An evaluation of fitness for practice curricula: self-efficacy, support and self-reported competence in preregistration student nurses and midwives

Aims and objectives. This element of the larger Scottish evaluation aimed to explore differences between access routes, cohorts and higher education institutes (HEI) (universities and colleges) in levels of self-efficacy, student support and self-reported competence in a nationally representative sample of student nurses and midwives.

Background. This paper reports findings from the National Review of Pre-Registration Nursing and Midwifery Programmes in Scotland. Fitness for practice curricula have been the heart of many recent developments in nurse and midwifery education. Fitness for practice set out to map out the future direction of preregistration nursing and midwifery education with the aim of ensuring fitness for practice based on healthcare need. There have been no national evaluations of the effectiveness of this strategic objective. Previous major evaluations in the 1990s suggested that students may not have had the skills needed to be fit for practice.

Design. The study design was a cross-sectional survey of a stratified random sample of student nurses and midwives (n = 777). Data collected included demographic information, generalised perceived self-efficacy, student support and self-reported competency.

Results. Students reported high levels of self-reported competency. There were no significant differences between two cohorts or between students with different access routes. Students rated support from family and friends highest and support from HEI lowest. There was a significant difference in support levels between HEI. Self-efficacy scores were similar to other population means and showed small-moderate correlations with self-report competence. Similarly, self-reported competency appears to be at the higher end of the spectrum, although older students may have a more realistic perception of their competence. However, support from HEI was seen as less satisfactory and varied from one institution to another.

Conclusions. This study portrays a relatively positive picture of preregistration fitness for practice curricula. Questions are raised about the relative value students place on support from educationalists and mentors and whether support from family and friends and from peers needs to feature more prominently in curricula. The study provides modest support for social cognitive theory.

Relevance to clinical practice. The major drivers for changes in preregistration curricula stemmed from fears about the competence of students. This study did not provide support for this viewpoint, and students' self-reports suggest that curricula are, in this respect, meeting their objectives. Nevertheless support from mentors and from educational institutes may need to be improved.