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Critical Care Nurse· 2026Q1

A New Competence Standard Improves Nurses’ Confidence in Readiness to Practice

Julie Miller, Mary Stahl, Sara Grieshop, Devin Bowers

Short summary

A new evidence-informed competence framework and toolkit significantly increased nurses' confidence in key practice areas, with 92% finding it effective for minimal supervision and 90% 1-year retention achieved in a beta test.

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Key points

  • Orientees reported increased confidence in recognizing and intervening for patient instability after implementing the new competence framework.
  • 92% of orientees found the framework's performance outcomes and metrics effective for preparing them to work with minimal supervision.
  • 88% of nurse leaders, educators, and preceptors rated the framework outcomes and metrics as moderately to completely effective.
  • The beta test achieved a 90% nurse retention rate at 1 year, outperforming the national average.

AI-generated from the title and abstract; the full text is not read.

Abstract

Background An evidence-informed competence framework, with measurable performance outcomes and knowledge, skills, and abilities metrics, and an implementation toolkit were developed and beta tested to determine nurse readiness for transitioning from orientation to autonomous practice. Objective To evaluate satisfaction and toolkit implementation and impact, and to identify opportunities for improvement. Methods Sites replaced their orientation methods with the competence framework, and beta testing took place over a 1-year period. Surveys before and after implementation measured orientee and nurse leader confidence in orientees’ ability to recognize a change in stability, intervene for a change in stability, advocate on behalf of the patient, and provide safe patient care. Comparisons of length of orientation, satisfaction, and opportunities for improvement were assessed. Nurse retention at 1 year was determined. Results Thirteen progressive care and critical care units with 49 orientees completed the beta test; 24 orientees completed the before and after surveys. After beta testing, orientees reported increased confidence levels in all polled performance outcomes compared with before orientation. Most (92%) orientees reported the framework performance outcomes and knowledge, skills, and abilities metrics were moderately to completely effective in preparing them to work with minimal supervision. Most (88%) nurse leaders, educators, and preceptors rated these same outcomes and metrics as moderately to completely effective. Nurse retention at 1 year was 90%. Conclusion The beta test demonstrated improvement in confidence in all polled areas, and 1-year retention outperformed the national average. The competence framework is effective in answering the question, How do leaders know when the nurse is ready to transition from orientation to more independent practice?

The authors' abstract, as published at the source. Critical Care Nurse, 2026 · DOI ↗

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