Compétences d’infirmiers nouvellement diplômés d’un programme de baccalauréat basé sur l’approche par compétences : une ethnographie ciblée d’un milieu de soins aigus

In the last 15 years, two important reports (Frenk et al., 2010; Institute of Medicine, 2003) have supported the need for reform in nursing education and other health sciences curricula to build on competency-based education (CBE). This change was intended to prepare new graduates for the reality of health systems and future challenges. Few studies have focused on how newly graduated nurses (NGNs) from these reformed programs use the competencies they have developed. The purpose of this study was twofold: first, to describe the deployment of competencies of NGNs from a competency-based undergraduate nursing program in a Quebec faculty of nursing, as perceived by various actors in acute care settings and second, to examine the influence of the culture of acute care settings on competency deployment by NGNs. To guide this study, a theoretical framework integrating Benner’s professional advancement model (1982) to Tardif’s work on competency-based education and competency development (2006) was built. A focused ethnography was conducted on three acute care units of an academic hospital. Convenience and snowball sampling strategies were used to recruit 19 key actors: NGNs (n = 4), nurse preceptors (n = 2), clinical nurse specialists (n = 9) and other professionals (n = 4). Data were collected through individual interviews, focus groups and observation, and analyzed according to Roper and Shapira (2000) ethnographic nursing analysis framework. Three themes were identified to describe the deployment of competencies of NGNs. The first theme concerns the professional beginnings of NGNs, the appropriation of their new role, the fragmentation of their practice into tasks and the development of their practice. The second theme relates to the collaboration of NGNs in the interprofessional team, their difficulty in the management of the intraprofessional team with licensed practical nurses and their ability to maintain a relationship with patients and families. The last theme concerns the scientific practice of NGNs, their increased scientific curiosity and their use of scientific and credible sources that must be encouraged. The elements described in these three themes were analyzed in the light of the competency framework to conclude that the NGNs deploy seven of the eight competencies developed during their training. Organizational and individual factors were identified as influencing the deployment of competencies of NGNs. Organizational factors are orientation, stability, workload, as well as the scientific culture of the unit. Personal factors have been linked to groups of professionals: for NGNs, personality and clinical placements during their initial training; for nurses working with NGNs, to be role models, to promote integration and to denounce bullying; and for other health professionals, to recognize nursing expertise. The knowledge gained from this study provides a better understanding of the competencies of NGNs and the elements influencing the beginning of their practice. These results have implications for the various fields of nursing practice and will help improve initial training programs and ease the transition period between the academic environment and the clinical setting.

Keyphrases: Competency-based education, Clinical competence, Cultural context, Ethnography, Nursing education, Newly graduated nurse, Nursing, Acute care