Norwegian nurse educators’ self-rating of competencies: a nationwide cross-sectional web-survey

Nurse educator competencies

There is currently no international agreement on what competencies are required for nurse educators [34]. While there is international agreement on minimum professional qualifications for registered nurses (RN) and principles for nursing education, consensus on professional requirements for nurse educators and principles for educating nurse educators is lacking [34]. However, it has explicitly been argued that nurse educators’ competencies should be clearly defined [17].

To promote excellence in nursing education and to ensure the educational quality of nurse educators, the [39] published a description of core competencies for nurse educators. Through a collaborative Delphi process, stakeholders identified eight core competence domains for nurse educators: theories and principles of adult learning; curriculum and implementation; clinical nursing practice; research and evidence; communication, collaboration and partnership; ethical principles and professionalism; monitoring and evaluation; and finally, management, leadership, and advocacy [39]. While they provide a good framework for educating educators, these competence domains have been criticized for not having been empirically tested [30].

In the United States, the National League for Nursing (NLN) recently provided what may be the best known description of nurse educators’ core competencies [9]. These competencies are facilitating learning; facilitating learner development and socialization; using assessment and evaluation strategies; participating in curriculum design and evaluation of program outcomes; pursuing continuous quality improvement in the academic nurse educator role; and engaging in scholarship, service, and leadership. Both the WHO’s and NLN’s list of competencies highlight that these educator comptencies are in line with educators’ tasks and responsibilities no matter the educational context [39].

Other researchers have also broadened the field of nurse educator competencies. Zlatanovic et al. [43], having synthesized the empirical results of 25 studies in a systematic review, identified five broad themes that were considered educator competencies: academic, nursing, and pedagogical competencies; attitudes; management and digital technology. It has further been argued that nurse educators’ competencies are better assessed as a more integrated situated competence [43]. Moreover, in their meta-synthesis based on nine studies [11], identified six main themes as important for nurse educators’ competence and for their continuous development: self-development, supervising, interaction, researching, a subject on nurse educators’ own profession, networking, and multiculturalism competencies. In aiming to clearly define nurse educators core competencies [16], reported in a review of six quantitative studies that three core competence domains were highly rated by educators themselves, namely knowledge, skills and attitudes. In this review, educators’ age, academic degree, healthcare experience, research activities, and the type of organization in which they worked were the factors that most influenced their competence [16].

Measuring nurse educator competencies

Several instruments have been developed to measure health care educators’ competencies. Most often, these instruments measure educators’ competence in specific domains related to subjects or themes such as ethical, pedagogical, cultural and linguistic diversity competence [16]. Furthermore, some generic instruments such as Evalution of Requirements of Nurse Teachers (ERNT) [25, 28] or the Health and Social Care Educator’s Competence (HeSoEduCo) instrument [17] have been psychometrically tested. ERNT assesses nursing competence, pedagogical competence, evaluation skills, personality factors, and relationship with students, which correspond to most of the previously mentioned WHO core competencies for nurse educators. The ERNT instrument was used in a previous Norwegian survey in which 348 nurse educators rated their own competencies [7]. The reported results from this study were that nurse educators rated themselves higher in the domains of pedagogical and nursing competence than in those of evaluation skills, personality factors, and relationship with students. In contrast and interestingly, in a self-evaluation, Finnish nurse educators rated themselves highest on the ERNT domains “relationship with students” and lowest on “pedagogical competence,” as reported by [28]. However, in the same study, while nurse educators rated their nursing competence as high, nursing students were more critical when scoring their educators competencies using the same ERNT instrument. Interestingly, the largest differences between the educators’ scores and the students’ scores were on the nursing competence domain [28]. Other interesting results are reported by [21] on Polish students, who gave the highest score on the student-educator relationships domain.

Considering how educational quality in nursing depends heavily on nurse educators’ competencies [29, 8], there has been calls for more research on these issues [12, 16, 29]. Smith et al. [31] recently reported that nurse educators have requested professional development possibilities related to professional competencies and communication and collaboration, among other themes. Regularly and systematically investigating and assessing how nurse educators rate their own competencies has the potential to inform educational leaders about the domains in which educators need support or professional development. At a time when recruiting and keeping educators is challenging, providing support for competence development [36] and addressing educators’ job satisfaction [2] and work-place culture [15] should be prioritized. Thus, this study aimed to investigate how Norwegian nurse educators rated their competencies, as well as how these competencies were associated with core background variables.

Design

A cross-sectional web survey design [23] was applied for this Norwegian nationwide cross-sectional study. This study is part of a larger study investigating nurse educators’ competencies and use of pedagogical approaches related to clinical placement, and reports findings from data collected with the ERNT instrument.

Sample and research contexts

The target population was nurse educators employed at Norwegian educational institutions with a bachelor’s program in nursing. Inclusion criteria for nurse educators were working full or part time as a nurse educator and having supervised bachelor’s students in clinical placement during the last three years. Exclusion criteria were just the opposite of the inclusion criteria. When recruiting participants for the study, we initially contacted the head of the institute, department, or faculty at the 13 nursing educational institutions in Norway to ask for their cooperation. Of these, 11 leaders agreed to cooperate.

The requirements for permanent appointment to an academic position at universities and university colleges for the bachelor’s degree of nursing programs in Norway, are authorization as an RN, holding a relevant master’s degree, and pedagogical competence of minimum 15 credits in the European Credit Transfer and Accumulation System (ECTS).

Data collection

Data were collected using a web link developed for this study; several constructed theme-based items and validated instruments, involving the ERNT instrument, were built up to form one complete web-based questionnaire. To develop and distribute the web link, we used a survey solution developed and hosted by the University of Oslo (nettskjema.no). The leaders forwarded the e-mail with study information and the web link to the nurse educators’ e-mail addresses; the consent form and inclusion criteria were part of the questionnaire. The survey could be completed in 10–12 min, and leaders received two reminders.

In total, 163 nurse educators logged into the web link and responded to the questionnaire. Of these, seven had not supervised students during the last three years, and two delivered empty questionnaires. Thus, the final sample of responding informants was n=154 nurse educators. The nurse educators’ mean working experience was 12.9 years (SD 9.2); 86.3 % were permanently employed and 76.8 % had formal supervision training. Altogether, 50.3 % supervised students in municipal health care and 59.5 % supervised nursing students in hospitals, entailing that some educators supervised in both contexts. Nurse educators’ background variables are presented in Table 1.

Statistical analysis

Educators’ self-ratings were described univariately by ERNT mean scores (on items and domains), standard deviations and percentages. Differences in ERNT mean scores related to age group, academic degree group and supervision experience group were tested by one-way ANOVAs, Bonferroni-corrected for multiple comparisons as more than two groups were compared on each of the three explanatory variables. The multivariable associations between nurse educators’ self-ratings and age, education and supervision experience were analyzed by multiple linear regression.

Ethical considerations

The study was performed in accordance with the ethical principles of the World Medical Association’s Declaration of Helsinki [42] and registered and approved by the Norwegian Agency for Shared Services in Education and Research, nr 966,120. Educators who filled out and submitted their responses to the questionnaire through the web link were considered to have consented to participate in the study. To ensure anonymity, we avoided indirect using identifiable information like exact age and left out exact academic degree and educational institution.

Nurse educators’ self-ratings of their competencies

The nurse educators rated their competence as good on all competence domains and single competence items, and ERNT total mean score was 4.62 (SD 0.28) (Table 2). For the competence domains, “relationship with students” had the highest score, whereas the second highest score was “nursing competence.” “Personality factors” received the lowest score, followed by “pedagogical competence” and “Evaluation skills.”

The single competence item on which the educators rated themselves highest was “Encouraging students to integrate theory and practice,” followed by “taking students seriously.” The two lowest rated single competences were “Being consistent” and “Making active use of the literature and research in the field.”

Bivariate associations between nurse educators’ self-rated competencies and individual background variables

The bivariate relationships between nurse educator self-rated competencies and the background variables of age, academic degree, and supervision experience were studied by one-way analysis of variance (ANOVA), corrected for multiple group comparisons (Table 3).

A one-way ANOVA analysis of differences in ERNT total mean scores of the four age groups, Bonferroni-corrected for multiple comparisons, showed that no age group mean was significantly different from any other age group mean.

A one-way ANOVA analysis of the ERNT total mean scores of the three supervision experience groups, Bonferroni-corrected for multiple comparisons, showed that no group mean was significantly different from any other group mean.

A one-way ANOVA analysis of the ERNT total mean scores of the three academic degree groups, Bonferroni-corrected for multiple comparisons, showed that the mean score of nurse educators not holding a master’s degree was significantly lower (p=0.023) than the average score of nurse educators holding a master’s degree (assistant professor/lecturer competence), and significantly lower (p=0.012) than the average score for nurse educators with a PhD or similar (associate professor or professor competence).

Multivariate associations between nurse educators’ self-rated competencies and individual background variables

The multivariate associations of the dependent variable nurse educator self-rated competencies (ERNT total mean score) and the predictor variables nurse educator age, academic degree and supervision experience (background variables) were studied using multiple regression analysis (Table 4).

When controlling for the other predictors (age and supervision experience) in the model, the ERNT total mean score was significantly related to academic degree. Responders not holding a master’s degree scored themselves significantly lower than those holding a master’s degree. There was no significant difference between those holding a master’s degree and those holding a PhD. When controlling for academic degree and supervision experience, no age group scored themselves significantly higher than did the reference group 40 years or younger. When controlling for age and academic degree, length of supervision experience was not significantly related to the ERNT total mean score.

Nurse educators self-rating of competencies

The results of this Norwegian study show that nurse educators rated themselves highly on the competence domains, with “relationships with students” receiving the highest rating. These results deviate from an earlier Norwegian cross-sectional study [7] looking at the same population more than 20 years ago in which “nursing competence” and “pedagogical competence” were the highest rated domains. Considering that today’s nurse educators have considerably higher academic qualifications than in the study from 2002, it is interesting that they rated themselves highest on “relationships with students.” However, considered together with findings reported in the Finnish study by [28] and the Polish study by [21] where students rated the student-educator relationships highest, our findings are interesting and underline how educators emphasize the importance of this reciprocal relationship. In our study, the single competence item “taking students seriously” was the second highest rated of all the ERNT items, possibly highlighting the influence of student-centered perspectives in Norwegian nursing education. This result is also supported by [35] finding that educators strive to provide students with a safe, welcoming and inclusive learning environment.

The nurse educators’ score on the “nursing competence” domain appeared to be the second highest, which is in line with the findings from the earlier Norwegian study [7]. In our study, the single item “encouraging students to integrate theory and practice” was the highest rated of all ERNT items. This result concurs with the finding reported in a systematic review by [16] that educators strongly emphasized evidence-based knowledge when supporting students integrating theory and practice in their placements [16] also reported that educators with the highest academic degrees focused most on evidence-based knowledge and underlined the importance of future nurses’ competence in searching for updated research-based knowledge relevant for the clinical field [16]. The results of our study suggest that educatorsprioritize this important issue and that they apply pedagogical approaches to support students bridging theory and practice, as is also recommended by [30].

Interestingly, the competence domain with the lowest self-rating was “personality factors”. This domain, which includes being consistent, admitting mistakes, and being open minded and flexible, also received the lowest rating in an earlier Nordic study by [28]. Within this domain, the single competence item “being consistent” was the lowest rated item of all ERNT items across competence domains in our study. This result is both interesting and alarming and might reflect how educators may feel alone in challenging situations with students, for example when assessing students at risk of failing. Being consistent can be quite challenging when powerful students activate fellow students, establish subgroups, and bring their case to educational leaders or, in the worst case, threaten legal action. Likewise, disagreements with the clinical RN supervisor concerning educational and assessment situations might affect educators’ consistency.

The competence domain “pedagogical competence” appeared to be the second lowest, in contrast to reported results from the previous Norwegian study by [7] in which that domain was rated highest. A possible factor leading to this difference is that the time an educator has at their disposal for each nursing student in clinical placement has been radically diminished, creating a considerable burden for educators [6]. The difference might also be explained by the educational changes in Norwegian nursing education the past 20 years in Norway. These changes entail a considerable increase in workload with less time available for any pedagogical task, and a constant pressure on educators to prior research and publications. While pedagogical competence previously was the most highly valued and the core competence for educators, competence in research and publications has taken over that role.

When comparing the results with those of [21]; who reported that postgraduate training students scored their educators lowest on pedagogical competence, the difference in scores can most likely be explained by differences in educational culture, training and the educators’ backgrounds, as discussed by [34].

Nurse educators’ competencies associated with nurse educators’ background variables

The results illustrated that neither educators’ age nor their supervision experience was associated with the self-rated ERNT total mean scores. These results deviate from those of [7] for the same population, who reported that on the domain relationship with students, educators with longest educator experience rated themselves significantly higher than those with shorter educator experience.

In our study, only the background variable academic degree was significantly associated with higher ERNT total mean scores. Educators not holding a master’s degree scored scored themselves significantly lower than those holding a master’s degree. There was none significant difference between those holding a master’s degree and those holding a PhD.

Our results thereby contrast the results reported in a review by [16] where educators’ age, academic degree, healthcare experience, research activities, and the type of organization in which they worked, were the factors that most influenced their competence as educators. On the other hand, our results are in line with those reported in a Japanese study [30]. There are, however, some differences in the SDs between the Norwegian and the Japanese samples, and thus they are not directly comparable. Despite not addressing educators’ competence domains exactly, a South Korean study by [33] reported that the background variables age, experience and academic degree were all significantly associated with clinical teaching efficacy, which is considered an interesting result in this research field.

Moreover, it is reasonable that higher academic nursing education might entail more confidence in one’s own competence and explain why academic degree was significantly associated with the ERNT total mean score.

Limitations and strengths

One weakness of this study is that we were not able to report the response rate, as it was not possible to identify the total number of educators invited by their leader to participate. Another weakness is that there was a ceiling effect with the ERNT scores as most educators gave themselves high scores and ERNT does not discriminate between scores at the upper end of the scale. Group differences in scores on scales on which most respondents score themselves quite high, tend to be found not statistically significant. Moreover, self-reported data may lead to inaccurate findings as individuals tend to not respond correctly, consequently threatening the reliability of study findings [1]. Further adding to study limitations is the absence of any verifiable and more objective or neutral ratings. However, a recent study found that the validity of self-reported competence scores was positively associated with level of education [38], which is interesting related to our sample. It is also considered a limitation that certain categories have a small number of participants, such as ’Educators not holding a master’, which accounts for only 6.6 % of the total. Small changes in the number in these categories might have affected. The accuracy and the interpretation of the results.

A strength of this study is that it was a nationwide survey, and although we are not able to report the response rate, the sample size was good (n=154) and we considered it acceptable for the performed statistical analyses. The sample size is large enough to allow for generalization. It is considered a strength that ERNT is an instrument developed in a Nordic context, and thus should be culturally suitable for Norwegian nurse educators.

Recommendations for educational practice and research

Based on the findings, leaders in nursing educational institutions are recommended to establish a mentoring and support team for both inexperienced and experienced educators. In particular, it is important to provide organized mentoring for unexperienced and young educators.

Furthermore, and due to the comprehensive challenges educators face in their work, the results of this study invite educational institutions and nurse educators themselves to rate their competencies on a regular basis. Educational institutions could provide an easily completed instrument to help educators assess their level within the core competence domains. Such an assessment might support each educator’s professional development in many ways. Novice educators may get an idea of how they rate themselves, bring their assessments to their employee interview, or monitor their own improvement. Currently, there are number of instruments for self-evaluation, so each institution should probably choose the instrument best suited to its needs [13]. Moreover, instruments bringing in a more objective item than that of self-evaluation should be considered [29].

Recommendations for further research

Based on our findings, qualitative studies are needed to explore in depth why educators rate themselves low on the competence domains “pedagogical competence” and “evaluation skills.” Furthermore, qualitative studies aiming to better understand what characterizes nurse educators’ struggles with being consistent with students and why they rate themselves low on “making active use of the literature and research in the field” would be valuable. Moreover, research aiming to extend the ERNT instrument with competence domains addressing technological and digital competence, as well as research and publishing competence.