Determinants of Nursing Clinical Skills and Clinical Competence: A Systematic Review

Abstract

This systematic review synthesises evidence on the determinants of nursing clinical skills and broad clinical competence among pre-licensure nursing students, new graduate nurses, and licensed nurses. Using a PRISMA-informed process, the review searched the predefined eleven-year eligibility window and identified 531 records. After duplicate removal, title-and-abstract screening, and full-text assessment, 54 primary empirical studies met the inclusion criteria. Fourteen determinants were inductively coded and organised into four interrelated domains: contextual-relational, experiential-pedagogical, personal-cognitive, and professional-development. The determinants most frequently examined were self-efficacy, learning environment, practice exposure, education and training, and experience or tenure. Across the evidence base, stronger competence was generally associated with supportive clinical learning environments, effective supervision, constructive staff interaction, repeated authentic practice, structured simulation, actionable feedback and debriefing, reflective learning, and appropriately calibrated self-efficacy. Stress and anxiety were generally associated with poorer performance or less favourable competence ratings, although the direction and magnitude of these relationships varied by context and measurement approach. Workforce studies additionally emphasised educational preparation, clinical tenure, professional identity, and organisational conditions. Considerable heterogeneity in populations, study designs, settings, instruments, and outcome definitions precluded defensible quantitative pooling; narrative synthesis was therefore used. The review distinguishes the frequency with which determinants were studied from the strength of their evidential influence, preserves analytical separation between student and workforce findings, and identifies priorities for longitudinal, multi-site, objectively assessed, and theory-driven research.