I S S U E S A N D IN N O V A T I O N S I N N U R S I N G E D U C A T I O N

Competence of newly-graduated nurses – a comparison of the

perceptions of qualified nurses and students
Anna Lofmark PhD RN
Senior Lecturer, Department of Caring Sciences and Sociology, University of Gavle, Gavle, Sweden

Bibbi Smide PhD RN

Senior Lecturer, Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala,
Sweden

Karin Wikblad PhD RN

Professor, Department of Medical Sciences, Uppsala University, Uppsala, Sweden

Accepted for publication 26 July 2004

Correspondence: L O F M A R K A . , S M I D E B . & W I K B L A D K . ( 2 0 0 6 ) Journal of Advanced Nursing

Anna Lofmark, 53(6), 721–728
Department of Caring Sciences and Competence of newly-graduated nurses – a comparison of the perceptions of
Sociology,
qualified nurses and students
University of Gavle,
Aim. This paper reports a study that compares opinions of final year nursing stu-
S-801 76 Gavle,
Sweden.
dents, rating their own competence, with the opinions of experienced nurses on the
E-mail: anna.lofmark@hig.se competence of newly-graduated nurses.
Background. The transition of nursing preparation into higher education is regarded
as positive, although it has led to differences in opinion about the competence of
newly-graduated nurses and their readiness to enter the nursing profession. There
are studies showing that newly-graduated nurses perceive themselves as holistically
focused, professional practitioners, while other nurses are concerned that newly-
graduated nurses do not have necessary skills.
Methods. A convenience sample of 106 nursing students in the final week of their
course and 136 nurses who had experience of supervising nursing students com-
pleted a questionnaire. The data were collected in 2002.
Results. Own competence, in the form of ability to perform nursing care, was
rated by nursing students to be good or strongly developed in most of the
investigated areas of nursing care. Experienced nurses also estimated newly-
graduated nurses’ competence to be good or strongly developed, although to a
lesser extent. Nurses qualified within the previous 5 years rated newly-graduated
nurses’ competence to be higher in comparison with those with less recent
education.
Conclusions. Further studies are needed to broaden our understanding of why
some areas of nursing care, such as ethical awareness, were rated very highly,
while others, like informing and teaching of co-workers and planning and pri-
oritizing interventions had the lowest rating.

Keywords: competence, graduate nurses, higher education, nurse education,

nursing profession, questionnaire, survey

2006 The Authors. Journal compilation
2006 Blackwell Publishing Ltd 721
A. Lofmark et al.
Introduction
Nursing education has been subject to many changes over the
years, and one educational change that has been questioned is
the move into universities. Has it really equipped newly-
graduated nurses with the necessary knowledge, skills and
confidence to function in contemporary healthcare settings?
This issue has been discussed internationally (Maben &
Macleod Clark 1998, Gerrish 2000, Greenwood 2000, The
Swedish Board of Health and Welfare 2002).
Academic education has replaced vocational training and
gradually a new curriculum is replacing the old one
(Kapborg 1998, Pilhammar Andersson 1999). The aca-
demic demands on nursing education are, for example, that
teaching should provide students with the ability to make
critical judgements, solve problems and follow the devel-
opment of knowledge within the field of teaching, and to
develop students’ ability to exchange information on a
scientific level. Nursing education must normally follow a
state’s or country’s specific guidelines and in some cases
international directives, such as those from the European
Union (Department of Education 1992).
Background
Competence
Regulations for nursing education assume that nurses, at
registration, have reached a standard prepared for auton-
omous practice and for which they can be held account-
able. However, what establishes this standard of
competence is not always defined (Bradshaw 1997). Dis-
cussion around the meaning of competence in nursing
started in the United Kingdom (UK) in the late 1980s and
continues internationally (Bradshaw 1997, 1998, Milligan
1998, McMullan et al. 2003). The key words or constructs
within definitions of competence vary (Eraut 1988),
although there is a general consensus that competence is
based on a combination of components that reflect: (a)
knowledge, understanding and judgement; (b) a range of
skills – cognitive, technical or psychomotor and interper-
sonal; and (c) a range of personal attributes and attitudes
(Redfern et al. 2002, Alexander & Runciman 2003). Even
if the definition and use of the concept has led to confusion
and contradiction, it is actively promoted and used (Girot
1993, While 1994, Milligan 1998). In the present study,
competence was described in terms of learning outcomes
and ability to perform nursing care (Alexander & Runci-
man 2003) through the integration of cognitive, affective
and psychomotor skills (Girot 1993).
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Perceptions of competence
Evaluation of competence in the transition process from
university student to Registered Nurse was described three
decades ago by Kramer, who saw this period as shock-like
reactions to work situations for which graduates thought they
were prepared (Kramer 1974).
Recent studies have shown that nurses today feel better
prepared for their work. New graduates perceived themselves
as professional practitioners with theoretical knowledge,
both holistically focused, and research-oriented (Macleod
Clark et al. 1997) and feelings of responsibility and
accountability (Maben & Macleod Clark 1998). In their
final clinical period, students and their supervisors assessed
the students’ clinical performance well above the expected
level (Glover et al. 1997). Gerrish (2000) found that newly
qualified nurses have developed a more active style of
learning and that they found the transition less stressful than
nurses had done over a decade earlier. Overall, the move into
higher education is regarded as positive. However, concerns
were expressed that newly qualified nurses do not have the
full range of necessary skills (Watson & Kiger 1994,
Meerabeau 2001, The Swedish Board of Health and Welfare
2002). Nurses who had just completed their preregistration
course found that they were not adequately prepared for
what they were likely to encounter, and that there was lack of
support (Gerrish 2000, Pigott 2001). They also expressed
anxiety about making mistakes (Kelly 1998). Professional
socialization, experienced as difficulties with ‘fitting in’ as
quickly as possible and being acknowledged as competent
by their more experienced colleagues was noted by Clare
(1993), while Gray and Smith (1999) found that the process
of professional socialization during the students’ final place-
ment was facilitated by a mentor and the learning environ-
ment.
In Sweden, only one report has been published on the
proficiency of newly-graduated nurses in relation to health-
care needs, and this indicated that they had insufficient
management and technical skills (The Swedish Board of
Health and Welfare 2002). The sparse number of studies, as
well as the differences in opinions that have been highlighted
in the literature, were the reasons for this study.
The study
Aim
The aim of this study was to compare final year student
nurses’ views of their own competence with qualified nurses’
perceptions of newly-graduated nurses’ competence.
Issues and innovations in nursing education
Design
A descriptive design using a questionnaire survey was
adopted. The data were collected in 2002.
Participants
A convenience sample of students from two universities
offering a 3-year Bachelor’s degree level nursing programme
was chosen. The students were asked to participate during
the final week of their course. Of a total of 127 students (61
and 66 respectively), 21 declined participation, and thus 106
were included in the study.
Two hundred experienced nurses were randomly selected
from the nursing staff at two hospitals and asked to
participate in the study. All nurses were working where
students had been practising during their clinical education.
The criterion for participation was to have had supervisory
experience of nursing students on the Bachelor of Nursing
programme. The response rate was 68% (n ¼ 136).
Data collection
A questionnaire comprising 18 items was used. It was based
on an evaluation form used previously in clinical nursing
education (Löfmark & Thorell-Ekstrand 2000). One version
of the questionnaire had questions for the students and one
version was directed to the experienced nurses, although the
questions were the same. The evaluation form had been
systematically developed from documents, requirements and
international guiding principles for nursing education
(Department of Education 1992, SFS 1992, 1993, SOSFS
1993, 1995, ICN 1997, Salvage & Heijnen 1997) and had
been in continuous use at both universities for 5 years. The
18 items in the questionnaire were almost identical with the
factors in the evaluation form and were therefore familiar to
both students and nurses (Table 2).
The questions formulated for final year students concerned
evaluation of their competence, described as experience of
their own ability to give nursing care. The experienced nurses
were asked about their opinions of newly-graduated nurses’
competence in nursing care. Response alternatives for each
item were rated as low ability, good ability and strongly
developed ability.
The questionnaire included two items not occurring in the
assessment form. One item concerned comparisons between
the current newly-graduated nurses and nurses who gradu-
ated 5–10 years previously. The three response alternatives
were: more competent, as competent or less competent. The
second item concerned newly-graduated nurses’ competence

2006 The Authors. Journal compilation
2006 Blackwell Publishing Ltd
Competence of newly-graduated nurses
Table 1 Characteristics of the groups included in the study
Nursing students Nurses
Characteristic (n ¼ 106) (n ¼ 136)
Age (years ± SD ) 29Æ3 ± 6Æ4 36Æ5 ± 10Æ0
Years since qualification (n) – 9Æ1 ± 9Æ2
Nurse employment – 8Æ8 ± 9Æ0
(years ± SD )
Participated in post-basic – 67Æ6
nurse education (%)
in relation to nursing care, where the alternatives were very
high, high, low and very low competence. Demographic data
were also collected (Table 1).
For the two student groups, the questionnaires were
distributed in the classroom. In one group, the questionnaire
was filled in immediately, while in the other group the
students were asked to return it in a few days time. No
reminders were sent out.
In the experienced nurses group, coded questionnaires were
handed out on each ward and then collected from the wards
or sent back using the internal post. Reminders were sent out
to the nurses after 3 weeks and this resulted in a further
51 questionnaires being returned, giving a total of 136.
Ethical considerations
The nursing director of each hospital, the head nurses of the
actual wards, representatives of the nurses’ union and the
heads of the education departments were contacted for
permission to carry out the study. Both students and nurses
were informed in writing about the aim of the study and the
fact that their participation was voluntary. The student form
was filled in anonymously. The nurses’ form had a code
number, so that reminders could be sent to non-respondents.
Confidentiality was assured.
Data analysis
The psychometric properties of the 18-item questionnaire
were tested and considered to possess both good validity and
reliability. A factor analysis with varimax rotation was
performed to determine the construct validity of the assess-
ment form and four factors were revealed from the analytic
procedure. The items were summed into four factors and
divided by the number of items included, after which
Cronbach’s alpha co-efficient was calculated for evaluation
of internal consistency. The possible range of scores for all
18 items was 1–3. The factors were called: (i) communication
(five items, Cronbach’s a ¼ 0Æ75); (ii) patient care (seven
723
A. Lofmark et al.

Table 2 Percentage of students (n ¼ 106)

Items Students (%) Nurses (%)
rating their own competence (good or
Ethical awareness 100Æ0 90Æ4 strongly developed ability) and nurses
Communication/interaction with patients 99Æ1 93Æ3 (n ¼ 136) rating the newly-graduated
Ability to co-operate 99Æ0 97Æ1 nurses’ competence (good or strongly
Preparing for action and working speed 99Æ0 94Æ1 developed ability)
Self-knowledge 99Æ0 86Æ6
Administering drugs 98Æ1 88Æ1
Undertaking nursing interventions 97Æ2 86Æ0
Assessing patients’ needs for nursing care 93Æ4 74Æ8
Reporting, documenting, writing patient care records 89Æ5 83Æ6
Using theoretical knowledge 88Æ7 75Æ9
Re-assessing patient’s situation and nursing interventions 87Æ7 69Æ6
Informing and instructing patients and relatives 87Æ7 63Æ7
Planning, carrying out and delegating tasks 87Æ7 57Æ0
Assisting with/performing investigations and treatments 83Æ8 63Æ9
Accuracy and reliability 82Æ5 48Æ5
Using knowledge of research and developmental work 79Æ2 69Æ9
Planning the work and prioritizing nursing interventions 71Æ8 47Æ8
Informing and teaching co-workers and students 67Æ6 44Æ8

items, Cronbach’s a ¼ 0Æ85); (iii) personality characteristics
(four items, Cronbach’s a ¼ 0Æ88); and (iv) knowledge
utilization (two items, Cronbach’s a ¼ 0Æ57; Table 3). The
strength of the intercorrelations indicated that the question-
naire possessed good reliability as three of the domains
exceeded the 0Æ70 level. The only domain with an alpha
co-efficient <0Æ70 was knowledge utilization. This might be
because of the fact that only two items were included in this
domain.
Descriptive data are presented as percentages, mean
values and standard deviations. The response alternatives
‘good ability’ and ‘strongly developed ability’ in the ques-
tionnaire were grouped together (Table 2). Comparisons
between groups were made using Student’s t-test and chi-
square-test. The level of significance was defined as
P < 0Æ05.
items, 75% or more of the experienced nurses (n ¼ 136)
rated the newly-graduated nurse as having a good or strongly
developed ability to provide nursing care. Three items were
rated by <50% of the experienced nurses (n ¼ 136) as good
or strongly developed. When the 18 items were combined
into the four factors revealed in the factor analysis, nursing
students rated their competence to be higher in all factors
compared with how experienced nurses rated the competence
of newly-graduated nurses (Table 3).
Nurses who had graduated less than 5 years previously had
slightly higher ratings than those having graduated more than
5 years previously but the difference was statistically signifi-
cant only in one of four factors, that of patient care (Table 4).
Competence of newly-graduated nurses compared with
those who graduated more than 5 years previously

Eighteen percent of nursing students (n ¼ 106) and 11% of

Results
Competence in newly-graduated nurses
Final year nursing students estimated their competence, rated
as a higher ability to provide nursing care, in all 18 items
compared with experienced nurses (Table 2). In 10 of the 18
experienced nurses (n ¼ 136) reported that newly-graduated
nurses were more competent than those who had graduated
under the old curriculum (more than 5 years previously), but
30Æ9% of the nursing students (n ¼ 106) and 41Æ3% of
experienced nurses (n ¼ 136) thought that they were less
competent (v2 ¼ 3Æ58, d.f. ¼ 2, P ¼ 0Æ17; Table 5).

Table 3 Mean values (±SD ) in four factors

Factor Students (n ¼ 106) Nurses (n ¼ 136) Statistics (d.f. ¼ 234)
of competence in newly-graduated nurses as
Communication 2Æ11 ± 0Æ38 1Æ77 ± 0Æ35 t ¼
6Æ98; P < 0Æ0001 rated by nursing students and nurses
Patient care 2Æ17 ± 0Æ38 1Æ77 ± 0Æ36 t ¼
8Æ23; P < 0Æ0001
Personal characteristics 2Æ68 ± 0Æ34 2Æ11 ± 0Æ38 t ¼
11Æ95; P < 0Æ0001
Knowledge utilization 1Æ99 ± 0Æ45 1Æ82 ± 0Æ49 t ¼
2Æ78; P < 0Æ01

Maximum score 3.

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Issues and innovations in nursing education Competence of newly-graduated nurses

Table 4 Mean values (±SD ) for nurses’

<5 years since >5 years since
ratings of the competence of newly-
graduation graduation
graduated nurses, with reference to the
Factor (n ¼ 70) (n ¼ 60) Statistics
time since their own graduation
Communication 1Æ83 ± 0Æ34 1Æ72 ± 0Æ35 t ¼ 1Æ81; d.f. ¼ 128; P < 0Æ08
Patient care 1Æ87 ± 0Æ37 1Æ65 ± 0Æ30 t ¼ 3Æ75; d.f. ¼ 128; P < 0Æ001
Personal characteristics 2Æ16 ± 0Æ41 2Æ05 ± 0Æ34 t ¼ 1Æ65; d.f. ¼ 128; P < 0Æ1
Knowledge utilization 1Æ87 ± 0Æ50 1Æ75 ± 0Æ48 t ¼ 1Æ38; d.f. ¼ 128; P < 0Æ8

Maximum score ¼ 3; missing answers ¼ 6.

Table 5 Students’ and nurses’ ratings of competence in newly- action and working speed were estimated as the strongest in
graduated nurses compared with nurses who had graduated >5– this group of nurses. Both groups considered competence to
10 years previously (%)
be good or strongly developed in more than half of the
How competent is the newly- examined fields. These findings are congruent with those of
graduated nurse when compared studies of the readiness of newly-graduated nurses to enter
with those who graduated
the nursing profession as competent Registered Nurses (Clark
>5–10 years previously? Students Nurses
et al. 1997, Gerrish 2000, Greenwood 2000).
More competent 18Æ0 11Æ1 These findings are of interest from both an educational and
As competent 51Æ1 47Æ6 a professional point of view. In the academic curriculum
Less competent 30Æ9 41Æ3
more emphasis has been placed on teaching students to ‘learn
how to learn’. The idea is to enable nurses without experience
to follow the development in contemporary healthcare
Table 6 Students’ and nurses’ ratings of competence in newly- settings where the demands are constantly changing. Fur-
graduated nurses in relation to the expected nursing role (%) thermore, nurses need to become lifelong learners. An idea
put forward by Watkins (2000) is that nurses need this
Competence Students Nurses
capability both for academic reward as well as to be
Very high 2Æ0 0Æ78 competent in nursing care. This means that students must
High 45Æ5 48Æ1
know how to keep learning and stay abreast of developments
Low 50Æ5 48Æ8
Very low 2Æ0 2Æ3 in nursing. Bradshaw (1997) considered educational policy in
academic curricula to be directed more towards self-directed
methods of learning. Students are assumed to be responsible
A final item in the questionnaire dealt with competence in for their own educational development. Areas where both
relation to the expected nursing role. About half of the students and experienced nurses rated ability as good or
students and experienced nurses rated competence as high or strongly developed were ethical awareness, ability to co-
very high, while the other half of the group rated competence operate and preparation for action. All are examples of
as low (Table 6). prominent aspects of nursing care and can be seen as crucial
for development of the profession. Outcomes of the present
study correspond with those of other studies that support
Discussion
newly-graduated nurses’ competence. An example is that
The main finding was that final year nursing students rated newly-graduated nurses are holistically focused (Macleod
themselves as having a good or strongly developed ability to Clark et al. 1997) and that skills that are demanded in
provide nursing care, and did so to a greater extent than healthcare will increase in the future (Greenwood 2000).
judged by experienced nurses in the 18 investigated areas of The findings may also question the accuracy of final year
nursing. Nursing students in their final week of education nursing students’ self-assessments. James (1995) discussed the
evaluated their ability as strongest in areas of ethical stereotyped images of nursing and proposed that the complex
awareness, communication with patients, ability to world could be seen as simple. Glover et al. (1997) pointed to
co-operate, preparing for action and working speed, and the fact that students may have unrealistic expectations of
self-knowledge. These areas were also assessed by experi- their ability to function as nurses. Löfmark et al. (2001)
enced nurses as good or strongly developed among new questioned students’ self-assessments when they perceived
graduates. Ability to co-operate and being prepared for themselves as being independent of supervision to a great

2006 The Authors. Journal compilation
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A. Lofmark et al.
extent, both at the beginning and end of their clinical nursing
practice. For that reason, feedback from supervisors during
clinical periods is essential to make students aware of their
ability in different areas. Our findings cite support from
experienced nurses for newly-graduated nurses’ competence
when different areas were rated, although to a lower degree.
There is therefore much variation of opinion as to whether
nursing education prepares students for the demands of
working in the nursing profession. Further study is therefore
needed with relevance for both nursing education and the
healthcare sector.
A second finding was that nurses with an academic nursing
education and less than 5 years experience of nursing gave
higher ratings in all four factors covered in the questionnaire
(communication, patient care, personal characteristics and
knowledge utilization), although only patient care differed
statistically significantly. This result is possibly supported by
the suggestion that nurses educated within the pre-academic
system might have difficulties with coping with today’s
academic demands in nurse education, and resistance to
change may influence their opinion (Maben & Macleod
Clark 1998, Wallin et al. 2003). Bradshaw (1997) concluded
that reforms in nursing education have brought shifts in the
standard of competence in recent years. Our results might
also have been influenced by lack of awareness among
experienced nurses, who trained according to the pre-
academic curricula, of the intentions and content of the
new curriculum. In the future this difference might be an
interesting area for investigation.
The third aspect of our findings was the opinions of final
year students and experienced nurses concerning competence
among newly-graduated nurses and those who had graduated
more than 5–10 years previously. These findings could be
interpreted as suggesting that nursing education over the
years has led to about the same level of competence. Nurses
with work experience were more hesitant, and only 58% of
them rated newly-graduated nurses as competent/more com-
petent. Seventy percentage of nursing students rated newly-
graduated nurses as competent or more competent. For
nursing students this issue can only be a guess, but it is of
interest as this issue is often debated.
The fourth area concerned competence in relation to
expectations about the nursing role. About half of the
participants in both groups regarded competence as low or
very low for newly-graduated nurses. This result might reflect
doubt about the demands of the nursing role in relation to
expected competence. The workload of Registered Nurses
seems to be continually increasing. They need not only to be
competent in clinical and technical skills, but must also be
competent in decision-making, priority setting, critical ana-
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2006 The Authors. Journal compilation
2006 Blackwell Publishing Ltd
lysis, judgement and in research utilization (Macmillan
1999). These are all competencies that are emphasized in
academic nursing education.
Connected to the move to academic nursing education,
there has been a general critique that newly-graduated nurses
are lacking in nursing skills (Meerabeau 2001). The only
Swedish report on this also revealed limited management and
technical skills (The Swedish Board of Health and Welfare
2002). An area that corresponded to management skills in the
questionnaire was planning the work and distribution of
tasks, which was also rated low by both groups and showed
different ratings between the groups. A comparative study by
Gerrish (2000) in the UK covering a 10-year period pointed
out that newly-graduated nurses felt inadequately prepared
for their new roles and that the transition process remained
stressful. She highlighted that the transition from student to
Registered Nurse is not always easy and straightforward.
Even if students in some sense feel inadequately prepared for
new responsibilities and expectations, their active learning
style enables them to adapt to the new role and may also
encourage them to manage the transition process better
(Gerrish 2000, Pigott 2001). In order to counter criticism
about the lack of nursing skills and of interprofessional
education, specific training wards and simulation laboratories
have been developed, enabling students to train in nursing
care under supervision. Experiences from training wards in
Sweden and the UK are very positive (Fallsberg & Wijmaa
1999, Freeth et al. 2001).
The area of nursing care rated as demonstrating the lowest
ability by both final year students and experienced nurses was
that of informing and teaching co-workers and students. This
rating was lower than that for informing and teaching
patients and relatives. It may be that informing other
healthcare personnel and students is rarely dealt with during
nursing education programmes (Table 2). When health care
needs are changing because of an ageing population, modi-
fication of the healthcare delivery system and changing
professional roles will follow suit. Ability to teach healthcare
personnel as well as patients and relatives is highlighted as a
goal in the guiding principles for nursing education, as well as
in international guidelines for nursing education (SFS 1993,
ICN 1997, Salvage & Heijnen 1997, Alexander & Runciman
2003). Looking towards the future, it is important that
healthcare professionals incorporate learning with and from
each other, but also able to inform and teach patients
(Mcilfatrick 2004).
Planning and prioritizing nursing interventions was an area
that was also rated low. In the development of team working
this is an important ability (Fallsberg & Wijmaa 1999). Our
results indicate that more effort has to be put into educating
Issues and innovations in nursing education
What is already known about this topic
• The move of nursing education into universities is gen-
erally viewed as beneficial.
• There are differences in opinion as to whether current
nursing education prepares nursing students for the
demands of contemporary healthcare.
What this paper adds
• Final year nursing students rated themselves as com-
petent and having good or strongly developed ability to
perform nursing care in most of the investigated areas
and this was confirmed by experienced nurses.
• Final year nursing students considered themselves to
have a strongly developed competence in some areas,
such as ethical awareness, while other areas, such as
planning interventions and informing co-workers and
students, were given a low rating.
• Final year nursing students were more likely than
experienced nurses to consider that newly-graduated
nurses are competent or more competent than those
who had graduated 5–10 years previously.
students about teaching, planning and prioritizing because of
increasing and changing healthcare demands.
Study limitations
Our respondents were final year students and experienced
nurses. The nursing students evaluated their current situ-
ation, while the experienced nurses in some questions
responded to issues that were not limited to the present
time. The answers from the latter must therefore be
interpreted with caution. Relying on memory is hazardous,
although rating competence is probably a mixture of
feelings and experiences, which Tulving and Thomson
(1973) believe makes recall easier.
Conclusion
The findings highlight the importance of assessment of
students during their clinical education, using adequate
assessment tools, and incorporating student self-assessment.
Most people agree that there are high demands on newly-
graduated nurses in health care today. Educational reforms
are constantly occurring and new curricula are called into
question. University-based nursing education is more focused
than previously on encouraging an active learning style and

2006 The Authors. Journal compilation
2006 Blackwell Publishing Ltd
Competence of newly-graduated nurses
lifelong learning, which may help newly-graduated nurses in
their transition process.
Author contributions
KW was responsible for the study conception and design. AL,
BS and KW performed the data collection. KW performed the
data analysis. AL, BS and KW drafted the manuscript. KW,
BS and AL made critical revisions to the manuscript. KW
provided statistical expertise.
References
Alexander M. & Runciman P. (2003) ICN Framework of Compe-
tencies for the Generalist Nurse. ICN – International Council of
Nurses, Geneva.
Bradshaw A. (1997) Defining ‘competency’ in nursing (part 1): a
policy review. Journal of Clinical Nursing 6, 347–354.
Bradshaw A. (1998) Defining ‘competency’ in nursing (part II).
Journal of Clinical Nursing 7, 103–111.
Clare J. (1993) Changing the curriculum – or transforming the con-
ditions of practice? Nurse Education Today 14, 282–286.
Clark J.M., Maben J. & Jones K. (1997) Project 2000: percep-
tions of the philosophy and practice of nursing: shifting per-
ceptions – a new practitioner? Journal of Advanced Nursing 26,
161–166.
Department of Education (1992) EU Directives Regarding Nursing
Education and Midwifery Education. Utbildningsdepartementet,
Stockholm (in Swedish).
Eraut M. (1988) Concepts of competence. Journal of Interprofes-
sional Care 12, 127–139.
Fallsberg M.B. & Wijmaa K. (1999) Students attitudes towards the
goals of an inter-professional training ward. Medical Teacher 21,
576–581.
Freeth D., Reeves S., Goreham C., Parker P., Haynes S. & Pearson S.
(2001) Real life’ clinical learning on an interprofessional training
ward. Nurse Education Today 21, 366–372.
Gerrish K. (2000) Still fumbling along? A comparative study of the
newly qualified nurse’s perception of the transition from
student to qualified nurse. Journal of Advanced Nursing 32,
473–480.
Girot E. (1993) Assessment of competence in clinical practice – a
review of the literature. Nurse Education Today 13, 83–90.
Glover P., Ingham E. & Gassner L.-A. (1997) The development of an
evaluation tool for grading clinical competence. Contemporary
Nurse 6, 110–116.
Gray M. & Smith L. (1999) The professional socialization of di-
ploma of higher education in nursing students (Project, 2000): a
longitudinal qualitative study. Journal of Advanced Nursing 29,
639–647.
Greenwood J. (2000) Critique of the graduate nurse: an international
perspective. Nurse Education Today 20, 17–23.
ICN (1997) Nursing Education: Past to Present. Vol 1: Current and
Future Trends. ICN, Geneve.
James C. (1995) Professional education – who learns what? Nurse
Education –Today 15, 161–163.
727
A. Lofmark et al.
Kapborg I. (1998) Nursing education in Sweden: development from
vocational training to higher level education. Journal of Advanced
Nursing 27, 372–378.
Kelly B. (1998) Preserving moral integrity: a follow-up study with
new graduates nurses. Journal of Advanced Nursing 28, 1134–
1145.
Kramer M. (1974) Reality Shock: Why Nurses Leave Nursing. CV
Mosby, St Louis.
Löfmark A. & Thorell-Ekstrand I. (2000) Evaluation by nurses and
students of a new assessment form for clinical nursing education.
Scandinavian Journal of Caring Sciences 14, 89–96.
Löfmark A., Carlsson M. & Wikblad K. (2001) Student nurses’
perception of independence of supervision during clinical nursing
practice. Journal of Clinical Nursing 10, 86–93.
Maben J. & Macleod Clark J. (1998) Project 2000 diplomats’ per-
ceptions of their experiences of transition from student to staff
nurse. Journal of Clinical Nursing 7, 145–153.
Macleod Clark J., Maben J. & Jones K. (1997) Project 2000: per-
ceptions of the philosophy and practice of nursing: shifting per-
ceptions – a new practitioner? Journal of Advanced Nursing 26,
161–168.
Macmillan M. (1999) Rethinking nursing. Editorial. Collegian 6, 5.
Mcilfatrick S. (2004) The future of nurse education: characterised by
paradoxes. Nurse Education Today 24, 79–83.
McMullan M., Endacott R., Gray M., Jasper M., Miller C., Scoles J.
& Webb C. (2003) Portfolios and assessment of competence:
a review of the literature. Journal of Advanced Nursing 41, 283–
293.
Meerabeau E. (2001) Back to bedpans: the debates over preregis-
tration nursing education in England. Journal of Advanced Nur-
sing 34, 427–435.
Milligan F. (1998) Defining and assessing competence: the distraction
of outcomes and the importance of educational process. Nurse
Education Today 18, 273–280.
Pigott H. (2001) Facing reality: the transition from student to
graduate nurse. Australian Nursing Journal 8, 24–26.
Pilhammar Andersson E.P. (1999) From vocational training to aca-
demic education: the situation of schools of nursing in Sweden.
Journal of Nursing Education 38, 33–38.
728
2006 The Authors. Journal compilation
2006 Blackwell Publishing Ltd
Redfern S., Norman I., Calman L., Watson R. & Murrels T. (2002)
Assessing competence to practise in nursing: a review of the lit-
erature. Research Paper in Education 17(1), 51–77.
Salvage J. & Heijnen S. (1997) Nursing in Europe: Recourse for
Better Health. WHO Regional Publications, European Series,
Copenhagen.
SFS (1992) Higher Education Act 1992:1434. Utbildningsförlaget,
Stockholm (in Swedish).
SFS (1993) The Higher Education Ordinance 1993:100. Ut-
bildningsförlaget, Stockholm (in Swedish).
SOSFS (1993) Socialstyrelsens allmänna råd om omvårdnad inom
hälso – och sjukvården (General Recommendations for Patient
Care in the Healthcare System, Issued by the Swedish Board of
Health and Welfare), SOSFS 1993:17. Socialstyrelsen, Stockholm
(in Swedish).
SOSFS (1995) Socialstyrelsens allmänna råd. Kompetenskrav för
tjänstgöring som sjuksköterska och barnmorska (Nurses Respon-
sible for General Care. Description of Required Competence.
General Recommendations Issued by the Swedish Board of Health
and Welfare) SOSFS 1995:15. Socialstyrelsen, Stockholm (in
Swedish).
The Swedish Board of Health and Welfare (2002) Översyn av ny-
utexaminerade sjuksköterskors yrkeskunnande och kompetens i
förhållande till hälso – och sjukvårdens behov (Overhaul of Newly
Graduated Nurses’ Skills and Competence in Relation to the Needs
in Health Care. Socialstyrelsen, Stockholm (in Swedish).
Tulving E. & Thomson D.M. (1973) Encoding specificity and re-
trieval processes in episodic memory. Psycological Review 80,
352–373.
Wallin L., Bostrom A., Wikblad K. & Ewald U. (2003) Sustainability
in changing clinical practice promotes evidence-based nursing care.
Journal of Advanced Nursing 41, 509–518.
Watkins M.J. (2000) Competency for nursing practice. Journal of
Clinical Nursing 9, 338–346.
Watson L. & Kiger A. (1994) Clinical staff and the new student nurse
anticipating change. Nurse Education Today 10, 457–464.
While A.E. (1994) Competence versus performance: which is more
important. Journal of Advanced Nursing 20, 525–531.