Nursing and Health Sciences (2010), 12, 147–154

Research Article

Competence assessment of nursing graduates of

Jordanian universities nhs_507 147..154

Reema Safadi, rn, phd,1 Malak Jaradeh, rn, phd,2 Amal Bandak, rn, phd2 and
Erika Froelicher, rn, ma, mph, phd3
1
Department of Maternal and Child Health Nursing, Faculty of Nursing, University of Jordan, 2Department of Maternal
and Child Health Nursing, Faculty of Nursing, Applied Science University, Amman, Jordan and 3University of California
San Francisco, San Francisco, California, USA

Abstract This cross-sectional survey assessed the level of competence of nursing graduates of Jordanian universities
(2001–2004 cohorts) in relation to the type of university, sex, hospital type, and working area. A convenience
sample (n = 258) of full-time nurses (6 months–4 years’ experience) was selected from public, private, and
teaching hospitals. A specifically designed tool with a rating scale of 1–5 was used to evaluate the nurses’
competence in five nursing competencies (management, professionalism, problem-solving, nursing process,
and knowledge of basic skills). The findings showed a satisfactory competency level with no significant
differences related to the type of university or sex. General ward nurses scored significantly better than those
in intensive care units in relation to management, professionalism, and nursing process, while the teaching
hospital nurses showed significantly better performance in professionalism and management skills than did
the nurses in the other two sectors. We recommend that nurse recruitment policies should consider individual
competencies rather than innate characteristics in their selection of employees.

Key words competence assessment, competence skills, Jordan, Jordanian universities, nursing graduates.

INTRODUCTION The evaluation of clinical nursing practice can be under-

taken by comparing the level of competence against prede-
Present-day health services are highly complex and high-
termined standards of practice (Kaiser & Rudolph, 2003).
quality care is mandatory. Nursing competence is vital to
Bircumshaw (1989) suggested using quantitative and quali-
provide such care. Competence in nursing practice and edu-
tative approaches to measure competence and advocated the
cation has been the concern of the Joint Commission on
development of an integrated approach that incorporates
Accreditation of Healthcare Organizations (JCAHO) and
a measurement of performance (Bartlett et al., 2000). The
other educational accreditation bodies, generating apprehen-
JCAHO in the USA, the International Council of Nurses
sion and concern among health practitioners and educators in
(ICN), the Nursing and Midwifery Council (NMC) in the
relation to meeting the standards set by these organizations.
UK, and the National League for Nursing are the main agen-
Competence has been defined in a number of ways. Most
cies concerned with developing and monitoring the standards
importantly, definitions include the requirements of essential
of health care. Each has a board of professionals for licensure
cognitive, psychomotor, and affective skills and the enhance-
purposes and for setting standards of minimal competence
ment of skills acquisition through formal knowledge and
for nurses. The American Nurses’ Association undertakes the
clinical experience. Decision-making and critical thinking are
responsibility and commitment of securing the public’s safety
integral parts of the process (Robb et al., 2002). Competence
through social policy, standards, scope of nursing practice,
is the concept used to determine whether or not a nurse is
and the ethical code of practice statements (Rowell, 2003).
fulfilling the required standards for safe practice. It also is
In Jordan, the first baccalaureate nursing program (Bach-
defined as the personal skills that are developed through
elor of Science or BSc) was established at the public Univer-
professional education and training and includes observable
sity of Jordan in 1972 with international consultants to
behaviors that occur in professional practice and unobserv-
develop the nursing curriculum. The rapid growth and
able attributes, capacities, dispositions, attitudes, and values
demand for more nurses led to the establishment of more
(Tzeng & Ketefian, 2003).
public and private universities offering BSc nursing pro-
grams, totalling six public and eight private universities today.
Being the pioneers in nursing education, public universities
Correspondence address: Reema Safadi, Faculty of Nursing, University of Jordan,
Amman 11942, Jordan. Email: r.safadi@ju.edu.jo continuously have provided academic leadership for philoso-
Received 2 September 2009; accepted 26 October 2009 phy of education and curriculum development and testing

© 2010 The Authors doi: 10.1111/j.1442-2018.2009.00507.x

Journal Compilation © 2010 Blackwell Publishing Asia Pty Ltd.
148
and have helped the private sector in designing its programs.
The exchange of faculty members between the public and
private sectors resulted in a uniformity of curricula across
Jordan.
Although the curricula are the same, there are differences
in the admission criteria and tuition fees between the two
sectors. The public universities’ admission process is highly
competitive, based on students’ high school grades; whereas,
this is more flexible and more lenient in private universities,
which allow the admission of lower academic ranking
students.
There are three reasons for conducting this study. The first
is the increasing number of nursing graduates from the dif-
ferent universities in the absence of a central regulating and
monitoring body, until the establishment of the Jordanian
Nursing Council (JNC) in 2002.
The second reason is the recent interest of Jordanian men
in nursing, which has added to the competition and has led to
more men being admitted into private universities due to the
limited number of places in public universities. An enroll-
ment level of male students of 65% (out of 6106) in these
programs (Ahmad & Alasad, 2007) has provided a rich
supply of manpower for the health-care industry locally,
regionally, and internationally. Knowledge about whether or
not there is a difference in the competence level attributed to
the university of graduation or sex would inform decision-
makers in nursing education in evaluating their program’s
outcomes and enable nursing directors in practice settings
to employ nurses based on the level of competence of the
graduates of these educational programs. This is especially
important when there is more than one type of educational
program and a maldistribution of nursing graduates accord-
ing to sex: an abundance of male nurses and a shortage of
female nurses.
The third reason is the increase in population and the
emphasis on the provision of cost-effective, high-quality
health-care services in the last three decades, coupled with
the greater sophistication of patients about health issues,
which requires scientific evidence about the competency of
graduates of different universities. We hope that this study
will provide such evidence.
As a result of the existing dual educational system, we
evaluated the level of competence of Jordanian nurses gradu-
ating from various institutions via the health-care service
providers’ perspectives. To date, it is not known how the
graduates of this dual system perform once they are in the
workplace and in which setting they would have better
competence.
The aims of this study were to: (i) examine the competence
levels of nurses; and (ii) provide information to education
programs, service sectors, and policy-makers about gradu-
ates’ level of competence and curriculum effectiveness. The
results would help in the future evaluation of programs as
these graduates have been in work settings for only 1–4 years.
To our knowledge, our hospitals do not offer intensive train-
ing courses, as is common in institutions in the USA and UK,
suggesting that the knowledge gained at university and infor-
mal colleagueship are what new graduates depend on for
their early practice.
© 2010 The Authors
Journal Compilation © 2010 Blackwell Publishing Asia Pty Ltd.
R. Safadi et al.
Unlike in the West, where competence evaluation is well
studied, the examination of competence remains an impor-
tant issue in Jordan and the region. The results of this study
might be of relevance to countries starting their nursing pro-
grams, licensing exams, program accreditation, and quality
control evaluations.
This study specifically aims to answer the following ques-
tions:
1 Is there a significant difference in the level of competence
that can be attributed to the graduating university (public
versus private universities)?
2 Is there a significant difference in the level of competence
between male and female nurses?
3 Is there a significant difference in the level of competence
between nurses working in general wards and nurses working
in intensive care units (ICUs)?
4 Is there a significant difference in the level of competence
among nurses working in the different types of hospitals
(public, private, and teaching hospitals)?
Literature review
Several international studies have evaluated nursing students
and newly qualified nurses for their level of competence
(Bartlett et al., 2000; Redfern et al., 2002; Watson, 2002).
Although the aims and methods of these studies differed, the
overall goals were to assess if educational and health-care
organizations are preparing their students to satisfy the needs
of health-care consumers.
Studies of clinical performance have investigated nurses’
competencies in various aspects of practice, encompassing
safety, knowledge, skills, affect, motivation, leadership,
interpersonal relations/communication, professional devel-
opment (Dunn et al., 2000; Cowan et al., 2005), professional-
ism, and nurse practice laws (Liu et al., 2007; Son et al., 2007).
The authors of these studies agreed on the complexity of the
concept and suggested the need to develop a holistic defini-
tion (Cowan et al., 2005). The findings of Dunn et al. (2000)
suggested 20 competency standards for specialized critical
care, grouped into six domains of nursing. Liu et al. (2007)
developed a tool to measure the clinical practice competen-
cies of Chinese nurses. No studies were found that investi-
gated competencies in relation to the area of work, the
graduating university, and the type of hospital. Meretoja et al.
(2004) described 593 Finnish registered nurses’ self-assessed
level of competence on 19 units (wards, emergency rooms,
outpatient clinics, ICUs, and operating rooms). The nurses
working in the operating rooms and emergency/outpatient
unit were significantly more competent in managing situa-
tions (P < 0.05) than the ward nurses. Conversely, the ward
nurses had higher competence levels in the helping role and
ensuring quality.
METHODS
Design
A cross-sectional design, using a survey technique, was
employed to answer the study’s questions.
Competence assessment of nurses
Sampling and data collection
A convenience sample was used, consisting of nursing gradu-
ates (n = 258) who were cohorts of 2001–2004, from four
public and two private universities, and who were working
full-time (6 months–4 years) in public, private, and teaching
hospitals.The areas of work included medical, surgical, mater-
nity, and pediatrics (general wards), and coronary care,
intermediate, neonatal ICUs, and emergency rooms (ICUs).
Graduates of all public and private universities (north,
middle, and south) of Jordan were represented. A conve-
nience sample of one public hospital, the largest hospital in
Amman, eight private hospitals in Amman, and one teaching
hospital in the north were selected to represent practice in
Jordanian hospitals. Although the private hospitals are in
excess, they constitute a similar number of beds when com-
pared with the public and teaching hospitals. Hospitals in
Amman were over-sampled because most university gradu-
ates are employed in the capital. The north was represented
by the largest teaching hospital in that area. No hospital from
the south was chosen due to the limited funds for travel. The
selected hospitals included urban and rural settings.
Institutional review board approval was obtained from the
research committee of Alzaytoonah Private University and
each hospital. Approval for data collection was obtained
from the nursing administrators and supervisors. A total of
310 questionnaires was distributed to 10 hospitals, with a
return rate of 83% (n = 258). After giving full information
about the evaluation questionnaire to the involved supervi-
sors in the various hospital settings, they were asked to com-
plete the forms by evaluating eligible nurses in their work
area. The supervisors were able to decline participation. A
willingness to evaluate was implied by answering the ques-
tionnaire. The nursing supervisors obtained consent from the
nurses. The researchers planned to evaluate the nurses differ-
ently from the usual hospital appraisal because each hospital
had its own criteria and timing for doing so. A uniformly
designed tool that measured the competence of all nurses
was designed to ensure equivalence of measurement across
all hospitals.
Measurement
A specifically designed tool was used to measure nurses’ level
of competence. The tool was intended to use statements that
were similar to the currently used hospitals’ evaluation tools.
Thus, the researchers ensured simplicity, cultural adaptation
of the tool, as well as the cooperation of supervisors. The
researchers included a selection of competence skills items
that reflected a high importance to nursing practice across all
nursing work areas.
A two-part questionnaire was developed for this study:
a demographic data section (six items) and a competence
assessment scale (27 items) (see Appendix I). The questions
reflected the universal standards of care found in the litera-
ture; that is, those of the ANA, NMC, and ICN. The com-
petence assessment questions contained basic concepts
inherent in nursing education programs and of practicing
nurses’ competencies: management (three items), profession-
Journal Compilation © 2010 Blackwell Publishing Asia Pty Ltd.
149
alism (seven items), problem-solving (five items), nursing
process (eight items), and knowledge of basic nursing prin-
ciples (four items). The nursing supervisors were asked to
rate their nurses’ competence on a scale of 1–5, where
1 = “low competence” and 5 = “excellent competence”.
For the face validity of the questionnaire, five nurse aca-
demics and two nursing directors were consulted to classify
the items. Some items required rewording to match the com-
monly used hospital criteria for nurses’ appraisal. Items were
reworded for two reasons: (i) to rephrase the variously stated
evaluation statements of the participating hospitals into one
statement that combined the meaning of this criterion; and
(ii) to simplify the wording for easier completion by the
supervisors. A pilot test (n = 50) was carried out to evaluate
the questionnaire and the item consistency for the scale was
calculated (Cronbach’s a = 0.97).
In Jordan, where there is a severe nursing shortage and an
overload of work, expecting the supervisors to participate in
an inter-rater reliability exercise is not feasible. Placing this
additional responsibility on the supervisors most likely would
have resulted in them being unable to participate.
Data management and analysis
The Statistical Package for Social Sciences Version 14 was
used (SPSS, Chicago, IL, USA). Summary descriptive statis-
tics, the Student’s t-test, and analysis of variance (anova)
were used to provide the demographic details of the sample
and to test for differences in competence levels by the uni-
versity type, sex, number of years of practice, working area,
and hospital type.
RESULTS
Sample characteristics
The sample represented 258 nursing graduates (2001–2004
cohorts) of six BSc programs in nursing. Of these, 75.6% were
men and 72.9% were graduates of private universities. The
number of male nurses exceeded that of the female nurses
in both the public (71%) and private universities (89.9%). No
private university graduates worked in the teaching hospital,
while 79.7% worked in private hospitals. Over half (57.1%)
of the graduates from the public universities were working in
private hospitals, 17.4% in a public hospital, and 25.5% in the
teaching hospital.
Figure 1 shows that a higher proportion of the sample was
general ward nurses and that an equal number of graduates
from the public and private universities worked in ICUs
(38.4% and 39.1%, respectively) and general wards (61.6%
and 60.9%, respectively). Figure 2 depicts the type of
working areas (general wards versus ICUs) by the type of
hospital (public, private, and teaching).
The graduates of the public and private universities had
similar above-average mean scores in the five competencies.
The highest mean scores of the graduates from the public
(4.04 ⫾ 0.57) and private (4.15 ⫾ 0.63) universities were for
management. The lowest mean score of the graduates of
public universities was in knowledge of basic sciences
© 2010 The Authors
150 R. Safadi et al.

(3.75 ⫾ 0.80), whereas the lowest mean score for the gradu-
ates from private universities was in the nursing process
(3.84 ⫾ 0.77). None of the type of university comparisons was
statistically significant.
Table 2 shows above-average mean scores for all compe-
tencies for men (4.06 ⫾ 0.61) and women (4.11 ⫾ 0.52), with
the highest scores for both men and women in management
(Table 1). The lowest mean scores for men were in the
Figure 1. Distribution of students by the type of university and
work area. ( ), graduated from public university; ( ), graduated
from private university.
Figure 2. Distribution of nurses by the type of hospital and work
area. ( ), intensive care units; ( ), general wards.
nursing process (3.78 ⫾ 0.71) and knowledge of basic prin-
ciples (3.78 ⫾ 0.81); for women, the lowest mean score was in
knowledge of basic principles (3.79 ⫾ 0.84). None of the sex
comparisons was statistically significant.
All the comparisons of nurses’ level of competencies by
general wards or ICUs showed higher mean scores for
general wards; they were significantly higher in manage-
ment (t = -3.20, P < 0.001), professionalism (t = -3.68,
P < 0.001), and the nursing process (t = -2.10, P = 0.04). The
general ward nurses showed an overall significantly better
performance than the ICU nurses (t = -2.59, P < 0.01)
(Table 3).
An anova was used to test the difference in the level of
competence between the nurses working in the three types of
hospitals. The scores for management (F = 4.79, P = 0.01) and
professionalism (F = 4.02, P = 0.02) were significantly better
for the nurses working in the teaching hospital, compared
to the nurses in the private and public hospitals (Scheffe’s
post-hoc test) (Table 4).
The number of years of experience since graduation
(ⱕ 4 years) in relation to the level of competence was evalu-
ated and was not found to be significantly different in any
competency skills.
DISCUSSION
The competence assessment of nurses in this study represents
graduates from all parts of Jordan including urban and rural
areas. Men and private hospitals are over-represented in our
sample as a reflection of the larger proportion of men enter-
ing nursing education programs. The JNC (2003) indicated
that, of 6007 registered nurses in the taskforce, there were
3829 female nurses (63.7%) and 2178 male nurses (36.3%).
It is estimated that the ratio of men to women has increased
in the last few years due to men’s greater interest in nursing
sciences. As the salaries of nurses are extremely low, more
men tend to seek employment in the private sector because
of higher pay and because they are the predominant provider
for their own family. This differs from countries that have
relatively few men in the nursing profession, such as the

Table 1. Level of competence in the five nursing competency skills by type of university

Type of
Competency university N Mean SD t P-value

Management Public 186 4.04 0.57 -1.40 0.16

Private 69 4.15 0.63
Professionalism Public 186 3.98 0.64 -0.74 0.46
Private 69 4.05 0.69
Problem-solving Public 186 3.82 0.75 -1.01 0.31
Private 69 3.92 0.77
Nursing process Public 186 3.76 0.69 -0.76 0.44
Private 69 3.84 0.77
Knowledge of basic principles Public 186 3.75 0.80 -1.01 0.31
Private 69 3.87 0.86
Overall performance Public 186 3.86 0.64 -0.98 0.33
Private 69 3.95 0.71

© 2010 The Authors

Journal Compilation © 2010 Blackwell Publishing Asia Pty Ltd.
Competence assessment of nurses 151

Table 2. Level of competence in the five nursing competency skills by sex

Competency Sex N Mean SD t P-value

Management Male 195 4.06 0.61 -0.62 0.57

Female 63 4.11 0.52
Professionalism Male 195 3.98 0.67 -1.15 0.27
Female 63 4.08 0.59
Problem-solving Male 195 3.82 0.77 -1.17 0.26
Female 63 3.95 0.72
Nursing process Male 195 3.78 0.71 -0.41 0.68
Female 63 3.82 0.69
Knowledge of basic principles Male 195 3.78 0.81 -0.04 0.97
Female 63 3.79 0.84
Overall performance Male 195 3.87 0.64 -0.73 0.47
Female 63 3.94 0.71

Table 3. Level of competence in the five nursing competency skills by work area

Competency Setting N Mean SD t P-value

Management ICUs 99 3.93 0.56 -3.22 0.002*

General wards 158 4.17 0.59
Professionalism ICUs 99 3.82 0.63 -3.68 0.000*
General wards 158 4.12 0.64
Problem-solving ICUs 99 3.74 0.75 -1.87 0.063
General wards 158 3.92 0.75
Nursing process ICUs 99 3.67 0.74 -2.10 0.040*
General wards 158 3.86 0.68
Knowledge of basic principles ICUs 99 3.68 0.85 -1.58 0.120
General wards 158 3.85 0.79
Overall performance ICUs 99 3.75 0.66 -2.59 0.010*
General wards 158 3.96 0.64

*P ⱕ 0.05. ICUs, intensive care units.

Table 4. Level of competence in the five nursing competency skills by hospital type

Competency Hospital N Mean SD F P-value

Management Private 161 4.03 0.55 4.79 0.01*

Public 46 4.01 0.75
Teaching 49 4.31 0.48
Professionalism Private 161 3.95 0.61 4.02 0.02*
Public 46 3.95 0.82
Teaching 49 4.24 0.56
Nursing process Private 161 3.76 0.69 0.42 0.65
Public 46 3.86 0.83
Teaching 49 3.81 0.66
Problem-solving Private 161 3.83 0.69 0.14 0.87
Public 46 3.85 0.97
Teaching 49 3.90 0.73
Knowledge of basic principles Private 161 3.73 0.80 1.00 0.37
Public 46 3.88 0.94
Teaching 49 3.85 0.74
Overall performance Private 161 3.85 0.63 1.23 0.29
Public 46 3.90 0.83
Teaching 49 4.00 0.58

*P ⱕ 0.05.

© 2010 The Authors

Journal Compilation © 2010 Blackwell Publishing Asia Pty Ltd.
152
USA, where a recent national survey showed that the pro-
portion of men who enrolled in baccalaureate nursing pro-
grams in 2002 was 9.6% (Girard, 2003).
Like most studies, our study had some limitations. First, we
used a non-probability convenience sample, which limits the
generalizability of our findings. Future studies can improve
on this through stratified random sampling. Second, our tool,
which had strong face validity, needs to be validated for psy-
chometric properties. Moreover, an evaluation by the super-
visors as the sole assessment measure of staff competence
might be prone to subjectivity and bias; most likely, any bias
would be in the direction of the null. Despite these limita-
tions, our study yielded important findings about nurses’
competencies in relation to their graduating university, dif-
ferent hospital sectors, clinical settings, sex, and number of
years of experience.
The five salient findings from this study are that: (i) the
assessment of competencies in all areas were satisfactory on
a scale of 1–5; (ii) the graduates from the public and private
university programs were similarly competent; (iii) the male
and female nurses were equally competent; (iv) the nurses
who worked on general wards rated higher in management,
professionalism, and nursing process competencies than did
the nurses who worked in ICUs; and (v) the nurses working
in the teaching hospital had significantly higher competencies
in management and professionalism than did those working
in private and public hospitals. The possible explanations for
the above results are discussed.
Despite the differences in the level of entry to nursing, we
found that nursing graduates of the public and private uni-
versities have comparable competencies in all areas. This is a
reflection of the similarities in the educational programs, phi-
losophies and curricula. Although the private universities
were established later than the public universities and have
less stringent rules for accepting students, the Ministry of
Higher Education places greater emphasis on applying strict
accreditation standards on these new programs.
In this study, the similarities of competence between male
and female nurses counteract Hathaway’s (1990) findings.
As rated by nursing faculty members and administrators,
Hathaway indicated that a “typical male nurse” was statisti-
cally significantly different from a “typical female nurse”.
Men were better than women in professional development,
but had a lower competence level in their knowledge base
and patient communication. From the current study, it seems
that, regardless of sex, new graduates continue to apply what
they learned in their baccalaureate programs accurately and
abide by the hospital’s policies and procedures; therefore,
they do not demonstrate individual clinical innovations or
creativity. As beginners, this is a safe approach in a country
where seniority and following the hierarchical order are
valued more than creativity and innovation. For nurses, it is
important to gain the basic knowledge as beginners and to
develop gradually to the next stage of professional develop-
ment, which is consistent with Benner’s model of novice to
expert in nursing (Benner, 2001).
The general ward nurses’ better rating than ICU nurses in
overall performance, professionalism, management, and the
nursing process is contrary to what is reported in the litera-
© 2010 The Authors
Journal Compilation © 2010 Blackwell Publishing Asia Pty Ltd.
R. Safadi et al.
ture. This result may be attributed to the graduates’ short
period of experience (4 years); thus, they have not yet
achieved the required higher competencies needed for prac-
tice in the ICU setting. Another possible explanation for
these differences in competence is related to the supervisors’
higher expectations of the nurses choosing to work in ICUs,
putting them at a disadvantage from the beginning of their
career. Copnell (2008) suggested that working with critically
ill patients requires that nurses be highly knowledgeable.
Luotola et al. (2003) found that values and attitudes, tacit
professional skills, and intuition were perceived to be impor-
tant qualifying requirements for nurses working in ICUs.
Furthermore, Saastamoinen (2007) indicated that the func-
tions of nurses working in ICUs necessitate holistic patient
care that requires special comprehensive competencies, pro-
fessional skills, and expertise in order to offer this higher
level of competence. According to Benner’s stages of nursing
expertise, a proficient nurse must have 3–5 years of experi-
ence to provide care in terms of “wholes”, rather than in
“parts” (Berman et al., 2008), and to demonstrate intuition
and decision-making ability is even more complex (King &
Clark, 2002). Atkinson and Tawse (2007) referred to the
importance of specialized education in promoting hematol-
ogy nurses’ levels of knowledge and confidence; this input
had enabled nurses to reach a level that experience alone
could not have achieved.
In light of the above explanations, the burden of heavy
workloads, and the lack of continuing education opportun-
ities, the deficiency of professional development is an
expected outcome for Jordanian nurses. In this study, the
nurses who worked on general wards rated significantly
higher in overall competence and, more specifically, in man-
agement, professionalism, and the nursing process than did
the nurses working in ICUs. The higher competencies of the
general ward nurses in these three abilities might have been
achieved through the experiential learning gained on general
wards, with larger numbers of patients, higher patient–nurse
ratios, the variety of case-mix, and closer personal contact
with patients and their family. Moreover, the nurses working
on general wards utilize the nursing process in their care
plans and are given more responsibilities and management
tasks than the nurses in ICUs.
The higher competence levels in management and profes-
sionalism of the nurses working in the teaching hospital
might be related to the expectation of them to serve as role
models for students and to be able to manage the working
conditions between students and staff members.Additionally,
teaching hospitals are more selective in recruiting nurses and,
thus, reflect higher competence after employment.
CONCLUSION
The current study is the first in Jordan in which hospital
supervisors assessed the level of competence of nursing
graduates from Jordanian universities. The competence
assessment showed that, regardless of the type of university,
sex, number of years of experience, work area, and type of
hospital, Jordanian nurses’ performance was judged as satis-
factory. No significant differences in the overall level of
Competence assessment of nurses
competence existed between public and private university
graduates, male and female nurses, or between the three
types of hospital. However, nurses working on general wards
showed a significantly better overall performance and in
three competencies (management, professionalism, and
nursing process) than did nurses working in ICUs. Add-
itionally, nurses working in the teaching hospital had a
significantly higher performance in two competencies
(management and professionalism) than did nurses in the
public and private hospitals.
These findings are consistent with Jordanian health-care
institutions’ lack of support for new graduates at entry into
practice and, more specifically, into ICUs. The similarities in
the curricula of the nursing educational programs reflect on
nurses’ competence afterwards, yielding a satisfactory level
of performance in practice areas. Therefore, employment
decisions that favor a specific graduating university or sex are
not scientifically grounded, remaining an institutional prefer-
ence. Hospital policies and nurse recruiters should consider
individual competence rather than innate characteristics in
the selection of new employees.
ACKNOWLEDGMENTS
The authors would like to acknowledge the assistance and
cooperation of the nursing administration, supervisors, and
nursing staff of all the participating Jordanian hospitals for
their sincerity and keenness to provide us with the nurses’
evaluations.
REFERENCES
Ahmad M, Alasad J. Patients’ preferences for nurses’ gender in
Jordan. Int. J. Nurs. Pract. 2007; 13: 237–242.
Atkinson J, Tawse S. Exploring haematology nurses’ perceptions of
specialist education’s contribution to care delivery and the devel-
opment of expertise. Nurse Educ. Today 2007; 27: 627–634.
Bartlett H, Simonite V, Westcott E, Taylor H. A comparison of
nursing competence of graduates and diplomats from UK nursing
programmes. J. Clin. Nurs. 2000; 3: 369–381.
Benner PE. From Novice to Expert: Excellence and Power in Clinical
Nursing Practice. Upper Saddle River, NJ: Prentice Hall, 2001.
Berman A, Snyder S, Kozier B, Erb G. Kozier & Erb’s Fundamentals
of Nursing: Concepts, Process, and Practice (8th edn). Upper
Saddle River, NJ: Pearson Prentice Hall, 2008.
Bircumshaw D. How can we compare graduate and non-graduate
nurses? A review of the literature. J. Adv. Nurs. 1989; 14: 438–443.
Copnell B. The knowledgeable practice of critical care nurses: a post
structural inquiry. Int. J. Nurs. Stud. 2008; 45: 588–598.
Journal Compilation © 2010 Blackwell Publishing Asia Pty Ltd.
153
Cowan DT, Norman I, Coopamah VP. Competence in nursing prac-
tice: a controversial concept – A focused review of literature. Nurse
Educ. Today 2005; 25: 335–362.
Dunn SV, Lawson D, Robertson S et al. The development of com-
petency standards for specialist critical care nurses. J. Adv. Nurs.
2000; 31: 339–346.
Girard N. Men and nursing – editorial. The American Association
of Colleges of Nursing. AORN J. 2003; 77: 728–730 [Cited 11 Aug
2009.] Available from URL: http://findarticles.com/p/articles/
mi_m0FSL/is_4_77/ai_99983125/.
Hathaway AL. Nursing faculty and nursing administrators’ per-
ceptions regarding men in nursing (doctoral dissertation). Los
Angeles: University of Southern California, 1990.
Jordanian Nursing Council (JNC). Current and Projected Nursing
Manpower in Jordan 2003. 2008. [Cited 25 Sep 2009.] Available
from URL: http://www.jnc.gov.jo/arabic/publications/publications.
htm.
Kaiser KL, Rudolph EJ. Achieving clarity in evaluation of
community/public health nurse generalist competencies through
development of a clinical performance evaluation tool. Public
Health Nurs. 2003; 20: 216–227.
King L, Clark MC. Intuition and the development of expertise in
surgical ward and intensive care nurses. J. Adv. Nurs. 2002; 37:
322–329.
Liu M, Kunaiktikula W, Senaratanaa W, Tonmukayakula O, Eriksen
L. Development of competency inventory for registered nurses in
the People’s Republic of China: scale development. Int. J. Nurs.
Stud. 2007; 44: 805–813.
Luotola V, Koivula M, Munnukka T, Estedt-Kurki P. [Competence
and qualification requirements of intensive care nurses.] Hoitotide
2003; 15: 233–243 (in Finnish).
Meretoja R, Leino-Kilpi H, Kaira AM. Comparison of nurse compe-
tence in different hospital work environments. J. Nurs. Manag.
2004; 12: 329–336.
Redfern S, Norman I, Calman L, Watson R, Murrels T. Assessing
competence to practice in nursing: a review of the literature. Res.
Pap. Educ., 2002; 17: 51–77.
Robb Y, Fleming V, Dietert C. Measurement of clinical performance
of nurses: a literature review. Nurse Educ. Today 2002; 22: 293–300.
Rowell PA. The professional nursing association’s role in patient
safety. OJIN 2003; 8: [Cited 5 Oct 2008.] Available from URL:
http://nursingworld.org/MainMenuCategories/ANAMarketplace/
ANAPeriodicals/OJIN.
Saastamoinen T. [Nursing in an intensive care unit – professionalism
of the nurse.] Sairaanhoitaja 2007; 80: 33–37 (in Finnish).
Son JT, Park M, Kim HR, Lee WS, Oh K. [Analysis of RN–BSN
students’ clinical nursing competency.] Taehan Kanho Hakhoe Chi
2007; 37: 655–664 (in Korean).
Tzeng HM, Ketefian S. Demand for nursing competencies: an explor-
atory study in Taiwan’s hospital system. J. Clin. Nurs. 2003; 12:
509–518.
Watson R. Clinical competence: starship enterprise or straitjacket?
Nurse Educ. Today 2002; 22: 476–480.
© 2010 The Authors
154 R. Safadi et al.

APPENDIX I

Competency evaluation questionnaire

Evaluation
No. Statement Excellent Very good Good Acceptable Weak

1 Personal appearance and appropriateness to profession (professionalism)

2 Commitment to working hours (management)
3 Communication with patients and their family (nursing process)
4 Communication with physicians and health team members (nursing process)
5 Communication with hospital administration staff (human resources and
finance personnel, etc.) (management)
6 Communication with nursing colleagues (nursing process)
7 Commitment to hospital rules and regulations (professionalism)
8 Commitment to the profession’s ethical guidelines (professionalism)
9 Conceptual knowledge of nursing (familiarity with the sciences and theoretical
concepts of nursing) (knowledge of basic principles)
10 Implementing nursing skills safely (nursing process)
11 Keeping up-to-date with the latest in the nursing profession (knowledge of
basic principles)
12 Participation in scientific research and utilization of its results
(professionalism)
13 Knowledge of the nursing process steps (knowledge of basic principles)
14 Ability to implement the nursing process steps (nursing process)
15 Ability to evaluate patients’ needs (physical, psychological, social, and
spiritual) (problem-solving)
16 Ability to diagnose patients’ nursing problems (problem-solving)
17 Providing nursing care according to priorities (problem-solving)
18 Implementing nursing responsibilities based on appropriate scientific
justification (problem-solving)
19 Managing critical nursing cases appropriately (problem-solving)
20 Using time efficiently (management)
21 Initiating new ideas related to the profession’s development (knowledge of
basic principles)
22 Having administrative abilities and accountability (professionalism)
23 Showing enthusiasm in carrying out nursing responsibilities (professionalism)
24 Applying hospital policies and procedures appropriately (professionalism)
25 Maintaining patient safety (nursing process)
26 Documenting nursing activities (nursing process)
27 Communicating nursing activities orally (nursing process)

The instrument was designed and distributed to the participants in Arabic. This is a translated copy. The terms in parentheses are the
competency labels.

© 2010 The Authors

Journal Compilation © 2010 Blackwell Publishing Asia Pty Ltd.
Copyright of Nursing & Health Sciences is the property of Wiley-Blackwell and its content may not be copied
or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission.
However, users may print, download, or email articles for individual use.