Revealing a gap in the clinical competence of nursing staff in nursing homes: A cross-sectional study with the Ms. Olsen test

Abstract

Background: The elderly population and their life expectancy have increased, and current long-term care (LTC) for frail older people has limited capabilities because of many diseases among the patients. The nursing staff needs to have a certain level of clinical competence to identify diseases at an early stage and to assess and provide good nursing care to patients with different diseases. In Finland, nursing care in nursing homes is based on evidence-based and high-quality nursing care. However, earlier inspections by the National Supervisory Authority for Welfare and Health showed many discrepancies between the nursing staff’s clinical competence and adequate and continuous education. Aim: This study aimed to explore nursing staff, i.e the clinical competence and decision-making skills of registered and practical nurses in nursing homes for older people in Finland and to analyse the association between nurses’ clinical competence and fundamental background factors Methods: We conducted a cross-sectional study of 337 participants in 50 nursing homes in the western part of Finland. The instrument used was the validated Ms. Olsen test, an extraction of NOP-CET. Statistical analyses were conducted with descriptive statistics and correlations and a cut-off for clinical competence. Results: The clinical competence test, Ms Olsen test was used in Finland for the first time to evaluate the nursing staffs´ clinical competence in nursing homes. This study disclosed that nursing staff showed worrisome limitations in their clinical competence in the LTC in the western part of Finland and the Ms. Olsen test revealed that only one-fourth of the RNs and a third of the PNs passed the cut-off for the clinical competence test. In the self-evaluation, almost all (98.9%) of the participants evaluated themselves as having pretty good to very good clinical competence, which differed remarkably from the results of the Ms. Olsen test. The Finnish Current Care Guidelines were used on a daily basis by 7.4% and weekly by 30%. A statistically significant moderate correlation was found for the nursing staff between Swedish as a working language and mother tongue and the score for clinical competence. No statistically significant correlations were found between the nursing staff’s clinical competence and their use of the Finnish Current Care Guidelines. Previous research has argued that continuous education will enhance nursing staff’s status and clinical competence; however, according to our study, continuous education was not prioritised.