What Do Nurses Actually Need? Is It Competence or Confidence?

Qualified nurses are expected to be competent to practice independently, but some has insufficient training and knowledge (i.e., modern technological equipment) necessary for independent practice, can be in the phase of adaptation with the new environment and people, or can be from a new role or task, while others have skills and knowledge, but lacks or have little confidence in putting into practice. Nurses who lack confidence in their profession may compromise the delivery of safe and effective healthcare that bears impact to competence. The Joint Commission on Accreditation of Healthcare Organizations emphasizes that competence is an important criterion required from each healthcare provider. In addition, the Institute of Medicine stresses that nurse competence plays a significant role in providing patients with safe care.

Confidence and competence in nursing practice

Confidence is required for effective engagement in multidisciplinary setting. All nurses must practice with confidence according to the code: Standards of conduct, performance and ethics for nurses and midwives [1]. In the book, Key Concepts of Nursing [2], confidence within nursing practice is defined in two ways. First, it is as a secret that is confided or entrusted to another. Second, it is a freedom from doubt; belief in yourself and your abilities. Professional confidence is associated with clinical competence by performance. In a study participated by 80 nurses entitled, Assessing the educational needs of palliative care link nurses, two thirds that had gone palliative care training considered themselves to already possess the necessary skills, confidence and competence relating to skill based elements; however, less towards practice issues.

Competence refers to a potential ability and/or a capability to function in a given situation

According to American Nurses Association, the public has the right to expect registered nurses to demonstrate professional competence throughout their careers. In nursing, it is a possession of not mere license but basic skills including clinical competence- use of nursing process and technical skills, general competence- communication and problem solving capacity, and moral competence – use of ethics, beliefs and values.

Factors that impacts competence

The health care field needs nurses who can work who are effective and efficient in their practices. Hence, there are factors that significantly affect the excellent performance of a professional nurse. Mentorship plays a crucial role in setting, developing and building goals together with the novice nurse. In addition, the organization’s acknowledgement and support to the workplace environment and nursing practices. Moreover, ethics as nurses executes his moral duties and obligations inherent with his professional standards, boundaries, behavioural and values system. Lastly, it is essential to evaluate competence by starting with self-reflection, and external validation continuously.

Furthermore, the administration’s decision in engaging on accreditation is an integral part of building professional competence in the healthcare settings. The Magnet Hospital Recognition Program, now known as Magnet Nursing Services Recognition Program for Excellence in Nursing Services, established by the American Nurses Association (ANA) [3] together with the American Nurses Credentialing Center (ANCC) supports the recognition of excellent nursing practice. The program is awarding institutions that are a “magnet” to those professionals that provide quality nursing services [4].

Improving self by building self-efficacy

An individual has to have faith in himself before anyone else does. Albert Bandura, a psychologist, developed the Self-efficacy theory. The theory is “the belief that one has the power to produce that effect by completing a given task or activity related to that competency”. It illustrates that self-efficacy is trusting capacities of oneself resulting to accomplishment of his goal which is one way to identify, develop and improve oneself to have self-confidence. In addition, it stated factors that enhance self-efficacy by experiential learning, identifying potentials, moral support and emotional stability. How we perceive ourselves affects our performance, satisfaction and quality of life in a wide range of situations. Self-confidence is a key component of effective clinical performance. It affects competence to perform and is sustained by constant practice of quality performance increasing more prowess and confidence. Thus, clients are guaranteed with superior healthcare services. However, to start the process, an individual must believe himself and actualize it. It's a win-win situation.

The following shows how confidence you are on duty

Doing what you believe to be right, even if others mock or criticize you for it. Being willing to take risks and go the extra mile to achieve better things. Admitting your mistakes, and learning from them. Wait for others to congratulate you on your accomplishments. Lastly, accepting compliments graciously. “Thanks, I really worked hard on that prospectus. I'm pleased you recognize my efforts”.

Recommendations on boosting confidence with competence

• Improve your nursing skills. Individual confidence is built up over several events or training sessions. There are numerous nursing courses, workshops, seminars and conference that provide enhancement and excellent skills. The more specialization in a particular subject, the more aware, the more successful, and the more impressive you will become.

• Have ample preparations. Prioritize, think in advance, and anticipate. Be well prepared at your very best i.e., make a reminder’s checklist. Before going into a patient room, have everything you need. For physician referrals, be certain on what to communicate.

• Practice effective communication. Effective communication prevents errors and corrects mistakes. It promotes safe practice by asking adequate support and knowledge particularly with colleagues and other multidisciplinary team members.

• Enhance skills by the following ways: Speak clearly with objectivity. Listen and verify/clarify, make sure you understand the message. Pay attention to the other person’s non-verbal cues (read between the lines), and readiness (be sensitive with his mood, condition or state of authority) in communication. Ask questions and find out solutions and answers.

• Know your self- worth. Do not expect gratitude at all times from your services. Often times, we are “thanked” at the last moment. Learn to handle this fact. Acknowledge your own success and believe that you have done your part in the best of your knowledge and capabilities.

• Focus on what is positive and what makes your work fulfilling. See things in a better perspective. Enjoy what you are doing, it will make you feel good and in turn, builds more confidence in completion of your tasks.

• Be extra curious. In the nursing profession, continuous education is a lifetime responsibility. Learning makes you a more confident person and will drive you towards being excellent in all the things you do.

• Think of achieving the end-goal and the common good. It is how well you improve yourself. Do not keep comparing yourself and competing to other people since there will always be someone more experienced, knowledgeable or skillful than you. Acknowledge your strengths and weaknesses. Motivate yourself to achieve the goals you set for a given day.

• Do something new/challenging. The most difficult part is always at the beginning of any journey. Confidence is built on outcome achievement, overcoming fears and hardships. Be persistent and always be consistent on excellent performance. This develops your self-esteem and pride of oneself.

• Be a catalyst of change. Do not be little your impact towards the change you hope for. Be active. Change maker starts within you.

• Positive self-talk. Ward off the effects of self-sabotage before it wears away your self-esteem. Start today, by gathering your strengths, motivating encouraging words/behaviors, and put yourself on a path toward greater satisfaction.

The nurses are almost always forefront of identifying and managing patient conditions that might be life-threatening. Competence on nursing is essential enabling provision of effective and safe quality patient care that is cost effective. Lack of confidence can hinder safe practice affecting quality performance and outcomes. Therefore, it is essential that nurses assess themselves and develop competence and confidence, depending on what their actual need. Life in general is a journey. The challenge and reward is in moving forward by developing your inner self and be at tune with change. So, nurses, have courage and start to trust yourself!