Nursing Open. 2023;00:1–12.  | 1wileyonlinelibrary.com/journal/nop2 1  |  INTRODUC TION Competence is a vital attribute for the provision of quality and safe care and professional standards (Flinkman et al., 2017). Therefore, self- recognition of nurse's own level of competence should be as- sessed during nurse education and be evaluated along the contin- uum of a nurse's professional career (Kajander- Unkuri et al., 2014; Kajander- Unkuri, Meretoja, et al., 2021; Lejonqvist & Kajander- Unkuri, 2021). Nursing students' competence has been predom- inantly evaluated in the period before graduation (Lejonqvist & Kajander- Unkuri, 2021; Kajander- Unkuri et al., 2014; Kajander- Unkuri, Meretoja, et al., 2021; Numminen et al., 2017). The devel- opment of nurses' competence and its contributing factors has been the subject of extensively growing research efforts worldwide. The clinical learning environment represents one of the factors enhanc- ing nurses' competence development. Learning in the workplace is widely recognized as an opti- mal setting for nursing students to apply competence to clini- cal nursing performance in real- life situations (Visiers- Jiménez et al., 2021). Various factors associated with clinical learning (pre- vious professional education in healthcare before nursing edu- cation, previous work experience in healthcare, the organization of clinical practice, type and duration of clinical placement, the supervisory relationship and the final clinical practicum charac- teristics) have been explored as contributing factors of compe- tence level (Kaihlanen et al., 2021;Kajander- Unkuri et al., 2014, 2021; Visiers- Jiménez et al., 2021). Findings from recent European studies revealed the associations between the nursing students' Received: 15 June 2022  | Revised: 31 January 2023  | Accepted: 20 February 2023 DOI: 10.1002/nop2.1708 E M P I R I C A L R E S E A R C H Q U A N T I T A T I V E Self- assessed competence of final- year nursing students Renáta Zeleníková1  | Elena Gurková2  | Radana Pěrůžková1  | Lenka Štureková3  | Darja Jarošová1  | Satu Kajander- Unkuri4,5 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd. 1Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic 2Department of Nursing, Slovak Republic, Faculty of Health Care, University of Prešov in Prešov, Prešov, Slovak Republic 3Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic 4Department of Nursing Science, University of Turku, Finland, Turku, Finland 5Diaconia University of Applied Sciences, Helsinki, Finland Correspondence Satu Kajander- Unkuri, Department of Nursing Science, University of Turku, Finland, 20014 University of Turku, Turku, Finland. Email: satu.kajander@utu.fi Funding information Ostravská Univerzita v Ostravě, Grant/ Award Number: SGS04/LF/2020- 2021; Finnish Nursing Education Foundationm, Grant/Award Number: 2017_2018_2019 Abstract Aim: To examine the overall level of self- assessed competence of final- year nursing ‘bachelors’ degree students in the Czech Republic. In addition, the study aimed at the factors associated with the students' level of competence. Design: A cross- sectional observational study. Methods: Data were collected with the Czech version of the Nurse Competence Scale from 274 final- year nursing students of the bachelor's nursing program. Data were analysed using descriptive statistics and multiple regression analyses. Results: Majority of the students (80.3%) assessed their level of competence as good or very good. The highest level of competence was assessed in the category of ‘man- aging situations’ (VAS mean 67.8) and ‘work role’ (VAS mean 67.2). Previous work experience in healthcare and successful supervisory experience had a positive as- sociation with self- assessed competence. Students who completed clinical placement during the COVID- 19 pandemic assessed their level of competence as lower than stu- dents before the pandemic. No Patient or Public Contribution. K E Y W O R D S COVID- 19, Czech Republic, nurse competence scale, nursing education, nursing students, professional competence, self- assessment 20541058, 0, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1002/nop2.1708 by U niversity of Turku, W iley O nline Library on [15/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 2  |    ZELENÍKOVÁ et al. experience of their final clinical practicum and the level of their self- assessed competence (Kajander- Unkuri et al., 2014, 2021; Visiers- Jiménez et al., 2021) and easier transition experience (Kaihlanen et al., 2021). However, these European studies were conducted before the COVID- 19 pandemic. Palese et al. (2022) found that new nurses graduating during the COVID- 19 pandemic assessed their competence as lower than new nurses who grad- uated before the COVID- 19 pandemic in Italy. It is important to investigate whether the situation is the same in other countries. Many clinical settings where clinical placements usually take place were cancelled entirely during the first wave of the pan- demic COVID- 19, for example elective surgery and non- urgent procedures that are required placements according to the EU di- rective (2005/36/EC). Instead, there were caring for COVID- 19 patients. Therefore, nursing students lost the opportunity to practice some nursing skills. COVID- 19 workplace conditions had a profound impact on the organizational changes of the final clin- ical practicum and therefore on nursing students' experience of their clinical practicum and their learning opportunities (Barisone et al., 2022; Collado- Boira et al., 2020; Ulenaers et al., 2021; Velarde- García et al., 2021). During this period, final- year nursing students in many countries were confronted with the necessity of work obligations, changing clinical placement planning, missing traditional clinical supervision and insufficient support from the clinical placement site. Nursing students were facing challenges of concerns for limited learning opportunities, workplace safety, in- creased workload and limited or missing interaction with their clin- ical placement mentor (Barisone et al., 2022; Ulenaers et al., 2021; Velarde- García et al., 2021). These factors could have a noticeable impact on the final- year nursing students' self- assessed compe- tence level. 2  |  BACKGROUND There are many competence requirements for nurses globally, for example American Nurses Association [ANA], 2015; Australian Nursing and Midwifery Council [ANMC], 2016; Canadian Nurses Association [CNA], 2015; Nursing & Midwifery Council [NMC], 2014; Singapore Nursing Board [SNB], 2018. The requirements for the competence of nurses in the European Union are based on the common requirements for the professional competence of nurses incorporated in Directives 2002/36/EC and 2013/55/EU of the European Parliament and the Council (European Commission, 2005, 2013). The harmonization of competence requirements, their im- plementation into European directives and the establishment of a congruent approach to their assessment have been the endeavour of several European projects (Tuning educational structures in Europe, Tuning, 2005; European Healthcare Training and Accreditation Network, EHTAN, 2005) and European Federation of Nurses Associations (EFN) has published a guideline for the implementation of competence requirements into national nursing education pro- grams (EFN, 2015). Despite these harmonization efforts, the definition of ‘com- petence’ in the nursing literature is ambiguous and confusing, with terms such as competence, competency and performance being used inconsistently and often interchangeably (Kajander- Unkuri et al., 2013; Pijl- Zieber et al., 2014). The concept of nurse competence has been also broadly explored by many authors (McMullan et al., 2003; Pijl- Zieber et al., 2014; Watson et al., 2002; Wu et al., 2015). Current literature reviews (Cowan et al., 2005; McMullan et al., 2003; Pijl- Zieber et al., 2014; Watson et al., 2002; Wu et al., 2015) identify three main conceptualizations and ap- proaches to defining the concept of competence. The first ap- proach is a behavioural- and performance- oriented approach. The second approach, referred to as generic, focuses on a wider range of skills that are conceptually linked. The third approach is a com- prehensive, holistic approach, in which competence is defined as a dynamic, constantly changing construct, integrating the knowl- edge, skills and attitudes of the individual with the context in which they can be applied (McMullan et al., 2003; Watson et al., 2002). In the Czech Republic, a behavioural approach dominates, which is reflected in the evaluation of clinical competencies of nurs- ing students. Much of the ambiguity and misinterpretation of the term competence is based on the dominance of the behavioural approach, respectively, use of the term in a descriptive than nor- mative sense, resp., its reference to activity and not to quality or state of being (McMullan et al., 2003). Pijl- Zieber et al. (2014) em- phasize the importance of holistic conceptualization of the con- cept, its connection with quality, resp., state of being relating to the overall ability of a person to carry out a particular activity. The International Council of Nursing (1997) also defines in the definition of competence its contextual aspect, the application of knowledge, skills and judgement. Therefore, in our work, we proceed from the third holistic approach in which competence is defined as adequate and to the required degree of integrated knowledge, skills, attitudes and values in the specific context of situations in nursing practice (Meretoja, Leino- Kilpi, & Kaira, 2004). Ambiguity in the definition of nurses' competence is also reflected in differences in approaches to their evaluation (Wu et al., 2015). Only scarcity of papers have been focused on the generic competence evaluation of nursing students in the Czech Republic measured by valid and reliable instruments. Multinational re- search projects (e.g., COMPEUnurse, Kajander- Unkuri, Koskinen, et al., 2021) have significantly contributed to empirical evidence re- lated to the graduated nurses' competence development. Previous studies performed in the Czech Republic examined fulfilling the competencies of members of a nursing team in acute care hospitals (Mikšová et al., 2014) or used specific instruments (e.g. for mea- suring moral judgement competence, Bužgová & Sikorová, 2013). These studies did not include an explicit conceptualization, an ap- proach to the measurement of this concept or instruments without reported psychometric properties used. Students' self- assessment tools are one of the methods of assessing students' competence level. Their use by final- year nursing students can be an effective means of reflection and internal motivation for the student, gaining 20541058, 0, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1002/nop2.1708 by U niversity of Turku, W iley O nline Library on [15/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License     |  3ZELENÍKOVÁ et al. an objective picture of their competence, based on which the stu- dent can purposefully plan their further progress. The aim of the study was to examine the overall level of self- assessed competence of final- year nursing ‘bachelors’ degree stu- dents in the Czech Republic. We focused also on the analysis of factors associated with the level of students' competence, including the COVID- 19 pandemic period. 2.1  |  Research question The research questions to be answered are • What is the level of competence of final- year nursing students in the Czech Republic based on their self- assessments? • What factors are associated with the level of competence? 3  |  THE STUDY 3.1  |  Design The study has a cross- sectional observational study design. 3.2  |  Method 3.2.1  |  Sample The target group of this study was final- year nursing students study- ing at universities in the Czech Republic. Nursing education of gen- eral nurses in the Czech Republic follows the EU Directives. There are 15 universities where nursing can be studied. The length of bachelors' study program in nursing is 3 years in total. In 2019, the mean annual number of graduating nurses per 100,000 inhabitants in the Czech Republic was 28.7 (OECD, 2020). In addition, in 2019, there were 1460 graduates in general nursing in the Czech Republic (Ministry of Health in the Czech Republic, 2021). Participants were selected for the research sample on the basis of inclusion criteria (final year of the bachelor's study program in full- time or part- time form, consent to participate in the study), with the guaran- tee of anonymity. The sample size was estimated by a power analysis: the statistical power of 80%, the significance level of 0.05 (two- tailed) and the relevant NCS total mean difference as five points and SD 15.7. The minimum sample size was 156 respondents (Kajander- Unkuri et al., 2014). A total of 274 final- year nursing students from four uni- versities in the Czech Republic took part in the research. 3.2.2  |  Instrument A questionnaire set consisting of two parts was used for data col- lection. The first part consisted of items related to demographic data and other background questions (Table 1). In the second phase of data collection, job- related data were collected during the COVID- 19 pandemic. The second part of the questionnaire set con- sisted of Nurse Competence Scale items (NCS, Meretoja, Isoaho, & Leino- Kilpi, 2004), which were back- translated in COMPEUnurse study project (Kajander- Unkuri, Koskinen, et al., 2021) and vali- dated (Pěrůžková et al., 2022). The NCS is a generic self- assessment tool designed to assess the competence of nurses from different areas of practice, cultures and years of practice. However, it is also widely used to evaluate the competence of graduating nurs- ing students (Flinkman et al., 2017; Kajander- Unkuri, Koskinen, et al., 2021). The conceptual framework of the tool is the theoreti- cal categories of Benner's work - From novice to expert (Benner, 1984). The tool is based on a holistic approach to conceptualizing TA B L E 1  Sample characteristics (n = 274). Variable Descriptive statistics Age Mean 26.6 ±SD ± 6.9 Min- Max 20– 48 Gender Female 250 (91.9%) Male 22 (8.1%) Previous professional qualification in healthcare Yes 184 (68.4%) No 85 (31.6%) Work experience before or/and during this education in healthcare besides clinical placements Yes 169 (62.6%) No 101 (37.4%) Leaving intentions Never 113 (41.9%) Fairly seldom 112 (41.5%) Fairly often 38 (14.1%) Often 7 (2.6%) Nursing as the 1st study choice Yes 193 (72.6%) No 73 (27.4%) Occurrence of clinical supervision None appointed/ no named supervisor 42 (16.0%) A personal supervisor, strained relation 15 (5.7%) Unplanned change of supervisor 6 (2.3%) Situational supervisor (supervision varied according to the placement/hospital ward) 72 (27.5%) Group supervision 30 (11.5%) Successful supervisory experience (one, functioning relation) 95 (36.3%) Other 2 (0.8%) 20541058, 0, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1002/nop2.1708 by U niversity of Turku, W iley O nline Library on [15/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 4  |    ZELENÍKOVÁ et al. nurses' competence. It was created to overcome the shortcomings of tools for assessing nurses' competence— the absence of theoret- ical and methodological basis and rigorous psychometry (Flinkman et al., 2017; Lejonqvist & Kajander- Unkuri, 2021). It contains of 73 items grouped into seven categories (Table 2). The competence level in each item is assessed using a visual analogue scale (VAS) ranging from 0 (low level) to 100 (high level). For a more accurate description of the competence level, the VAS score is divided into the following areas: a score ≤25 indicates low, >25– 50 indicates rather good, >50– 75 indicates good and >75– 100 indicates very good competence level. The relevance of the use of competence items is assessed on the basis of a frequency scale from 0 (not related to work) to 3 (used very often). The internal consistency of the individual subscales of the original NCS version, assessed by Cronbach's alpha coefficient, ranged from 0.79 to 0.91 (Meretoja, Isoaho, & Leino- Kilpi, 2004). In this study, Cronbach's alpha coef- ficient ranged from 0.84 to 0.95 showing strong internal consist- ency (Pěrůžková et al., 2022). 3.2.3  |  Data collection A total of 11 Czech universities were contacted for the purposes of the study. To gain permission for the study, one of the researchers contacted the head of the nursing department or other responsible persons at each university where the Bachelor's Study programme in nursing in full- time or part- time form is offered. Data collection was carried out in the period 2018– 2021 in two phases. In the first phase, data collection took place from February 2018 to July 2019 in the Competence of Nursing Students in Europe (COMPEUnurse) project at four universities in the Czech Republic with a return rate of 30% (710 were distributed and 213 questionnaires were returned). In the second phase, data collection took place from February 2021 to September 2021. In the second phase, 10 universities were con- tacted; however, only students from three universities took part in the research. In one university, data collection took place in paper form, 58 questionnaires were distributed and 57 were returned. Data were collected in close cooperation with the contact person of each included university. Students were asked to complete a ques- tionnaire during class time and drop it in a dedicated box in a sealed envelope to ensure anonymity. The return rate was 98%. Only four questionnaires were returned from the universities where the ques- tionnaires were distributed and completed online. 3.3  |  Analysis The method of descriptive and inductive statistics was used for data analysis. Quantitative variables were evaluated by arithmetic mean, standard deviation, absolute abundance (N) and relative abundance (%). The normality of the quantitative data was verified using the Shapiro– Wilk normality test and skewness. Almost all variables were normally distributed with skewness <1.00. Only the age and length of previous work experience in healthcare had skewness >1.00. Based on the results of the normality test for the overall NCS score and for NCS categories according to the observed variables (age, previous professional qualification in healthcare, previous work ex- perience in healthcare, length of previous work experience in health- care, nursing as the first study choice, leaving intentions, occurrence of clinical supervision and clinical placement before/during the COVID- 19 pandemic) (see Table 1), appropriate parametric (Pearson correlations, Student's t test) or non- parametric tests (Spearman correlations, Mann– Whitney test) were chosen. According to the multinational European study (Warne et al., 2010), we divided nurs- ing students’ experience with clinical supervision into two groups: some variation of unsuccessful supervisory experience (no named supervisor, the unplanned change of supervisor, a personal supervi- sor was named, but the relationship with this person did not work, group supervision) and successful individual supervisory experience. For exploring the relationship between variables, multiple lin- ear regression analyses were used. These multiple regressions were hierarchical over the blocks, but statistical (stepwise) in the blocks NCS competence category Category Level of competence (mean) Level of competence (±SD) Frequency of using competence itemsa (%) Cronbach's alpha Helping role 57.2 18.2 68.4 0.841 Teaching – coaching 59.8 19.9 65.9 0.944 Diagnostic functions 61.8 19.8 65.1 0.870 Managing situations 67.8 19.2 72.3 0.903 Therapeutic interventions 61.3 20.6 61.9 0.922 Ensuring quality 54.6 21.6 49.7 0.888 Work role 67.1 18.9 69.2 0.951 Overall score 62.2 17.0 64.6 0.981 aCompetence items are used occasionally or very often. TA B L E 2  Level of competence and frequency of using the competence items (NCS). 20541058, 0, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1002/nop2.1708 by U niversity of Turku, W iley O nline Library on [15/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License     |  5ZELENÍKOVÁ et al. (Tabachnik & Fidell, 2001). Linear regression analyses were per- formed to investigate the relationship between the overall score and categories of the NCS (dependent variables) and the following independent variables: age, previous professional qualification in healthcare, previous work experience in healthcare, length of previ- ous work experience in healthcare, nursing as the first study choice, leaving intentions, occurrence of clinical supervision, clinical place- ment before/during the COVID- 19 pandemic. Except for the age and length of previous work experience in healthcare, all independent variables were dichotomized (Table 1). Age, previous professional qualification in healthcare, previous work experience in healthcare and length of previous work experience in healthcare were entered stepwise in the first block; nursing as the first study choice, leaving intentions, occurrence of clinical supervision and clinical placement before/during the COVID- 19 pandemic were entered stepwise in the second block. One of the outputs of the multiple regression is also a multicollinearity test, which gives a VIF (variance inflation factor) statistic and a tolerance statistic. Multicollinearity of variables was measured by correlation coefficients, variance inflation factor (VIF) and the tolerance index before the regression analysis. If the toler- ance index is 0.2 or less, then multicollinearity exists in the data. Similarly, a VIF of 5 or greater indicates multicollinearity. In our data, values of VIF ranged between 1.00 and 2.05 for all variables. The tolerance index was higher than 0.2 for all variables (Yu et al., 2015). A significance level of p = 0.05 was chosen. IBM SPSS Statistics for Windows, Version 20.0 statistical software was used for statistical processing. 3.4  |  Ethics The research study was approved by the Ethics Committee of the Faculty of Medicine of the University of XXXX (Nos. 14/2017 and 16/2020). The study was a part of COMPEUnurse study pro- ject which has permission from the copyright holders for translat- ing and using the NCS. To gain permission for the study, one of the researchers contacted the head of the nursing department or other responsible persons at each university where the Bachelor's Study programme in nursing in full- time or part- time form is of- fered. Informed consent to inclusion in the research was included in the questionnaires in online and paper form. In the case of paper questionnaires, consent was expressed by signing it; in the online form, consent was expressed by answering a question concerning in- formed consent. The informed consent included an explanation that the respondents' participation in the research is anonymous, volun- tary, with the opportunity of revoking the consent to be included in the research at any time. 4  |  RESULTS The characteristics of the selected research sample are described in Table 1. Fifty- six (98.2%) out of 61 students were involved in work duty, and the highest number of 32 students (56.1%) worked as a nurse. A total of 5 (8.8%) students believed that they did not carry out activities at all during their work duties according to the achieved competencies. The highest number of students 21 (36.8%) stated that they carried out activities during their work duty very often. 4.1  |  Level of self- assessed competence Students´ overall level of competence was good (VAS mean 62.2, SD 17.0). A significant part of students (58.7%) assessed their level of competence as good (VAS > 50– 75), about one- fifth (21.6%) as very good (VAS > 75– 100) and only 3.1% as low (VAS ≤25). The highest level of competence was assessed by students in the category of Managing situations (VAS 67.8, SD 19.2) and Work role (VAS 67.1, SD 18.9). On the contrary, they assessed their compe- tence as lowest in Helping role (VAS 57.2, SD 18.2) and in Ensuring quality (VAS 54.6, SD 21.6) (Table 2). 4.2  |  Factors related to the level of self- assessed competence The level of competence differed mainly in terms of previous work experience in healthcare and methods of supervision (Table 3). Previous experience with work in healthcare had a positive rela- tionship with the self- assessed competence of final- year nursing students (p = 0.017), especially in Managing situations (p = 0.003), Work role (p = 0.018) and Helping role (p = 0.010). Students with a successful individual form of supervision reported a higher level of overall competence (p = 0.001) in the following categories: Managing situations (p = 0.001), Therapeutic interventions (p = 0.009) and Work role (p = 0.001). Students who completed clinical placement during the COVID- 19 pandemic assessed their competence level as lower than students before the pandemic (Table 3). Statistically significant differences in terms of placement before and during the pandemic were found in the overall competence (p = 0.008) and the four categories of the NCS: Helping role (p = 0.023), Managing situation (p = 0.001), Therapeutic interventions (p = 0.001) and Work role (p = 0.010). No statistically significant relationship was found between age, length of work experience, total NCS score and NCS categories (Table 4). The stepwise multiple regression analyses indicated that only three of the seven categories (Managing situations, Therapeutic interventions and Work role) were affected by the selected inde- pendent variables. Overall score of the NCS was predicted by two factors (previous work experience in healthcare and occurrence of clinical supervision), explaining only a total of 5% of the variance. However, the percentages of variance explained by these factors were low and, therefore, results suggest that the level of self- assessed competence is not strongly associated with previous work experience in healthcare and occurrence of clinical supervision. In addition, previous work experience in healthcare and successful 20541058, 0, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1002/nop2.1708 by U niversity of Turku, W iley O nline Library on [15/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 6  |    ZELENÍKOVÁ et al. T A B L E 3   Fa ct or s re la te d to t he le ve l o f s el f- as se ss ed c om pe te nc e (g ro up c om pa ri so n) . C om pe te nc e ca te go ry /f ac to r H el pi ng r ol e m ea n (S D ) Te ac hi ng / co ac hi ng m ea n (S D ) D ia gn os ti c fu nc ti on s m ea n (S D ) M an ag in g si tu at io ns m ea n (S D ) Th er ap eu ti c in te rv en ti on s m ea n (S D ) En su ri ng qu al it y m ea n (S D ) W or k ro le m ea n (S D ) O ve ra ll sc or e m ea n (S D ) Pr ev io us pr of es si on al qu al ifi ca tio n in he al th ca re a Ye s 57 .8 1 (1 7. 03 ) 60 .8 4 (1 8. 79 ) 62 .0 8 (1 9. 06 ) 69 .9 7 (1 7. 55 ) 62 .5 7 (1 9. 15 ) 55 .0 7 (2 1. 01 ) 68 .1 3 (1 7. 16 ) 69 .3 0 (1 5. 26 ) N o 58 .0 3 (1 8. 02 ) 59 .9 2 (1 9. 65 ) 63 .6 5 (1 8. 38 ) 67 .8 3 (1 8. 56 ) 60 .7 2 (2 1. 06 ) 55 .6 8 (2 0. 01 ) 67 .6 2 (1 8. 82 ) 62 .4 0 (1 7. 07 ) W or k ex pe rie nc e be fo re o r/ an d du rin g th is e du ca tio n in h ea lth ca re be si de s cl in ic al pl ac em en ts a Ye s 60 .0 6* (1 6. 28 ) 62 .3 4 (1 7. 60 ) 6 4. 19 (1 7. 16 ) 71 .6 5* * ( 15 .4 2) 63 .9 8 (1 8. 8 0) 56 .7 1 (2 0. 73 ) 70 .3 2* * ( 16 .0 8) 65 .2 2* ** (1 4. 06 ) N o 54 .6 0 (1 8. 35 ) 57 .8 8 (2 0. 71 ) 60 .0 5 (2 0. 93 ) 63 .8 7 (2 0. 56 ) 59 .2 3 (2 0. 67 ) 53 .1 6 (2 1. 21 ) 64 .3 6 (1 9. 43 ) 59 .6 8 (1 7. 73 ) Le av in g in te nt io ns b N ev er /s el do m 58 .6 7 (1 6. 98 ) 61 .3 1 (1 8. 58 ) 62 .9 8 (1 8. 53 ) 69 .5 8 (1 6. 93 ) 62 .3 6 (1 9. 24 ) 55 .4 9 (2 0. 63 ) 68 .1 7 (1 6. 91 ) 63 .4 8 (1 5. 38 ) Fa irl y of te n/ of te n 53 .6 9 (1 8. 43 ) 55 .9 9 (2 0. 74 ) 59 .9 7 (2 0. 20 ) 63 .3 3 (2 1. 87 ) 60 .2 2 (2 2. 21 ) 53 .8 8 (2 2. 69 ) 66 .4 2 (2 1. 06 ) 60 .2 2 (1 7. 75 ) N ur si ng a s th e fir st st ud y ch oi ce b Ye s 57 .8 0 (1 7. 78 ) 60 .3 1 (1 9. 13 ) 62 .8 9 (1 8. 61 ) 68 .3 8 (1 7. 77 ) 62 .3 3 (1 9. 57 ) 54 .4 0 (2 0. 01 ) 67 .5 3 (1 7. 68 3) 62 .9 2 (1 5. 63 ) N o 58 .1 0 (1 6. 41 ) 60 .9 6 (1 9. 19 ) 61 .6 1 (1 9. 57 ) 69 .9 6 (1 7. 83 ) 62 .0 7 (1 9. 71 ) 57 .7 3 (2 3. 03 ) 69 .6 1 (1 7. 20 ) 63 .5 6 (1 6. 42 ) Pe rio d of c lin ic al pl ac em en tb B ef or e th e C O V ID - 1 9 pa nd em ic 57 .9 8* (1 9. 05 ) 60 .3 6 (2 0. 88 ) 62 .3 3 (2 0. 22 ) 69 .3 7* (1 9. 77 ) 63 .1 7 (2 1. 20 )* 53 .3 4 (2 2. 45 ) 68 .2 2* (1 9. 51 ) 63 .2 6* * ( 17 .8 3) D ur in g th e C O V ID - 1 9 pa nd em ic 54 .6 9 (1 4. 88 ) 57 .9 1 (1 7. 98 ) 60 .0 0 (1 8. 39 ) 62 .5 5 (1 6. 39 ) 54 .9 6 (1 7. 34 ) 52 .2 3 (1 8. 41 ) 63 . 3 5 (1 6. 49 ) 58 .9 1 (1 3. 69 ) O rg an iz at io n of su pe rv is io na U ns uc ce ss fu l su pe rv is or y ex pe rie nc e 56 .4 7 (1 6. 18 ) 58 .8 9 (1 8. 61 ) 60 .0 7 (1 7. 99 ) 63 .5 4* ** (1 8. 85 ) 57 .9 6 (1 9. 39 )** 52 .8 8 (2 0. 41 ) 63 .6 6* * ( 17 .3 9) 59 .8 8* * ( 15 .4 1) Su cc es sf ul s up er vi so ry ex pe rie nc e 59 .4 1 (1 7. 43 ) 61 .7 1 (1 8. 89 ) 6 4. 39 (1 8. 53 ) 72 .0 9 (1 6. 02 ) 64 .6 4 (1 9. 15 ) 56 .8 2 (2 0. 96 ) 71 .0 1 (1 6. 63 ) 65 .2 1 (1 5. 15 ) Th e bo ld v al ue s ar e st at is tic al ly s ig ni fic an t v al ue s. a D at a (N C S ca te go rie s an d N C S ov er al l s co re ) w er e no rm al ly d is tr ib ut ed fo r t he te st ed p ar am et er (t te st w as u se d to d et er m in e st at is tic al ly s ig ni fic an t d iff er en ce s be tw ee n gr ou ps ). b D at a (N C S ca te go rie s an d N C S ov er al l s co re ) w er e no t n or m al ly d is tr ib ut ed fo r t he te st ed p ar am et er (M an n– W hi tn ey te st w as u se d to d et er m in e st at is tic al ly s ig ni fic an t d iff er en ce s be tw ee n gr ou ps ). *p  <  0 .0 5; * *p  <  0 .0 1; * ** p <  0 .0 01 . 20541058, 0, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1002/nop2.1708 by U niversity of Turku, W iley O nline Library on [15/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License     |  7ZELENÍKOVÁ et al. supervisory experience contributed to a higher level of two areas of self- assessed competence: Managing situations and Working role. Only 2% of total variance in therapeutic intervention was accounted for by nursing students' experience of their final clinical practicum during the COVID- 19 pandemic. Low percentage of the variance suggests that the level of self- assessed competence is not strongly affected by previous work experience in healthcare, occurrence of clinical supervision or nursing students' experience of their final clin- ical practicum during the COVID- 19 pandemic. Other characteris- tics of nursing students had no significant relationship to the level of self- assessed competence (Table 5). 5  |  DISCUSSION The aim of this study was to examine the overall level of self- assessed competence of final- year nursing ‘bachelors’ degree students in the Czech Republic and to analyse the factors associated with the level of students' competence. The results of our study revealed that most of the final- year nursing students assessed their level of competence as good or very good. The highest assessments were in ‘managing situations’ and ‘work role’ before completing their bachelor's studies. This re- sult may be a logical consequence of the focus on clinical practice in the university hospital setting and of the specific period (COVID- 19 pandemic)— the predominance of acute conditions, the short length of hospital stays and the need for prompt nurse responses. In this clinical learning environment, therefore, emphasis may be placed on collaborative care and recognizing changing situations and pri- oritizing activities flexibly and appropriately (Meretoja, Isoaho, & Leino- Kilpi, 2004). However, European studies have also identified considerable variability in students' level of competence across European countries (Kajander- Unkuri, Koskinen, et al., 2021; Nilsson et al., 2019). Comparative European studies evaluating the com- petence level of nursing students in different EU countries were carried out before the COVID- 19 pandemic. Part of the sample of this study (22.3%) consisted of final- year students in the bach- elor's study program general nursing, who graduated during the COVID- 19 pandemic. Most of them (98.2%) were ordered to work as nurses. However, medical and nursing students in their final year of education were called by government resolution to work duty (Government of the Czech Republic, 2020). This resolution of the Government of the Czech Republic was adapted as a part of se- ries of early population- wide interventions and measures to mit- igate the epidemic situation and to prevent the overcrowding of healthcare facilities. The duty resolution (Government of the Czech Republic, 2020) has been used to compensate for the critical short- age of staff in overloaded hospitals. Many nursing students worked as auxiliary staff during the crisis. Compared with previous European comparative research (Kajander- Unkuri, Koskinen, et al., 2021; Nilsson et al., 2019), stu- dents in our cohort reported a lower rate of competence assess- ment in several NCS categories. We also found differences in our T A B L E 4   Sp ea rm an c or re la ti on s be tw ee n se lf- as se ss ed c om pe te nc e, t he le ng th o f w or k ex pe ri en ce in h ea lt hc ar e an d th e ag e of s tu de nt s. H el pi ng ro le Te ac hi ng /c oa ch in g D ia gn os ti c fu nc ti on s M an ag in g si tu at io ns Th er ap eu ti c in te rv en ti on s En su ri ng qu al it y W or k ro le O ve ra ll co m pe te nc e A ge W or k ex pe ri en ce O ve ra ll co m pe te nc e Rh o 0. 77 4* * 0. 86 7* * 0. 86 1* * 0. 87 7* * 0. 86 4* * 0. 81 5* * 0. 90 2* * 1 0. 05 3 - ,0 41 A ge rh o 0. 06 8 0. 03 6 0. 03 8 0. 07 5 0. 05 7 −0 .0 29 0. 05 0 0. 05 3 1 0. 72 9* * W or k ex pe rie nc e rh o 0. 00 3 −0 .0 98 −0 .0 88 0. 05 3 0. 01 4 −0 .1 4 0 0. 00 7 −0 .0 41 0. 72 9* * 1 ** p <  0 .0 1. 20541058, 0, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1002/nop2.1708 by U niversity of Turku, W iley O nline Library on [15/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 8  |    ZELENÍKOVÁ et al. research sample. Students who completed clinical placement during the COVID- 19 pandemic as part of their work duties rated their competence level lower than students before the pandemic. This might be due to that during the COVID- 19 pandemic, many students completed several clinical placements without the traditional model of individual clinical supervision assigned by the mentor. The role of supervisory relationship between student and mentor should be emphasized as it has been found to promote competence develop- ment (Visiers- Jiménez et al., 2021) and professional development (Saukkoriipi et al., 2020). If the supervision during the pandemic was limited, this supports the finding that competence was assessed lower. The Italian study (Palese et al., 2022) likewise confirmed the changes in nursing students' perceived competence levels due to the impact of the COVID- 19 pandemic. The changes and measures taken in undergraduate education to address the impact of the COVID- 19 pandemic may have influenced new graduates' perceptions of their own competence and their employment status after graduation (Palese et al., 2022). The relationship between the attributes of a nursing students' final clinical learning environment with the level of their self- assessed competence was investigated in several multi- country European studies (Kaihlanen et al., 2021; Visiers- Jiménez et al., 2021). The contribution of the students' perceptions of their final clinical learn- ing environment, good supervisory relationship to a better level of self- assessed competence and to the success of the transition of newly graduated nurses was highlighted (Kaihlanen et al., 2021; Visiers- Jiménez et al., 2021). During clinical placement, students are in two different but interconnected contexts that affect their learn- ing process in clinical settings— the context of learning and the context of caring. The ideal clinical environment can make reasonable use of and bring together these two contexts, that is it gives the conditions for professional growth, the development of competence combined with the development of independent thinking and openness to change (Gaberson et al., 2015). During the ordered work duty, the interconnection of the men- tioned contexts was absent, and the students performed individual activities that resulted from the needs of the workplace, without any connection to the goals of education. Students faced limited learning opportunities, organizational changes in the final clinical practicum or missing interaction with the clinical placement mentor (Allande- Cussó, 2020; Dziurka et al., 2022; Goni- Fuste et al., 2021; Ulenaers et al., 2021; Velarde- García et al., 2021). The COVID- 19 pandemic brought many changes in nursing ed- ucation worldwide, and some studies described negative impacts Predictor R R2 change b T p Overall competence (F = 6.47**) Previous work experience in healthcare 0.16 0.025* −0.145 −2.34 0.020 Occurrence of clinical supervision 0.22 0.024* 0.157 2.53 0.012 Constant 13.523 Managing situation (F = 11.99***) Previous work experience in healthcare 0.20 0.041** −0.182 −2.99 0.003 Occurrence of clinical supervision 0.30 0.047*** 0.219 3.59 0.000 Constant 12.794 Therapeutic interventions (F = 8.99***) Clinical placement before/during the COVID- 19 pandemic 0.23 0.053** −0.205 −3.28 0.001 Occurrence of clinical supervision 0.26 0.015* 0.123 1.95 0.05 Constant 10.706 Working role (F = 8.06***) Previous work experience in healthcare 0.154 0.024* −0.137 −2.21 0.028 Occurrence of clinical supervision 0.247 0.037* 0.194 3.14 0.002 Constant 12.564 *p < 0.05; **p < 0.01; ***p < 0.001. TA B L E 5  The association of the background factors with overall competence and competence categories analysed with stepwise logistic regression. 20541058, 0, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1002/nop2.1708 by U niversity of Turku, W iley O nline Library on [15/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License     |  9ZELENÍKOVÁ et al. on clinical learning (Angasu et al., 2021; Kang & Hwang, 2023). In the Polish qualitative study (Dziurka et al., 2022), students ex- pressed fear that cancellation of classes during lockdowns may affect their future work. The impact of changes in nursing practi- cum caused by the COVID- 19 pandemic on new graduate nurses has been investigated in a Korean study (Kang & Hwang, 2023) and the results revealed a significant difference in the difficul- ties in nursing tasks if nursing students experienced substitute of nursing practice. Although students in our sample were able to continue with clinical practice during pandemic, the content of practice was adapted to the needs of hospitalized patients. For example, there were cancelled elective surgical procedures and many departments were temporarily transformed and served as COVID- 19 departments. In addition, students experienced signif- icant changes in the nursing curriculum due to online theoretical courses and restrictions during clinical practice. In the latest sys- tematic review and meta- synthesis (Shorey et al., 2022), it was confirmed that nursing undergraduates experienced many sudden and extreme changes during remote and online education, and they had to rapidly adapt and accept them. Moreover, key clini- cal skills and competencies were perceived to be less developed (Shorey et al., 2022) as continuity of learning was interrupted due to difficulties with visualizing, understanding and linking theoret- ical knowledge to practice. These factors may also be one of the explanations for the different perceptions of students' compe- tence before and during the COVID- 19 pandemic. What another European study revealed can not be omitted is that having a good final clinical practice has significant impact on a simpler transition from student to nurse (Kaihlanen et al., 2021) as it can enhance a successful transition (Kaihlanen et al., 2020a) and is associated with turnover intentions (Kaihlanen et al., 2020b). In addition to the time of clinical placement (before and during the COVID- 19 pandemic), other variables affecting levels of self- assessed competence were confirmed— previous work experience in healthcare and the method of supervision. Previous work experi- ence in healthcare has a positive association with the level of com- petence self- assessment of final- year nursing students, especially in the category of managing situations and work role. Similar findings are reported by comparative European studies (Kajander- Unkuri, Koskinen, et al., 2021; Nemcová et al., 2021; Nilsson et al., 2019). For a significant part of the students in our sample (72.6%), deci- sion to study to become a general nurse was their first study choice. However, the relationship between the first study choice and the development of competence was not found to be statistically signif- icant in our study. The decision to study general nursing as the first choice is considered a factor in the nurses' competence— in terms of the greater orientation of nursing students for care and expertise (Kajander- Unkuri, Meretoja, et al., 2021). This factor has been stud- ied in several studies (e.g. Kajander- Unkuri et al., 2021; Nemcová et al., 2021), but with mixed results. Only a small amount part of the students in our study (16.7%) considered leaving intentions often or very often. Although the amount is small, it is worrying that students who have not even graduated and worked as registered nurses had already considered leaving. The intentions to leave the nursing pro- fession were unrelated to any of the categories of competence. The complexity, the dynamism of the clinical setting and the multifactorial conditionality of the process of gaining clinical expe- rience and competencies in students also imply the complexity of its research. One of the areas that we can influence on the part of educational institutions is the strategies and methods of clinical su- pervision by mentors and teachers, the healthcare staff itself, facil- itating the learning process in the clinical departments. The results of our cross- sectional study highlight the importance of student su- pervision during clinical practice as one of the factors influencing the competence self- assessment in nursing students. The form of supervision was mainly monitored in relation to the perception of the clinical department. Studies in Western EU countries (Saarikoski et al., 2013; Warne et al., 2010) clearly confirm the change from traditional group supervision to an individualized supervisory rela- tionship between the mentor and the student. Thus, the effective- ness of students' individual supervision has strong empirical support (Saarikoski et al., 2013; Warne et al., 2010). The method of supervi- sion, the frequency of supervision meetings and the length of clinical practice were identified as factors that significantly affect students' assessment of the clinical learning environment. The relationship be- tween the mentor and the student and the pedagogical atmosphere of the final clinical learning environment are highlighted as contrib- uting factors of competence level (Kaihlanen et al., 2021; Visiers- Jiménez et al., 2021). Further research should focus on monitoring the relationship between the clinical environment and competence development. Moreover, it is necessary to develop efficient clinical practice education for nurses that will respond appropriately to any pandemic situation. Clinical practice needs to pay more attention to the adaptation of new graduate nurses to compensate for the insuf- ficient clinical practice during the COVID- 19 pandemic. 5.1  |  Limitations This study has some limitations. The first limitation is the charac- ter of the scale used. Self- assessment scales are characterized by a considerable degree of subjectivity, students may overestimate or underestimate their competence known as self- assessment bias. However, self- assessment is an established part of compe- tence assessment. The second limitation of the study is the highly unbalanced gender ratio of the sample since the actual ratio of the available male and female Czech nursing students is unbalanced. The third limitation of the study is the low return of the questionnaires. Questionnaires could have only been completed by motivated stu- dents, and this could have had an impact on the results obtained. However, the sample size was based on the power analysis, and this study is among the first studies where the level of competence of Czech nursing students has been assessed. However, the sample size is not representative of all final- year nursing students in the Czech Republic as it came from four universities. Therefore, the results cannot be generalized to the entire population. 20541058, 0, D ow nloaded from https://onlinelibrary.w iley.com /doi/10.1002/nop2.1708 by U niversity of Turku, W iley O nline Library on [15/03/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on W iley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 10  |    ZELENÍKOVÁ et al. 6  |  CONCLUSION The evaluating competence of final- year nursing students is a part of the quality assurance of nursing education in the Czech Republic and an important tool for the competence requirements during the profes- sional education of nurses. Most students rated the level of their com- petence as good or very good. Previous work experience in healthcare and successful supervisory experience, the final clinical practicum before the COVID- 19 pandemic contributed to a better level of self- assessed competence of these nursing students. There is a need for further studies investigating the impact of the COVID- 19 students' clinical learning environment and learning opportunities during this critical period on the graduating nursing students' self- assessed com- petence level and the transition process of newly graduated nurses. AUTHOR CONTRIBUTIONS RZ, EG, RP, LŠ, DJ, SK- U: Made substantial contributions to concep- tion and design, acquisition of data or analysis and interpretation of data. RZ, EG, RP, LŠ, DJ, SK- U: Involved in drafting the manuscript or revising it critically for important intellectual content. RZ, EG, RP, LŠ, DJ, SK- U: Given final approval of the version to be published. Each author should have participated sufficiently in the work to take pub- lic responsibility for appropriate portions of the content. RZ, EG, RP, LŠ, DJ, SK- U: Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. ACKNO WLE DG E MENTS We would like to thank all nursing students who participated in this study and all contact persons at all universities who kindly helped with the data collection. We are grateful to Professor Riitta Meretoja for her expertise in the NCS instrument and its interna- tional use of it. FUNDING INFORMATION This contribution was supported by the Faculty of Medicine, University of Ostrava, Czech Republic; Grant SGS: Clinical learning environment and development of competence of nursing students (SGS04/LF/2020– 2021). Finnish Nursing Education Foundationm, Grant/Award Number: 2017_2018_2019. CONFLIC T OF INTERE S T S TATEMENT The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. DATA AVAIL ABILIT Y S TATEMENT All data generated during this study are included in this published article. RE SE ARCH E THIC S COMMIT TEE APPROVAL The research study was approved by the Ethics Committee of the Faculty of Medicine of the University of Ostrava (nos. 14/2017 and 16/2020). REPORTING GUIDELINE The STROBE checklist for observational cross- sectional studies was followed for reporting the research study. PATIENT CONSENT S TATEMENT Not needed. ORCID Renáta Zeleníková https://orcid.org/0000-0003-1491-6696 Elena Gurková https://orcid.org/0000-0002-5629-9414 Radana Pěrůžková https://orcid.org/0000-0003-4628-7476 Lenka Štureková https://orcid.org/0000-0002-9516-0722 Darja Jarošová https://orcid.org/0000-0002-3032-3076 Satu Kajander- Unkuri https://orcid.org/0000-0003-2668-5856 R E FE R E N C E S Allande- Cussó, R. 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