74.
  42. Pijl-Zieber EM, Barton S, Konkin J, Awosoga O, Caine V. Competence and competency-based nursing education: finding our way through the issues. Nurse Educ Today. 2014;34(5):676-8.
  43. Pijl-Zieber EM, Barton S, Konkin J, Awosoga O, Caine V. Mind the gap: Quantifying the performance gap between observed and required clinical competencies in undergraduate nursing students. Nurse Educ Today. 2014;34(5):667-9.
  44. Yanhua C, Watson R. A review of clinical competence assessment in nursing. Nurse Educ Today. 2011;31(8):832-6.
  45. Garside JR, Nhemachena JZ. A concept analysis of competence and its transition in nursing. Nurse Educ Today. 2013;33(5):541-5.
  46. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287(2):226-35.
  47. Bradshaw A, Merriman C. Nursing competence 10 years on: fit for practice and purpose yet? J Clin Nurs. 2008;17(10):1263-9.
  48. Windsor C, Douglas C, Harvey T. Nursing and competencies—a natural fit: the politics of skill/competency formation in nursing. Nurs Inq. 2012;19(3):213-22.
  49. Bradshaw C, O'Connor M, Butler MP, Fahy A, Tuohy D, Cassidy I, et al. Nursing students' views of clinical competence assessment. Br J Nurs. 2012;21(15):923-7.
  50. Cowan DT, Norman I, Coopamah VP. Competence in nursing practice: a controversial concept–a focused review of literature. Nurse Educ Today. 2005;25(5):355-62.
  51. Tilley DS. Competency in nursing: A concept analysis. J Contin Educ Nurs. 2008;39(2):58.
  52. Del Bueno DJ. Competency based education. Nurse Educator. 1978;3(3):10-4.
  • Receive Date: 30 October 2015
  • Revise Date: 19 December 2015
  • Accept Date: 10 January 2016
  • First Publish Date: 01 March 2016