Assessment of Differential Perceptions of Core Nursing Competencies between Nurse Managers and Nursing Graduates: A Cross-Sectional Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you very much for the opportunity to review this manuscript.

Below are my comments concerning the article.

The abstracts: Methods: please describe the tools you used in the study.

Please describe the size simpling in the method section's main text. Is there a specific research tool, or were the tools based on the previous research?  The description is not clear.   What is the content validity index - I don't understand this statement. What were the norms for the tools? It's challenging to interpret the results.

Author Response

Point-by-point reply

We thank the editor and reviewers for their valuable comments and suggestions.

Reviewer: 1

Comments and Suggestions for Authors

Thank you very much for the opportunity to review this manuscript.

Below are my comments concerning the article.

1. The abstracts: Methods: please describe the tools you used in the study.

Reply: We thank the reviewer for the important comment. Following the reviewer's comment, we have rewritten the methods section in the abstract and the main text. Please see the revised methods section and our reply below in comment 3.

2. Please describe the size sampling in the method section's main text.

Reply: In view of the reviewer's comment, we have added a description of the sampling size in the method section's main text as follows: "The questionnaire consisted of 47 items in total and was addressed specifically to 390 Israeli nurses by a link to the questionnaire. Of those, 331 nurses completed the questionnaire in full (a response rate of 87%). One hundred forty-eight of them were nursing graduates (71 women, 48%), with a mean age of 28.14 years and a standard deviation (SD) of 5.62. Additionally, 183 out of 220 nurse managers in hospitals and the community, who had been in a managerial position for at least a year (159 women, 87%), with a mean age of 43.44 years (SD = 10.31), completed the questionnaire, with a response rate of 83%. Sixty-nine questionnaires were disqualified due to significant missing data". Please see the revised methods section, page 4, lines 174-182.

3. Is there a specific research tool, or were the tools based on the previous research?  The description is not clear. What is the content validity index - I don't understand this statement. What were the norms for the tools? It's challenging to interpret the results

Reply: We thank the reviewer for the important comment regarding clarifying the research tool description. We have a specific questionnaire that is based on the Yang et al., study. We added a table (Table 1) that emphasized the Alpha Cronbach values for each component of the competencies. Please see page 4, lines 166-174; pages 4-5, lines 182-201; and Table 1 pages 5-6." The study tool is an internationally validated questionnaire. The validation was conducted for each of the six domains in the questionnaire. The reliability of this instrument was examined and found suitable for measuring the profile characteristics of a graduate nurse with professional training in an academic program [1]. We used the psychometric measurement instrument [1] which is designed to examine the psycho-technical competencies of the graduates and their suitability to the requirements of the demanding health system. The online questionnaire was created using the Qualtrics method, professionally translated from English to Hebrew, constructed and validated by five professional and experienced individuals in the field of research for adequate content validity". "A pilot study was conducted with 30 nurses, resulting in a Cronbach's alpha of 0.78 for all the questions in the questionnaire. Items were presented on a five-point Likert scale in which 1 denotes 'definitely not important’; 2 denotes ' not important ‘; 3 denotes 'neutral '; 4 denotes ' important' and 5 denotes 'definitely important '. In this way, we avoided potential bias by presenting two responses that reflect lower importance and two responses that reflect high importance. The questionnaire consisted of two parts. The first part included demographic information (age, gender), advanced training, and job seniority. The second part addressed the following six domains:(1) Professionalism in Research – Research capability, writing skills (in English as a research language), and digital information skills, Internal reliability: Cronbach's alpha 0.844; (2) Direct Patient Care – Performing basic and advanced nursing skills safely and securely, Internal reliability: Cronbach's alpha 0.877; (3) Support and Communication Skills – Emphasizing effective communication skills with patients and enhancing their well-being through social and emotional support, Internal reliability: Cronbach's alpha 0.853; (4) Professional Knowledge – Relevant clinical knowledge, managing nursing care for patients, quality of care, and health promotion, Internal reliability: Cronbach's alpha 0.855; (5) Personal Abilities – Self-confidence, self-control, and professional competency, Internal reliability: Cronbach's alpha 0.822 ; (6) Intellectual Skills – Valuing critical thinking, self-assessment, and personal commitment to continuous learning, Internal reliability: Cronbach's alpha 0.733 (Table 1)".

Table 1: Scales for evaluating study variables in factor analysis

References

1. Yang FY, Zhao RR, Liu YS, Wu Y, Jin NN, Li RY, Shi SP, Shao YY, Guo M, Arthur D, Elliott M. A core competency model for Chinese baccalaureate nursing graduates: A descriptive correlational study in Beijing. Nurse Education Today. 2013 Dec 1;33(12):1465-70.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thanks for the opportunity to review this interesting paper. Overall well written but somethings I would suggest to action.

There are different theories/concepts about competence this needs setting out and what lens the author is taking.

Nursing Reports is a international journal. Please add commentary that relates your context of the study and international implications.

Limitations -surely asking the young grads to rate themselves as well as managers would have been more applicable-is this where you are going with the project?

Data is well presented – but table 1 needs to show exact p-values, whether significant or non-significant. It’s not adequate simply to star significant findings. These could be appended to the table in a new column, or they could replace the column of t-values, which are calculational values and of little relevance to the reader.

Figure 1 poor: looks distorted. It seems to have been stretched in the horizontal direction

Text under Figure 1: more examples of exact p-values being omitted; for example:

The independent sample t-test indicated that the difference in the direct care index of 231 nurses was found to be statistically not significant, t = .492, n.s.,

Here “n.s.” presumably means non significant, but we need to know the exact value.

There should be better consistency in the level of precision of quoted values quoted, which range from 2 to 4 significant figures.

I have had tom state major revision but sure all the suggestions are actionable.

Author Response

Point-by-point reply

We thank the editor and reviewers for their valuable comments and suggestions.

Reviewer: 2

Comments and Suggestions for Authors

Thanks for the opportunity to review this interesting paper. Overall well written but somethings I would suggest to action.

Reply: We thank the reviewer for the positive comment.

1. There are different theories/concepts about competence this needs setting out and what lens the author is taking.

Reply: Following the reviewer's comment, we elaborated on this point as follows: "Several concepts and definitions of competence and competency are presented, including those from nursing regulatory bodies in Canada, the American Academy of Ambulatory Nursing, and other generalized definitions. These definitions revolve around the integration and application of knowledge, skills, judgments, and personal attributes necessary for safe and ethical practice". "Foss et al., defined these as the amalgamation of abilities, knowledge, and skills essential for the execution of a specific task [2]. Within the realm of nursing, competency encapsulates the profound mastery of a pertinent body of knowledge, complemented by a spectrum of skills, which span clinical, interpersonal, and technical dimensions, vital for efficacious performance in a clinical setting [3]. Competence-Based Education delineates the requisite criteria that learners must meet to evince competency [4]. This educational approach necessitates the pinpointing of fundamental competencies indispensable for delivering holistic nursing care in clinical contexts. The common understanding is that competence is required to apply the knowledge from the studies, to interact with the patients and the staff, and to provide quality care. Thus, the rationale for our study is the increasing demand for competent graduates and the need to develop Israeli national standards of core competencies and develop a psychometric instrument to identify and measure the core competencies needed by undergraduate nursing graduates". Please see page 2, lines 81-85; and pages 2-3, lines 90-102.

2. Nursing Reports is an international journal. Please add commentary that relates your context of the study and international implications.

Reply: We thank the reviewer for the important comment. Following the reviewer's comment, we have added a text regarding international implications. "The growth and aging of the population and the multiplicity of patients with multimorbidity and complex needs has combined with the trend in professional development to create a demand for more efficient training of nurses aimed at producing graduates with a high standard of professional qualifications. These include proficiency in handling information and learning skills, critical thinking, communication skills for counseling and support, technical skills, moral competence [5], and commitment to continued learning. All of this is required by a healthcare system that provides care at a high standard and fosters young leadership. Therefore, our vision for the future is to tailor the curriculum to the workplace. This is because the congruence between the ratings given by the graduates and the nurse managers of the importance of the six core nursing competencies is based on the advanced clinical practice period experienced by the young graduates. Today, there is a demand for nursing educators to provide learning opportunities and to train nurses in medical science technology, and the health system who have the potential for young leadership to bridge the gap between newly graduated nurses and nurse managers, and to minimize the discrepancy between the training received in professional schools and what is required in the clinical field to ensure nursing competency. A good alignment between the perceived necessary skills held by nurse managers and those of the new nursing graduates should lead to job satisfaction and occupational commitment of the young nurses, reducing attrition from the profession or from work that meets international standards". Please see page 3, lines 107-126.

3. Limitations -surely asking the young grads to rate themselves as well as managers would have been more applicable-is this where you are going with the project?

Reply: Following the reviewer's comment, we added this point to our study limitations. Please see page 9, lines 328-333. "The information was obtained by self-reporting from the participants, which might have led to non-differential misclassification. However, there is no other way to obtain information regarding evaluating competence other than self-reporting by the participants, since such information is usually not available in administrative databases. In addition, in this type of variable, the personal perception of the participants is important, thus the self-report on evaluating competence does not necessarily constitute a limitation".

4. Data is well presented – but table 1 needs to show exact p-values, whether significant or non-significant. It’s not adequate simply to star significant findings. These could be appended to the table in a new column, or they could replace the column of t-values, which are calculational values and of little relevance to the reader.

Reply: In agreement with the reviewer's comment, we have added exact P-values in a new column to Table 2. Please see the revised Table 2.

5. Figure 1 poor: looks distorted. It seems to have been stretched in the horizontal direction.

 Reply: Following the reviewer's comment, we removed the figure that shows identical data that appeared in Table 1.

 6. Text under Figure 1: more examples of exact p-values being omitted; for example: The independent sample t-test indicated that the difference in the direct care index of 231 nurses was found to be statistically not significant, t = .492, n.s. Here “n.s.” presumably means non significant, but we need to know the exact value.There should be better consistency in the level of precision of quoted values quoted, which range from 2 to 4 significant figures.

Reply: We thank the reviewer for the important comment. In view of the reviewer's comment, we modified the text and added the exact P-values Please see the revised text on page 7, lines 237-244.

References

1. Yang FY, Zhao RR, Liu YS, Wu Y, Jin NN, Li RY, Shi SP, Shao YY, Guo M, Arthur D, Elliott M. A core competency model for Chinese baccalaureate nursing graduates: A descriptive correlational study in Beijing. Nurse Education Today. 2013 Dec 1;33(12):1465-70. https://publicationslist.org/data/m.elliott/ref32/Core%20competency%20model.pdf

2. Foss GF, Janken JK, Langford DR, Patton MM. Using professional specialty competencies to guide course development. Journal of Nursing Education. 2004 Aug 1;43(8):368-75.
3. Newble D, Dawson B, Dauphinee D, Page G, Macdonald M, Swanson D, Mulholland H, Thomson A, van der Vleuten C. Guidelines for assessing clinical competence. Teaching and Learning in Medicine: An International Journal. 1994 Jun 1;6(3):213-20.
4. Calzone KA, Jenkins J, Masny A. Core competencies in cancer genetics for advanced practice oncology nurses. InOncology nursing forum 2002 Oct 1 (Vol. 29, No. 9).
5. American Nurses Association. Nursing: Scope and Standards of Practice. Available online:  https://www.nursingworld.org/~4adb8c/globalassets/ catalog/book-toc/ toc-nursing-scope-and-standards-of-practice-3e.pdf (accessed on 6 May 

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Thanks for resubmitting your work and amendments made. I am happy this is ready for publication.

Author Response

Re: R2-Revision of Manuscript ID: nursrep-2659178, entitled: "Comparing Perceptions of the Core Nursing Competencies Between Nurse Managers and Graduating Nursing Students: Cross-Sectional Study"

We are pleased that our manuscript was well received by the reviewers and editor and that it will be further considered for publication in Nursing Reports pending our addressing the additional requested revisions.

Accordingly, please find enclosed a revised version of our manuscript that addresses the comments raised by the reviewers and editor. Please see below our point-by-point responses to each of the comments. The changes in the text are marked in colour.

We thank the editor and reviewers for their comments and suggestions, which we believe have substantially improved the manuscript.

Sincerely,

Mahdi Tarabeih (Ph.D.)

School of Nursing Sciences, The Academic College of Tel-Aviv-Yaffa, 2 Rabenu Yerucham St. P.O.B 8401, Tel-Aviv, 61083, Israel. 

Tel: +972-3-6803300; Fax 97236803301. 

Email: [email protected] 

Point-by-point reply

We thank the editor and reviewers for their valuable comments and suggestions.

Reviewer: 1

Comments and Suggestions for Authors

Thanks for resubmitting your work and amendments made. I am happy this is ready for publication.

Reply: We thank the reviewer for the positive comment.