Gonzalez Garcia 2022 A Competency Model For Nurse Execut
Gonzalez Garcia 2022 A Competency Model For Nurse Execut
Gonzalez Garcia 2022 A Competency Model For Nurse Execut
DOI: 10.1111/ijn.13058
ORIGINAL RESEARCH
1
Faculty of Health Sciences Nursing
Department, Universidad de Leo n, Leo
n, Spain Abstract
2
Faculty of Health Sciences, Nursing and Background: Nurses capable of adequately developing their competencies in the
Physiotherapy Department, Grupo SALBIS
n, Universidad de Leo
n, Leo
n,
management field are essential for the sustainability of health-care organizations.
Investigacio
Spain Such competencies should be included in a model of specific competencies.
3
n Hospital, Leo
Surgical Department, Leo n, Aim: The aim of this research is to propose a competency model for nurse executives.
Spain
Methods: The Delphi method was applied to reach a consensus on the required com-
Correspondence petencies, and Principal Component Analysis (PCA) was applied to determine the
Arrate Pinto-Carral, Faculty of Health
Sciences, Nursing and Physiotherapy construct validity and reduce the data set's dimensionality. Consensus was defined
Department, Universidad de Leo n, Calle El based on at least 80% of the experts agreeing with the proposed competencies. For
Hayedo n 1-7 -A, Leo n 24007, Spain.
Email: agong@unileon.es each competency, the development levels were beginner, advanced beginner, com-
petent, highly competent and expert.
Results: From among the 51 competencies that were identified to define a model for
nurse executives, decision-making, leadership and communication stood out. The
PCA indicated the structural validity of the proposed model by saturation of the prin-
cipal components (Cronbach's α > 0.631).
Conclusion: Nurses wishing to develop their professional careers as nurse executives
must first develop the competencies shown in the proposed model. Nurse executives
should follow the educational programmes specified in this study, to adapt their
knowledge to this role's requirements.
KEYWORDS
chief nurse, competency, governance, nurse director, nurse executive
Summary statement
What is already known about this topic?
• The Nurse Executive has a very complex role in health care and has a great impact
in institutional governance and sustainability of health-care organizations, improv-
ing quality of care and patient outcome.
• The necessary competencies for nurse executives are usually not clearly defined,
which could explain the lack of conceptualization of their roles.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
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© 2022 The Authors. International Journal of Nursing Practice published by John Wiley & Sons Australia, Ltd.
• Little research has been addressed to competencies for nurse executives in any
countries.
What this paper adds?
• Fifty-one competencies were defined, structured according to their defining char-
acteristics in six dimensions: management; communication and technology; leader-
ship and teamwork; knowledge of the health system; nursing knowledge and
personality.
• The level of development of each competency ranged across ‘competent’, ‘very
competent’ and ‘expert’.
• The training needed for nurse managers is at master's and doctoral study levels.
The implications for this paper:
• This model has implications for organizational policies, the efficiency of organiza-
tions and their sustainability, as well as for the education and practice of nursing
management
• The proposed model contributes to the definition of the nurse executives' func-
tions, their selection processes, the design of their curriculum in traditional aca-
demic institutions and to continuous professional development programs by
organizations.
• A better understanding of competencies is likely to provide information on inter-
ventions that can improve nurses' work environment, patient care, patient safety
and organizational outcomes.
1 | I N T RO DU CT I O N to other nurses (Clark, 2012) (Figure 1). Likewise, they are responsible
for managing resources, organizing nursing care, planning and evaluat-
Economic and social changes have led to an adaptation of health care ing the services provided and contributing to the achievement of opti-
at all levels and a change in the way these services are provided mal results for both their organizations and patients, as well as
(Cathcart & Greenspan, 2012; Cummings et al., 2010; Ding providing support and motivation for teamwork (American Organiza-
et al., 2019; Kantanen et al., 2017). The principal drivers for the devel- tion of Nurse Executives, 2015; Scoble & Russell, 2003). Due to the
opment of high-level management competencies are the relationships increasing responsibilities that the nurse executives must address,
between the economy, sustainability and quality of health care, which extensive training—including adaptation to complex environments and
are directly related to higher performance and results (Boyatzis, 1982; competencies—are often required, for which a doctoral level is prefer-
Groves, 2011; Kerfoot & Luquire, 2012; MacMillan-Finlayson, 2010; able (Clark, 2012). While management competencies are an essential
Savage & Kub, 2009). resource to identify, guide and train nurse executives (Meadows &
In this context, nurses must be a part of the health-care core ser- Dwyer, 2015), such competence training in management must go
vices, so that health-care organizations can address these changes beyond the field of nursing (Baxter & Warshawsky, 2014;
(Aiken et al., 2011; Thorne, 2019). Accordingly, Whitt et al. (2011) Chase, 2012; DeOnna, 2006).
affirmed that when nurses are involved in different parts of the Although there is no standard definition of managerial compe-
health-care process (management and nursing care), better results are tence (Gunawan et al., 2019), it can be defined as the correct combi-
achieved (Ho et al., 2017). nation and application of nurse executives' knowledge, attitudes and
skills in specific management functions that are observed and mea-
sured as behaviours (Gunawan et al., 2020).
1.1 | BACKGROUND The necessary competencies for nurse executives have been
described by different researchers. Chase, for instance, identified tech-
Nurse executives (in Spanish: ‘directora de enfermería’ and ‘sub- nical, human, conceptual, leadership and financial management skills
directora de enfermería’) are responsible for aligning the mission, (Chase, 2010). The American Organization of Nurse Executives (AONE)
vision, values, philosophy and culture of their organizations with nurs- identified relationship management, communication, leadership, knowl-
ing care activities, as well as for transferring this corporate perspective edge of the health-care environment and financial skills as strategic
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GONZALEZ GARCÍA ET AL. 3 of 11
2 | METHODS
2.2.2 | Participants
2.1 | Literature review
In this study, we decided to invite experts from two categories—
This study was based on the results of the scoping review carried out health management and health environment—and 12 groups, since
during 2018–2021 to identify the necessary competencies for nurse the objective was to obtain a 360 image of the nurse manager envi-
executives (González-García et al., 2021). Electronic databases (Web ronment (Table 1). Therefore, 50 experts were contacted by tele-
of Science, Scopus, PubMed and CINAHL) were used, and 56 compe- phone; all agreed to participate. Subsequently, an e-mail was sent
tencies were identified and utilized as the basis for the Delphi study, with the informed consent, commitments and explanations of the pro-
which assesses the competencies for executive positions. cess. None of the experts dropped out of the study.
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GONZALEZ GARCÍA ET AL.
T A B L E 1 Sociodemographic
Characteristics Range/category Frequency Percentage
characteristics of the panel expert
Age <40 10 20
41–50 15 30
51–60 18 36
>60 7 14
Sex Female 32 64
Male 18 36
Education Master's degree 34 68
PhD 14 28
Expert group 1 Minister of health 3 6.1
Expert group 2 Head of the health department 5 10
Expert group 3 General Council of Nurses 3 6
Expert group 4 Scientific association 4 8
Expert group 5 Trade union 3 6
Expert group 6 General manager 5 10
Expert group 6 Medical director 2 4
Expert group 6 Nurse executive 5 10
Expert group 6 Management director 1 2
Expert group 7 Middle nurse manager 2 4.1
Expert group 8 Nursing supervisor 3 6.1
Expert group 9 Nurse 3 6.1
Expert group 9 Doctor 2 4.1
Expert group 9 Assistant nursing care technician 2 4.1
Expert group 10 Nursing degree students 2 4.1
Expert group 11 Research/teaching 4 8.2
Expert group 12 Lawyer 1 1
2.2.4 | Delphi questionnaires For the purpose of this study, the term ‘development level’ was used
to refer to the depth of knowledge that nurse executives needed to
Two ad hoc questionnaires were developed as measurement acquire in each competence, at each of the functional levels. Thus, the
instruments: levels of development were as follows:
• Competencies required for nurse executives: Each participant • Beginner follows the rules and plans.
rated their level of agreement or disagreement with each compe- • Advanced beginner provides partial solutions to unfamiliar or com-
tence on a Likert scale of one to five (1 = Strongly disagree; plex situations.
5 = Strongly agree). • Competent demonstrates strong competence.
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GONZALEZ GARCÍA ET AL. 5 of 11
• Highly competent demonstrates significant competence. and ‘competent’ levels. The way to reach the required level of devel-
• Expert demonstrates behaviours of the competency model. opment of each competence was also agreed upon, during these
rounds. Table 2 shows the final consensus, which constitutes the
competency model for nurse executives in Spain, grouped into six
2.3 | Principal component analysis dimensions, based on their defining characteristics (Figure 2).
Table 3 presents the consensus regarding the training necessary
Principal component analysis (PCA) is a data transformation tech- for the development of each of the competency levels.
nique, whose objective is to reduce the multivariate data's dimension-
ality and preserve as much relevant information as possible
(Sewell, 2008). The factor analyses were carried out following the 3.3 | Principal components analysis
Thurstone theory (Thurstone, 1931, 1957) in three phases:
(i) evaluation of the adequacy of the data for the factor analysis, For the PCA, the competencies were grouped based on their defin-
(ii) extraction of the factors and (iii) rotation and interpretation of the ing characteristics into six dimensions. The first three dimensions—
factors. management; communication and technology; and leadership and
To determine the data's suitability for factor analysis, the Kaiser– teamwork—were saturated in four main components; the fourth
Meyer–Olkin test was used. The next step consisted of factor extrac- and fifth dimensions—knowledge of the health system and
tion using the Kaiser criterion, which takes a decision based on an personality—were saturated in two main components, whereas the
eigenvalue greater than one (Kaiser, 1960), and a scree plot, which is a sixth dimension—nursing knowledge—was saturated in only one
graphical representation of the eigenvalues (Cattell, 1966). Finally, to component (Table 4). Since the factor loadings of each of the inte-
achieve a simple, and easy to interpret structure, the factors were gral items of each dimension far exceeded the lower limit of 0.4,
rotated and interpreted by means of the varimax rotation method and and the Cronbach's α demonstrated the quality of the fit (Table 4),
Kaiser's standardization. it can be concluded that the proposed model is structurally
adequate.
This proposal coincides with that of AONE, which uses the compe- achieved through continuous training, the ‘Experto Universitario’
tent, proficient and expert levels for the development of competen- and the university specialization diploma. Regarding the ‘highly com-
cies, and highlights how these levels are achieved through master's or petent’0 level, a consensus was reached relating to the ‘Experto
doctoral studies (Crawford et al., 2017; Waxman et al., 2017). Further- Universitario’, the university specialization diploma or the master's
more, the results of the present study emphasize the need for a high degree. Finally, the ‘expert’ level is achieved through master's and
level of competence development, similar to the conclusion of doctoral studies. Rizany et al. (2018) point out that the competency
Sandehang et al. (2019) and Clark (2012), who stated that the nurse of nurse executives was greater when they have developed
executives required a deep development of competencies beyond the advanced studies (master's or doctorate), in addition to having expe-
field of nursing. rience in a wide field of changing environments (Clark, 2012). These
During Delphi rounds 3 and 4, the expert panel reached a con- results involve university institutions, given that the evidence points
sensus on the training that the nurse executives should develop at to the fact that the training required for nurse excutives is funda-
the executive level for the three levels of competencies (‘expert’, mentally of a university nature and that these organizations are
‘highly competent’ and ‘competent’). The ‘competent’ level is responsible for the development of training programmes. The
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GONZALEZ GARCÍA ET AL. 7 of 11
T A B L E 3 Level of competencies
Univ. Ext. Cont. Ed Univ. Exp. Univ. spec. D Master Ph.D.
development and training
Novice 100%
Noviced advance 90% 98%
Competent 90% 90% 96%
Very competent 96% 100% 96% 96%
Expert 96% 96%
Abbreviations: Cont. Ed, continuing education; Master, Master's degree; Univ. Exp., university expert;
Univ. Ext., university extension diploma; Univ. Spec. D., university specialization diploma.
competency model is a guide for the development of training at the The communication skills expected from nurse executives should
level of university expert, university specialist, master's degree and include the ability to transmit critical thinking, make nursing teams
doctorate for the executive manager. reflect before acting (Scoble & Russell, 2003) and facilitate conflict
The PCA verified the competency model for nurse executives at resolution and shared decision-making, as well as the creation, partici-
the operational levels, evidencing the importance of competencies pation and management of teams (Garman et al., 2006).
that defined the three main components: communication (communi-
cation skills, relationship management and conflict management),
leadership (leadership skills and team management) and decision- 4.1 | Limitations
making (decisions based on ethical principles). The eigenvalue
obtained confirms the importance of the relationship between This study included competencies from very different environments,
decision-making and ethical principles (Loreggia et al., 2018), the where the role of nurse executives was not understood in the same
need for strong leadership in working teams (Berrios Martos way. To overcome this limitation, the levels of consensus necessary
et al., 2008) and communication as a fundamental factor for conflict to validate the competencies in the Spanish health system were
resolution (Garman et al., 2006). raised.
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GONZALEZ GARCÍA ET AL.
Management dimension
CP 1 CP2
Quality and safety 0.971
Quality and improvement processes 0.948
Identification and responsibility with the organization 0.917
Health policy 0.838
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GONZALEZ GARCÍA ET AL. 9 of 11
TABLE 4 (Continued)
CP 1 CP2
Explained variance 57.954% 29.970%
Eigenvalue 2.318 1.199
α Cronbach 0.749
Nursing knowledge
CP 1
Nursing training planning 0.918
Nurse research 0.910
Nursing theories 0.822
Clinical skills 0.777
Explained variance 73.733%
Eigenvalue 2.949
α Cronbach 0.808
Personality
CP 1 CP2
Awareness of personal strengths and weaknesses 0.905
Strategic vision 0.891
Personal and professional balance 0.836
Compassionate 0.884
Emotional intelligence 0.735
Explained variance 54,76% 21,705%
Eigenvalue 2,738 1,085
α Cronbach 0,809
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