The core components of clinical competency for MNS students are derived from 11 main categories: evaluation and observation of the medical condition, prediction of disease progression, clinical operational skill, health education and health promotion, documentation of medical treatment and nursing records, communication and cooperation, administration, promotion of professional development, self-development, knowledge of law and ethics, and personal traits, which are shown in Fig. 1.
The categories and subcategories of clinical competency
Main Category 1: Evaluation and observation of the medical condition
The participants emphasized that the evaluation and observation of medical conditions is the essential clinical competency for MNS students since it is the premise of clinical nursing work, the basis of clinical decision-making, and closely related to nursing safety. The following statements emphasize this finding.
“I think the competency of the evaluation and observation of the medical condition is very important. If you want to do anything in clinical practice, evaluation and observation come first.” (N1).
“I think the competency of keen evaluation and observation of the medical condition is a prerequisite for solving clinical problems.” (E4).
“The competency to evaluate and observe a patient’s medical condition is crucial since patients in our CCU frequently have changing illnesses, such as cardiac arrest or ventricular fibrillation, and if you don’t have this competency, you may risk a medical accident.” (N2).
Main Category 2: Prediction of disease progression
Most of the participants highlighted that MNS students should have the competency to predict disease progression since it would reduce the occurrence of adverse nursing events, improve patient outcomes, and ensure patient safety.
“I feel like the competency to predict disease progression is crucial for MNS students. They must be concerned about what patients may experience abnormally in the future and how to handle these abnormal events. If they can predict in advance, it may reduce subsequent adverse nursing events, improve patient outcomes, and ensure the safety of patients.” (N2).
“I believe that the competency to predict disease progression is essential, especially during the night shift when there is a paucity of medical staff. They must predict potential situations, particularly with regard to severely ill patients, so that they won’t panic when the bad accidents come.” (N1).
Main Category 3: Clinical operational skill
Participants identified clinical operational skills as the most essential clinical competency for MNSs’ clinical work. Based on the experiences of the participants, the clinical operational skills included three parts: basic clinical skills, specialty clinical skills, and rescue skills.
“Only when they are familiar with clinical operational skills, and then better combine clinical operational skills with theory, which will be beneficial for clinical improvements.” (E6).
“If the clinical operational skill is not adequate, it will affect how well medical staff cooperate in clinical and daily clinical work’s completion.” (N1).
“I believe that clinical operational skill competency is most crucial. If the MNS students couldn’t inject well, I couldn’t get her to do more work.” (N6).
“Within clinical operational skills, rescue skills are also important.” (E6).
“I consider that the MNS students should have high-quality specialty clinical competencies and that the breadth and depth of their specialty clinical skills should be wider than those of undergraduate nurses, which is directly related to the level of clinical specialty nursing.” (E5).
Main Category 4: Health education and health promotion
The participants stated that MNS students should be able to conduct effective health education and health promotion, which are essential methods for preventing disease and promoting people’s health.
“Whether it’s before or after a patient is discharged from the hospital, the competency to provide them with appropriate health education is equally essential. Ineffective health education might impact on the patient’s treatment or the nurse-patient relationship.” (N2).
“I believe that with ‘Healthy China 2030’ strongly emphasizing the importance of disease prevention and national health promotion, MNS students, as highly educated talents in nursing, should not only be able to provide effective health education to patients but also take on the prevention and management of diseases, which will promote national health.” (E1).
Main Category 5: Documentation of medical treatment and nursing records
As the participants noted, one of the most crucial clinical competencies for MNS students is the ability to accurately document medical treatment and nursing records, which is related to protecting MNSs’ legal rights.
“Medical treatment and nursing records must be timely and accurate documents in order to preserve nurses’ legal documentation in the event of a medical dispute.” (N13).
Main Category 6: Communication and cooperation
Participants noted that MNS students should be able to choose appropriate communication skills according to the features of various communication objectives and be able to cooperate effectively with team members in clinical practice in order to conduct clinical work efficiently and advance their careers.
“I feel that communication skills are equally crucial. Some graduate students could be good at conducting research, but they might not be able to effectively express themselves, which is also a really sad thing.” (E6).
“Communication competency is also important to the old with the old communication method, to the old director with the old director communication method, and to the young doctors with the young doctor’s communication method. I think the MNS students who have this ability will develop very well in clinical.” (E1).
“I think MNS students’ social activity is wide in clinical; they not only need to communicate and cooperate with colleagues in the department but also communicate and cooperate with the management, so communication and cooperation competencies are very important in clinical.” (E3).
Main Category 7: Administration
Participants stated that MNS students should have the ability to administration, which should be reflected in the management of patients, diseases, and their own daily work.
“Patient management competency is also required; whether managing one or more patients, MNS students must be able to offer the patient integrated services.” (E3).
“I feel that MNS students’ administration competency isn’t the management of people at the beginning; it should be reflected in the management of a specific disease, such as chronic disease management.” (E6).
“The ability to manage their work is also very important, which is also important for the safety and treatment of patients.” (N8).
Main Category 8: Promotion of professional development
Participants state that MNS students should develop clinical practice by applying their evidence-based thinking and innovation to transform the traditional nursing model and advance the nursing profession’s development.
“As highly educated talents, MNS students should be able to employ innovative thinking to transform traditional nursing care and improve the quality of nursing care in clinical practice.” (E5).
“I believe that MNS students should not only provide nursing care but also innovate and change the complex clinical process by using evidence-based views.” (N7).
Main Category 9: Self-development
The category of “self-development” represented the MNSs’ capacity to promote their own expertise, skills, and careers. First, participants feel that MNS students should be able to update their specialty knowledge and skills to keep up with advances in clinical treatment technology.
“In my opinion, MNS students need to be able to develop themselves, particularly in terms of their ability to become more specialized and master more cutting-edge clinical knowledge.” (E3).
“I believe it’s critical that we keep up with the pace at which doctors are updating their specialties, or else they might have doubts about our graduate nurses.” (N6).
Then, experts also agree that MNS students should have an active learning attitude, as this might facilitate individual development.
“I believe that the first step in learning is to have an active attitude toward it. Only through one’s own active attitude can one learn more, and others are also more eager to teach you.” (N2).
In addition, participants also mentioned that MNS students should be able to conduct self-reflection and personal career planning, which was linked to the sustainability of their own careers.
“I believe MNS students should have the capability to reflect, which is crucial, including reflecting on how much they have changed over time, how far behind they still are, what they achieved today, and what limitations they still face. Additionally, the capacity to do personal career planning is crucial, such as knowing what to plan for the present, what to plan for the future, and how to grow sustainably.” (E1).
Main Category 10: Knowledge of law and ethics
Participants agreed that MNS students should be knowledgeable about nursing law and ethical decisions that arise in clinical environments in order to better handle ethical dilemmas and safeguard themselves in clinical practice.
“Mastering knowledge of nursing rules and regulations are also necessary in order to safely protect nurses themselves.” (N1).
“Knowledge of ethical decisions is also needed; there may be some end-stage patients who have a strong sense of survival but whose family members do not want to continue to rescue them for various reasons, and they may ask nurses to turn off some monitoring and channels. In such a situation, what should they do ethically? This ability is also necessary.” (N1).
Main Category 11: Personal traits
The competency to self-adjust rapidly to maintain a good physical and mental state was considered by participants to be a personal trait of MNS students, which would help MNSs in adjusting to the high-pressure clinical environment.
“MNS students require the competency to cope with pressure. Because the MNSs have a higher degree in the clinical environment, other nurses usually evaluate them with higher standards; if they fall once, they should adjust themselves.” (E5).
“Timely self-adjustment is required. MNS should work the night shift at the clinic since it is exhausting for them to adjust to the time change between shifts, but they may still need to deal with pressure from patients and physicians. If they were unable to adapt, it would cause them to experience severe internal friction.” (N1).
Participants agreed that MNS students should have the competency to maintain empathy, since this may impact the nurses-patients interaction and also offer patients psychological support.
“Empathy is another crucial trait. The relationship between nurses and patients may be improved if they could put themselves in the patients’ shoes and feel the experiences they are going through” (N2).
“There may be some patients with depression or suicidal thoughts in clinical; they should put themselves in their shoes to take patients out of the sad mood, so I think empathy is also very important” (N1).
Being responsible for patients should be another personal trait of MNS students, which was linked to patient safety.
“I agree that having a sense of responsibility is crucial and that patient safety ought to be placed first, no matter what the issue” (N8).
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