Date of Award


Document Type


Degree Name

Doctor of Education (Ed.D.)


Learning, Leadership and Change

First Advisor

Larry Boese

First Committee Member

Rod P. Githens

Second Committee Member

Carol Ann Friedman


Background: “Nurses provide essential care to the millions of people who are hospitalized each year as a result of illness or injury” (Smith, 2012, p. 172). The Institute of Medicine reported approximately 44,000-98,000 patients die annually resulting from a medical error, and health care errors ranked among the top 10 for the leading causes of death in the United States (Smith, 2012).

Problem: Nurse competence impacts safe and quality nursing, and several research studies investigated the measurement of nurse competence among nurses in various nursing settings (Flinkman et al., 2016). However, a review of the research revealed limited studies in the emergency department (ED) setting and in the United States (O’Leary, 2012).

Method: This study implemented a quantitative nonexperimental research design using the combination of an instrumental case study and a cross-sectional survey for this study’s sample. An Internet-based SurveyMonkey questionnaire collected data on nurse competence from registered nurses (RNs) working in the ED at a San Francisco Bay Area hospital. Part I of the questionnaire integrated Meretoja, Isoaho, and Leino-Kilpi’s (2004) Nurse Competence Scale (NCS) consisting of 73 closed-ended clinical indicators divided into seven competence areas. Participants rated their level of competence and frequency of use for each clinical indicator. Part II of the questionnaire obtained background information about participants. A total of 21 out of 110 potential participants completed the survey.

Results: The data analysis using Statistical Package for Social Sciences (SPSS) provided descriptive and nonparametric correlation statistics. Descriptive statistics described survey respondents. The least and most competent areas were ensuring quality and managing situations, respectively. The most frequent length of nursing experience was at least 60 months and the most frequent number of hours worked was at least 65 hours per 2-week period. Nonparametric correlation statistics, including Kendell’s tau-b and Spearman’s rho, identified significant relationships. A significant relationship existed between the frequency of using clinical skills and level of competence for four of the seven competence areas. A significant relationship existed between the background factor of experience, both as an RN and an ED RN, and level of competence for many clinical indicators. A significant relationship existed between the background factor of hours worked and level of competence for one clinical indicator.

Conclusion: Despite the small sample size of 21 survey respondents, this study revealed findings consistent with the existing research on nurse competence. This study offers implications and recommendations for practice relative to nurse competence, nurse competence assessment, and transitions to new settings of nursing practice to support the nursing profession and safe and quality nursing.