What Shapes Clinical Competence in Intensive Care Nurses? A Hierarchical Regression Analysis.

backgroundClinical competence is central to safe and high-quality nursing care in intensive care units (ICUs). Although professional experience has long been regarded as a primary pathway to competence, this assumption requires empirical testing in contemporary ICU nursing, where care is increasingly shaped by advanced technologies, evidence-based protocols and structured professional development. However, it remains unclear whether clinical competence among ICU nurses is shaped primarily by accumulated experience or by structured ICU training and certification.

aimThe primary aim of this study was to determine the clinical competence levels of ICU nurses. The secondary aim was to examine the relative contributions of sociodemographic characteristics, professional experience, ICU experience, certification and ICU training to clinical competence using hierarchical regression analysis. STUDY

designA descriptive cross-sectional study. Data were collected using a self-administered online questionnaire prepared with Google Forms. The questionnaire included the Nurse Information Form, which assessed selected socio-demographic and professional characteristics and the Intensive and Critical Care Nursing Competence Scale (ICCNCS), which assessed competence across knowledge, skills, attitudes and values. Total ICCNCS scores range from 108 to 540 and are categorised as poor (108-216), fair (217-324), good (325-432) or excellent (433-540), with higher scores indicating greater clinical competence. Hierarchical multiple regression analysis was performed to determine the determinants of clinical competence.

resultsThe study was conducted over a six-month period, between October 2022 and March 2023 and included 253 ICU nurses from 36 hospitals in Türkiye. The mean ICCNCS total score was 441.58 ± 51.66 out of 540, corresponding to the excellent competence category; 130 nurses (51.4%) were classified as having excellent competence. The model, including age, gender and total nursing experience, explained 29.3% of the variance in competence. The inclusion of ICU experience increased the explained variance from 29.3% to 29.4% (p > 0.05). In contrast, when education and certification variables were added to the model, the explanatory power increased from 29.4% to 33.7%, and the final model was found to be statistically significant (p < 0.001).

conclusionsThese results suggest that clinical competence among ICU nurses cannot be explained solely by experience. They also question the experience-competence assumption underlying Benner's Novice-to-Expert model and support education-driven competence development approaches in contemporary ICU nursing. RELEVANCE TO CLINICAL PRACTICE: By challenging Benner's experience-based assumption, this study supports education-driven competence development through structured ICU training, certification and continuing professional development.