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© Borgis - New Medicine 3/2009, s. 70-74
*Ibolya Tulkán, Erika Erdősi, Magdolna Pogány, Kornélia Helembai
Hungarian Nurses and Nurse Graduates´ Competences in International Context
University of Szeged, Faculty of Health and Social Sciences, Department of Nursing, Hungary
Head: Dr Kornélia Helembai, PhD
Summary
Aim. The aim of this article is to show how graduates finishing the 4-year BSc nursing training in 2007 and undergraduates finishing their training in 2008 shortly before their final exams assess their competences, and to compare the strengths and weaknesses of Hungarian nursing practice with the international results.
Material and methods. Nursing competency has always been a topic of interest and a subject of debate in Hungary. There are no data available in Hungary that are suitable for international comparison on what competences can be practised in Hungarian healthcare. The method of data collection was carried out by questionnaire. 6 training sites of 3 training institutions were selected. A total sample of 458, from which a sample of 123 students graduated in 2007 (N = 123) and a sample of 335 undergraduate students were graduating in 2008 (N =335), was surveyed. The analysis of data was performed using the SPSS statistical package. Assessment of relations between variables was performed by Kruskal-Wallis test and Friedman test.
Results. A common feature of the Hungarian and international findings is that the care delivery competence domain is the first, and research and development is the last in the rank, but there are country-specific features as well.
Conclusion. The results of the research can serve as a basis to develop nursing education.
Introduction
The European Union aims to be the most dynamic and competitive knowledge-based area in the world by 2010. Keys to this initiative are education, training, development of competences and strengthening the connection between economy and training [1]. European nursing training and nursing practice are greatly influenced by the EU´s strategic decisions, supported by several international projects [2-5]. Although nowadays great emphasis is put on the competence-based approach, there is no universal definition [6-10] or measurement tool [11-14] for comparing transparency and diversity of nursing qualification, training and practice.
There are no suitable data available in Hungary for national or international comparison on what nursing competences can be practised in Hungarian healthcare and how the gap between the training and the possibilities and expectations of the healthcare institutions should be approached. The problems of nursing training and practice in Hungary – e.g. decrease of interest in the nursing profession [15], absence of reinforcements, over-loaded nursing staff [16], lack of social recognition of the profession [17], well-trained nurses seeking employment abroad or leaving their profession [16] – demand even more accurate preparation for competences.
Aim
Our aim was to study what competences can be used in Hungarian nursing practice, what are the strengths and weaknesses of Hungarian nursing practice in an international context, and what conclusions can be drawn to develop the education programme of the training institutions.
Material and methods
The study took place from January to May 2008. Selection of samples was carried out by random sampling, using a multi-step method. At the first stage 6 training sites of 3 training institutions were selected, at the second stage students who graduated from BSc training and obtained a college leaving certificate in 2007 and undergraduate students shortly before their final exams in 2008. The training institutions were similar considering their schooling regions, number of students, the regional practical background, the educational programme and location.
The EHTAN NCQ self-assessment questionnaire [2] supplemented with some demographic items, was used in the research. EHTAN NCQ is the only competence-related questionnaire relevant to current nursing practice in Europe; hence it can serve as a basis for international comparison. EHTAN NCQ was originally used with nurses working at acute general medical and surgical units. The questionnaire focuses on 8 competence domains (Table 1). The frequency of performing each of the listed competences had to be rated on a four point scale (where never = 1, occasionally = 2, usually = 3, always = 4) [2].
Table 1. Friedman probe by competence-domains Mean number in rank N = 455 (Number of participants).
Competence-domainsNumber in rank /MeanOrder of rank
Care delivery6,121.
Professional and ethical practice5,942.
Communication5,703.
Team-working4,534.
Health promotion4,455.
Personal and professional development4,206.
Assessment2,897.
Research and development2,168.
Recording and analysis of data was performed by SPSS for Windows 15.0, using descriptive statistical methods. Assessment of relations between variables was performed using Kruskal-Wallis test and Friedman test.
Results
The distribution of students who graduated in 2007 and undergraduates graduating in 2008 is shown in Fig. 1. A total sample of 458, from which a sample of 123 students graduated in 2007 (N = 123) and a sample of 335 undergraduate students were graduating in 2008 (N =335), was surveyed. 9.75% of the respondents who graduated in 2007 and 20% of the undergraduate students graduating in 2008 were regular students. 90.24% of students who graduated in 2007 and 80% of undergraduate students graduating in 2008 were correspondent students. The proportion of those aged 31-35 was the highest (27%). The study sample was characterized by female dominance. The majority of respondents, 90.2% of the students who graduated in 2007, and 77.9% of students graduating in 2008, were employed at the time of the study. Most of them worked at clinics or hospitals. (Fig. 2) 72.2% of the employed respondents were working as nurses (BSc nurses, specialist nurses) – senior nurse managers are excluded, while middle nurse managers are included, as they are involved in everyday nursing activities. (Fig. 3) The great majority of the respondents have been working for more than 7 years.
Fig. 1. Distribution of students graduated in 2007, undergraduates graduating in 2008
according to the training sites (N = 458).
§ Training sites: K1, K2, K3, K4, K5, K6
N= Number of participants
Fig. 2. Distribution of working respondents according to the level of care (%).
N=308
N = Number of respondents
Fig. 3. Distribution of respondents working as nurses according to their position in (%).
N = 371
N= Number of respondents
Comparison of self-assessment of competence domains
The Friedman test was used to compare the averages relating to competence domains and a significant difference was indicated (p =0.000). On the basis of the data (Table 1) it can be concluded that care delivery was rated the highest among the competence domains. Assessment and research and development received the lowest means.
Comparison of self-assessment of competence domains by training site
For the 2007 students the Kruskal-Wallis test showed no significant difference between training sites, while for the 2008 students the evaluation of research and development domain was significantly different (p =0.001).
Comparison of self-assessment of competence domains by types of training
The Kruskal-Wallis test can prove that the regular students ranked the assessment domain significantly higher than the correspondent students (p =0.036).
Relation of self-assessment of competence domains with the working period
No significant correlation can be observed between the working period in healthcare and/or social working area and the means of competence self-assessment.
Self-assessment of competence domains depending on the study achievement
The Kruskal-Wallis test indicated a significant correlation. The poorer the students estimated their study achievement, the lower they ranked the personal and professional development (p =0.003), the professional and ethical practice (p=0.001), the research and development (p =0.002) and the team-working domains (p =0.021).
Self-assessment of competence domains by students employed as nurses
Special attention was paid to the competence self-assessment of participants employed as nurses in order to compare our results completely with the findings of the EHTAN survey. The Kruskal-Wallis test proved that the conclusions valid for the total sample were valid for the sample of participants employed as nurses in all the above-mentioned aspects.
Self-assessment of competence domains by positions and units
To verify that EHTAN NCQ is reliable in measuring undergraduate nursing students as well, the Kruskal-Wallis test was performed in three aspects. Firstly, participants employed as nurses were compared to those who are not employed as nurses (or not employed at all). Secondly, participants employed as nurses were compared to those working in other positions. Finally, competence self-assessment of nurses working at general medical and surgical units was compared to that of participants employed as nurses and to the total sample. The Kruskal-Wallis test was performed for each analysed aspect and it indicated a significant difference only in the care delivery domain (p =0.000).
Comparison between the study results in Hungary and the international results

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Piśmiennictwo
1. Detailed work programme on the follow-up of the objectives of education and training systems in Europe. Available from URL: http://www.see-educoop.net/education_in/pdf/detail-work-program-oth-enl-t02.pdf (Accessed 15. 02. 2008). 2. Cowan T D, Wilson-Barnett, J D, Norman, J I, Murrels, T: Measuring nursing competence: Development of a self-assessment tool for general nurses across Europe. International Journal of Nursing Studies 2008; 6: 902-913. 3. Bíró Zs H: Ekvivalenciától a kompetenciáig. Interjú Csákó Mihállyal, az ELTE TáTK Szociológia Intézetének docensével. (From equivalence to competence. Interview with Csákó M, senior professor of the Department of Sociology Faculty of Social Sciences, ELTE.) In: Educatio 2007; 2:285-292. 4. González J, Wagenaar R eds.: Tuning Educational Structures in Europe. Universities´ Contribution to the Bologna Process. An Introduction. Bilbao and Groningen, 2006.152 pp. 5. Gábor K, Tulkán I, Helembai K, Csanádi Lajosné, Szögi Zoltánné, Unginé Kántor K: At the European union´s door – A Hungarian team´s experiences of participating in the Project Leonardo for better nursing care. International Journal of Nursing Practice 2008, 14, 4:329-334. 6. Cowan T D, Norman J I, Coopamah P V: A project to establish a skills competency matrix for EU nurses. British Journal of Nursing 2005; 11:613-617. 7. Farkas É: Igásló kontra szárnyaló pegazus, avagy a kompetenciák felértékelődése. (Work-horse versus flying pegasus, or the appreciation of competences.) Felnőttképzés 2006; 4:43-52. 8. Henczi L, Zöllei K: Kompetencia-menedzsment. (Competence - Management) Perfekt Gazdasági Tanácsadó, Oktató és Kiadó Zárkörűen Működő Részvénytársaság 2007. 315pp. 9. Jakó M: A kompetencia fogalmának értelmezési lehetőségei Magyarországon. (Interpretation possibilities of the concept of competence in Hungary.) Humánpolitikai Szemle 2004; 5:47-55. 10. Udvardi-Lakos E: Paradigmaváltás a gyakorlatban II. Kompetencia, modularitás. (Changing paradigms in Practice II. Competence, Modularity.) Szakképzési Szemle 2006; 1: 91-118. 11. Fitzpatrick, J M, While, A E, Roberts, J D: Measuring clinical nurse performance: development of the King´s nurse performance scale. International Journal of Nursing Studies 1997; 3:222-230. 12. Bartlett H P, Simonite V, Westcott L, Taylor H R: A comparison of the nursing competence of graduates and diplomates from UK nursing programmes. Journal of Clinical Nursing 2000; 9: 369-381. 13. Redfern S, Norman I, Calman L, Watson R, Murrels T: Assessing competence to practise in nursing: a review of the literature. Research Papers in Education 2002; 1:51-57. 14. Meretoja R, Isoaho H, Leino-Kilpi H: Nurse Competence Scale: development and psychometric testing. Journal of Advanced Nursing 2004; 2: 124-133. 15. Balogh Z: Mi lett veled, nővérke? Helyzetkép az egészségügyi munkaerőpiacról. (Little nurse, what now? Report on the situation of healthcare workforce.) Egészségügyi Gazdasági Szemle 2009; 1: 15-22. 16. Csetneki J: Ápolók kritikus helyzetben. (Nurses in Critical State.) Ápolásügy 2008; 1:5-6. 17. Egészségügyi fejlesztési politikai koncepció, 2005. augusztus 31. (Political concept on health care development 31 August 2005)Available from URL: http://www.eum.hu/archivum/sikeres-magyarorszagert/egeszsegugyi (Accessed 16. 03. 2009).
Adres do korespondencji:
*Ibolya Tulkán
University of Szeged, Faculty of Health and Social Sciences, Department of Nursing
Temesvári krt. 31, 6726 Szeged, Hungary
tel: 00-36-62-545-039
e-mail: tulkan@etszk.u-szeged.hu

New Medicine 3/2009
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