Content area
Aim
To develop and validate a self-rated scale for evaluating the core competencies of clinical nurse educator (CNE).
Background
The competency of CNE is critical in ensuring the quality of clinical internship training and lifelong nursing education. Currently, we lack validated evaluation tools to measure CNE’s competency.
Design
Scale development and validation.
Methods
Guided by core competency theory and previous constructed Chinese CNEs’ core competency, a draft scale was constructed in October 2023 after literature review. Through Delphi consultation from January to May 2024, the initial version of the scale was developed. Following a pilot survey in May 2024, through data collection from June to July 2024, the scale was refined using item analysis, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).
Results
Data from 601 CNEs were analyzed. The final 35-item scale comprised four dimensions: clinical nursing skills (7 items), clinical teaching competency (9 items), management and leadership competency (15 items) and innovation and research competency (4 items). Item was rated on a 5-point Likert scale. The scale demonstrated strong psychometric properties: total Cronbach’s α = 0.975 (subdimensions: 0.870–0.966), split-half reliability = 0.940, test-retest reliability = 0.833 and content validity index = 1.00. CFA results confirmed acceptable model fit (χ²/df = 2.023, RMR = 0.022, RMSEA = 0.059, TLI = 0.931, CFI = 0.937).
Conclusion
The developed scale exhibits robust reliability and validity, providing a scientifically grounded tool for self-assessing CNEs’ core competencies. It may be a reference for CNE selection, training and evaluation in clinical settings.
1 Introduction
With the increasing global emphasis on universal health coverage ( World Health Organization, 2015), the growing aging population and the rising number of patients with complex chronic diseases have led to a surge in the demand for nursing services. Meanwhile, continuous advances in medical technology have driven improvements in the quality of nursing care ( Soares et al., 2018). Together, these factors place higher demands on nursing education and workforce development. In China, the number of registered nurses has risen from 4.71 million in 2020–5.86 million in 2024 ( National Bureau of Statistics, 2025). This rapid expansion indicates that a large number of novice nurses will soon join the workforce. Accelerating their professional development to meet clinical needs has become a pressing challenge for healthcare institutions. Consequently, clinical nursing education and training have emerged as key strategies for promoting high-quality hospital development and enhancing institutional competitiveness ( Feng et al., 2023).
The role definition of clinical nurse educators (CNEs) varies considerably across countries. For instance, Lachat et al. (1992) described the clinical educator as jointly appointed by hospitals and universities, responsible for both staff development and undergraduate nursing student supervision to bridge the gap between education and practice. In the United States, the National League for Nursing (NLN) introduced the role of the Academic Clinical Nurse Educator in 2018, requiring specific certification before taking on clinical teaching responsibilities ( Christensen and Simmons, 2019). Other literature emphasizes that CNEs focus on facilitating staff development, delivering nursing skills and knowledge training, providing solutions to clinical issues and establishing policies and procedures to support professional growth, particularly for newly graduated nurses ( Mateo and Fahje, 1998; Brennan and Olson, 2018; Schipper, 2011). Notably, in many countries, CNEs do not engage in routine bedside care but dedicate their time exclusively to teaching and educational management. In contrast, in China, CNEs are dual-role practitioners who provide direct patient care while simultaneously supervising nursing students and coordinating continuing education for in-service nurses ( Feng and Wan, 2009; Hou and Zhu, 2008). This unique positioning makes them a cornerstone for ensuring teaching quality and promoting the overall competence of the nursing workforce ( Tan et al., 2021; Chen et al., 2019; Jiang et al., 2022).
Given the differences in role expectations, the core competency requirements for CNEs also vary across countries. Lemetti et al. (2023), through a review of literature published between 2000 and 2020, identified 19 international assessment tools for nurse educator competencies. These tools predominantly focus on three domains: teaching, clinical nursing and management/leadership skills. However, most studies reported only basic psychometric properties such as face validity, content validity and internal consistency, with limited application of standardized reporting guidelines. Furthermore, the choice of assessment tool should align with the theoretical and cultural context where CNEs practice, emphasizing the importance of developing context-specific measures.
In China, research on CNE competency assessment remains limited, with only two relevant studies identified ( Tao, 2019; Ye et al., 2022). Our research team previously developed a preliminary competency framework for Chinese CNEs in 2019 using focus group interviews and Delphi consultation ( Tao, 2019). This framework included four first-level domains—clinical nursing, clinical teaching, management and leadership and scientific innovation—further divided into 16 s-level indicators and 57 sub-items. However, it has not yet been translated into a validated measurement tool and given the evolving demands of clinical nursing education, some content requires further refinement and updating. Another study by Ji (2020) developed and tested a competency scale, but due to COVID-19 restrictions, the sample was limited to CNEs from only two provinces. Moreover, some items were ambiguously worded and poorly categorized, limiting the tool’s clarity and practical applicability.
These gaps highlight the urgent need for a scientifically rigorous, culturally relevant and psychometrically sound tool to evaluate the competencies of Chinese CNEs. Therefore, guided by the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) framework, this study aimed to develop and validate a self-rated scale for assessing the core competencies of CNEs. This tool will provide an evidence-based foundation for the selection, training and evaluation of CNEs, ultimately enhancing the quality of clinical nursing education, fostering nursing professional development and improving the overall competency of the nursing workforce.
2 Methods
This study was conducted in five sequential phases to develop and validate the Self-Rated Scale for Core Competencies of CNEs, based on the theoretical framework of CNEs' core competencies previously studied by our team.
2.1 Establishment of the research team
The research team consisted of five members, including a Chief Nurse, an Associate Chief Nurse, a Charge Nurse and two Staff Nurses. The team composition included one PhD holder, one Master's degree holder and three Master's degree candidates. Team members were responsible for conducting literature reviews, developing survey instruments and Delphi consultation questionnaires, performing data analysis and discussing expert opinions as part of the research activities.
2.2 Literature review
We conducted a literature review in PubMed, Web of Science, Embase, OVID, CINAHL and China’s databases, including CBM, CNKI, VIP and Wanfang in January 2023. The search was conducted from the inception of each database until December 2022. The search terms used were a combination of MeSH and free-text terms, including "clinical educator*", "clinical nurse educator*", "nurse educ-ator*", "clinical nursing teacher*", "clinical Instructor*", "nursing professional development educator*", "NPD educator*", "nursing professional development practitioner*", "NPD practitioner*", capacit*, abilit*, competenc*, "core competenc*", evaluate, evaluation, scale, questionnaire, tool. Taking Web of Science as an example, the detailed search strategy is: ((TS=("clinical educator*" OR "clinical nurse educator*" OR "nurse educator*" OR "clinical nursing teacher*" OR "clinical instructor*" OR "nursing professional development educator*" OR "NPD educator*" OR "nursing professional development practitioner*" OR "NPD practitioner*")) AND TS= (capacit* OR abilit* OR competenc* OR "core competenc*")) AND TS= (evaluate OR evaluation OR scale OR questionnaire OR tool). Based on the findings of this review and our research team’s previously developed CNE core competency framework, the draft version of the self-rated CNE core competency Scale was formulated in October 2023.
2.3 Expert consultation
The initial version of the self-rated scale for core competencies of CNE was developed through the Delphi expert consultation method from January to May 2024. The inclusion criteria for experts were as follows: (1) Nursing Education Management Experts: Minimum ten years of clinical nursing experience and 5 years of nursing education management experience; Associate Chief Nurse title or higher; bachelor's degree or higher. (2) Clinical Nursing Management Experts: Minimum 10 years of clinical nursing experience and 5 years of clinical nursing management experience; Associate Chief Nurse title or higher; bachelor's degree or higher; position as head nurse or above. (3) Clinical Nursing Education Experts: Minimum 10 years of clinical nursing education experience; Charge Nurse title or higher; bachelor's degree or higher.
Based on the draft scale, a first-round expert consultation questionnaire was developed, which included the research background and objectives, definition and responsibilities of clinical nurse educators, the development process of the draft scale, the purpose of the expert consultation, instructions for completion and contact information. The questionnaire consisted of two main sections:
(1) Expert Consultation Form for the Self-rated Scale for Core Competencies of CNE: This included all items of the scale. Experts were asked to rate the importance and relevance of each item using a 5-point Likert scale (1 = very unimportant to 5 = very important). Space was provided for experts to suggest modifications, additions, or deletions.
(2) Expert Information Survey: This collected basic information about the experts, including professional title, education level, workplace, position, years of experience, as well as their judgment basis and familiarity with the topic.
The second and third-round questionnaires were revised based on the results of the previous rounds, with modified items indicated. Electronic questionnaires were distributed via WeChat or email. Data were analyzed using SPSS 22.0. The effective response rate measured the expert engagement rate. Expert Authority Level (Cr) was assessed using the authority coefficient. The concentration of Expert Opinions was evaluated through the mean scores and full score ratio of item importance and relevance. Coordination of Expert Opinions was measured using the coefficient of variation (CV) and Kendall's W. Items with a mean importance/relevance score > 3.5, full score ratio > 0.2 and CV < 0.25 were retained. Further revisions were made based on expert feedback and discussions within the research team.
2.4 Cognitive interviews
A purposive sampling method was employed to select 20 CNEs from a tertiary Grade A hospital in Zhejiang Province for the pilot survey in May 2024. Participants were invited to complete cognitive interviews after finishing the scale assessment. Inclusion criteria: (1) Officially appointed by the nursing department; and (2) Willing to participate in the study. Exclusion criteria: Individuals unavailable for clinical work during the survey period due to extended leave or other reasons. The verbal probing method was employed, where participants completed face-to-face, semi-structured interviews after completing the scale.
Prior to the interviews, the study purpose was explained and informed consent was obtained. Interviews were conducted in comfortable, quiet environments. Participants first completed the scale while their completion time was recorded. Subsequently, their understanding of scale items and key terms, as well as overall impressions and suggestions, were elicited.
All interviews were audio-recorded and promptly transcribed. The research team discussed and revised scale items based on interview findings. Data collection continued until saturation was reached (no new information emerged). The interview guide, developed through team discussion, included:
(1) General probing question: What are your overall impressions of this scale?
(2) Comprehension probing question: Are all items understandable? Could you explain certain items in your own words? (selected items were probed further)
(3) Comfort probing question: Did any items make you uncomfortable? Were there any hesitations during completion?
(4) Content probing question: Are all items relevant to the core competencies of clinical nurse educators? Does the scale comprehensively cover all essential competencies? Any additional suggestions?
Three interview rounds were conducted. Transcripts were carefully reviewed to extract significant statements about each item. Similar responses were merged, with recurring information or themes annotated and categorized. Any ambiguous statements were clarified with the original respondents when possible. Items with questionable validity were discussed by the research team for potential revision.
The pilot testing process yielded valuable insights for refining the scale's content validity and user acceptability before formal validation studies.
2.5 Validity and reliability analysis
Using convenience sampling, we recruited CNEs from Chinese tertiary A hospitals from June to July 2024. Inclusion required being formally appointed and willing to participate in the study. Those on extended leave were excluded. The sample size was calculated according to Kendall's estimation principle, which requires 5–10 times the number of variables ( Wu, 2022). For factor analysis, approximately 300 cases were needed ( Wu, 2010). Accounting for a potential 10 % invalid responses, a total of 506 questionnaires were planned for collection. The survey was administered via Wenjuanxing (an online survey platform) and consisted of two sections: (1) Demographic information included gender, age, ethnicity, marital status, education level, professional title, years of clinical experience and years serving as a CNE; and (2) The pilot version of the self-rated scale for core competencies of CNE. The platform settings restricted each participant to a single submission and required completion of all items. Two researchers independently verified all data prior to statistical analysis. SPSS 22.0 and AMOS 26.0 were used for data processing. The study conducted item analysis using critical ratio and homogeneity tests, assessed reliability through test-retest, Cronbach's α and split-half methods and evaluated validity via content validity and construct validity (exploratory/confirmatory factor analyses), which was in accordance with the recommendations ( Streiner and Kottner, 2014).
2.6 Ethical approval
This study was approved by the ethics committee of the local hospital (approved number: K2023071). All participants provided their consent to participate in the study.
3 Results
3.1 The result of literature review
The initial literature search identified 2957 articles. After removing duplicates, reviewing titles and abstracts and conducting full-text assessments with research team discussions, 11 relevant articles were ultimately included (8 Chinese and 3 English publications).
Building on the 57 connotations of 16 s-level specific competencies from our research team's previously established core competency framework for CNEs (
Ye et al., 2022) (
3.2 The result of expert consultation
The study involved nineteen female experts with a mean age of 45.58 (SD 6.94) years and an average professional experience of 24.05 (SD 8.64) years, among whom twelve held Associate Chief Nurse or higher professional titles. The expert consultation process achieved complete participation in both the first and second rounds, while the third round saw a response rate of 78.9 % with fifteen participants. The authority coefficients demonstrated high consistency, with values of 0.899 for the initial two rounds and 0.908 for the final round. Throughout the three consultation rounds, forty-three items underwent modification, while thirteen were either eliminated or consolidated. Employing a 5-point Likert scale ranging from "strongly agree" to "strongly disagree," the research team developed the initial version of the scale comprising forty-five items distributed across four competency domains: Clinical Nursing Skills (9 items), Clinical Teaching Competency (15 items), Management and Leadership Competency (15 items) and Innovation and Research Competency (6 items). Complete scoring details regarding item importance and relevance are available in
3.3 The result of cognitive interviews
The cognitive interview participants comprised 20 CNEs from tertiary hospitals. Most were senior nurses (18/20) with over 10 years of clinical experience (14/20) and 3–10 years of clinical teaching experience (10/20).
Three rounds of cognitive interviews were conducted with CNEs (n = 8,6,6 respectively). Participants generally understood all items and found the content comprehensive. Key revisions included: The item: " I have good emotional control ability and can use reasonable ways to reduce the work stress" was split into two separate items (emotional control and stress reduction) per two educators' suggestions; The adverb "well" was removed from the item: " I am well aware of my own strengths and weaknesses and make a reasonable career plan to promote my own development" to reduce response bias. No changes were made to the other three items, which the interviewees had commented on after our discussion. Data saturation was achieved after three rounds of data collection.
The pilot version of the scale contained 46 items across four dimensions: Clinical Nursing Skills (9 items), Clinical Teaching Competency (15 items), Management and Leadership Competency (16 items) and Innovation and Research Competency (6 items). Reverse-scored items (1–2 per dimension) were added to minimize response bias. Each item was rated on a 5-point Likert scale (1–5).
3.4 The result of validity and reliability analysis
3.4.1 Sample characterization
A total of 609 questionnaires were collected via Wenjuanxing, with 601 valid responses after excluding those from non-clinical departments or with incorrect information (98.7 % validity rate). The respondents included 22 males (3.7 %) and 579 females (96.3 %). The characteristics of the participants are shown in
3.4.2 Item analysis
The item analysis demonstrated satisfactory discriminative power, with all items showing statistically significant differences (t = 3.833–29.482, P-value <0.05) between high and low scorers in independent samples t-tests. Pearson correlation analysis revealed generally adequate item-total correlations (r = 0.155–0.828, P-value<0.01), though items 5, 14, 19, 33 were deleted due to suboptimal correlations (r < 0.4).
3.4.3 Validity and reliability analysis
3.4.3.1 Structural validity
The collected sample was randomly divided into two groups (n = 309 and n = 292) for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively.
(1) EFA results: Common factors were extracted using principal component analysis with varimax rotation. Items were removed based on the following criteria: factor loading (absolute value) ≤ 0.50, communality ≤ 0.20, fewer than three items per factor, or cross-loading with similar high values (
Wu, 2010). KMO test and Bartlett's sphericity test were performed before each factor analysis and the results showed that the KMO value was greater than 0.9 and the Bartlett sphericity test was significant (
P-value < 0.001). Four common factors were extracted for analysis. As a result, items 40, 44, 2, 23, 25, 46 and 21 were deleted and items 22 and 24 were adjusted from the dimension “Clinical Teaching Competency” to the dimension “Management & Leadership Competency” after three analyses. Then, the remaining 35 items were used for the fourth analysis, the results showed that the communalities of all items’ ranged from 0.471 to 0.815, with a cumulative variance interpretation rate of 68.305 % and the factor loads of all items met the standard requirements (see
(2) CFA results
Using AMOS 26.0, a structural equation model was constructed with the second sample (n = 292), treating the 35 items as observed variables and the four competencies as latent variables. The model demonstrated good fit after modification (χ²/df = 2.023, RMR = 0.022, RMSEA = 0.059, TLI = 0.931, CFI = 0.937). Although the GFI and NFI were slightly below 0.90, other indices met the criteria, supporting robust structural validity. The revised model is shown in
3.4.3.2 Content validity
Six experts, comprising two nursing education administrators, two nursing managers and two clinical nurse educators (including two chief nurses and four associate chief nurses), evaluated item relevance using a 4-point scale. All items received scores of 3 or 4, yielding I-CVI = 1.000 and S-CVI = 1.000, indicating excellent content validity.
3.4.3.3 Reliability
The scale exhibited high internal consistency (Cronbach’s α= 0.975), with subscale α values of 0.874 (Clinical Nursing Skills), 0.940 (Clinical Teaching Competency), 0.966 (Management and Leadership Competency) and 0.870 (Innovation and Research Competency). The Split-half reliability was 0.940. In this study, 32 CNEs were investigated for the second measurement two weeks later to calculate the retest reliability, and the retest reliability was 0.833 (see
4 Discussion
This study followed the COSMIN Study Design checklist and based on our team’s previous research, developed a self-rated scale specifically designed to assess the core competencies of CNEs in China. The development process included a comprehensive literature review, Delphi expert consultations and cognitive interviews. The final scale consisted of four domains and 35 items : Clinical Nursing Skills (7 items), Clinical Teaching Competency (9 items), Management and Leadership Competency (15 items) and Innovation and Research Competency (4 items).
The scale showed outstanding internal consistency, with a Cronbach’s α of 0.975 for the overall scale and values ranging from 0.870 to 0.966 for the subscales. Split-half reliability (0.940) and two-week test-retest reliability (0.833) indicated strong temporal stability. Content validity, evaluated by six experts, achieved perfect scores for both I-CVI and S-CVI (1.000). Additionally, the scale demonstrated strong feasibility and acceptability, as evidenced by a high response rate (98.7 %) and positive feedback on item clarity during the pilot testing. Although most model fit indices indicated an acceptable fit, the GFI and NFI were slightly below the recommended threshold of 0.90, suggesting a moderate model fit. This insufficiency may be attributed to several factors. First, the final model contained 35 items across four latent variables, with an uneven distribution of items, particularly within the management and leadership domain. Second, the sample size for the CFA (n = 292) may have been relatively limited given the model’s complexity, which could have affected the stability of these indices. Additionally, the diverse backgrounds of participants from multiple hospitals may have introduced heterogeneity, further influencing model performance. Future research should consider refining the scale structure, increasing the sample size and including more homogeneous, multi-center samples to improve model fit and strengthen structural validity.
While our results share certain similarities with previously developed domestic and international instruments, there are also notable differences that reflect the unique roles and responsibilities of CNEs in China. The first dimension, clinical nursing skills, emphasizes the ability of CNEs to apply advanced nursing knowledge, provide standardized care and ensure patient safety. This finding is consistent with certain Chinese tools, such as the Master of Nursing Specialist Postgraduate Teacher's Ability Assessment Questionnaire developed by Wang et al. (2017), which included clinical nursing as one of its five core domains. In contrast, some international instruments do not include the evaluation of clinical practice skills, such as the Clinical Nurse Educator Skill Acquisition Assessment (CNESAA) developed by Nguyen et al. (2017) and the Nurse Educator Skill Acquisition Assessment (NESAA) by Ramsburg and Childress (2012). These instruments focus primarily on competencies related to teaching processes, curriculum development and leadership, reflecting a conceptualization of the nurse educator role as predominantly educational rather than clinical. Similarly, other tools may assess professional knowledge but still exclude direct bedside nursing competence. This distinction highlights the practical reality in China, where CNEs are expected to serve as role models by demonstrating clinical excellence while simultaneously maintaining high-quality patient care. Therefore, unlike these educator-centered tools, our scale integrates direct clinical practice as a central component, capturing the dual-role nature of Chinese CNEs, who are simultaneously responsible for both patient care and the supervision and education of nurses. Therefore, our tool may provide a reference for other countries where their CNEs assume similar job descriptions to ours.
The second dimension, clinical teaching competency, is one of the most identified domains in competency frameworks for nurse educators. It encompasses a broad range of teaching-related skills, including curriculum implementation, assessment of learning outcomes and supervision and guidance of students and staff in clinical settings. This dimension is conceptually similar to domains included in the Academic Clinical Nurse Educator Skill Acquisition Tool ( Shellenbarger and Sebach, 2022) and the CNESAA ( Nguyen et al., 2017), which were designed for faculty in academic institutions and hospital-based educators involved in students’ clinical training, respectively. Ramsburg et al. (2012) developed the NESAA based on the eight core competency areas proposed by the NLN, emphasizing the educator’s role in facilitating learning, promoting learner development and socialization, using assessment and evaluation strategies and participating in curriculum design and program outcome evaluation. Similarly, Nguyen et al. (2017) highlighted the importance of the nurse educator’s ability to help students integrate theoretical knowledge with clinical practice. Together, these findings underscore that clinical teaching competency is a fundamental and indispensable component of CNE roles, directly influencing the quality of clinical education and learner outcomes.
The third dimension, management and leadership, contains the largest number of items in the scale, reflecting the pivotal role of CNEs in organizational communication, coordination, leadership and professional development. This dimension encompasses core responsibilities, including coordinating nursing education, facilitating effective teamwork and leading continuous quality improvement initiatives. Previous Chinese instruments, such as those developed by Ren and Liu (2021)) and Wang et al. (2017), included management-related items but typically as smaller subscales or in combination with other domains, which limited their ability to fully reflect this competency area. The NESAA incorporates leadership and change-agent functions as key domains; however, these competencies are framed primarily in academic institutions rather than clinical practice environments. In contrast, our study integrates clinical education management with operational leadership, recognizing that Chinese CNEs must navigate complex responsibilities, including staff training, cross-department collaboration and the standardization of educational processes. This dual emphasis highlights the unique expectations placed on CNEs working in hospital settings—responsibilities that are not fully addressed by existing international tools.
The fourth dimension, innovation and research competency, was the smallest domain in our scale, but represents a critical area for the future development of nursing education. Items within this domain focus on evidence-based practice, the conduct and application of research and the promotion of professional growth. While instruments such as the Capabilities of Nurse Educators questionnaire by McAllister and Flynn (2016) and the NESAA include scholarship and research-related competencies, these measures are primarily designed for academic educators rather than clinicians. In contrast, our findings highlight the integration of research with clinical practice, encouraging CNEs to actively engage in innovation and directly apply research evidence to improve both patient care and teaching strategies. In China, previous tools have either overlooked this competency altogether or limited its evaluation to clinical instructors for master’s degree nursing students. By explicitly incorporating innovation and research ability, our scale addresses this gap and aligns with national priorities to advance nursing science and promote evidence-based practice in clinical settings.
In summary, while our four-factor structure shares common elements with existing scales, it is uniquely tailored to the dual-role responsibilities of Chinese CNEs. Unlike other tools that focus primarily on academic teaching or proprietorship, this scale captures the full spectrum of CNE responsibilities, from direct clinical care to teaching, management and research. These differences underscore the importance of developing culturally and contextually relevant instruments that reflect the realities of local healthcare systems. Future studies should further validate these dimensions across diverse clinical settings and explore their applicability to other healthcare contexts.
5 Limitations
This study has several limitations. First, the literature review for developing the initial item pool included only full-text articles in Chinese and English, which may have resulted in the omission of relevant tools published in other languages. Second, criterion validity and convergent validity were not assessed due to the lack of a gold standard and appropriate reference measures. Third, convenience sampling and self-reported data may have introduced sampling and information bias. Fourth, although most model fit indices indicated an acceptable fit, the GFI and NFI values were slightly below the recommended threshold of 0.90, suggesting a moderate model fit. Future studies should refine the model and use larger, multi-center and more diverse samples to improve fit and strengthen validity.
6 Conclusion
Developed through a combination of literature reviews, expert consultations, cognitive interviews and psychometric testing, this 35-item self-rated scale demonstrates strong reliability, validity, feasibility and practicality. It serves as a valuable tool for evaluating and promoting the core competencies of CNEs, ultimately enhancing the quality of clinical nursing education. Future research should further examine convergent validity and incorporate external evaluations from nursing managers and peers to strengthen the objectivity and comprehensiveness of competency assessment.
Ethical approval
This study was approved by the ethics committee of the local hospital (The Fourth Affiliated Hospital of Zhejiang University School of Medicine; No. K2023071).
Funding source
This study was supported by
CRediT authorship contribution statement
Junqing Chen: Writing – original draft. Lili Yang: Writing – review & editing, Supervision, Methodology, Conceptualization. Wang Jinyun: Writing – original draft, Methodology, Investigation, Formal analysis, Conceptualization.
Declaration of Competing Interest
The authors declare no potential conflict of interest concerning the research, authorship, and publication of this editorial.
Appendix A Supporting information
Supplementary data associated with this article can be found in the online version at
Appendix A Supplementary material
Supplementary material
Table 1
| First-level indices | Second-level specific competencies |
| 1.Clinical teaching competency | 1.1 Education and teaching theory |
| 1.2 Teaching assessment ability | |
| 1.3 Teaching design ability | |
| 1.4 Teaching implementation ability | |
| 1.5 Teaching evaluation ability | |
| 2.Clinical nursing skills | 2.1 Clinical nursing knowledge |
| 2.2 Clinical nursing operating skills | |
| 2.3 Ability to solve clinical problems | |
| 2.4 Critical thinking ability | |
| 3.Management and leadership competency | 3.1 Organization and coordination ability |
| 3.2 Self-management ability | |
| 3.3 Time management ability | |
| 3.4 Professional development ability | |
| 3.5 Leadership | |
| 4.Innovation and research competency | 4.1 Innovation |
| 4.2 Evidence-based nursing/practice |
Table 2
P ＜0.05.
| Round 1 | Round 2 | Round 3 | ||
| Importance | Mean score | 3.32–4.89 | 4.05–4.95 | 4.40–5.00 |
| Full score ratio | 31.58–94.74 % | 42.11–94.74 % | 40–100 % | |
| Coefficient of variation | 0.06–0.54 | 0.05–0.30 | 0–0.12 | |
| Kendall’ W | 0.165 * | 0.114 * | 0.287 * | |
| Relevance | Mean score | 3.42–5.00 | 4.11–4.89 | 4.40–5.00 |
| Full score ratio | 26.32–100 % | 42.11–94.74 % | 40–100 % | |
| Coefficient of variation | 0–0.55 | 0.06–0.28 | 0–0.12 | |
| Kendall’ W | 0.145 * | 0.120 * | 0.206 * |
Table 3
| Items | Number (%) | |
| Gender | Male | 22(3.7) |
| Female | 579(96.3) | |
| Age | 20–30 | 93(15.5) |
| 31–40 | 398(66.2) | |
| 41–50 | 103(17.1) | |
| > 50 | 7(1.2) | |
| Highest Education level | Vocational secondary diploma | 1(0.2) |
| Associate degree/Higher vocational diploma | 8(1.3) | |
| Bachelor's diploma | 567(94.3) | |
| Master's diploma | 25(4.2) | |
| Professional Titles | Nurse | 13(2.2) |
| Staff Nurse | 119(19.8) | |
| Charge Nurse | 371(61.7) | |
| Associate Chief Nurse | 97(16.1) | |
| Chief Nurse | 1(0.2) | |
| Work Experience | 3–5 years | 40(6.7) |
| 5–10 years | 125(20.8) | |
| ＞10 years | 436(72.5) | |
| Experience as CNE | ≤ 1 year | 83(13.8) |
| 1–3 years | 134(22.3) | |
| 3–5 years | 106(17.6) | |
| 5–10 years | 163(27.1) | |
| ＞10 years | 115(19.1) |
Table 4
| Item | Factor loading | Communalities | |||
| 1 | 2 | 3 | 4 | ||
| 1.I have a solid knowledge of basic nursing and related diseases, and can be integrated into clinical practice. | 0.221 | 0.319 | 0.556 | 0.277 | 0.536 |
| 3.I can skillfully use nursing procedures to care for patients' health and standardize records. | 0.316 | 0.240 | 0.717 | 0.229 | 0.723 |
| 4.I can skillfully use health education procedures, and communicate with patients and their families to implement health education. | 0.305 | 0.286 | 0.682 | 0.239 | 0.696 |
| 6.I can judge the existing and potential health problems of patients, do predictive nursing, and effectively organize and implement rescue. | 0.413 | 0.320 | 0.529 | 0.216 | 0.599 |
| 7.I have good professional ethics and accomplishment, take patients as the center and provide quality nursing services. | 0.227 | 0.090 | 0.774 | 0.077 | 0.665 |
| 8.I follow laws, regulations and ethical principles to carry out clinical practice. | 0.159 | 0.086 | 0.763 | 0.029 | 0.616 |
| 9.I love nursing career and am full of enthusiasm for nursing work. | 0.283 | 0.348 | 0.641 | 0.004 | 0.613 |
| 10.I can skillfully use the related knowledge of educational psychology to carry out clinical teaching activities. | 0.318 | 0.741 | 0.190 | 0.145 | 0.706 |
| 11.I can skillfully apply educational theory to teaching activities. | 0.308 | 0.800 | 0.206 | 0.197 | 0.815 |
| 12.I can correctly use the methods of educational needs assessment in clinical teaching, such as questionnaires, quality control reports, interviews and so on. | 0.240 | 0.654 | 0.254 | 0.330 | 0.658 |
| 13.I can make a teaching plan based on the clinical problems and the evaluation results of clinical teaching needs. | 0.415 | 0.607 | 0.245 | 0.261 | 0.668 |
| 15.I can adopt targeted education or training strategies in clinical teaching according to the results of comprehensive analysis. | 0.454 | 0.590 | 0.223 | 0.279 | 0.681 |
| 16.I can teach learners according to their learning ability and characteristics, and flexibly use appropriate teaching methods to implement teaching. | 0.460 | 0.587 | 0.288 | 0.212 | 0.684 |
| 17.I can use all kinds of teaching aids and information technology to implement clinical teaching. | 0.458 | 0.611 | 0.235 | 0.276 | 0.714 |
| 18.I can use the method of teaching evaluation correctly to evaluate clinical nursing teaching continuously, scientifically and effectively. | 0.406 | 0.669 | 0.277 | 0.264 | 0.759 |
| 20.I can effectively guide learners to reflect on themselves. | 0.396 | 0.532 | 0.257 | 0.243 | 0.565 |
| 22.I can create a good learning environment. | 0.647 | 0.386 | 0.244 | 0.205 | 0.669 |
| 24.I can actively participate in clinical nursing education, act according to principles, and be objective and fair. | 0.617 | 0.152 | 0.479 | 0.141 | 0.653 |
| 26.I have good communication and coordination skills, and can coordinate the relationship with head nurses, department directors, nursing departments and other staffs. | 0.700 | 0.296 | 0.322 | 0.173 | 0.711 |
| 27.I can coordinate the relationship between the teaching requirements of nursing department and the requirements of nursing unit, and make timely adjustments when encountering conflicts. | 0.702 | 0.358 | 0.252 | 0.207 | 0.727 |
| 28.I can maintain positive communication, interaction and cooperation with other nursing units to jointly promote the development and practice of nursing specialty. | 0.721 | 0.368 | 0.258 | 0.195 | 0.759 |
| 29.I can skillfully apply the strategy of dealing with conflicts and coordinate all kinds of conflicts in clinical teaching and nursing work. | 0.730 | 0.336 | 0.271 | 0.200 | 0.759 |
| 30.I can communicate with learners in a timely and appropriate way, understand each other's ideas, give affirmation and encouragement, and grow up and make progress together. | 0.739 | 0.318 | 0.292 | 0.174 | 0.762 |
| 31.I can reasonably allocate and guide clinical education according to the specialty of clinical nurses. | 0.690 | 0.360 | 0.312 | 0.181 | 0.736 |
| 32.I have the consciousness and ability to learn independently, and acquire and share cutting-edge knowledge and skills. | 0.606 | 0.279 | 0.243 | 0.406 | 0.669 |
| 34.I can use reasonable ways to reduce the work stress. | 0.522 | 0.351 | 0.170 | 0.215 | 0.471 |
| 35.I can use time management skills to perform various tasks efficiently as planned. | 0.600 | 0.387 | 0.190 | 0.367 | 0.680 |
| 36.I am aware of my own strengths and weaknesses, and make a reasonable career plan to promote my own development. | 0.618 | 0.313 | 0.248 | 0.281 | 0.621 |
| 37.I can work according to the norms and play a role model. | 0.706 | 0.132 | 0.378 | 0.319 | 0.761 |
| 38.I can put myself in the other's shoes, actively guide nurses to formulate personalized career development paths, adapt to the needs of clinical development, and enhance the comprehensive ability of the team. | 0.676 | 0.320 | 0.248 | 0.325 | 0.727 |
| 39.I can participate in and assist in formulating the standards and methods of nursing quality evaluation, and continuously improve teaching activities according to the evaluation results. | 0.649 | 0.401 | 0.214 | 0.277 | 0.705 |
| 41.I am proficient in literature retrieval. | 0.243 | 0.122 | 0.145 | 0.777 | 0.699 |
| 42.I can practice evidence-based nursing and teaching. | 0.235 | 0.425 | 0.149 | 0.698 | 0.745 |
| 43.I can carry out research using scientific methods, based on clinical problems. | 0.314 | 0.408 | 0.045 | 0.663 | 0.706 |
| 45.I can actively disseminate research results. | 0.349 | 0.247 | 0.212 | 0.648 | 0.647 |
Table 5
| Cronbach’s α | Split-half reliability | retest reliability | |
| Clinical Nursing Skills | 0.874 | 0.779 | 0.730 |
| Clinical Teaching Competency | 0.940 | 0.910 | 0.770 |
| Management and Leadership Competency | 0.966 | 0.942 | 0.782 |
| Innovation and Research Competency | 0.870 | 0.884 | 0.755 |
| Total scale | 0.975 | 0.940 | 0.833 |
Copyright Elsevier Limited 2025