Background
In hospitals, nursing managers serve as unit administrative leaders responsible for ensuring the quality of patient care, clinical outcomes, and a healthy work environment. They apply professional knowledge and administrative authority in clinical practice [1, 2]. Due to healthcare system reform, technological innovation, and a growing older adult population and medical burden, a complex healthcare work environment has placed increasing demands on the competence of nursing managers [3, 4].
The American Organization for Nurse Executives identified five core competency domains for healthcare leadership: Communication and relationship management, knowledge of the healthcare environment, professionalism, business skills and principles, and leadership [5]. Along with five competencies, the sixth competency, leader within, was drawn from the American Organization for Nursing’s nurse manager leadership competencies, recognizing the influence and significance of experience, in addition to intrinsic motivation and understanding oneself as an essential part of becoming an effective leader [6]. Competencies represent knowledge, skills, and abilities, and have been used as a framework to facilitate the growth of the nurse leader and to assess skill progression and mastery [6]. As individuals without properly developed nursing managerial competencies can experience conflict, anxiety, and failure in their role performance, such development is vital [7, 8]. Additionally, it is known that expert nurse clinicians are promoted to nursing manager positions with minimal leadership experience or formal preparation for the role [9‐11]. According to a study of nursing managers at nine hospitals with more than 500 beds in Korea, 90.3% reported having opportunities for continuing education or training for management competency development in the past year; however, 49.5% stated that the actual duration of training was only approximately one day [12]. Gonzále et al. [13] stated that both prospective and current nursing managers should participate in educational programs that provide appropriate knowledge about the demands of managerial roles. Nevertheless, the support and preparation required for managers to develop these competencies in organizations are reportedly inadequate [14]. As the scope of nursing management tasks and the need for in-depth roles expand as a nurse’s career progresses, competencies must be differentiated according to the career levels of nurses, and managerial competencies must be developed [15]. Thus, providing systematic and continuous education is important [14, 16].
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Before developing a nursing management competency program, the educational needs of the target audience, and their level of knowledge must be understood [17]. Educational needs analysis refers to determining the extent of education required based on the difference between the desirable (what should be) and current states (what is) [18]. Methods for assessing educational needs include Borich’s [19] approach, which sets priorities by weighting the difference between current and required levels, and the locus for focus model (hereafter LFM) developed by Mink et al. [20]. The latter method, LFM, creates a coordinate plane, where the vertical axis represents the value of the difference between the current and required levels and the horizontal axis represents the value of the required level. It uses the average values of each axis to determine priorities with visual coordinates [20]. Studies have analyzed educational needs using performance (corresponding to the current level) and importance (corresponding to the required level) in areas such as nursing performance, developmental support nursing in neonatal intensive care units [21], communication among nursing students [22], and character education [23]. Furthermore, measuring tasks, frequently performed by practitioners in the field, which are important but perceived as difficult, can enable accurate assessment of educational needs, ensuring that the truly desired educational content is included [24].
Early research on the competencies of nursing managers in South Korea focused primarily on the development of competencies for charge nurses and higher-level managers [25, 26]. Recent studies have investigated the development of behavioral indicators for nursing management competencies [12, 27] and factors affecting nursing management competencies [28, 29]. Existing studies [25, 26, 30] focus primarily on the development of competency assessment tools. However, research on the competencies that currently require education among nursing managers is lacking, as these competencies may not align with contemporary managerial roles. Therefore, this study aimed to identify educational needs related to current nursing management competencies among nursing managers working in medium to large sized general hospitals. This study sought to provide baseline data for future educational programs aimed at developing competencies for nursing managers. The specific objectives of this study were to (i) reveal the general and job-related characteristics of nursing managers; (ii) ascertain the performance, importance, and difficulty of nursing management competencies for nursing managers; (iii) assess the educational needs of nursing managers; and (iv) analyze the priorities of the educational needs according to the areas and items.
Methods
Design
This was a descriptive study to assess educational needs for nursing management competency among hospital nursing managers.
Participants
Participants were nursing managers responsible for nursing unit management tasks at one tertiary general hospital with 900 beds, located in X province, X city, and six general hospitals with 100–300 beds, located in X and Y cities in South Korea. The sample size was calculated based on Cohen’s sample size formula using G-Power 3.1.9.7 for paired t-test with an effect size (f2) of 0.30 [31, 32], significance level (α) of 0.05, and power (1-β) of 0.90. A minimum sample size of 119 was required. Considering over 20% dropout rate [33], 160 questionnaires were distributed, and 155 responses were analyzed.
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Measurements
We employed a structured self-report questionnaire (Supplementary file). All measurement tools were used after obtaining approval from the original authors.
General and job-related characteristics
We used five items on the participants’ general characteristics, 11 items on job-related characteristics, and nine items on nursing managers’ participation in hospital management.
Nursing management competencies
Management competencies were evaluated using a tool developed by Cho [34] to evaluate nursing managers’ performance, which was later revised and supplemented by Kim and Kim [30]. The tool comprises 38 items in four domains: clinical expert (11 items), leader (nine items), administrative manager (12 items), and educator (six items). Responses were rated on a four-point Likert scale, with higher scores indicating higher nursing management competencies. The Cronbach’s alpha coefficient was 0.96 overall and 0.88 for clinical experts, 0.89 for leaders, 0.91 for administrative managers, and 0.81 for educators in the study by Kim and Kim [30]. In this study, Cronbach’s alpha was 0.97 overall, 0.93 for clinical experts, 0.92 for leaders, 0.93 for administrative managers, and 0.91 for educators.
Educational needs for nursing management competency
Before analyzing the educational needs for nursing management competency, importance and performance were evaluated using the nursing management competency tool developed by Kim and Kim [30]. Responses were rated on a four-point Likert scale (importance: 1 = not at all important, 4 = very important; performance: 1 = never performs, 4 = performs very frequently). Higher scores indicated higher levels of importance and performance. Educational needs were analyzed using the Borich needs assessment method which identifies and prioritizes educational needs by comparing the importance of a competency with the current level. A higher required level (importance) and a lower current level (performance) indicate higher educational needs. Additionally, the relative difficulty of each nursing management competency was evaluated using the same tool [30], on a four-point Likert scale (1 = very easy, 4 = very difficult). In this study, Cronbach’s alpha coefficients were 0.95 for importance, 0.96 for performance, and 0.96 for difficulty.
Data collection and ethical considerations
Data were collected after receiving approval from the Institutional Review Board of the first author’s university and of the G university hospital. Data were collected from April 1 to May 20, 2023. Prior to the surveys, permission was obtained from the department of nursing at the hospitals, and then the researcher personally visited the nurses to inform them about the purpose of the research and the data collection process. Participants were assured of their anonymity and confidentiality, and provided signed informed consent before taking part in the survey. Those who agreed to participate were given the choice of completing either a paper-based or online self-report questionnaire, based on their preference. The collected data were codified and used solely for research purposes. The questionnaires will be stored for three years after the conclusion of the study and then disposed of to maintain anonymity.
Data analysis
The collected data were analyzed using SPSS 25.0 (IBM Corp., Armonk, NY, USA). General characteristics, job-related characteristics, and level of nursing management competencies were analyzed using frequency, percentage, mean, standard deviation, and median. Differences between the importance and performance of each item of the nursing management competencies were analyzed using a paired sample t-test. Educational needs for nursing management competencies were assessed using means and standard deviations, rank analysis, the Borich needs assessment method, and the LFM. The Borich needs assessment formula is as follows:
$${\rm{Borich}}\,{\rm{needs}}\,{\rm{score}} = {{\left\{ {\Sigma \left( {RL - PL} \right) \times \overline {RL} } \right\}} \over N}$$
RL: required level (importance), PL: present level (performance), \(\overline {RL}\): average of the required level, N: total number of cases
The LFM was analyzed using a scatterplot distribution of Borich needs scores to prioritize educational needs on the x-y plane. The vertical axis represented the discrepancy between the RL (importance) and PL (performance), with the mean of the discrepancy as the midpoint. The horizontal axis represented the RL (importance), with the mean importance level as the center [20]. By creating a coordinate plane with these two axes and dividing it into quadrants using the mean values of each axis, we employed a visual method to determine priorities by plotting the coordinates as points in the respective quadrants. Therefore, items that fell into the high discrepancy, high importance quadrant (HH, Quadrant I), are the highest priority as they are crucial and require significant improvement. Items in the low importance, high discrepancy quadrant (LH, Quadrant II) are considered a lower priority compared to high importance items, even if the discrepancy is significant. Items in the Low importance, low discrepancy quadrant (LL, Quadrant III), are not considered a priority since neither the importance nor the need for improvement is high. Items in the high importance, low discrepancy quadrant (HL, Quadrant IV) are, despite their high importance, close to the required level, indicating little need for immediate action [18]. High reasons priority items for educational needs were determined by identifying the highest and second-highest priority items through the overlap between the Borich needs assessment and the HH quadrant of the LFM [18, 32].
Results
General and job-related characteristics
Participants were from general (51.6%) and tertiary hospitals (48.4%), averaging 41.03 ± 6.58 years old, with 94.8% being women. More than a third had a master’s degree (36.1%) and Their average clinical experience was 17.58 ± 6.79 years, with 4.51 ± 3.56 years as nursing managers, and 3.20 ± 2.80 years in their current department. They supervised an average of 20.85 ± 11.62 nursing staff and 1.16 ± 1.99 nursing assistants. Over half (54.8%) reported overtime in the past week. Promotion training had been given to 45.8%, averaging 1.56 ± 1.32 days, mainly in leadership (83.1%) and communication (73.2%). Less than 50% received training in other areas such as information (46.5%) and budget management (26.8%). Participation in hospital management was rated low by 53.5% and high by 46.5% (Table 1).
Table 1
General and job-related characteristics (n = 155)
Characteristic | Categories | n | % | Mean ± SD | Range |
|---|---|---|---|---|---|
Age (years) | ≤ 34 | 22 | 14.2 | 41.03 ± 6.58 | 27–57 |
35–39 | 48 | 31.0 | |||
40–44 | 40 | 25.8 | |||
≧ 45 | 45 | 29.0 | |||
Gender | Female | 147 | 94.8 | ||
Male | 8 | 5.2 | |||
Marital status | Single | 28 | 18.1 | ||
Married | 127 | 81.9 | |||
Educational level | Diploma | 29 | 18.7 | ||
Bachelor’s degree | 70 | 45.2 | |||
≧Master’s degree | 56 | 36.1 | |||
Hospital type (beds) | General (100–300 beds) | 80 | 51.6 | ||
Tertiary ( ≧ 900 beds) | 75 | 48.4 | |||
Work unit | Ward | 90 | 58.1 | ||
Special unit1 | 51 | 32.9 | |||
Outpatient department | 14 | 9.0 | |||
Total clinical career (years) | 5–9 | 15 | 9.7 | 17.58 ± 6.79 | 5.00–36.50 |
10–14 | 40 | 25.8 | |||
15–19 | 44 | 28.4 | |||
≧ 20 | 56 | 36.1 | |||
Career as nurse manager (years) | < 2 | 39 | 25.2 | 4.51 ± 3.56 | 0.25–20.00 |
2–4 | 50 | 32.3 | |||
≧ 5 | 66 | 42.6 | |||
Career as nurse manager in current unit (years) | < 2 | 65 | 41.9 | 3.20 ± 2.80 | 0.25–14.08 |
2–4 | 51 | 32.9 | |||
≧ 5 | 39 | 25.2 | |||
Span of control: nurse | ≦ 15 | 57 | 36.8 | 20.85 ± 11.62 | 2–82 |
16–20 | 44 | 28.4 | |||
≥ 21 | 54 | 34.8 | |||
Span of control: nurse aid | 0 | 78 | 50.3 | 1.16 ± 1.99 | 0–9 |
1 | 50 | 32.3 | |||
≥ 2 | 27 | 17.4 | |||
Span of control: other | 0 | 95 | 61.3 | 0.83 ± 1.96 | 0–14 |
1 | 40 | 25.8 | |||
≥ 2 | 20 | 12.9 | |||
Weekly work (hours) | ≤ 40 | 106 | 68.4 | 42.03 ± 4.80 | 10–57 |
≥ 41 | 49 | 31.6 | |||
Overtime in the past week | Yes | 85 | 54.8 | ||
No | 70 | 45.2 | |||
Promotion training for nurse manager | Yes | 71 | 45.8 | ||
No | 84 | 54.2 | |||
Promotion training period (days; n = 71) | 1 | 54 | 76.1 | 1.56 ± 1.32 | 1–7 |
≥ 2 | 17 | 23.9 | |||
Promotion training content (n = 71, multiple responses) | 1) Hospital introduction | 27 | 38.0 | ||
2) Material management | 45 | 63.4 | |||
3) Leadership | 59 | 83.1 | |||
4) Communication skills | 52 | 73.2 | |||
5) Information management | 33 | 46.5 | |||
6) Quality improvement | 32 | 45.1 | |||
7) Infection control | 32 | 45.1 | |||
8) Budget management | 19 | 26.8 | |||
9) Human resource management | 41 | 57.7 | |||
10) Professional knowledge | 14 | 19.7 | |||
11) Safety management | 37 | 52.1 | |||
12) Environmental management | 37 | 52.1 | |||
13) Self-management | 22 | 31.0 | |||
14) Performance management | 28 | 39.4 | |||
15) Preparation for healthcare institution evaluation | 21 | 29.6 | |||
Degree of participation of nurse managers in hospital operation | Low (≤ 2.67) | 83 | 53.5 | 2.69 ± 0.36 (Median 2.67) | 1.89–3.78 |
High (> 2.67) | 72 | 46.5 |
Educational needs for nursing management competencies: importance, performance, and difficulty
The importance of nursing management competencies had an average score of 3.39 ± 0.33, performance had an average score of 2.76 ± 0.49, and difficulty had an average score of 2.43 ± 0.44. The order of importance for the domains was as follows: leader, administrative manager, clinical expert, and educator. The order of performance for the domains was as follows: clinical expert, leader, administrative manager, and educator. The order of difficulty for the domains was as follows: educator, leader, administrative manager, and clinical expert (Table 2) (Fig. 1).
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Table 2
Importance, performance, and difficulty scores for nursing management competency items (n = 155)
Domain | Item | Importance | Performance | Importance-Performance | t | p | Difficulty |
|---|---|---|---|---|---|---|---|
Mean ± SD | Mean ± SD | Mean ± SD | Mean ± SD | ||||
Clinical expert | 1. Establishment and improvement of the latest evidence-based practice guidelines and patient care standards within the nursing unit. | 3.29 ± 0.55 | 2.65 ± 0.64 | 0.64 ± 0.70 | 11.34 | < 0.001 | 2.48 ± 0.65 |
2. Guidance in nursing provision using the nursing process. | 3.32 ± 0.56 | 2.79 ± 0.64 | 0.53 ± 0.65 | 10.17 | < 0.001 | 2.32 ± 0.62 | |
3. Observation and guidance for the safe and accurate performance of nursing duties. | 3.56 ± 0.52 | 3.12 ± 0.65 | 0.45 ± 0.68 | 8.20 | < 0.001 | 2.23 ± 0.64 | |
4. Activities for the prevention of safety incidents, especially with high-risk patients, and seeking strategies to prevent recurrences. | 3.63 ± 0.57 | 3.06 ± 0.72 | 0.56 ± 0.75 | 9.34 | < 0.001 | 2.38 ± 0.70 | |
5. Ensuring the accuracy and appropriateness of handovers and nursing records through inspection and guidance. | 3.53 ± 0.55 | 3.19 ± 0.73 | 0.34 ± 0.70 | 6.00 | < 0.001 | 2.22 ± 0.65 | |
6. Information exchange and appropriate resolution with related departments and clinical departments involved in patient care. | 3.42 ± 0.51 | 3.01 ± 0.69 | 0.41 ± 0.73 | 6.96 | < 0.001 | 2.30 ± 0.67 | |
7. Development of patient education materials and effective teaching. | 3.31 ± 0.55 | 2.56 ± 0.81 | 0.75 ± 0.83 | 11.27 | < 0.001 | 2.52 ± 0.67 | |
8. Counseling of clients, supporting decision-making, and providing emotional support. | 3.42 ± 0.53 | 2.94 ± 0.71 | 0.48 ± 0.78 | 7.58 | < 0.001 | 2.31 ± 0.62 | |
9. Guidance for the practice of patient-centered nursing. | 3.45 ± 0.54 | 2.88 ± 0.74 | 0.57 ± 0.77 | 9.14 | < 0.001 | 2.45 ± 0.69 | |
10. Inspection and guidance for appropriate admission and discharge nursing care. | 3.46 ± 0.54 | 3.06 ± 0.78 | 0.41 ± 0.86 | 5.90 | < 0.001 | 2.15 ± 0.58 | |
11. Participation in evidence-based practice, quality improvement, and clinical nursing research to improve nursing practice. | 3.16 ± 0.59 | 2.45 ± 0.85 | 0.71 ± 0.88 | 10.01 | < 0.001 | 2.61 ± 0.74 | |
Sub total | 3.41 ± 0.36 | 2.88 ± 0.50 | 2.26 ± 0.48 | ||||
Leader | 12. Lead and exemplify the practice of the hospital and nursing department’s vision and core values. | 3.19 ± 0.56 | 2.62 ± 0.79 | 0.57 ± 0.85 | 8.29 | < 0.001 | 2.60 ± 0.66 |
13. Establish, implement, and evaluate annual, monthly, and weekly work plans within the nursing unit. | 3.15 ± 0.53 | 2.48 ± 0.85 | 0.67 ± 0.88 | 9.45 | < 0.001 | 2.59 ± 0.71 | |
14. Coordinate and collaborate with patients, nursing staff, medical staff, and other departments to achieve common goals. | 3.37 ± 0.55 | 2.80 ± 0.78 | 0.57 ± 0.81 | 8.68 | < 0.001 | 2.59 ± 0.65 | |
15. Share new policies and information with nursing staff, gather their opinions, and make suggestions to the nursing headquarters. | 3.36 ± 0.51 | 2.69 ± 0.82 | 0.67 ± 0.87 | 9.62 | < 0.001 | 2.54 ± 0.70 | |
16. Identify root causes of problems, report promptly, and find reasonable solutions. | 3.64 ± 0.55 | 3.00 ± 0.67 | 0.64 ± 0.75 | 10.53 | < 0.001 | 2.35 ± 0.70 | |
17. Encourage nursing staff to freely express their opinions and support their participation in decision-making. | 3.54 ± 0.56 | 3.00 ± 0.72 | 0.54 ± 0.78 | 8.60 | < 0.001 | 2.34 ± 0.72 | |
18. Recognize the abilities and characteristics of nursing staff and delegate roles accordingly. | 3.49 ± 0.55 | 2.84 ± 0.75 | 0.65 ± 0.84 | 9.63 | < 0.001 | 2.36 ± 0.63 | |
19. Understand the grievances of nursing staff, make efforts to resolve them, and utilize available resources. | 3.52 ± 0.54 | 2.90 ± 0.76 | 0.62 ± 0.81 | 9.54 | < 0.001 | 2.43 ± 0.66 | |
20. Create an atmosphere where nursing staff can work happily and with mutual trust. | 3.66 ± 0.50 | 3.14 ± 0.69 | 0.52 ± 0.78 | 8.30 | < 0.001 | 2.28 ± 0.68 | |
Sub total | 3.43 ± 0.36 | 2.83 ± 0.55 | 2.45 ± 0.49 | ||||
Administrative manager | 21. Development and implementation of plans for securing resources (staff, equipment, space, budget, etc.) necessary for nursing tasks. | 3.48 ± 0.56 | 2.60 ± 0.82 | 0.88 ± 0.93 | 11.77 | < 0.001 | 2.68 ± 0.71 |
22. Allocation of appropriate nursing staff based on nursing requirements and adjusts tasks. | 3.59 ± 0.55 | 2.72 ± 0.78 | 0.88 ± 0.95 | 11.51 | < 0.001 | 2.72 ± 0.68 | |
23. Evaluation of nursing staff competency and performance. | 3.33 ± 0.54 | 2.53 ± 0.80 | 0.80 ± 0.86 | 11.54 | < 0.001 | 2.44 ± 0.67 | |
24. Creation of nursing staff work schedules, attendance, and accumulated time management. | 3.49 ± 0.53 | 2.84 ± 0.94 | 0.65 ± 0.98 | 8.30 | < 0.001 | 2.32 ± 0.79 | |
25. Maintenance and management to ensure the appropriate use of medications, medical devices, and supplies. | 3.52 ± 0.56 | 3.07 ± 0.71 | 0.45 ± 0.72 | 7.78 | < 0.001 | 2.16 ± 0.62 | |
26. Maintenance and management of a safe and therapeutic work environment. | 3.63 ± 0.52 | 3.12 ± 0.70 | 0.52 ± 0.70 | 9.23 | < 0.001 | 2.27 ± 0.67 | |
27. Record keeping, including patient records, management of related documents, and maintenance of information security. | 3.42 ± 0.56 | 2.97 ± 0.72 | 0.45 ± 0.74 | 7.60 | < 0.001 | 2.25 ± 0.65 | |
28. Participation in various committees within and outside of the nursing department and Task Force Team activities. | 3.06 ± 0.61 | 2.33 ± 0.90 | 0.74 ± 0.88 | 10.37 | < 0.001 | 2.63 ± 0.69 | |
29. Assessment and management of nursing unit performance, including performance indicators. | 3.12 ± 0.56 | 2.40 ± 0.92 | 0.72 ± 0.92 | 9.72 | < 0.001 | 2.55 ± 0.70 | |
30. Assistance to patients and families in understanding hospital regulations, identifying and resolving complaints from dissatisfied customers. | 3.39 ± 0.56 | 2.84 ± 0.82 | 0.55 ± 0.81 | 8.46 | < 0.001 | 2.58 ± 0.74 | |
31. Ensuring that nursing staff work in a safe environment and engaging in activities to prevent accidents. | 3.66 ± 0.54 | 2.96 ± 0.69 | 0.70 ± 0.72 | 11.98 | < 0.001 | 2.37 ± 0.69 | |
32. Conducting other necessary management tasks within the nursing unit. | 3.34 ± 0.57 | 2.91 ± 0.78 | 0.43 ± 0.83 | 6.49 | < 0.001 | 2.30 ± 0.69 | |
Sub total | 3.42 ± 0.37 | 2.77 ± 0.58 | 2.44 ± 0.47 | ||||
Educator | 33. Planning, operating, and evaluating education programs organized by the nursing unit or team. | 3.19 ± 0.58 | 2.37 ± 0.81 | 0.81 ± 0.81 | 12.46 | < 0.001 | 2.61 ± 0.73 |
34. Establishing, implementing, and evaluating career-based nurse competency development plans. | 3.27 ± 0.51 | 2.34 ± 0.87 | 0.93 ± 0.88 | 13.09 | < 0.001 | 2.58 ± 0.73 | |
35. Managing the training of new employees according to standardized on-site training guidelines. | 3.52 ± 0.54 | 2.78 ± 0.82 | 0.74 ± 0.91 | 10.12 | < 0.001 | 2.30 ± 0.76 | |
36. Evaluating nursing student practicums and participating in outsourced education. | 3.19 ± 0.52 | 2.56 ± 0.85 | 0.63 ± 0.85 | 9.21 | < 0.001 | 2.29 ± 0.69 | |
37. Developing nursing staff educational materials and programs and participating in instructor activities. | 3.11 ± 0.61 | 2.29 ± 0.90 | 0.82 ± 0.96 | 10.66 | < 0.001 | 2.70 ± 0.73 | |
38. Completing education to enhance competency as a manager and participating in external activities. | 3.19 ± 0.58 | 2.25 ± 0.83 | 0.94 ± 0.79 | 14.82 | < 0.001 | 2.63 ± 0.72 | |
Sub total | 3.24 ± 0.43 | 2.43 ± 0.69 | 2.52 ± 0.58 |
Fig. 1
The level of importance, performance, difficulty in nursing management competency
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The nursing management competency items with the highest importance were from the administrative manager and leader domains: “Ensuring that nursing staff work in a safe environment and engage in activities to prevent accidents” (3.66 ± 0.54 points) and “Create an atmosphere where nursing staff can work happily and with mutual trust” (3.66 ± 0.50 points). The item with the highest performance was in the clinical expert domain: “Ensuring the accuracy and appropriateness of handovers and nursing records through inspection and guidance” (3.19 ± 0.73 points). In contrast, the items with the lowest performance were in the educator domain: “Completing education to enhance competency as a manager and participating in external activities” (2.25 points) and “Developing nursing staff educational materials and programs and participating in instructor activities” (2.29 points). The difference between importance and performance was significant for all items (p < .001). The highest-ranked difficulty was in the administrative manager domain: “Allocation of appropriate nursing staff based on nursing requirements and adjustment of tasks” (2.72 ± 0.68 points) and “Developing nursing staff educational materials and programs and participating in instructor activities” (2.70 ± 0.73 points) (Table 2).
Priority of educational needs for nursing management competencies: analysis of educational needs
In the Borich needs assessment, higher values of the required level (importance) and lower values of the current level (performance) resulted in higher educational need scores. The results revealed that the items with the highest educational need were “Appropriate nursing staff allocation, and task coordination based on nursing needs” in the administrative manager domain. Importance was rated at 3.59, whereas performance was rated at 2.72, resulting in an educational need of 3.15 points. The next highest educational need items were in the administrative manager and educator domains: “Development and implementation of plans for securing resources (staff, equipment, space, budget, etc.) necessary for nursing tasks” (3.05 points) and “Establishing, implementing, and evaluating career-based nurse competency development plans” (3.04 points), respectively (Table 3).
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Table 3
The priority of educational needs for nursing management competency based on Borich Needs Assessment and the LFM
Domain | Item and number | Borich | LFM | n | |
|---|---|---|---|---|---|
Needs score | Ranking | Quadrant | (%) | ||
ADM | 22. Allocation of appropriate nursing staff based on nursing requirements and adjusts tasks. | 3.15 | 1 | HH | 7 |
ADM | 21. Development and implementation of plans for securing resources (staff, equipment, space, budget, etc.) necessary for nursing tasks. | 3.05 | 2 | HH | (18.4) |
EDU | 35. Managing the training of new employees according to standardized on-site training guidelines. | 2.59 | 7 | HH | |
ADM | 31. Ensuring that nursing staff work in a safe environment and engaging in activities to prevent accidents. | 2.55 | 8 | HH | |
LD | 16. Identify root causes of problems, report promptly, and find reasonable solutions. | 2.32 | 11 | HH | |
LD | 18. Recognize the abilities and characteristics of nursing staff and delegate roles accordingly. | 2.27 | 13 | HH | |
ADM | 24. Creation of nursing staff work schedules, attendance, and accumulated time management. | 2.27 | 14 | HH | |
EDU | 34. Establishing, implementing, and evaluating career-based nurse competency development plans. | 3.04 | 3 | LH | 12 |
EDU | 38. Completing education to enhance competency as a manager and participating in external activities. | 3.00 | 4 | LH | (31.6) |
ADM | 23. Evaluation of nursing staff competency and performance. | 2.66 | 5 | LH | |
EDU | 33. Planning, operating, and evaluating education programs organized by the nursing unit or team. | 2.59 | 6 | LH | |
EDU | 37. Developing nursing staff educational materials and programs and participating in instructor activities. | 2.55 | 9 | LH | |
CE | 7. Development of patient education materials and effective teaching. | 2.48 | 10 | LH | |
LD | 15. Share new policies and information with nursing staff, gather their opinions, and make suggestions to the nursing headquarters. | 2.26 | 15 | LH | |
ADM | 28. Participation in various committees within and outside of the nursing department and Task Force Team activities. | 2.25 | 16 | LH | |
CE | 11. Participation in evidence-based practice, quality improvement, and clinical nursing research to improve nursing practice. | 2.24 | 17 | LH | |
ADM | 29. Assessment and management of nursing unit performance, including performance indicators. | 2.23 | 18 | LH | |
LD | 13. Establish, implement, and evaluate annual, monthly, and weekly work plans within the nursing unit. | 2.11 | 20 | LH | |
CE | 1. Establishment and improvement of the latest evidence-based practice guidelines and patient care standards within the nursing unit. | 2.10 | 21 | LH | |
EDU | 36. Evaluating nursing student practicums and participating in outsourced education. | 1.99 | 23 | LL | 5 |
Leader | 14. Coordinate and collaborate with patients, nursing staff, medical staff, and other departments to achieve common goals. | 1.9 | 25 | LL | (15.8) |
ADM | 30. Assistance to patients and families in understanding hospital regulations, identifying and resolving complaints from dissatisfied customers. | 1.86 | 28 | LL | |
LD | 12. Lead and exemplify the practice of the hospital and nursing department’s vision and core values. | 1.81 | 29 | LL | |
CE | 2. Guidance in nursing provision using the nursing process. | 1.75 | 30 | LL | |
ADM | 32. Conducting other necessary management tasks within the nursing unit. | 1.44 | 35 | LL | |
ADM | 26. Maintenance and management of a safe and therapeutic work environment. | 2.3 | 12 | HL | 13 |
LD | 19. Understand the grievances of nursing staff, make efforts to resolve them, and utilize available resources. | 2.18 | 19 | HL | (34.2) |
CE | 4. Activities for the prevention of safety incidents, especially with high-risk patients, and seeking strategies to prevent recurrences. | 2.04 | 22 | HL | |
CE | 9. Guidance for the practice of patient-centered nursing. | 1.96 | 24 | HL | |
LD | 20. Create an atmosphere where nursing staff can work happily and with mutual trust. | 1.91 | 26 | HL | |
LD | 17. Encourage nursing staff to freely express their opinions and support their participation in decision-making. | 1.89 | 27 | HL | |
CE | 8. Counseling of clients, supporting decision-making, and providing emotional support. | 1.63 | 31 | HL | |
ADM | 25. Maintenance and management to ensure the appropriate use of medications, medical devices, and supplies. | 1.59 | 32 | HL | |
CE | 3. Observation and guidance for the safe and accurate performance of nursing duties. | 1.59 | 33 | HL | |
ADM | 27. Record keeping, including patient records, management of related documents, and maintenance of information security. | 1.54 | 34 | HL | |
CE | 10. Inspection and guidance for appropriate admission and discharge nursing care. | 1.41 | 36 | HL | |
CE | 6. Information exchange and appropriate resolution with related departments and clinical departments involved in patient care. | 1.39 | 37 | HL | |
CE | 5. Ensuring the accuracy and appropriateness of handovers and nursing records through inspection and guidance. | 1.18 | 38 | HL | |
Prioritization of nursing management competencies based on borich needs assessment and the LFM
To determine the importance of nursing management competencies and the priority of educational needs, we analyzed the distribution of items in the LFM quadrants. The results identified seven items in Quadrant I (HH), 12 items in Quadrant II (HL), six items in Quadrant III (LL), and 13 items in Quadrant IV (HL; Table 3; Fig. 2).
Fig. 2
Distribution of educational needs for nursing management competency using the Locus for Focus Model. Note. HH = high importance, high discrepancy; HL = high importance, low discrepancy. LH = low importance, high discrepancy; LL = low importance, low discrepancy
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Comparing the Borich needs assessment scores and rankings with the priority areas identified using the LFM (Table 3) demonstrated that the highest priority educational need items were related to administrative manager competencies: “Allocation of appropriate nursing staff based on nursing requirements and adjusts tasks” (Borich: 3.15 points, LFM-HH) and “Development and implementation of plans for securing resources (staff, equipment, space, budget, etc.) necessary for nursing tasks” (Borich: 3.05 points, LFM-HH). The second-highest educational need items were in the educator area: “Establishing, implementing, and evaluating career-based nurse competency development plans” (Borich: 3.04 points, LFM-LH) and “Completing education to enhance competency as a manager and participating in external activities” (Borich: 3.00 points, LFM-LH).
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Discussion
This study aimed to identify the educational needs of nursing managers in hospitals by assessing the importance and performance of nursing management competencies and evaluating their difficulty levels to determine accurate training needs.
The findings showed the item with the highest importance score was “Ensuring that nursing staff work in a safe environment and engage in activities to prevent accidents” (within the administrative manager domain), which aligns with the results of previous research on the importance of nursing managers’ safety management competencies [30, 35]. This underscores the broader significance of nursing managers’ roles in ensuring safety for patients and staff, which is an essential focus area in nursing management competency education.
The item with the highest performance score was “Ensuring the accuracy and appropriateness of handovers and nursing records through inspection and guidance” (within the clinical expert domain). This was consistent with the results of Choi [36], who reported a high-performance score for on-site training tasks (4.3 points), and those of Yu and Jang [15], who reported a high-performance score for nursing task performance competencies (3.13 points). Therefore, nursing managers were significantly involved in providing direct nursing care in clinical settings. However, the item with the lowest performance score was “Completing education to enhance competency as a manager and participating in external activities” (within the educator domain). These results suggest variations based on the hospital environment and level of educational support, as studies targeting nursing managers at tertiary hospitals indicated higher performance of self-management competencies compared to this study [15, 35]. First-time or frontline nursing managers are frequently required to balance more patient-care duties and new management duties than senior-level administrators. However, the fact that nursing managers, as clinical experts, perform direct nursing duties in clinical settings rather than making decisions and providing administrative support indicates the need for reconsideration and education regarding managerial roles.
The item with the highest difficulty score was “Allocation of appropriate nursing staff based on nursing requirements and adjustment of tasks” (administrative manager domain), aligning with the previous study on the challenge of work schedule in nursing management [37]. Additionally, “Developing nursing staff educational materials and programs and participating in instructor activities” was also seen as very difficult. This highlights the need for better management and education on staffing and staff education competencies.
This study analyzed the educational need priorities using the Borich need assessment and the LFM. The results regarding the educational needs for nursing management competencies, were consistent with those of previous studies [31, 36, 37]. This implies that while all items constituting nursing management competencies were considered important, there was a notable difference in performance, suggesting a need to explore methods to improve performance based on the importance of the competency.
First, this study identified seven items in Quadrant I (HH). These items had a discrepancy value between importance and the current level that was higher than the average, as well as an importance level higher than the average. Among these seven items, four were related to the administrative manager domain, and none were related to the clinical expert domain. This suggests that despite the importance of administrative managers’ competencies, their performance was lacking. Notably, the first and second priorities for educational needs belonged to the administrative manager domain: “Allocation of appropriate nursing staff based on nursing requirements and adjustment of tasks” and “Development and implementation of plans for securing resources (staff, equipment, space, budget, etc.) necessary for nursing tasks.” This was consistent with previous studies [15, 31, 38], which indicate that nursing task analysis and staffing are among the most important educational needs.
Appropriate staffing is a critical for maintaining job satisfaction among nurses [39]. Work overload can cause a vicious cycle of turnover by increasing the intent to leave among experienced nurses [40]. Nursing managers consistently report that the shortage of nursing staff is a serious issue. Despite ongoing efforts to improve the working environment, the problem of insufficient numbers of nurses and a lack of experienced nurses remain unresolved in Korea [41]. Although managing human resources for nurses is likely to become increasingly challenging, there is a notable lack of concrete plans to develop specific alternatives for human resource management [42]. Therefore, it is crucial to prioritize educational strategies that support role transition and include competency development programs [2], focusing on areas such as human resource management and staffing, to enhance the competencies of nursing managers.
The second-priority area for education was identified as Quadrant II (LH) which included 12 items, accounting for 32.6% of the total items. These items had low importance but exhibited a significant discrepancy between performance and the required level. In other words, the LH quadrant contained items with an average value that was below the overall desirable average, and a high level of discrepancy, making it the next highest priority area after the HH quadrant. Most of the items included in this quadrant pertained to the educational domain; “Plan, operate, and evaluate nursing unit or team education programs,” “Establishing, implementing, and evaluating career-based nurse competency development plans,” “Develop nursing staff educational materials and educational programs,” “Participate in teaching activities,” and “Receive training to enhance competencies as a manager and participate in external activities.” Notably, the item with the highest priority for educational needs was “Establish, implement, and evaluate a competency development plan for nurses based on their career” within the educator domain. This aligns with previous findings regarding staff education competency in human resource management capabilities [30]. A systematic and strategic human resource management system for nurses would provide career development, acknowledges nurses’ professionalism, and offer appropriate compensation to retain experienced nurses with excellent competencies, thereby improving their quality [43, 44].
In this study, “Receive training to enhance competencies as a manager and participate in external activities” was identified as the item with the highest educational demand. External activities refer to active participation in nursing associations and academic societies, which helps nursing managers increase their competency as educators by acquiring the latest nursing knowledge. Therefore, nursing managers must continuously strive to develop and advance their careers. Furthermore, organizational support for effective role transition of new nursing managers is required to facilitate the development of educational competencies even after they become nursing managers [41, 45]. This study also found that the high priority competencies for educational needs also had high difficulty levels. This aligns with Kim’s [24] findings that accurately identifying educational needs involves measuring tasks that are frequently performed and considered important but also perceived as difficult by the participants. Therefore, future analyses of educational needs should consider the difference between importance and performance and include an analysis of difficulty to identify educational needs more accurately.
Among the participants, those with graduate degrees were the most prevalent (36.1%), which was consistent with the findings of previous studies [12, 29]. In some Korean hospitals, nursing managers are required to have a master’s degree or higher. In China, 6.7% of nursing managers hold graduate degrees [46]. In Taiwan, less than 25% of nursing managers hold master’s degrees [47, 48]. In South Korea, to become a nursing manager, an individual must be proficient in various roles, including patient, personnel, and resource management as well as academic activities. Moreover, organizations place a strong emphasis on performance. Consequently, nursing managers who do not engage in further study may be considered negligent in their duties. Therefore, many nursing managers consider pursuing external training, certification programs, or graduate education [49].
The pursuit of graduate education must be promoted to enhance the leadership knowledge and skills necessary to perform the role of a nursing manager [50]. Furthermore, previous studies have shown that nurses with postgraduate degrees have higher average competency levels than nurses with lower levels of education [51, 52]. Requiring advanced education for nursing manager positions and providing organizational support for nursing managers is an important first step in growing a leadership pipeline [2]. As such, as a foundation for the development of nursing manager competencies and the faithful execution of their roles, hospital organizations need to support higher education for nursing managers [11, 53].
Furthermore, we found that 45.8% of the participants had received education related to job promotion. This differed from the results of studies that focused on nursing managers in tertiary general hospitals, where approximately 56.2–59.3% of participants reported having received nursing management education related to their jobs [16, 37]. However, previous research indicates that not all nursing managers are adequately prepared for management positions [50]. Studies have shown that nurses in the hospitals in South Korea have a limited interest in career development and planning, as job promotions have historically been based on seniority [54, 55]. Internationally, the selection of nursing managers has been based largely on clinical expertise rather than managerial skills or leadership abilities [56]. Managers are expected to acquire managerial skills through experience after taking on their roles [45]. In some cases, individuals without formal managerial training are promoted to management positions based on strong clinical performance or upon reaching tenure [57]. Therefore, a support system is necessary for new managers to adapt, as opportunities for administrative education are lacking and difficulties exist in learning communication skills and empathy [53]. Nevertheless, nursing management competencies can be learned through education and enhanced through appropriate training [58]. The results of this study and previous research highlight the necessity to provide systematic managerial education to enhance nursing management competencies in nursing organizations. Moreover, nurse executives should lead changes to organizational policies and practices to improve nursing manager role transition and onboarding. Warshawsky et al. [45] argued that nurse executives should ensure the availability of 6–12-month formal onboarding or competency-based residency programs to support nursing managers’ transition into their roles. Program content and delivery models require regular role preparation support. In this study, nursing manager promotion education contents included leadership (83.1%), communication (73.2%), supply management (63.4%), human resource management (57.7%), environmental management (52.1%), and safety management (52.1%). Conversely, education on information management, quality improvement activities, infection control, performance management, self-management, budget management, and professional knowledge was below 50%. These results are somewhat similar to those of previous studies [11, 14]. Lee et al. [11] found that leadership was the most common content in nursing manager education, and Yu and Jang [14] reported that patient safety education (73.7%) was frequently conducted. Therefore, additional education related to overall hospital organizational performance, budget management, and professional knowledge that appeared with low frequency in this study is necessary for nursing managers.
Limitations
This study had some limitations. The participants were nursing managers in charge of nursing units at one tertiary general hospital and six general hospitals in a provincial area, and this study relied on self-reported questionnaires from respondents, which may affect the validity of the results. Furthermore, due to the cross-sectional nature of this study, causality cannot be established. However, this study is significant in that it is the first to analyze the educational needs of the latest nursing management competencies among nursing managers in regional hospitals in South Korea, utilizing the Borich needs assessment and LFM. Moreover, this study highlights the necessity of enhancing human resource management competencies for administrative managers and educators, along with the need for improved education in these areas.
Conclusions
This study revealed that there is a high demand among nursing managers in South Korea for education on how to plan and implement strategies to secure resources, such as the workforce, equipment, space, and budget, required for nursing tasks, as well as how to allocate appropriate nursing staff based on nursing needs and task coordination. In addition, as the duration and content of promotional education for nursing managers are insufficient, future research should develop and apply systematic managerial capacity training programs to strengthen human and material resource management capacities in hospitals and verify their effectiveness. Furthermore, more extended research that varies by region and hospital size should be conducted to substantiate the outcomes of this study.
Acknowledgements
We extend our gratitude to the participants of this study. In addition, we would like to thank Editage Korea for assisting with English language editing.
Declarations
Ethics approval and consent to participate
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Gyeongsang National University (GIRB-A23-NY-0014) and Gyeongsang National University Hospital (GNUH 2023-03-005). Informed consent was obtained from all subjects involved in the study before data collection.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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