Nurses’ professional competencies in urgency and emergency units: A mixed-methods study

Ferreira, Kemilys Marine; Balsanelli, Alexandre Pazetto; Santos, José Luís Guedes dos

doi:10.1590/1518-8345.6554.3936

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 31 • 2023 • https://doi.org/10.1590/1518-8345.6554.3936 copy

Nurses’ professional competencies in urgency and emergency units: A mixed-methods study ^* * Paper extracted from master’s thesis “Mapping the professional competencies of nurses working in urgency and emergency units”, presented to Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to describe the professional competencies of nurses working in urgency and emergency services and to understand their perception of the essential competencies for professional performance and updating.

Method:

a sequential, mixed-methods and explanatory study, conducted with emergency nurses. To obtain the quantitative data, a questionnaire with 78 items was used, answered by 39 nurses and analyzed using descriptive statistics and non-parametric tests. In turn, the qualitative data were obtained through semi-structured interviews with 17 nurses, whose interpretation was based on inductive content thematic analysis. The data were combined by connection.

Results:

a high level of competence was obtained in the self-assessment of urgency and emergency nurses in Factor 2 - Relations at work and a lower level in Factor 6 - Professional excellence (p=0.036). The qualitative data corroborated positively with the “Relations at work” factor, identifying the association of knowledge and practical experience, with competencies beyond a scenario devoid of permanent education.

Conclusion:

despite the high levels of competence identified in emergency nurses, the strengthening of educational strategies favors professional development and recognition.

Descriptors:
Professional Competence; Emergency Nursing; Leadership; Nursing Administration Research; Emergency Medical Services; Nurse’s Role

Highlights:

(1) Emergency nurses demonstrated a high level of professional competence.

(2) The absence of Permanent Education affected nurses’ professional competencies.

(3) Recognition occurs with knowledge, experience and interpersonal relationships.

(4) Permanent Education in the emergency sector can develop professional competencies.

N*	Representative items of nurses’ actions in emergencies	Competence Level (n=39)
N*	Representative items of nurses’ actions in emergencies	1 n _i ^† f _i (%) ^‡	2 n _i ^† f _i (%) ^‡	3 n _i ^† f _i (%) ^‡	4 n _i ^† f _i (%) ^‡	5 n _i ^† f _i (%) ^‡
4	Constantly updates knowledge in emergencies.	0	8 (20.5)	13 (33.3)	12 (30.7)	6 (15.3)
29	Makes a Nursing diagnosis for the client according to the theoretical framework adopted in the institution.	0	3 (7.6)	12 (30.7)	17 (43.5)	7 (17.9)
31 ^§	Participates in realistic simulation in emergencies periodically.	2 (5,2)	11 (28,9)	18 (47,3)	5 (13,1)	2 (5,2)
55	Uses other opportunities for their professional development.	0	0	16 (41.0)	16 (41.0)	7 (17.9)

N*	Representative items of nurses’ actions in emergencies	Competence Level (n=39)
N*	Representative items of nurses’ actions in emergencies	1 n _i ^† f _i (%) ^‡	2 n _i ^† f _i (%) ^‡	3 n _i ^† f _i (%) ^‡	4 n _i ^† f _i (%) ^‡	5 n _i ^† f _i (%) ^‡
2	Maintains emotional control when deploying solutions to problems.	0	1 (2.56)	11 (28.21)	19 (48.72)	8 (20.51)
5 ^§	Achieves agreements at work by resorting to dialog.	0	1 (2,63)	9 (23,68)	19 (50,00)	9 (23,68)
14	Acts without prejudging people.	0	2 (5.13)	11 (28.21)	17 (43.59)	9 (23.08)
18	Conveys a message without distorting its content with the means available to do so.	0	0	10 (25.64)	20 (51.28)	9 (23.08)
19	Makes people feel like they are part of a group.	0	0	5 (12.82)	20 (51.28)	14 (35.90)
22	Acts within the limits of the ethics required by the globalized world when communicating.	0	0	10 (25.64)	17 (43.59)	12 (30.77)
23	Has transparent, honest and responsible behaviors in relationships with people.	0	0	5 (12.82)	19 (48.72)	15 (38.46)
29	Listens to people without prejudging their ideas and opinions.	0	2 (5.13)	10 (25.64)	18 (46.15)	9 (23.08)
43	Maintains a healthy professional relationship with people.	0	4 (10.26)	15 (38.46)	16 (41.03)	4 (10.26)
48	Avoids conflicting behaviors with people.	1 (2.56)	2 (5.13)	10 (25.64)	16 (41.03)	10 (25.64)
49	Clarifies other people’s doubts according to needs.	0	0	8 (20.51)	20 (51.28)	11 (28.21)
55	Accepts people as they are.	0	1 (2.56)	11 (28.21)	16 (41.03)	11 (28.21)
63	Guarantees expression of each person’s will.	0	4 (10.26)	12 (30.77)	18 (46.15)	5 (12.82)
65	Seeks to establish harmonious contact with the other.	0	1 (2.56)	6 (15.38)	21 (53.85)	11 (28.21)
66	Identifies the action freedom limit they have.	0	2 (5.13)	7 (17.95)	22 (56.41)	8 (20.51)
69	Listens to people with a clear interest in fulfilling their requests.	0	1 (2.56)	7 (17.95)	17 (43.59)	14 (35.90)
76	Proposes adjustments without generating conflicts.	0	0	11 (28.21)	20 (51.28)	8 (20.51)
78	Maintains a good relationship when managing emotions at work.	1 (2.56)	0	14 (35.90)	16 (41.03)	8 (20.51)

Factor*	Classification	Type of performance						p ^§	E.S. ^\|\|
		Secondary		Tertiary		Total
		n _i ^†	f _i (%) ^‡	n _i ^†	f _i (%) ^‡	n _i ^†	f _i (%) ^‡
1	Not at all competent	0	0.00	0	0.00	0	0.00	0.887	0.031
	Little competent	0	0.00	0	0.00	0	0.00
	Competent	1	4.17	1	6.67	2	5.13
	Very much competent	13	54.17	7	46.67	20	51.28
	Extremely competent	10	41.67	7	46.67	17	43.59
2	Not at all competent	0	0.00	0	0.00	0	0.00	0.173	0.230
	Little competent	0	0.00	0	0.00	0	0.00
	Competent	1	4.17	0	0.00	1	2.56
	Very much competent	14	58.33	6	40.00	20	51.28
	Extremely competent	9	37.50	9	60.00	18	46.15
3	Not at all competent	0	0.00	0	0.00	0	0.00	0.216	0.187
	Little competent	0	0.00	0	0.00	0	0.00
	Competent	3	12.50	3	20.00	6	15.38
	Very much competent	17	70.83	5	33.33	22	56.41
	Extremely competent	4	16.67	7	46.67	11	28.21
4	Not at all competent	0	0.00	0	0.00	0	0.00	0.532	0.095
	Little competent	0	0.00	0	0.00	0	0.00
	Competent	2	8.33	2	13.33	4	10.26
	Very much competent	16	66.67	7	46.67	23	58.97
	Extremely competent	6	25.00	6	40.00	12	30.77
5	Not at all competent	0	0.00	0	0.00	0	0.00	0.168	0.227
	Little competent	0	0.00	1	6.67	1	2.56
	Competent	4	16.67	1	6.67	5	12.82
	Very much competent	14	58.33	5	33.33	19	48.72
	Extremely competent	6	25.00	8	53.33	14	35.90
6	Not at all competent	0	0.00	0	0.00	0	0.00	0.036 ^§	0.340
	Little competent	1	4.17	0	0.00	1	2.56
	Competent	12	50.00	3	20.00	15	38.46
	Very much competent	9	37.50	9	60.00	18	46.15
	Extremely competent	2	8.33	3	20.00	5	12.82
7	Not at all competent	0	0.00	0	0.00	0	0.00	0.973	0.010
	Little competent	0	0.00	0	0.00	0	0.00
	Competent	6	25.00	4	26.67	10	25.64
	Very much competent	14	58.33	8	53.33	22	56.41
	Extremely competent	4	16.67	3	20.00	7	17.95
Total	Not at all competent	0	0.00	0	0.00	0	0.00	0.295	0.166
	Little competent	0	0.00	0	0.00	0	0.00
	Competent	0	0.00	1	6.67	1	2.56
	Very much competent	18	75.00	7	46.67	25	64.10
	Extremely competent	6	25.00	7	46.67	13	33.33

ITENS

QUAN* RESULTS

QUAL ^† RESULTS

META-INFERENCES

33. Uses other opportunities for their professional development

50.0% of the nurses obtained Level of Competence 3 (Competent)

versus

220.0% of tertiary care

p ^‡ = 0,036

Category 1 - Professional recognition of nurses by the labor market

There is an association in the participants’ discourse that theoretical knowledge and practical experience are directly related to competence.

The interpersonal relationship is highlighted as a “key” to professional recognition.

There is a precarious permanent education scenario in the emergency units, which leads professionals to seek individual training according to the work need.

The participants seek emergency training through private means, mainly in digital platforms and online courses.

There is no practical training or realistic simulation in the emergency services surveyed.

Investment in human resources aimed at organizing a permanent education team, in addition to financial investment to purchase equipment to carry out practical training, which are strategies proposed by the participants to improve the current deficient scenario.

3. Constantly updates knowledge in emergencies.

4. Participates in realistic simulation in emergencies periodically

Category 2 - Permanent education deficient scenario of urgency and emergency services

ITENS	*QUAN RESULTS**	QUAL ^† RESULTS	META-INFERENCES
2. Maintains emotional control when deploying solutions to problems.	f ^‡ =19 (48,72%)	Secondary care nurses interviewed (n ^§=17) Y ou have to be agile, calm, you can’t get too anxious, because in the emergency sector you have to know how to control anxiety, nervousness, stress. (N9) [...] if we’re unable to have a good interpersonal or multiprofessional relationship, this is more difficult.… Because everyone learns to puncture a vein. It may take a little longer, or a little less, but everyone learns. But now, we make one person know how to deal with the other, then we already deal with other issues that are more personal, so I believe that what is more fundamental for a professional is the issue of good relationships, peers, team and patient alike, which is difficult. (N7)	The testimonies corroborate the positive self-assessment of the participants in Factor 2 - Relationships at work. Communication skills are directly related to interpersonal relationships at work. These relationships at work should be developed respecting the different opinions and practicing emotional control in the face of adversity.
5. Achieves agreements at work by resorting to dialog.	f ^‡ =19 (50,00%)
18. Conveys a message without distorting its content with the means available to do so.	f ^‡ =20 (51,28%)
19. Makes people feel like they are part of a group.	f ^‡ =20 (51,28%)
65. Seeks to establish harmonious contact with the other.	f ^‡ =21 (53,85%)
66. Identifies the action freedom limit they have.	f^‡= 22 (56,41%)	You need to have a connection among the team members [...] and we need to have the same words, speak the same language, right?! So I think a good team, a good service, it has to be quite cohesive. (N8) Nursing is a difficult profession from another point of view, because we’re already trained knowing that, unlike most of society, we won’t have Saturdays, Sundays or free holidays, we’d have a lot of work for some 30-35 years with Saturdays, Sundays and working holidays. And seek to create a healthy environment within the workplace. (N11)	For the participants, in addition to providing a less hostile and more pleasant work environment for all, interpersonal relationships reflect greatly on the satisfaction of the Nursing leader and the team, resulting in a high quality of the care provided to the patients.
76. Proposes adjustments without generating conflicts.	f^‡= 20 (51,28%)

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[1] Corresponding author:
Kemilys Marine Ferreira E-mail: kemilysmf@hotmail.com https://orcid.org/0000-0002-5523-3050