Aim To explore nurse leaders' experiences of professional responsibility to facilitate nursing competence in general wards. Background Nurse leaders are responsible for maintaining high levels of competence among nurses to improve patient safety. Methods Qualitative analysis was conducted between February and April 2019 using semi‐structured interview data from 12 nurse leaders in surgical and medical wards at three Norwegian hospitals. Results Four main themes were identified: struggle to achieve nursing staff competence; focus on operational and budgetary requirements rather than professional development; demands to organize sick leaves and holiday periods; and challenges in facilitating professional development. Conclusion Nurse leaders felt that their responsibilities were overwhelming and challenging. They witnessed more support for current administrative tasks than for the implementation of professional development. Additionally, unclear work instructions from the employer provided few opportunities to facilitate professional development. Hospital management failed to ensure quality of care and patient safety in general wards by not supporting the strengthening of nurses' professional competence and preventing turnover. Implications for Nursing Management Management may integrate formal work instructions that clarify nurse leaders' responsibilities as professional developers, allowing nurse leaders to meet their obligation of maintaining adequate professional competence among nursing staff in general wards.

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Failure to recognize the deterioration of hospital patients has led to the implementation of a system known as the Rapid Response System. The aim was to explore nurses’ use of the afferent limb of the Rapid Response System to recognize and respond to deteriorating patients. Data were collected via video recordings with observations of 20 registered nurses (RNs) from general wards performing scenarios in a simulation laboratory with focus group interviews. Data were analyzed using systematic text condensation. COREQ were followed. In the first scenario, nurses did not apply ABCDE or ISBAR, and the use of NEWS was insufficient. Completing an education program led to evident improvement in the use of the tools during the second scenario. Nurses initially viewed their new competency as useful, but it was not sustained a year later. Customized education programs and fidelity-scale simulations are suited but not sufficient to change clinical competency without management anchoring.