Working nurses studying for master's degrees who rated their clinical-practice learning and competence more positively also tended to report higher holistic nursing competence, a cross-sectional survey found. The strongest association was between the overall competence score and the clinical-practice measure's Learning and competence component, with a Spearman correlation of 0.506 and a p-value below 0.001.
The finding is a relationship, not evidence of cause. The researchers collected the information at one point in time, so the study cannot show that a better clinical learning setting causes competence to rise.
Learning and competence stood out
All of the HNCS competence components and ACS clinical-practice components were positively and significantly related. The overall competence score was also associated with Belongingness at 0.359 and Being welcomed at 0.314. In plain terms, higher scores on one measure generally went with higher scores on the other.
The weakest reported relationship was between Professional development and Being welcomed, with a correlation of 0.201 and a p-value of 0.001. The researchers reported post hoc statistical power of 0.68 for that association, a check made after the data had been collected.
Participants' self-ratings of holistic competence were generally high. On the seven-point response scale, the median overall HNC score was 5.67. Ethical practice and Professional development had the highest median scores, 6.0 each, while General aptitude scored 5.43 and Staff education and management 5.44.
On the ACS, the median, or middle score, was highest for Learning and competence at 4.00, followed by Being welcomed at 3.83 and Belongingness at 3.71.
Who took part and how scores were measured
Researchers surveyed 293 practising nurses enrolled in master's nursing programs in eastern Poland between January and June 2024. Eligible participants had at least six months of nursing practice and gave voluntary informed consent. Responses were collected through a computer-assisted web interview, and recruitment used purposive, convenience, and snowball sampling.
The group had a mean age of 42.93 years and mean nursing experience of 16.56 years. Women made up 96.59% of the sample, or 283 participants, while 81.57%, or 239 participants, lived in urban areas.
To capture competence, the HNCS asked people to rate 36 items on seven-point scales across five components; its total possible score runs from 36 to 252. The ACS measured three parts of clinical-practice quality: Being welcomed, Belongingness, and Learning and competence.
The analysis used Spearman correlations alongside Shapiro-Wilk and Mann-Whitney tests. For the 18 correlation comparisons, the researchers applied a Bonferroni correction, setting the adjusted significance threshold at p below 0.0028 rather than the general threshold of p below 0.05.
The result is an association, not a cause
Age, length of service, gender, and place of residence were not significantly related to holistic competence or perceived clinical-practice quality in this group. That result describes this sample; it does not establish that these characteristics have no relationship in other populations.
Non-random recruitment may limit how well the findings represent other nurses. The sample was drawn from eastern Poland and was overwhelmingly female, with 96.59% women, so the results should not be treated as a population-wide estimate.
The authors also warned that self-report can be shaped by social-desirability bias. Both measures were completed through the same web-based process at the same time, creating possible common-method bias, and the study did not perform confirmatory factor analysis in this sample.
The findings therefore offer a snapshot of how this group viewed its competence and clinical practice. They cannot tell whether changing the clinical learning experience would change competence.
Paper data and sources
Original title: Holistic nursing competence and clinical learning experience among professionally active nursing students: a cross-sectional study
Authors: Brodowicz-Król M, Więch P, Malm M et al.
Journal/Repository: Frontiers in medicine
Status: Peer-reviewed
First online: 2026-10-10
DOI: Not available
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