A STUDY OF COMPETENCY OF NURSES IN A GENERAL INTENSIVE CARE UNIT BASED ON CAREER LADDER, MID-LEVEL REFERRAL HOSPITALS

Abstract

This descriptive study aimed to explore the competencies of nurses working in general intensive care units (GICUs) based on the career ladder in M2-level secondary hospitals, using the Delphi technique. A total of 23 experts were selected from six professional groups: three critical care physicians, three GICU management experts, three nursing administration experts, three academic experts, seven critical care nursing specialists, and four advanced practice nurses. Data were collected in three rounds. In Round 1, experts were interviewed regarding the competencies of GICU nurses at three levels: operational, proficient, and expert. In Round 2, the interview data were analyzed to develop a questionnaire used to assess the importance of each competency. Median and interquartile ranges were calculated. In Round 3, experts reviewed and confirmed their opinions using the revised questionnaire, and the median and interquartile ranges were re-analyzed to finalize the findings.

The findings revealed seven core competencies for GICU nurses in M2-level secondary hospitals: 1) critical care nursing, 2) high-alert medication management, 3) communication and coordination for patient care, 4) complication prevention and management, 5) end-of-life care for critically ill patients, 6) utilization of medical devices and health informatics, and 7) quality management and care control. While these core competencies were consistent across all nursing levels, differences were observed in sub-competencies: 1) Operational-level nurses focused on basic care under the supervision of experienced nurses or preceptors; 2) Proficient-level nurses applied in-depth knowledge to manage complex cases and collaborated effectively within multidisciplinary teams; and 3) Expert-level nurses were capable of managing highly complex cases, resolving urgent problems, and advancing nursing practices through evidence-based approaches.

These findings can serve as a conceptual framework for developing competency-based performance assessment tools aligned with career ladder levels. Furthermore, nursing administrators may use these results to guide workforce planning and task allocation based on the competencies of nurses at each professional level.