Competence, professional self-confidence and patient safety Experiences of competence needs among ICU nurses in a local hospital

Background: Over the past 20 years, the organisation of specialist health services in Norway has developed from a system with many hospitals with a broad range of functions and expertise into a hierarchy with specialist expertise concentrated in a small number of hospitals. This reorganisation of healthcare has meant new challenges for ICU nurses. The professional practice of ICU nurses is governed by legislation on responsible treatment, care and support. Responsible ICU nursing requires appropriate competencies for the challenges of the individual ICU. The aim of this study is to shed light on nursing challenges and competence requirements by interpreting the experiences of five intensive care nurses from their work in a level 1 ICU (the lowest level). Design and method: Qualitative design with individual semi-structured interviews. Sample: Strategic. Five experienced ICU nurses from a level 1 unit. Analysis: Systematic text condensation. The findings revealed themes and sub-themes. Theme: experienced competence, sub-themes: being experienced, taking responsibility, and need for further development. Theme: experienced professional and systemic challenges, sub-themes: unclear expectations, unpredictable situations, individual and system. Conclusion: A lack of congruence was experienced between the challenges of reality and the responsibilities described. There was an uneven level of competence among both nurses and doctors in the ICU. ICU nurses had considerable responsibility for ensuring sound practices in their unit. They experienced a close relationship between competence, well-being, professional self-confidence, quality and patient safety. There was a particular need for training and competence development to help nurses prepare for and deal with unpredictable situations.