Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Nursing



First Advisor

Marlene Dufault


Nurses are at the forefront of recognizing and managing patient situations which may be potentially life-threatening. This study examines the nature and extent to which nursing experience and selected educational variables have on nurses’ perceptions of their competence in managing deteriorating patient situations in acute care. Self-awareness of nurses’ competence in managing these types of patient situations is critical. Benner’s Novice to Expert Model of developmental competency is the theoretical framework for this study.

A survey methodology was used to gather data on the variables: years of experience in nursing, years working in current specialty, educational preparation, national certification, area of specialization, cross- training in more than one specialty, and advanced life support or rapid response team member training. Attendance at a case review session where actual cases were reviewed was also a variable. Instrumentation included an adapted version of the Nurse Competence Scale, a thirteen- item scale related to managing patient situations. Content validity was established by an expert panel of nurses practicing in acute care in the roles of Clinical Nurse Specialist, Nurse Manager, and staff nurses.

The setting for the study was an acute care community hospital in the Northeast. Of 212 registered nurses eligible to participate in the survey, the data producing sample of 74 subjects resulted in a 35% return rate. Using SAS, data analysis included univariate descriptive statistics and logistic regression to determine predictive values on nurses’ self-perceived competence in managing deteriorating patient situations. Of special interest was the potential association with attendance at case review sessions.

Results indicate the overall score for nurses’ competence in managing patient situations is in the “good” range (between 8 and 9 on the study scale). Those who attended a case review session had higher overall scores in eleven of the thirteen aspects on the study scale. Cross-training to more than one specialty was predictive of nurses’ self-perceived competence in managing patient situations.

Limitations of this study include the small sample size, and that it was conducted in one community hospital and so findings may not be generalizable to other settings.

This study contributes to the knowledge base in nurse competence and nurses’ role in managing patient deterioration. Implications for nursing education and practice include integrating such competencies in program planning for orientation and continuing education.



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