Effectiveness of Pre-Employment Training in Improving the Basic Competencies, Level of Confidence and Reducing Anxiety among Nurses in Selected Tertiary Hospital in Muntinlupa City

Effectiveness of Pre-Employment Training in Improving the Basic Competencies, Level of Confidence and Reducing Anxiety among Nurses in Selected Tertiary Hospital in Muntinlupa City

Dr. Jon-Jon T. Martinez, Rn, Joane Paula Silva Ranoco, Rn, Man

ST. DOMINIC COLLEGE OF ASIA, Philippines

DOI: https://doi.org/10.51584/IJRIAS.2024.911057

Received: 27 November 2024; Accepted: 30 November 2024; Published: 23 December 2024

ABSTRACT

Background: The pre-employment training consists of structured programs designed to prepare novice nurses for their specific roles within a healthcare organization. The critical components of Pre-Employment Basic Competencies training are the following: Orientation- it introduces nurses to the hospital environment, its mission, vision, and core values; Clinical Competencies – focus on essential skills such as medication administration, intravenous line insertion, wound care, carrying out of orders and many more. Nurses should familiarize themselves with the Hospital Information System. They need to learn inter-professional collaboration among colleagues, effective teamwork, and communication. Hospital protocols and policies are emphasized to prevent errors and adverse events. This study aims to evaluate the effectiveness of critical reflection training among novice nurses in enhancing their clinical critical-thinking abilities, communication competency, and job performance.

Method: This study employed a converged mixed methods approach, incorporating quantitative and qualitative methodologies. This meticulously designed mixed methods study employed 100 respondents using a stratified random technique. In a qualitative study, purposive sampling was utilized in 10 selected participants based on provided insights into the training effectiveness.

Results: The study highlights the significant positive impact of the pre-employment competency program on newly hired nurses. The program enhanced participants’ clinical skills, communication abilities, and critical thinking. Most participants, predominantly young female nurses with less than five years of experience, reported a marked increase in their confidence and reduced anxiety related to their nursing duties. Results indicate the program was highly influential, scoring 4.52, categorized as “Very Effective.” The training significantly increased confidence (t = 18.4633, p = 0.000) and reduced anxiety (t = -7.80, p = 0.001), equipping nurses with the skills needed for clinical practice. Key strengths included patient assessment (4.66), critical thinking (4.60), psychomotor skills (4.50), and decision-making (4.50). Simulation exercises, hands-on practice, and role-playing contributed to reduced anxiety and improved confidence by familiarizing nurses with real-world scenarios in a supportive environment.

Nurses also reported enhanced communication skills, teamwork, and professional interactions. The training effectively aligned with role-specific responsibilities, addressing critical clinical competencies while identifying areas for curriculum refinement. Findings underscore the value of such programs in preparing nurses for professional roles, enhancing patient care quality, and fostering a confident, competent workforce. Continuous updates and targeted training are recommended to meet evolving nursing demands. The training also addressed communication skills and complaint management effectively. Participants benefited from learning effective communication techniques and engaging in role-playing exercises, which improved their interactions with doctors, co-workers, and patients. The focus on handling complaints and conflicts equipped nurses with strategies to manage difficult situations more confidently, thereby reducing anxiety and enhancing their effectiveness in dealing with various scenarios in the healthcare environment.

Despite the overall success of the training program, some gaps in coverage were noted, particularly about specific role responsibilities and essential topics. Demographic factors, such as gender and years of experience, also influenced participants’ experiences and outcomes. Future iterations of the program should address these gaps by refining content to cover all essential topics comprehensively and considering demographic variations to tailor the training more effectively. This approach will ensure that the program continues to support new nurses in delivering high-quality patient care and improving their job satisfaction.

Keywords: pre-employment, training, competencies, confidence, anxiety

BACKGROUND OF THE STUDY

Introduction

In the dynamic world of healthcare, novice nurses face a steep learning curve, especially those fresh out of nursing school or transitioning into a new clinical setting. Their journey from textbooks to bedside care involves theoretical knowledge, practical skills, adaptability, and confidence. The new nurses enter the workforce enthusiastically but encounter real-world challenges such as complex patient cases, diverse healthcare teams, and pressure to provide safe and effective care. Their transition from student to practitioner involves bridging the gap between theory and practice. The pre-employment training consists of structured programs designed to prepare novice nurses for their specific roles within a healthcare organization. The critical components of Pre-Employment Basic Competencies training are the following: Orientation- it introduces nurses to the hospital environment, its mission, vision, and core values; Clinical Competencies – focus on essential skills such as medication administration, intravenous line insertion, wound care, carrying out of orders and many more. Nurses should familiarize themselves with the Hospital Information System. They need to learn inter-professional collaboration among colleagues, effective teamwork, and communication.

Hospital procedures and guidelines are highlighted to avoid mistakes and adverse outcomes. Training and development focus on enhancing the efficiency of organizations, their members, and the groups they comprise. Training is linked to short-term improvements in organizational effectiveness through structured teaching, while development is tied to the advancement of both long-term organizational and employee objectives. Even though training and development have different meanings, they are frequently used interchangeably or in conjunction. Training and development have traditionally been a focus in applied psychology but are now closely linked with human resources management, talent management, human resources development, instructional design, human factors, and knowledge management. Due to changes in epidemiology, socioeconomics, and sociodemographics, there is an increasing variety and complexity of health issues among individuals, emphasizing the need for patient safety and patient-centered care. In order to effectively meet the different needs of patients, nurses need to have advanced skills, irrespective of the countries and health settings they are employed in. Therefore, nurses should undergo clinical training to enhance and sustain their skills. Clinical training is seen as a crucial aspect of ongoing professional development. Certain types of clinical training are frequently required as compulsory programs for obtaining and renewing licenses or other professional qualifications for registered nurses in multiple nations. These requirements also ensure that nursing professionals have job security and access to employment opportunities. The need for qualified nurses in the Philippines is increasing both within and abroad. With the country still generating many nursing graduates, evaluating the efficacy of pre-employment training programs is essential. These programs are designed to provide nurses with the essential knowledge, skills, and attitudes needed to succeed in their positions within local healthcare facilities or when participating in the international nursing workforce.

Background of the Study

New nurses face significant challenges transitioning from theoretical learning to practical bedside care. The gap between acquired and expected competencies in nursing education is often cited as critical, highlighting the need for improved educational practices within nursing institutions. Academic and practical settings have faced criticism for failing to prepare nurses to engage in patient care adequately. Nursing leaders and educators must understand the expected competencies of new nurses, as they have a comprehensive insight into the healthcare system and the challenges facing the nursing profession. Exploring these competency gaps is essential for revealing the necessities regarding the work readiness of new nurses. New nurses often encounter complex patient cases and diverse healthcare teams while carrying out doctors’ orders and working harmoniously with fellow nurses.

This study aims to evaluate the effectiveness of critical reflection training among novice nurses in enhancing their clinical critical-thinking abilities, communication competency, and job performance. Specifically, this study aims to assess the impact of critical reflection training on the clinical critical-thinking skills of novice nurses and determine its effect on their communication competencies. Additionally, the study seeks to evaluate the influence of critical reflection training on the overall job performance of these nurses. By providing strategic guidelines for implementing effective critical reflection training programs in nursing education and professional development, the study aims to identify the challenges and opportunities associated with such training in clinical settings. Furthermore, the study offers insights into how critical reflection training can bridge the gap between theoretical knowledge and practical application for novice nurses, ultimately enhancing their readiness and effectiveness in clinical practice.

Conceptual Framework

Figure 1. Self-developed Conceptual paradigm

This conceptual paradigm of the study illustrates three processes. The first box represents the inputs comprising all the contents, information, data, and other materials necessary for the training. This involves the following: A. The new nurses will undergo the pre-employment training. B. The Training Program includes the curriculum, modules, and activities provided during the training. C. Hospital resources, policies, and organizational culture are specific and essential to tertiary hospitals. Understanding these aspects helps nurses adapt to their roles, reduce stress, and enhance confidence, ultimately contributing to patient safety. Skills development focuses on competency-based training, honing practical skills such as patient assessment, medication administration, IV insertion, wound care, and communication. It equips nurses with essential knowledge, skills, and protocols, ensuring smoother integration into the healthcare team. The second box represents the process required in the implementation of the training. This involves various methods such as lectures, simulations, and hands-on demonstrations with the corresponding time frame by qualified trainers. Preceptors guide new nurses, providing mentorship and support throughout this critical phase. During demonstrations and evaluations, nurses observe and practice procedures. The process also requires participant assessment via written and practical exams and self-evaluation. Effective evaluation identifies areas for improvement. Feedback mechanisms from participants, trainers, and hospital staff during and after the training are also part of the process. The transition to the application of learned competencies will determine whether the participant has benefited from the training and is already capable of handling common patient care scenarios. The third box represents the output resulting from the training consisting of measured improvement in competencies such as clinical skills, communication, and improved critical thinking and decision-making. The job performance should improve, enhancing patient care, teamwork, and protocol adherence. Ultimately, this results in zero or minimal variances, improved patient satisfaction, safety, overall quality of care, and nursing staff satisfaction.

Statement of the Problem

The study aims to examine the effectiveness of pre-employment training on basic competencies, improving level of confidence and reducing anxiety for new nurses in selected tertiary hospitals in Muntinlupa City, with the highest level of health care facilities that provide specialized and complex services to patients.

Specifically, this study sought to address the following questions:

1. What is the demographic profile of the respondents?

1.1 Age
1.2 Gender
1.3 Educational Background
1.4 Years of Nursing Service Experience
1.5 Current area assignment

2. What is the level of experience and effectiveness of pre-employment basic competency training of new nurse?

3. Is there a significant difference on the level of experience and effectiveness based on their demographic profile?

4. What is the impact of the pre-employment training on the new nurses based on their levels of confidence and anxiety?

5. What is the level of confidence and anxiety before and after the training?

6. Based on the result of the study, what program can be made?

Null Hypothesis:

Ho1: There is no significant relationship between the pre-employment basic competencies training program and the demographic profile.
Ho2: There is no significant relationship between the pre-employment basic competencies training program and the levels of confidence, and anxiety.

Scope and Limitation

The study involved new nurses who underwent pre-employment training on essential nursing competencies in selected tertiary hospitals in Muntinlupa City. The study measured the impact of pre-employment training on the core competencies, job satisfaction, and patient safety, as well as the factors that influence the transfer of training. The study also explored the experiences and perceptions of new nurses (preceptors), trainers (staff educators, preceptors), and managers regarding the pre-employment training program and its outcome. The study used a sample of new nurses who have completed the pre-employment training program in selected tertiary hospitals in Muntinlupa City, as well as their trainers and managers.

The limitation of the study was that the findings may not be applicable in other settings or countries, as the pre-employment training program may vary in content, duration methods, and evaluation. The study may encounter some challenges in data collection, such as the participants’ availability and willingness, the instrument’s reliability and validity, and the ethical issues of informed consent and confidentiality. The study may also have some biases in data analysis, such as the possible subjectivity of the study participants, the interpretation of the results, and the integration of quantitative and qualitative data. Therefore, the study will use appropriate strategies to ensure the rigor and trustworthiness of the research process and the findings.

Significance of the Study

The significance of the study is that it establishes the impact of pre-employment basic competency training, which should benefit newly hired registered nurses, nursing leaders, nursing educators, hospital administrators, institutions, and future researchers.

Newly hired Registered Nurses. Undergoing the said training program can result in improved standardized practices, adherence to protocols, reduced errors, increased job satisfaction, optimized teamwork, better decision-making skills, and the best patient care outcomes.

Nursing Leaders With new nurses who are better prepared, the nursing leaders – supervisors and managers will have fewer problems to tackle, minimize variances and issues, and, somehow, be relieved of undue stress. They will have less difficulty implementing new policies, standard operating procedures, and other protocols, especially about patient safety and high-quality patient care.

Nursing Educators Educators can design customized training programs to close specific competency gaps and highlight efficient teaching techniques to guarantee more prepared nurses.

Hospital Administrators The favorable findings of this study will allow hospital administrators to focus on the hospital’s operational needs rather than on the time-consuming effort of resolving the unwanted issues and concerns related to nursing care.

Hospital Institutions With an effectively trained nursing staff at all levels, the institution will benefit from nursing staff and patient satisfaction. The institution will be known for its high-quality nursing care, resulting in increased patient loyalty.

Future Researchers The study will serve as the foundation for their future research, which will involve developing and investigating relevant topics or improving.

This study contributes to establishing the necessary curriculum or program for nurse training and development. By understanding the impact of pre-employment training, healthcare institutions can optimize their programs to ensure competent and dedicated nursing professionals. Hence, the study bridges the gap between education and practice, benefiting registered nurses, nursing leaders, hospital administrators, and the institution.

Definition of Terms

For a better understanding of the study, the following terms have been defined operationally:

ANXIETY is a mental state characterized by undue apprehension and fear, whether perceived or actual when assigned to perform specific nursing tasks.

BASIC NURSING COMPETENCIES are essential building blocks tailored explicitly for new nurses to guide them in their professional practice. These include the institutional mission and vision, core values, upholding ethical principles, integrity, and commitment to patient-centered care while demonstrating compassion, respect, and cultural sensitivity. In addition, communication, interpersonal skills, confidence building, evidence-based practices, and critical thinking are likewise emphasized.

EFFECTIVENESS measures how well the program equips the new nurses with the necessary competencies, knowledge, and skills required for their roles based on specific evaluation parameters. It should empower nurses to provide quality patient care, adhere to protocols, and contribute positively to healthcare outcomes.

LEVEL OF CONFIDENCE is feeling sure of oneself and one’s abilities to perform assigned tasks, duties, and responsibilities among the nursing staff.

NEW NURSES are registered nurses who have recently joined the institution. They may be fresh graduates or nurses with some experience.

PRE-EMPLOYMENT TRAINING encompasses the educational and skills-building programs provided to newly hired registered nurses before starting their roles. It aims to prepare them for the specific demands of their jobs, enhance their competencies, and ensure a smooth transition into the healthcare workforce. Some of these components are Orientation to the healthcare facilities, its policies, standard operating procedures, and the organizational culture.

The Department of Health defines TERTIARY HOSPITAL as a medical facility equipped with advanced services and a specialized workforce to support medical specialists. These hospitals play a crucial role in providing teaching, training, research functions, and clinical care. This may be a private or public (government)t owned and operated institution.

METHODOLOGY

In this chapter, the author outlined the methodology for the study, detailing the research design, study setting, respondent selection, research instrument, data collection procedures, validation, and statistical analysis.

Research Design

The researchers employed a converged mixed methods approach, integrating quantitative and qualitative methodologies. In the quantitative component, the study systematically focused on quantifying phenomena by collecting and analyzing numerical data to identify patterns, relationships, or trends. Structured tools such as surveys and pre- and post-training assessment scores were used to measure changes in participants’ knowledge and competencies, assessing the effectiveness of the pre-employment training in improving clinical skills and job performance.

The qualitative aspect aimed to understand human behavior, beliefs, and experiences. It focused on non-numerical data, including interviews with a subset of nurses to explore their perceptions of the training program, its impact on their confidence, anxiety, and preparedness, and suggestions for improvement. This approach provided more profound insights into the social and professional context of the participants.

Converged Mixed Method Design

The study followed the convergence mixed method design, integrating qualitative and quantitative data collected concurrently but analyzed independently. According to Creswell and Clark (2017), this design allows merging findings to understand the research problem comprehensively. It facilitated cross-validation and triangulation to enhance the study’s validity and provided a multidimensional view of the training program’s efficacy. By employing this approach, the study thoroughly evaluated the pre-employment training program’s effectiveness and influence on nursing practice, combining measurable outcomes with participants’ personal experiences and perceptions for a robust analysis.

Research Locale

The study used a mixed-methods approach to examine the effectiveness of pre-employment training among new nurses. It was conducted in selected tertiary hospitals in Muntinlupa City, Philippines, a critical healthcare hub in the region. These hospitals provided a diverse patient population and a wide range of healthcare professionals, offering valuable insights and data for assessing the training program’s effectiveness.

Population and Sampling

The study population consisted of registered nurses employed in the selected tertiary hospitals. These facilities emphasized holistic nursing care, a standard practice across various departments, including the Emergency Room, Medical-Surgical Unit, Intensive Care Unit, Maternal and Child Unit, General Nursing Unit, and Operative Services. The population encompassed nurses with diverse experiences and backgrounds, ensuring the broad applicability of the findings across different nursing services.

Sampling Technique

This mixed-methods study employed both quantitative and qualitative sampling techniques to ensure comprehensive data collection. A stratified random sampling technique was used for the quantitative component, dividing the nurse population into strata based on nursing service departments and randomly selecting respondents from each stratum. This approach ensured a representative sample, allowing for the generalization of findings on the effectiveness of pre-employment training for new nurses and their performance. For the qualitative component, purposive sampling was utilized to select participants based on specific criteria, such as their training experiences, confidence, and anxiety levels. This method was designed to provide in-depth insights into the training’s impact, focusing on research questions related to performance and attitudes. While the quantitative study involved a larger sample size for robust statistical analysis, the qualitative aspect relied on a smaller sample, emphasizing data saturation, where no new insights emerged from additional interviews.

Research Instrument

The study used a mixed-methods research instrument combining a structured questionnaire and a semi-structured interview guide to evaluate the effectiveness of pre-employment training for new nurses. The questionnaire, designed for the quantitative component, consisted of two major sections. The first collected demographic information and assessed confidence and anxiety levels using a Likert scale based on the Nursing Anxiety and Confidence Scale. It also evaluated work performance quality through carefully crafted statements rated by participants. The second component, a qualitative semi-structured interview guide, explored nurses’ personal experiences, perceptions, attitudes, job performance, and satisfaction. This dual approach enabled the study to quantify confidence, anxiety, and satisfaction levels while capturing the narratives behind the data. By integrating quantitative metrics with qualitative insights, the research comprehensively understood how basic competencies training influenced nurses’ performance and job satisfaction.

Table 1 4-point Likert scale for the measurement of effectiveness of pre-employment basic competencies training for Nurses

Validation of Instruments and Test of Reliability of the Instrument

The study ensured the validity and reliability of its research instruments to produce accurate and applicable findings for the broader nursing population. Content validity was established by conducting a thorough literature review and consulting nursing and health experts to ensure the survey and interview questions comprehensively addressed the effectiveness of pre-employment training on nurses’ work performance. Construct validity was enhanced using validated scales, such as the Nursing Anxiety and Self-Confidence Scale, while factor analysis tested the theoretical foundations of newly developed items. Where applicable, criterion validity compared the study’s instrument results with recognized anxiety and confidence levels post-training measures. To ensure reliability, Cronbach’s Alpha measured the internal consistency of the questionnaire, with high values indicating reliable measurement. A test-retest reliability assessment was conducted by administering the instrument to a small subset of the target population at two different times. Additionally, the questionnaire was pilot-tested to refine it before full implementation.

Statistical Treatment

The study employed various statistical methods to analyze the data. Descriptive statistics summarized demographic profiles using frequencies and percentages for categorical variables (e.g., gender, educational background) and central tendency and dispersion measures for continuous variables (e.g., age, years of experience). To evaluate the training’s effectiveness, paired t-tests or Wilcoxon signed-rank tests compared pre-test and post-test scores, with effect sizes calculated to measure the impact. Correlation analysis examined relationships between demographic variables and performance changes, and multiple regression analysis identified predictors of performance improvement post-training.

Anxiety levels during training were analyzed with descriptive statistics, and comparisons between groups were conducted using t-tests, ANOVA, or Kruskal-Wallis tests where appropriate. Confidence and anxiety levels before and after training were compared using paired t-tests or Wilcoxon signed-rank tests, with ANOVA or similar methods applied for multiple group comparisons. Qualitative data, including open-ended survey responses and interview transcripts, underwent content analysis to identify common themes and actionable insights. Thematic analysis of qualitative data further enriched the understanding of nurses’ perceptions and experiences.

By integrating these statistical treatments, the study provided a comprehensive evaluation of the training program’s effectiveness in improving competencies, boosting confidence, and reducing anxiety among new nurses. The findings offered evidence-based recommendations for enhancing nursing education and professional development programs.

Data Gathering Procedure

This study investigated the effectiveness of pre-employment training among new nurses using a mixed-methods approach that combined quantitative and qualitative techniques. Following approval from the Ethics Review Board, the data collection process was conducted in three phases:

Phase 1: Quantitative Data Collection

Recruitment and Consent: A formal letter of request for permission was forwarded to the concerned hospital departments for administering survey questionnaires.

Survey Distribution: Questionnaires were distributed to nurses across various departments in selected tertiary hospitals in Muntinlupa City. Respondents were given one to two weeks to complete the surveys.

Data Collection: The researcher retrieved the completed questionnaires, following up via messages or calls to ensure a high response rate. The surveys collected data on the effectiveness of the training program, focusing on improvements in skills, confidence, and anxiety levels among new nurses.

Phase 2: Qualitative Data Collection

Participant Selection: A purposive sampling method was employed to select a diverse subset of survey respondents for in-depth interviews, ensuring variation in experiences, work settings, and perspectives.

Conducting Interviews: Semi-structured interviews were conducted face-to-face, via telephone, or video conferencing based on logistical considerations and participant preferences. An interview guide facilitated discussions on the training’s quality, relevance, and impact on work performance, communication skills, confidence, and anxiety.

Recording and Transcription: With participant consent, interviews were audio-recorded and later transcribed. Identifiable information was anonymized to maintain confidentiality.

Phase 3: Data Consolidation and Analysis

Quantitative Data Analysis: Statistical analyses were performed on survey data to identify patterns, correlations, and differences in training quality and healthcare delivery before and after the training.

Qualitative Data Analysis: Thematic analysis was applied to interview transcripts to extract insights and themes related to participants’ experiences with the training program.

Mixed-Methods Integration: Findings from quantitative and qualitative analyses were integrated to draw comprehensive conclusions, combining statistical breadth with the depth of personal experiences to evaluate the overall impact of the pre-employment training on new nurses.

Ethical Considerations

Ethical considerations were prioritized throughout the research process to protect participants’ rights, confidentiality, and well-being and maintain the study’s integrity and credibility.

Informed Consent

Informed consent was obtained from all participants, ensuring they were fully aware of the study’s purpose, procedures, potential risks and benefits, and their rights. Participation was voluntary, with no coercion, and participants were allowed to withdraw from the study at any time without consequences.

Confidentiality and Privacy

Participants’ confidentiality and anonymity were strictly maintained. Personal and sensitive information was securely stored and accessible only to the researcher. Data were de-identified and presented in aggregate form to protect privacy and prevent tracing individual responses. Measures were taken to minimize any potential negative impact on participants’ well-being or professional reputation.

Minimizing Harm

Steps were taken to minimize harm or distress to participants. Support services were made available for those experiencing emotional or psychological challenges related to their participation. The study design, data collection, and analysis were conducted ethically and responsibly to reduce potential adverse effects.

Ethical Approval

An institutional review board or ethics committee reviewed and approved the study protocol to ensure compliance with ethical guidelines. Conflicts of interest were disclosed, and findings were reported transparently and accurately.

RESULTS AND DISCUSSION

In this chapter, the analysis of the data collected aims to provide a deeper understanding of the research questions posited. The results are presented in a clear and organized manner, highlighting key trends, patters, and relationship identified during the study

Quantitative Part

Table 2 Demographic Data of the Respondents

As shown in Table 2, the majority of respondents were in the 31-40 (34%) and 41-50 (36%) age brackets, with younger nurses (21-30) comprising 18% and those over 50 accounting for 12%. This indicated a workforce primarily composed of mid-career professionals, likely with significant experience and developed competencies. The predominance of nurses in their 30s and 40s suggested a stable and knowledgeable nursing staff, essential for delivering high-quality patient care. Consequently, pre-employment training programs were recommended to enhance existing skills while addressing mid-career nurses’ specific challenges, particularly in leadership and advanced clinical practices. It was also revealed that 62% of the respondents were female, while 38% were male, reflecting traditional gender dynamics in nursing. This significant representation of female nurses likely influenced team interactions and patient care approaches, with differing communication styles and perspectives enhancing collaborative practices. To maximize the effectiveness of pre-employment training, it was essential to consider these gender dynamics and foster an inclusive environment encouraging collaboration among all staff members. Addressing gender-specific challenges was further suggested to improve training outcomes. Educationally, 42% held a Bachelor’s degree, 38% a Master’s degree, and 20% a Doctorate, indicating a well-educated nursing workforce. The presence of highly educated nurses demonstrated a commitment to professional development, which could enhance care quality. Therefore, pre-employment training was recommended to leverage existing educational backgrounds, offering advanced modules for those with higher degrees focusing on leadership and evidence-based practice while reinforcing foundational skills for those with Bachelor’s degrees.

Regarding experience, 66% had 1 to 5 years of experience, 18% had more than 5 years, and 16% had only 1 year of experience. The predominance of relatively inexperienced nurses highlighted the need for ongoing support and training to build confidence and reduce anxiety. Pre-employment is recommended to emphasize practical skills and confidence-building strategy for less experienced nurses, potentially incorporating mentorship and simulation-based training to enhance clinical competencies.

Lastly, the results revealed a diverse nursing workforce, with 30% as Nurse Educators, 22% as Staff Nurses, 18% as Nurse Administrators, 16% as Nurse Supervisors, and 14% as Nurse Managers. This diversity indicated a multifaceted team capable of fulfilling various roles within the hospital, with Nurse Educators underscoring a commitment to continuous learning. To optimize training effectiveness, programs were advised to be tailored to the specific roles of the nurses, providing targeted training for Nurse Educators in teaching methodologies and for Staff Nurses in hands-on clinical skills. This approach aimed to enhance competencies, boost confidence, and reduce anxiety among nurses in their respective positions.

Table 3 Level of Experience of Nurses in the Pre-Employment Competency Program

Table 3 demonstrated that the overall mean score for the pre-employment competency program was 4.52, categorized as “Very Experienced,” reflecting a high level of satisfaction among participants regarding their training experience. The highest-rated aspects were communicating learning objectives and improving critical thinking abilities, scoring 4.60, indicating that participants felt exceptionally well-prepared in these areas. The extent of coverage of essential topics and the overall quality of the training followed closely, each with a mean score of 4.50, further reinforcing the program’s effectiveness in addressing relevant nursing roles and competencies. Additionally, participants rated the training’s impact on decision-making capability at 4.50 and its focus on patient safety protocols at 4.48, highlighting its critical relevance to nursing practice. These findings underscored the program’s strengths in delivering pertinent content and enhancing essential skills, effectively fostering confidence and preparedness among new nurses for their hospital roles. Continuous evaluation and refinement of the training content were recommended to ensure alignment with the evolving demands of nursing practice and its effectiveness in enhancing workforce competency.

Table 4 Level of Effectiveness of Nurses in the Pre-Employment Competency Program

Table 4 demonstrated that the overall mean score for the effectiveness of the pre-employment competency program was 4.52, categorized as “Very Effective,” reflecting a strong positive perception among participants regarding the training’s impact on their nursing practice. The highest-rated aspect was the training’s helpfulness in patient assessment, with a mean score of 4.66, indicating that participants found this element particularly beneficial for their clinical skills. The training’s effectiveness in preventing patient care-related issues scored 4.52, emphasizing its importance in maintaining high patient safety standards.
The improvement in psychomotor skills, such as IV insertions, received a score of 4.50, showing participants’ confidence in applying these essential skills post-training. Additionally, the enhancement in the quality of patient care was rated at 4.54, signifying that nurses recognized a substantial improvement in their ability to deliver quality care after completing the program. These findings indicated that the pre-employment competency program effectively equipped nurses with the necessary skills and knowledge to excel in their roles, ultimately contributing to better patient outcomes. Continuous monitoring and updates to the training curriculum were recommended to maintain its relevance and effectiveness in addressing the evolving needs of nursing practice..

Table 5 Level of Anxiety among Nurses Before and After the Pre-Employment Competency Program

Table 5 showed a significant shift in participants’ perceptions of anxiety related to their nursing roles. Most statements reflected a movement toward more excellent agreement, indicating that the training reduced anxiety levels and increased confidence in performing nursing tasks and engaging with colleagues and patients. These findings highlighted the program’s success in addressing the emotional and psychological barriers often faced by new nurses. The training alleviated anxiety and empowered participants by enhancing their self-efficacy in clinical settings. This shift demonstrated that the program met its objectives of preparing nurses for the demands of their profession.

The positive impact of the Pre-Employment Competency Program on reducing anxiety and boosting confidence had significant implications for nursing education and workforce readiness. By equipping new nurses with the necessary skills and assurance to navigate their roles, the program contributed to a more competent and confident nursing workforce, ultimately leading to improved patient care and outcomes. These findings underscored the importance of incorporating such training programs into pre-employment preparations for healthcare professionals.

Table 6 Level of Confidence among Nurses before and after the Pre-Employment Competency Program

According to Table 6, there was a substantial improvement in various areas of nursing practice after completing the pre-employment competency program. Before the program, nurses exhibited neutral levels of confidence in critical aspects such as applying nursing skills safely, handling real-world scenarios, interacting professionally with colleagues and patients, problem analysis, and clinical procedures, with mean scores ranging from 2.88 to 3.28.

These scores indicated neither agreement nor disagreement with statements reflecting their skills and confidence. Post-program scores significantly increased, ranging from 4.46 to 4.56, reflecting strong agreement with statements about their abilities and confidence. Nurses reported notable improvements in their confidence to apply nursing skills safely, manage real-world scenarios, and interact professionally. Additionally, there was a marked enhancement in their problem-solving abilities and knowledge of clinical procedures.

These findings indicated that the Pre-Employment Competency Program greatly enhanced nurses’ readiness and skills. The significant improvement in their confidence and perceived competencies demonstrated that the program successfully addressed critical aspects of clinical practice, including practical skills, problem-solving, and professional interactions. This enhancement in confidence was likely to contribute positively to patient care and safety. The results emphasized the value of such competency programs and suggested that similar future programs should continue incorporating interactive and real-world training elements to support new nurses in their transition to the workforce.

Table 7 Significant Differences on Experience Level Based on Demographic

Based on Table 7, the results showed that age did not significantly impact experience levels, with an F-value of 0.294 and a p-value of 0.830. Similarly, the general experience category did not yield significant differences, as indicated by an F-value of 0.177 and a p-value of 0.838. In contrast, gender was an essential factor, with an F-value of 3.544 and a p-value of 0.036, indicating that experience levels differed significantly based on gender. Additionally, years of experience showed a significant correlation with experience levels, with an F-value of 0.639 and a p-value of 0.033, suggesting that the time worked influenced differences in experience. Lastly, the type of work did not show significant differences, with an F-value of 1.056 and a p-value of 0.377.

These findings highlighted the significance of gender and years of experience as factors influencing experience levels, while age, general knowledge, and type of work did not have a substantial impact. The results underscored the importance of promoting gender diversity and inclusivity in organizational practices, ensuring equal access to professional development opportunities. Targeted training programs and mentorship initiatives could support underrepresented genders in advancing their careers. Moreover, the significant relationship between years of experience and experience levels suggested that organizations could benefit from leveraging the expertise of seasoned employees by establishing mentorship programs to facilitate knowledge transfer and enhance organizational performance. While other factors showed no significant effects, further research was recommended to explore the underlying reasons and develop strategies to address potential biases or barriers to professional growth.

Table 8 Significant Differences on Experience Level Based on Demographic

As shown in Table 8, age did not demonstrate significant differences in experience levels, with an F-value of 1.053 and a p-value of 0.378. Similarly, the general experience category also did not yield significant differences, as reflected by an F-value of 1.81 and a p-value of 0.043, indicating it did not significantly influence experience levels. In contrast, gender emerged as a statistically significant factor, with an F-value of 0.447 and a p-value of 0.047, showing a notable difference in experience levels based on gender. Additionally, years of experience showed a trend toward significance, with an F-value of 3.013 and a p-value of 0.059, suggesting meaningful differences in experience levels related to the number of years worked, though slightly above the conventional threshold for significance. Lastly, the type of work did not exhibit significant differences, with an F-value of 0.775 and a p-value of 0.514.

These findings underscored the significance of gender as a factor influencing experience levels, while age, general experience, and type of work did not appear to have a substantial impact. The near-significant relationship between years of experience and experience levels suggested that organizations should consider this factor in developing training and professional development programs. Specifically, organizations were encouraged to prioritize gender diversity and inclusivity, ensuring equal opportunities for growth and advancement. Targeted initiatives to support underrepresented genders in their career progression were recommended. Furthermore, recognizing the value of experience in shaping employee contributions and performance could benefit organizations. Establishing mentorship programs to leverage the knowledge of seasoned employees was suggested to enhance skill development and foster continuous learning. While certain factors showed no significant effects, further research was recommended to explore these dynamics and identify strategies for promoting equitable professional growth within organizations.

Table 9 Impact of Pre-Employment Competency Program on the Nurses Confidence and Anxiety Level

Table 9 highlighted a t-value of 18.4633 with a p-value of 0.000, indicating a highly significant positive impact of the pre-employment competency program on nurses’ confidence levels. This demonstrated that the program was effective in significantly increasing participants’ confidence. Similarly, for anxiety, the t-value was 7.80 with a p-value of 0.001, showing a significant effect. However, the negative t-value indicated that the program significantly reduced nurses’ anxiety levels. These findings had important implications for the nursing profession and the value of pre-employment competency programs. The substantial increase in confidence and decreased anxiety among participants suggested that such programs effectively prepare nurses for their professional roles. Enhanced confidence enabled nurses to make informed decisions, communicate effectively, and deliver high-quality care, fostering a more capable and self-assured workforce. This, in turn, contributed to better patient outcomes and increased job satisfaction. The notable reduction in anxiety levels was equally significant, as high anxiety can adversely affect job performance, decision-making, and overall well-being. By addressing anxiety through pre-employment competency programs, organizations supported nurses in managing stress and maintaining a healthy work-life balance, ultimately enhancing their professional readiness and overall performance.

Qualitative Part

Table 10 How the training was improved your level of confidence in the performance of your nursing tasks?

The findings suggest that the pre-employment competency training effectively enhanced nurses’ confidence levels through various factors. The training provided essential knowledge and practical skills fundamental to performing nursing tasks effectively. Positive feedback and support from trainers further reinforced nurses’ confidence, as they received encouragement and guidance throughout the training process. Simulation exercises and practice scenarios were particularly valuable in preparing nurses for real-life situations. By engaging in simulated scenarios, nurses gained hands-on experience and developed the skills to handle various situations confidently. This practical training component allowed nurses to apply their knowledge and receive feedback in a safe environment before encountering actual patients.

Table 11 How did the training improve your communication skills towards doctors, co-workers and patients?

The analysis of the training’s impact on communication skills revealed three key themes illustrating how the program enhanced nurses’ communication abilities. Firstly, the training introduced effective communication techniques that gave nurses valuable methods for more transparent and more effective interactions with doctors, patients, and colleagues. Participants noted that these techniques facilitated meaningful conversations and improved their overall communication abilities. Secondly, practice and role-playing exercises during the training significantly boosted nurses’ confidence in engaging with others. By simulating real-life scenarios in a supportive environment, nurses could practice their communication skills, contributing to their self-assurance when interacting in clinical settings. Lastly, focusing on specific communication strategies made it easier for nurses to convey important information. Participants reported that these strategies enhanced their ability to communicate effectively and fostered better relationships with doctors and patients, ultimately improving teamwork and patient care.
The implications of these findings are significant for the development and implementation of nursing training programs. Training curricula should incorporate effective communication techniques as a core component, ensuring nurses have the necessary skills to communicate clearly in their roles. Additionally, combining practice and role-playing exercises into training can enhance nurses’ confidence in their communication abilities, preparing them for real-world interactions. Emphasizing specific communication strategies tailored to the nursing context will enable nurses to convey critical information effectively. Furthermore, organizations should consider providing ongoing support and resources for nurses to continue developing their communication skills beyond initial training. By addressing these areas, nursing training programs can significantly enhance communication skills, improving collaboration among healthcare teams and better patient outcomes.

Table 12 In what way did the training affect your critical thinking and decision making?

The analysis of the interviews revealed two main themes that illustrate how the pre-employment competency training affected nurses’ critical thinking and decision-making skills. Firstly, participants reported that the training provided them with tools and strategies to analyze situations more effectively, enabling them to consider multiple perspectives and make well-informed decisions. This systematic approach allowed nurses to tackle problems thoughtfully and base their choices on evidence and best practices. Secondly, the training significantly boosted nurses’ confidence in making decisions, particularly in high-pressure situations. By offering a safe environment to practice decision-making skills and receive constructive feedback, the training prepared nurses to handle challenging scenarios with greater self-assurance. This increased confidence is crucial, as nurses often face time-sensitive situations that require quick and effective responses.
The implications of these findings are significant for the design and implementation of pre-employment competency training programs for nurses. Training programs should prioritize teaching critical thinking strategies, such as problem-solving frameworks and decision-making models, to help nurses analyze situations more effectively. Incorporating scenario-based learning and simulation exercises into the training can allow nurses to practice decision-making skills in realistic contexts, further boosting their confidence and preparedness for real-world challenges. Additionally, trainers should offer regular feedback and support to help nurses identify areas for improvement and enhance their critical thinking abilities. Organizations should also consider providing ongoing opportunities for nurses to develop their critical thinking and decision-making skills through mentorship programs and continuing education courses. By addressing these factors, pre-employment competency training programs can effectively enhance nurses’ critical thinking and decision-making skills, ultimately leading to improved patient care, reduced medical errors, and better overall outcomes.

Table 13 Please describe the effect of the training on the degree of anxiety regarding performance of nursing duties upon actual deployment in the assigned area

The analysis of the interviews revealed three key themes that describe the effect of the training on nurses’ anxiety regarding the performance of their duties upon actual deployment in their assigned areas. Firstly, participants noted that increased familiarity with tasks significantly lowered their anxiety levels when starting their roles. One nurse remarked, “The thorough preparation I received made me feel less anxious when I started working on the floor.” This suggests that comprehensive training provided nurses with the knowledge and skills to approach their duties confidently.

Secondly, the training created a supportive environment that familiarized nurses with their tasks, reducing anxiety about performing them in real scenarios. Participants expressed that practicing tasks during training made applying those tasks in real-life situations less intimidating. This hands-on experience allowed nurses to gain practical insights and build confidence in their abilities, contributing to a smoother transition into their roles.

Lastly, the training helped reduce anxiety through preparation, as the support and feedback provided during the training sessions contributed to lower anxiety levels. One participant noted, “The supportive nature of the training helped ease my anxiety about my performance.” This highlights the importance of a nurturing training environment where nurses feel encouraged and supported as they prepare for their responsibilities.

The implications of these findings are significant for the development and implementation of nursing training programs. Training should emphasize comprehensive preparation to ensure nurses feel familiar and confident in their tasks before deployment. Additionally, creating a supportive training environment is essential for reducing anxiety and fostering a sense of community among trainees. Incorporating practical exercises and simulations can further enhance familiarity with tasks, making real-life applications less daunting. Finally, ongoing support and feedback during training can play a crucial role in easing anxiety, ultimately leading to improved performance and job satisfaction among nurses as they transition into their roles. By addressing these factors, nursing training programs can effectively reduce anxiety levels and promote a more confident and capable workforce.

Table 14 What was the effect of the training on your attitude and level of anxiety when dealing with complaints from doctors and patients?

Table 15 How well did the training prepare you for your specific responsibilities in the hospital and to what extent did the training cover essential topics relevant to your role as a nurse?

The analysis of the interviews revealed two critical themes regarding how well the training prepared nurses for their specific responsibilities in the hospital and the extent to which it covered essential topics relevant to their roles. Firstly, participants highlighted the theme of role-specific preparation, noting that the training effectively addressed the specific nursing roles they were expected to fulfill. One nurse remarked, “The training was highly relevant to the tasks I perform daily,” indicating that the content was closely aligned with their practical responsibilities. This relevance suggests that the training was designed with an understanding of the daily challenges and tasks nurses encounter in their work environments.

Secondly, aligning with job responsibilities emerged as an important theme, with nurses evaluating how closely the training content matched their job requirements. While many participants expressed satisfaction with the breadth of topics covered, some noted that certain areas needed to be added. One participant stated, “It covered most of the topics I needed, though some areas were missing.” This feedback highlights the importance of ensuring that training programs comprehensively cover all essential topics relevant to nursing roles.

The implications of these findings are significant for the development and implementation of nursing training programs. Training should be designed to closely align with the specific responsibilities and tasks nurses encounter daily. This can be achieved by involving practicing nurses in the curriculum development to ensure the content is relevant and applicable. Additionally, ongoing assessments of training programs should be conducted to identify gaps in essential topics and make necessary adjustments. By addressing these factors, nursing training programs can effectively prepare nurses for their roles, enhancing their competence and confidence in providing high-quality patient care.

SUMMARY OF FINDINGS, CONCLUSION, AND RECOMMENDATION

With the results and discussion presented above, the researcher came up with a culmination of the research findings and analysis presented throughout this study. A concise overview of the key results and implications was provided, offering a comprehensive synthesis of the research outcomes. The conclusions drawn from the data are discussed, highlighting the significance of the findings and their implications for the field of study. Furthermore, based on the conclusion, practical recommendations will be proposed to guide future research directions and inform potential applications in practice.

Summary of Findings

The following are derived from the results of the study:

1. Most participants are young female nurses with less than five years of experience, and most work in hospitals. Age, gender, years of experience, general experience, and type of work are represented in the sample.
2. Participants are delighted with the pre-employment competency program. They rated various aspects of the program positively, indicating overall satisfaction.
3. Participants perceive the pre-employment competency program as highly effective in enhancing their nursing practice. The program received high effectiveness ratings across multiple competencies.
4. The training program effectively reduced anxiety levels and increased confidence among participants. There was a significant decrease in reported anxiety post-training.
5. There is a notable improvement in participants’ confidence across all areas of nursing practice after completing the program. Confidence levels significantly increased in clinical, communication, and critical thinking skills.
6. Gender and years of experience significantly influence the experience levels of participants, while age, general experience, and type of work do not. The data suggests that these factors affect how participants experience the program.
7. Gender is a significant factor in influencing experience levels, with a trend towards significance for years of experience. The results highlight the importance of considering gender and experience when assessing program impact.
8. The training improved nurses’ confidence by providing essential knowledge and practical skills, receiving positive feedback from trainers, and engaging in simulation exercises. These factors collectively enhanced their self-assurance in performing nursing tasks effectively.
9. The training improved communication skills by introducing effective communication techniques and providing practice through role-playing, which boosted confidence in interactions with doctors, co-workers, and patients.
10. The training enhanced critical thinking and decision-making skills by equipping nurses with analytical tools and strategies and boosting their confidence in making decisions under pressure.
11. The training reduced anxiety related to nursing duties by increasing familiarity with tasks, providing a supportive environment, and offering thorough preparation, which helped ease the transition into real-life scenarios.
12. The training positively affected nurses’ attitudes and reduced anxiety when handling complaints by improving their complaint management skills and providing strategies to handle conflict situations effectively.
13. The training effectively prepared nurses for their specific responsibilities by addressing role-specific tasks and aligning closely with job requirements, though participants noted some gaps in essential topics.

Conclusion

The study highlights the significant positive impact of the pre-employment competency program on newly hired nurses. The program enhanced participants’ clinical skills, communication abilities, and critical thinking. Most participants, predominantly young female nurses with less than five years of experience, reported a marked increase in their confidence and reduced anxiety related to their nursing duties. The structured combination of knowledge acquisition, practical skills training, and simulation exercises contributed to this improvement, preparing nurses for real-world challenges and boosting their self-assurance.

The training also addressed communication skills and complaint management effectively. Participants benefited from learning effective communication techniques and engaging in role-playing exercises, which improved their interactions with doctors, co-workers, and patients. The focus on handling complaints and conflicts equipped nurses with strategies to manage difficult situations more confidently, thereby reducing anxiety and enhancing their effectiveness in dealing with various scenarios in the healthcare environment.

Despite the overall success of the training program, some gaps in coverage were noted, particularly about specific role responsibilities and essential topics. Demographic factors, such as gender and years of experience, also influenced participants’ experiences and outcomes. Future iterations of the program should address these gaps by refining content to cover all essential topics comprehensively and considering demographic variations to tailor the training more effectively. This approach will ensure that the program continues to support new nurses in delivering high-quality patient care and improving their job satisfaction.

Recommendation

Based on the summary of findings and conclusion, the following are recommended:

1. Nurses must actively engage in all aspects of the pre-employment competency program, including practical skills and simulation exercises, to build confidence and competence in clinical practice.
2. The Department of Health should standardize and regularly update pre-employment competency training programs to cover all essential nursing skills and knowledge, ensuring alignment with current best practices in healthcare.
3. Hospital Administrators shall implement and monitor comprehensive pre-employment training programs for newly hired nurses, incorporating practical skills, simulation, and communication training, and provide continuous feedback and support.
4. Schools must enhance nursing curricula by integrating comprehensive pre-employment competency training that aligns with real-world clinical demands and fosters essential skills in communication, critical thinking, and complaint management.
5. Future Researchers should investigate the specific gaps in pre-employment competency training and how demographic factors influence training outcomes to develop targeted interventions for improving training programs.

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