Nursing Competencies in the Nursing Curriculum: Implications for Education and Practice

Background

For over 20 years, nurses have ranked as the most trusted, honest, and ethical profession (Brenan, 2023). However, many work-environment-related challenges impact the profession and standards of practice and patient outcomes. Over 5.2 million nurses are practicing in the United States (Smiley et al., 2023). Nationally, the nursing workforce is getting younger due to a mass exodus of experienced nurses during the pandemic. An estimated 200,000 nurses left the profession from 2020-2022, and 25% of all nurses plan to leave or retire in the next five years (Smiley et al., 2023). Inadequate staffing, heavy workloads, workplace safety, and unprecedented fatigue, stress, and burnout during the COVID-19 pandemic have negatively affected the U.S. nursing workforce, particularly younger, less experienced RNs (Aiken et al., 2023; Martin et al., 2023). In the recently published US Clinician Wellbeing Study of physicians and nurses during the COVID-19 pandemic, nurse burnout was directly associated with a higher turnover of nurses and physicians. Many nurses rated their hospitals poorly on patient safety and quality outcomes, reported too few nurses are available to care for patients, a poor work environment (leadership, teamwork), and lacked confidence in management (Aiken et al., 2023). Instead of workplace wellness and resilience programs, nearly 90% of nurse respondents desired improved staffing to lower nurse-to-patient ratios (Aiken et al., 2023).

Nurse-to-patient ratios have long been a contentious topic. California is the only state that have state-mandated minimum nurse-to-patient ratios (Aiken et al., 2010). When hospitals adhere to the law, lower ratios are consistently associated with significantly lower patient mortality, lower nurse burnout and job dissatisfaction, and higher quality of care (Aiken et al., 2010). Unlike pilots (Pilot Regulations, 2017) or truck drivers, no federal regulations limit the number of hours nurses can work (Institute of Medicine (US) Committee on the Work Environment for Nurses and Patient Safety & Page, 2004). Forcing some nurses to work more than 16 hours a day for multiple days due to mandatory overtime (Rogers et al., 2004), especially during the pandemic when hospitals were consistently short-staffed (Martin et al., 2023). In sentinel research conducted by Rogers and colleagues (2004), the likelihood of a nurse making an error or near error was three times higher when nurses worked 12.5 hours or more (Rogers et al., 2004). There was no relationship between the nurses’ age, hospital size, hospital unit type, and errors or near errors for work hours and overtime (Rogers et al., 2004). They concluded that longer shifts adversely affect patient care and contribute to burnout and retention (Rogers et al., 2004). Compared with other high-stakes professions, such as truckers, managed by specific industry-mandated work and hours of sleep rules (Summary of Hours of Service Regulations, 2022), nurses' practice standards lack guidance on work hours and environment. Whereas such specific federal standards do not govern nursing work environment regulations, professional nursing organizations guide the educational programs and require the nursing curricula to meet accreditation criteria successfully.