CRITICAL EVALUATION OF THE NEWLY QUALIFIED NURSE ’ S COMPETENCY TO PRACTISE-PART 1 R Troskie

In the Republic of South Africa a variety of fac to rs in flu en ce the n u rse ’s competency, such as: • The changing pattern of health care delivery, necessitated by the shift from a curative o rien tated to a comprehensive health service. The Health Act, 63 of 1977 as well as the N ationa l H e a lth P lan of 1986 fo rm u la ted policy to m eet the demands of this change. The South African Nursing Council, in response to the above policy, introduced the course for the education and training of a nurse (general, psychiatric and community) and midwife, leading to registration with the South African Nursing Council (Regulation no. 425 of 22 F eb ru ary 1985). The competency of the professional nurse having completed this course is being queried by senior members of the profession. • The p o p u la tio n p ro file in the Republic of South Africa. It has been e s tim a ted th a t th e re will be a population of between 27 million and 36 million in the Republic of South Africa by the year 2000 (Gerber, Nel & Van Dyk 1987:3). The Republic of South Africa is confronted by both a first and third world situation. This requires a diverse approach to health care in which primary health care, population development and family planning should receive priority (President Council Report 1983:76). Advancements in medical technology should however not be overlooked. "Increased acuity levels o f patients, decreased length o f hospitalization and the pro lifera tion o f health care technology and specialization have increased the need fo r highly experienced nurses" (B en n er 1982:402).


Summary
The competence o f the newly qualified nurse practitioner is questioned.Critical evaluation o f the competency o f the newly qualified nurse is performed by means o f self evaluation as well as evaluation by the newly qualified nurse's supervisor.This study shows the relationship between competency o f the newly qualified nurse and placement, orientation and guidance.Data analysis indicated that there is no significant relationship between the competency o f the newly qualified nurse and placement and orientation.The importance o f adequate guidance to the newly qualified nurse was quite clear.

PROBLEM
A c ritical ev aluation of the newly qualified nurse's competency to practise, in which she participates is essential to ensure the delivery of high quality care.Thorough orientation and guidance is necessary to help her accept the reality of her responsibilities.Allen (1982:1) maintained "A society undergoing rapid change needs professionals who have developed skills and who are able to evaluate the way their knowledge, experience and energy can best be utilized".
In the Republic of South Africa a variety of fa c to rs in flu e n c e th e n u r s e 's competency, such as: • The changing pattern of health care delivery, necessitated by the shift from a cu rativ e o rie n ta te d to a comprehensive health service.The Health Act, 63 of 1977 as well as the N a tio n a l H e a lth P lan of 1986 fo rm u la te d p o licy to m ee t th e demands of this change.The South African Nursing Council, in response to the above policy, introduced the course for the education and training of a nurse (general, psychiatric and community) and midwife, leading to registration with the South African Nursing Council (Regulation no.425 of 22 F e b ru a ry 1985).T he competency of the professional nurse having completed this course is being queried by senior members of the profession.

• T he p o p u la tio n p r o file in th e
Republic of South Africa.It has been e s tim a te d th a t th e r e w ill be a population of between 27 million and 36 million in the Republic of South Africa by the year 2000 (Gerber, Nel & Van Dyk 1987:3).The Republic of South Africa is confronted by both a first and third world situation.This requires a diverse approach to health care in which primary health care, population development and family planning should receive p riority (President Council Report 1983:76).
Advancements in medical technology should however not be overlooked.

"Increased acuity levels o f patients, decreased length o f hospitalization and the p ro lifera tio n o f h ea lth care technology and specialization have in crea sed the n e e d fo r highly exp erien ced nurses"
(B e n n e r 1982:402).
• Utilisation of available resources.
The available nursing personnel should be used effectively, and they should use the opportunity to develop th e m s e lv e s .O r ie n ta tio n a n d guidance of the newly qualified nurse will largely determine whether she will be competent to perform her duties in the changing health care scenario.
The problem investigated in this study is concerned with determining whether the newly qualified nurse is competent to practise within her scope of practice.

THE OBJECTIVES
The objectives of the study were to • identify the influence placement has on the com petency of the newly qualified nurse; • d e te rm in e w h e th e r o r ie n ta tio n contributed towards the competency of newly qualified nurses; • identify the type of guidance given by the supervisor/preceptor; • compare the supervisor's evaluation of the newly qualified nurse with that of the nurse's self-evaluation; • evaluate the competency of the newly qualified nurse related to:-* communication skills * management skills * the application of the scientific foundations of her practice and her participation in research; • determ ine other factors that could contribute towards the competency of the newly qualified nurse; • identify the knowledge base that could c o n tr ib u te to w a rd s th e su b ject Nursing Administration by developing a model for competency development.

HYPOTHESES
The following null hypotheses were fo rm ulated to test the relationship between the variables: • T here is no relationship between c o r r e c t p la c e m e n t a n d th e competency of the newly qualified nurse in her first post.
• Newly q u a lifie d nurses who are adequately orientated will not be e v a lu a te d a t a h ig h e r lev el of competency than those who are not adequately orientated.
• E ffe c tiv e g u id a n c e d o es not contribute towards the competency of newly qualified nurses to practice.
• T here will not be a considerable difference between the self-evaluation of the newly qualified nurse, and evaluation by her supervisor.

DEFINITION OF TERMS
The concepts in terms of this study were defined as follows: Competency.
The nurse acquires an official mandate to practise as a registered nurse after successfully completing her training.This m andate recognises the nurse's a b ilitie s , sk ills, k n o w led g e, understanding and experience.She therefore should be able to perform nursing activities safely, according to predeterm ined standards, within her scope of practice, in coordination with other members of the health care team.

THEORETICAL FRAMEWORK
The study was based on Bandura's social learning theory in which it was concluded that behaviour is learned through the processing of key concepts observed during the demonstration of desirable conduct.The observer arranges and combines the events to produce new behaviour after thorough practice.Retention of the observed conduct can only occur if the newly qualified nurse is given the o p p o rtu n ity to p rac tise .F e e d b a c k sh o u ld be given by the supervisor about those aspects which are only p a rtly m a s te re d .The newly qualified nurse must be motivated to a c q u ire the beh av io u r and should therefore work in the area of her interest (Marriner-Tomey 1990: 304-305).

LITERATURE STUDY
The literatu re studied revealed the following:

Evaluation instrument
The Slater nursing competency rating scale was studied as it was originally developed to measure the competency of new ly q u a lifie d n u rse s "Quality performance expected o f a first level staff nurse was the standard o f measurement" (W andelt & Stew art 1975).O ther instruments used in the construction of the evaluation tool were: • competency evaluation by Benner and Benner (1979:128 -135) based on p r a c tic a l p ro c e d u re s , was th e measuring scale adapted for use in this study; • O hio "C om m ission on nursing" in s tr u m e n t to m e a su re th e com petency of two categories of nurses (State of Ohio Department of H ealth 1980: 10 -17) m entioned specific responsibilities of registered nurses similar to those in the South African situation; • point evaluation by Bernhard and Schulte (1975: 18 -21); • evaluation instrum ent by Forbes Regional Health Center (Scrima 1987: 41-45).
These served as guidelines for factors r e q u ir in g e v a lu a tio n .W ith th is background information, and the scope of practice and training regulations of the South African Nursing Council as a basis, th e in stru m e n t for this study was constructed.The newly qualified nurse should be p laced in the area in which she is i n te r e s te d .T h e r e s p o n s ib ilitie s delegated to her should be scrutinised to determine whether she is able to cope as too much responsibility too soon may cause unnecessary stress preventing the nurse from optimum function.(Benner & Benner 1979:105-107).

The influence of orientation on the competency of the newly qualifled nurse
The goal of orientation is not to educate but to help the nurse to adjust to her working environment and to apply her know ledge.O 'C onnor (1986: 401) describes problems experienced by the newly qualified nurses as: • having theoretical knowledge but not b e in g a b le to so lv e p ro b le m s effectively; • a lack of technical skills as a result of lack of experience; • not being able to organise their work according to objectives; • insufficient leadership skills; • insufficient support from the group with which they work .
Curationis, Vol. 16, No. 3,1993 The need for guidance and a preceptor in d evelop in g as a com p eten t practitioner M ost nurses experience the period immediately after registration as the most stressful of their career.According to Benner (1982:402) the newly qualified nurse could be classified as an advanced beginner.This impUes that she needs help in determining priorities as she is only . .beginning to perceive recurrent meaningful patterns" in h e r c lin ic a l practice.Support by an experienced nurse is necessary to identify the most important patient care needs.
Quinn 's (1982:298) role theory, based on B andura's social learning approach, in d icates th a t a p e rso n displays a particular role when engaging in social interaction.The supervisor/preceptor shou ld be aw are th a t she may be re g a r d e d as a ro le m o d el w hose behaviour likely to be copied.

The competency of the newly qualified nurse in communication
The complexity of the interpersonal network of relationships within a health service has increased and a variety of people are making dem ands on the attention of the nurse (Ogier: 1982:96).
The nurse must be able to communicate with such variety at different levels of service.

A need for management skills
Each nurse practises within the policy of the organisation and simultaneously the South African Nursing Council regulates her practice and professional conduct.Management development and training is an ongoing process to prepare the nurse to set objectives to achieve the goal of the institution (Gerber et al. 1987: 208).
The management skills of the newly qualified nurse need attention because such skills are not practised during her training.This has been verified by Kihlgren & Rydholm (1988: 95) and summarised thus: "... nurses are inadequately prepared both formally and informally to assume management and leadership roles..." .

The research function of the newly qualified nurse
The literature study clearly indicated that the rese a rc h skills of n u rses need attention.Brownlee (1983: 97) reported that, even w here in strum ents were available to evaluate the rendering of care (for example nursing audit, problem orientated nursing records and nursing care plans) nurses did not use them.

Using the scientific base of the practice of nursing
Research identified a major degree of incompetence among newly qualified nurses in perform ing certain basic procedures, which caused them to feel insecure (Speedling et al. 1981: 225).
The scope of practice of the nurse is not described in specific procedures but is given in broad guidelines such as:- • sufficient knowledge of preventive and promotive care; • knowing principles, concepts and scientifically based facts; • keeping up to date with advancements in the medical science; • using research findings to improve the service.

Practising in a first and third world situation
To ensure value for money within a first and third world situation the following factors should be considered: • increase in the potential manpower h o u rs, th ro u g h an in c re a s e in productivity; • improving the quality of the service; • developing new areas of service; • change in a ttitu d e s of both the provider and user of the health service.
Essentially a literature study revealed that critical evaluation of the the newly qualified nurse's competency to practice has become a necessity.Such evaluation will help to determine whether the newly q u a lifie d n u rse is m e e tin g th e requirements set by changes in health policy.The areas req u irin g m ore practice could be identified, as well as the role of orientation and guidance, in preparing her for her responsibilities as an effective fully functioning professional nurse.

Target population
The target population included all newly qualified nurses within nine months of completion of training, from June 1989 to April 1990, in the Republic of South Africa, as well as their supervisors.
Statistics from the register of the South African Nursing Council indicated a total o f : • 336 Newly qualified nurses untilJune 1989; • 1097 Newly qualified nurses from July 1989 to April 1990.
These nurses were working in a variety of services in the RepubUc of South Africa which included areas such as:- • g e n e ra l, m idw ifery, p sy ch iatric, community health services; • private institutions, military hospitals; • rehabilitation centers, hospices; • local authorities, divisional councils; • occupational health services.
A A second sample taken from nurses who had com pleted their training in the ensuing sem ester, D ecem ber 1989, contributed towards the validity of the study.The data from the two groups were compared.As the data obtained from these two samples did not differ significantly, the d a ta w ere finally analysed in entirety.
To prevent bias and subjectivity of evaluation the supervisors of the newly qualified nurses were included in the survey.Therefore the study includes self-evaluation by the newly qualified nurse as well as the evaluation of the newly qualified nurse by her supervisor.

Sampling
Random sampling was not feasible as the target population worked in a variety of services and not all the services which w ere c o n ta c te d in o rd e r to g ran t perm ission to undertake this study, responded to the request.Thus it was decided to use as a sample all members of the target population who could be traced.

Permission
Permission was obtained from the four provinces (Transvaal, Orange Free State, Natal and Cape Province) as well as the institutions w here respondents were working.The respondents had the option of free participation and return of the short questionnaire was proof of informed consent.

Instruments
The instruments were based on studies discussed above in the literature review.Discussions also were held with nurse managers, tutors, professional nurses and members of the target population to determine the expectations of for the newly qualified nurse.
A questionnaire to the newly qualified nurse as well as one to her supervisor were constructed asking for information about:-• biographical details; • orientation and guidance received by the newly qualified nurse; • evaluation of the newly qualified n u r s e 's c o m m u n ic a tio n sk ills, management skills and her cHnical skills.
The competency was measured on a scale from 1 to 4 that could be interpreted as follows: • Level 1 = Supervision and instruction is needed.Was not introduced to the theory and principles.
• Level 2 = Supervision is needed.Understands theory and principles, but has had limited practice.
• Level 3 = Safe but practice is needed.Able to perform without supervision, b u t n e e d s p ra c tic e to p e rfo rm efficiently.
• Level 4 = Completely competent.C an perform efficiently w ithout supervision.
Internal validity, the degree to which the instrument revealed an accurate picture of the newly qualified nurse in her work s itu a tio n an d th e external validity r e f e rr in g to th e d e g re e to w hich generalisations could be made from the findings were tested.Construct validity was ensured by using the South African Nursing Council Regulation 425 and Regulation 2598 as a basis for evaluation.Experts and specialists in the field of study were asked to evaluate the tool for construct validity.Concepts used in the instrum ent were clearly defined.A factor analysis was done to further prove th e c o n s tru c t v alid ity and a high correlation among items grouped under a specific heading was found.
C riterio n validity was te s te d by determining whether the questions and evaluation were directed at competency in the practical situation.Testing was done by comparing the instrument with the regulations for training and practice as well as the responsibilities of a registered nurse.Concept validity was tested against the theoretical framework.
Reliability was tested by using the same instrument at three different times within one year.The findings did not differ significantly.Identical instruments were used by the newly qualified nurse and her supervisor.
An annexure is given with some examples from the instrum ent m easuring the management competency of the newly qualified nurse.This instrument, which also gathers data related to orientation and guidance received by the newly qualified nurse, takes 45 minutes to com plete and is available from the researcher on request.It is too lengthy to publish in full.

Pilot study
From the possible respondents 19 newly qualified nurses and their supervisors w ere se le c te d for th e p ilot study.
Analysis of the data revealed that the self-evaluation by the newly qualified n u rs e an d th e e v a lu a tio n by her supervisor did not differ with more than 1 p o in t on th e scale from 1 to 4. Questions requiring adjustments were changed accordingly and the instrument translated into English.
Data gathering D uring August 1989 the instruments were posted or handed to the first sample.Anonymity and confidentiality were ensured as respondents did not mention their names or the name of the institution on the questionnaire.Pairs of questionnaires were given the same code number to enable comparison of the self-evaluation and the evaluation by the supervisor.
The return date for the questionnaires was the 15 October 1989.Because of the poor return by the closing date, letters reminding the respondents to return the q u e s tio n n a ir e w e re se n t to all respondents.Despite all efforts only 62 out of the 123 pairs had been received plus 22 of the newly qualified nurses and 16 supervisors which could not be matched.
The second round was conducted during March 1990 and April 1990.The 280 pairs of questionnaires were posted and where possible handed out personally.A total of 151 pairs were received by the closing date 31 May 1990 as well as 18 questionnaires from the newly quahfied nurses and 9 from the supervisors that were not paired.

Limitations
The numbers of questionnaires returned by the two samples were: • 213 pairs (52,9% feedback) -253 new ly q u a lifie d n u rs e s (62,8% feedback) -238 supervisors (59,1% feedback) O nly th o se n u rse s who c o u ld be contacted could be included in the study, and random sampling was therefore impossible.Letters, however, were sent to all possible respondents but their response was poor.

Data analysis
The The ro ta te d solutions g ro u p ed the variables to the factor with which it was p rim a rily a s s o c ia te d .A m ore meaningful interpretation of data was achieved through the Varimax rotation of factors.In the interpretation of these solutions factor loadings of more than 0,40 were used; in a few cases only factor loadings of less than 0,40 but not less than 0,30 were used.The common factor variance (commonality) of the items were generally more than 0,5, thus a total of more than 200 responses per question was sufficient to justify factor analysis.
From the questionnaires ten factors were rotated from the management section and sixteen from the scope of practice com petency section.B iographical information rotated into nine factors and orientation and guidance into eleven factors.
Table 1 indicates the names of the five factors rotated, items and factor loadings of the communication evaluation section of the questionnaire.
In part two of this report, the results of the data analysis are discussed.Hierdie ondersoek-handleiding gee 'n besonder volledige, sistematiese en duidelike uiteensetting van die ondersoek van die pasgebore baba.Die klem val hoofsaaklik op die ondersoektegniek en normale bevindinge, alhoewel dit ook die mees algemene abnormale bevindings en die oorsake uitwys.
Die teks is keurig versorg, maklik leesbaar en maak baie gebruik van lyn-illustrasies.Hierdie handleiding kan nuttig aangewend word deur dosente en studentverpleegkundiges, asook verpleegkundiges wat betrokke is by die bantering en versorging van pasgebore babas.A n a ly sis of v a ria n c e te s te d the significance of differences between the four areas in which the newly qualified nurse was trained and working at the time of the research.

CHERlfi ROOS
From the analysis of the data as discussed in part 1 of the report on the research done, the following information was extracted:

Age
The ages of the newly qualified nurses varied between 21 and 36 years, with only 18,3% older than 25 years.N urses working in a m aternity unit worked with more registered nurses (10) than those working in a general ward (6).This could be an indication that nursing m anagem ent might be aware of the importance of support and guidance in a maternity unit where simultaneously two lives may be at stake.
It is also significant that 153 (60,7%) of th e new ly q u a lifie d n u rs e s w ere approached as to where they would like to work, while 201 (80,4%) worked in the area of interest.This could be an indication that nurse managers are aware of the interests of their staff and take it into co n sid eratio n when allocating personnel.The newly quaUfied nurses w e re a lso p la c e d in th e c o rr e c t hierarchical position.Both the newly qualified nurse and her supervisor agreed that she should be placed in a position where she could gradually be g u id e d to a ssu m e g r e a te r responsibilities.The supervisors and the newly qualified nurses differed markedly as to the desirability of rotation d u rin g th e firs t six m o n th s a fte r completion of training.Only 44,4% of the supervisors against 89,1% of the newly qualified nurses who rotated during the first six months described it as a learning experience.
The influence of o rientation on the competency of the newly qualified nurse.
The null-hypothesis was formulated, that orientation did not influence the the newly qualified nurse's competency to practise.According to data analysis the factor orientation to the service had a As far as the scope of p rac tic e is c oncerned th e re w ere no positive correlations between orientation and the nurses' competence.
The role of guidance in developing the newly qualified nurse towards competent practise.
Guidance played a much more important role in the development of the newly qualified nurse than did orientation.This was especially true in relation to support of senior personnel and the following four management factorsteaching p e rso n n e l, evaluating job p erform ance, organising work and setting of standards and doing a nursing audit.If the newly qualified nurse receives guidance she should have the ability to organise her service, to delegate effectively and to use her time efficiently.Acknowledging the potential of the nurse gives her the confidence to control the nursing care in the unit.Of the newly q u a lif ie d n u rse s 56,5% alw ays experienced support while only 2,8% claimed that they never received any support.
W hen senior personnel support the newly qualified nurse they are more c o m p e te n t m a in ta in and p ro m o te optimal health for the patient (r = 0,16 W hen senior personnel support the newly qualified nurse they are more competent to (r = 0,16 ; p = 0,008); and identify physiological reactions of the body to illness, trauma, emotional stress, treatment and medication (r = 0,20; p =

0,001).
There was positive correlation between the support of senior personnel and the placement of personnel in their area of interest, possibly because the nurse working in her area of interest is more p o s itiv e ly in c lin e d to w a rd s her supervisor.
The m anner in which the supervisor answ ered questions from the newly qualified nurse concerning problems e x p e rie n c e d in the un it, plays an important role in her development.Such a nurse could communicate better and maintain good interpersonal relations.A c c o rd in g to G e rris h (1990:36) communication and good interpersonal relations were aspects of behaviour that the newly qualified nurse could not handle effectively, which observation emphasises the role of guidance by the supervisor.
Nurses working in the area of interest could also promote and maintain their patients' health, providing them with sufficient exercise, rest and sleep.
The difference between the evaluation of the newly qu alified n u rse an d her s u p e r v is o r in r e la tio n to h e r communication skills.
The null hypothesis that there was no significant d iffe re n c e betw een the evaluation of the newly qualified nurse and her evaluation by her supervisor was rejected by the t-test.A significant difference was found on all the items under communication; the supervisor evaluated the newly qualified nurse at a lower level.The difference on the items varied between 0,184 and 0,598 on a four point scale.The newly qualified nurse evaluated herself between 3,11 and 3,80 on the scale from 1 to 4 whereas the supervisor's evaluation varied between 2,80 and 3,46.
The competency of the newly qualified nurse to communicate with patients and the patients' family is given in Table 2.
The evaluation of both groups indicated that the newly qualified nurse had the necessary theory and some practical experience, but needed more practice to become completely competent.Nelson (1978:124) concluded that: "Since nursing graduates and their supervisors perceived g r a d u a te s ' degree o f co m p eten cy differently, schools o f nursing and agencies that employ beginning practitioners should consult concerning realistic expectations of the competency o f . . .graduates".The difference in evaluation of the management skills according to the newly qualified nurse and her supervisor As with co m m u n icatio n skills the null-hypothesis was rejected.There were a significant difference in all items.
The difference in the evaluation of the management skills varied between 0,228 and 0,742; this difference was slightly higher in management items than with communication.Some of the items were r a te d low er th a n th o s e o f th e co m m u n icatio n item s by b o th the supervisor and the newly qu^ified nurse.
The newly qualified nurses' evaluation varying between 2,54 and 3,79 and that of the supervisor between 2,28 and 3,19.
The newly qualified nurse evaluated herself more highly in regard to the solving of p ro b le m s th a n d id h er supervisor.Between 219 (88,7%) and 231 (92,8%) evaluated themselves at levels 3 an d 4, c o m p a re d to th e s u p e rv iso rs 138 (5 9 ,0 % ) a n d 153 (65,4%).
A larger number of both newly qualified nurses (8,6%) and their supervisors (16,3%) identified a need for m ore theoretical knowledge on budgetary procedures than in any of the other areas.
Few respondents evaluated the newly qualified nurse as being completely competent in the area of research; only 27 (15,0%) of the newly qualified nurses and 25 (12,1%) of the supervisors, did so.More respondents agreed that the nurse did not have the necessary theoretical background to do research than in the other items (11,2% newly qualified nurses and 27,8% of their supervisors).
The nurses' ability to provide personnel development according to the potential of the individual was rated at only 31,8% being completely competent by the newly qualified nurse and 16,8% by their supervisors.Sovie (1983:31) stressed the importance of nurses having educational skills "Programmes that prepare nurses to be effective teachers are urgently needed".In responding to an open ended question the newly qualified nurse and h e r s u p e rv is o r a g re e d th a t delegating was an area w here more experience was needed.Nurses also felt that sometimes they were given too much responsibility too soon.

Difference in the evaluation between the newly qualified nurse and her supervisor in relation to her scope of practice skills
The null-hypothesis was also rejected in relation to the scope of practice items.
The newly qualified nurse evaluated herself at a higher level of competence in relation to her scope of practice than communication and management skills, (between 3,31 and 3,89).The difference between the evaluation of the supervisor and the nurse varied between 0,165 and 0,603 which is less th an w ith th e treatm ent and m edication correlated with the amount of support and guidance she has received from her supervisor.In agreement with Jacobs (1989:116), it was found that nurses were competent to give h e a lth e d u c a tio n to p a tie n ts , but experienced problems in coimselling.Table 3 indicates the competency of the newly qualified nurse to assess the needs of the patient.The newly qualified nurse experienced a lack of competency in identifying the social needs of the patient.Only 120 (48,2% ) e v a lu a te d th e m se lv e s co m p le te ly c o m p e te n t a g a in st 73 (31,6%) of the supervisors.Comparing this with the identification of the physical and psychological needs in patients, the p e rc e n ta g e s th a t a re c o m p le te ly competent are lower.
T he new ly q u a lifie d n u rse also experienced more problems in planning and evaluating nursing care than in doing nursing procedures.H er ability to monitor the reaction of the body to illn ess, tra u m a , e m o tio n a l stre s s.
graduates to be incorporated as members o f a multi-disciplinary health care team ensured that they continued to be frustrated by lack o f opportunity to play an equal role with other health professionals in patient management".
If supervisors would include the newly qualified nurse in discussions with other health care personnel it could help them to overcome this obstacle.
Caring for unconscious and high risk patients were rated lower by both the newly qualified nurse (43,6%) and her supervisor (36,2%) than caring for other categories of patients.
In answer to an open ended question newly qualified nurses mentioned that their expectations regarding practice were not met but they do appreciate the supervisor who supports them.Caring for the dying was an aspect the newly qualified nurse experienced negatively, jdthough most of them 230 (96,6%) and 178 (86,8%) of their supervisors found that they were in fact competent to care for the dying.

THE SOCIAL LEARNING THEORY AND ITS RELATION TO THE DEVELOPMENT OF THE NEWLY QUALIFIED NURSE
The contribution of the support received from s u p e rv iso rs in re g a rd to the development of competent practitioners cannot be over emphasised.The ability to learn desired behaviour in copying a model is supported by the findings.The social learning theory as described by Marriner-Tomey (1990:303-307) is one of the m ost im portant contributing factors in the development of competent practitioners.r e c e iv e s p e c ia l a tte n tio n .C o m m u n ic a tio n sk ills sh o u ld be presented in an intergrated way in both management and cUnical practice.
Process: A fte r a p p o in tm e n t as a registered nurse it is important that the nurse should be placed in the area (field) of interest.Orientation and guidance ( a c c o m p a n im e n t) is e s s e n tia l in acquiring the necessary skills to develop into a com petent practitioner.The supervisor should be a role model which is in accordance with the social learning theory.
Output: If the newly qualified nurse is placed correctly, receives the necessary orientation and guidance the following output could be expected: • correlation of theory and practice; • self study, as seniors motivate the newly qualified nurse; • w illin g n e ss to p o a rtic ip a te in personnel development; role-stress they experience in their first post-registration job.If they experience jo b s a tis fa c tio n , th e p ro c e s s of socialisation is enhanced.If this does not happen, they tend to resign.This may be one of the reasons why many of the newly qualified nurses could not be contacted within approximately three months of h a v in g c o m p le te d th e ir tra in in g .Weisman et al. (1981:189) reported that a number of younger nurses left the geographical area of their training.
When working in their area of interest, they experienced greater job satisfaction and were better able to develop their com petency.N ursing m anagem ent seem ed to be aw are of the nurses' in te rests and strive to place them, wherever possible, in their area of choice.
They were also placed in the correct hierarchical position, in order to receive guidance from their supervisors.Most of the nurses remained in one unit for at least three months, and experienced rotation as professional development.• professional growth; • the final outcome will be a competent nurse delivering high quality nursing care.

Implications of flndings
The fact that most newly quaUfied nurses a re in th e ir e a rly tw e n tie s a fte r completing training, could add to the Supervisors preferred nurses to stay in the same ward for at least three months as it contributed towards stability in the unit, and is of greater value to both the patient and the nurse.
Nurses in the community services did not get the same amount of guidance as their colleagues working in other areas.Newly qualified nurses who completed the degree course seemed to be more assertive and better able to exercise control.
M a n a g e m e n t s k ills n e e d e d m o re attention than clinical skills, as the nurses did not get the necessary practice in the area of management skills during their training.
A lack of orientation was experienced by a number of the nurses, especially those who stayed on in their training hospital.They were not orientated into accepting their new responsibilities.
Those nurses who received sufficient guidance in the first few months after registration did not experience any d iffic u lty in s o c ia lis in g .
T hey e n c o u n te re d few e r p ro b le m s in performing management procedures and in becoming competent at performing their duties.Some of the newly qualified nurses still needed practice in communication skills.
The nurses were not competent to do research or to apply research findings.P e rs o n n e l m a n a g e m e n t c o u ld be improved by the correct guidance, and nurses would be better able to organise their work.
If nurses are to be retained in the service, they should be placed correctly and be given support.Nurses experienced working with the dying and their family as stressful.

Recommendations
Nurse managers must take cognisance of the fact that nurses resign if they are not socialised into their new responsibilities and therefore they should provide the necessary support systems and working environment that will contribute towards job satisfaction.
The nurses' training background and age should be considered when placing them and delegating responsibilities.They should receive th e o p p o rtu n ity to develop their skills to become competent practitioners.
Placing nurses in the area in which they are interested leads to job satisfaction and productivity.
Rotation should be done discreetly to cause the minimum of disruption in the unit and to give the newly qualified nurse o p p o rtu n ity to d e v e lo p in to a independent practitioner.
In the community services provision should be made for support systems to help the newly qualified nurse solve problems.
O rientation program m es should be directed at the individual needs of the nurses, be given over a longer period and be followed by inservice education.Even if nurses are working in their training hospitals they still require orientation to their new responsibilities as a registered nurse.The necessary policy manuals must be available to the newly qualified nurse.It remains the responsibility of the supervisor to guide and support the newly qualified nurse in her new job.Supervisors m ust realise that their conduct influences their subordinates and the training of supervisors should receive attention.A preceptor should be appointed for the newly qualified nurse in her first post as correct guidance in maintaining good interpersonal relations is essential to enable the nurse to communicate effectively.
Nurses should be trained how to write reports and keep statistical records efficiently.
Nursing management and the training school should decide on what their expectations are for the newly qualified nurses.
T he n u rse s h o u ld be given th e opportunity during her train in g to develop m anagem ent skills.It is, however, important that they receive the necessary guidance in the work situation.
M ore attention should be given to research skills.This could be done as follows according to Phillips (1986:402): • The nurse manager should be a role model.
• Personnel should be informed about and guided in interpreting research reports.
• During ward rounds nurses should be e n c o u ra g e d to m ake r e c o m m e n d a tio n s on ways of improving the service.
• Newly qualified nurses should be assisted in decision making.
• P e rso n n e l s h o u ld be given th e opportunity to attend symposia and discussions on research aspects.

RECOMMENDATIONS FOR FURTHER RESEARCH
A study to determine the competency of n u rs e s w ho have c o m p le te d th e com prehensive training in the four disciplines could be done on a more representative basis.
A comparison between the competency of the newly qualified nurse who was allocated to a preceptor and one who was not allocated to a preceptor could be carried out.
The difference in the competency of n u rs e s w ho have c o m p le te d th e comprehensive course and nurses who did the one year course in midwifery and/or psychiatric nursing could be explored.

CONCLUSION
According to these research findings it is clear that the newly qualified nurse is competent to practice as a registered nurse after completion of her training.
Although the evaluation of the newly quaUfied nurse and her supervisor differs significantly, there is a certain degree of agreement, as these aspects requiring more attention are mentioned by both groups.
Placement of the newly qualified nurse plays a role in her ability to practise as a competent practitioner.O rientation should be directed more specifically to w ard s m an a g e m e n t a sp e c ts and guidance is very important for the newly qualified nurse to develop as a matixre practitioner.It seemed as though most of the nurses participating in this research received sufficient guidance from their supervisors.The competency of the newly qualified nurse is in agreement with the hypothesis as formulated, stating th a t the co m petency of th e newly qualified nurse is determ ined by the amount of guidance she receives.
This research does not indicate a need to query the com petence of the newly q u a lifie d n u rse w ho seem s to be sufficiently prepared to perform the tasks delegated to her.T here is also no significant difference in their ability to function in the four disciplines in which they have been trained.It is indeed encouraging that nursing management seems to be aware of problems that could be encountered by these nurses and take the necessary precautions to protect them against such difficulties.
Evaluation.In th is stu d y e v a lu a tio n re fe rs to determining the degree of competency of the registered nurse to practise.The norms of measurement are based on the scope of practice of the registered nurse as stip u late d in the South A frican Nursing Council Regulation no.2598 of 30 November 1984 and Regulation no.425 of February 1985.Newly qualifled nurse.Refers to a registered nurse within the first nine months after having completed the course in accordance with the Regulation no.425 of 22 February 1985 of the South African Nursing Council.
No.l Letters requesting the first 336 possible r e s p o n d e n ts to p a r tic ip a te w ere dispatched in July 1989.Despite two re m in d e rs to r e tu r n th e s h o rt q u e s tio n n a ire , only 142 co u ld be contacted.From this total of 142,19 were selected for the pilot study, resulting in the final sample size being 123 or 33,6% of the target population.Sample No. 2 The second round of sampling was done in April 1990.Letters were once more sent to all the possible respondents from a list received from the South African Nursing Council.A total of 280 possible re s p o n d e n ts w e re c o n ta c te d r e p re s e n tin g 25,5% of th e ta rg e t population.
of this report a review was given on the p ro b lem , th e o re tic a l fra m ew o rk , l ite r a tu r e stu d y and methodology.The factor analysis was discussed briefly.
supervisors evaluated the newly qualified nurse at 2,75 to 3,84 on the four point scale.
Figure 1 Model for competency development of nurses

N
urses are p rep a re d to practise in general, psychiatric, community health and midwifery services.The findings Curationis, Vol. 16, No. 3,1993 indicated no significant differences among different areas of practice.
SEARLE, C. (1980).The ward sistersome aspects of her role and function.Curationis.3,1,4-9.STATEMENT OF COMPETENCIES FO R TWO TYPES OF NURSES.(1981).State of Ohio department of health.Commission on nursing.10-17.S O V IE , M .D .(1 9 8 3 ).F o s te rin g p ro fe s s io n a l n u rsin g c a re e rs in h o s p ita ls : T h e ro le of sta ff development.Part 2. The Journal of Nursing Administration.13,1,30-33.SPEEDLING.E.J.; AHM ADI, K. & K U H N -W E ISSM A N , G. (1981).Encountering reality: Reactions of newly hired R.N.'s to the world of the medical center.International Journal of Nursing Studies.18, 4, 217-225.S U ID -A F R IK A .(1 9 7 8 ).W et to t sam evatting en wysiging van die wetsbepalings met betrekking tot die b e r o e p e van g e re g is tr e e r d e of in g e sk re w e v e rp le e g k u n d ig e s , verpleegassistente en vroedvroue; en om vir bykomstige aangeleenthede v o o rsie n in g te m aak.P re to ria : Staatsdrukker.(Wet no.50,1978: Wet op Verpleging, 1978 (soos gewysig).SUID-AFRIKA.(1977).Wet no.63, 1977: W et op gesondheid, 1977.Pretoria: Staatsdrukker.T R E E C E , E.W .& T R E E C E , J.W. (1986).E lem ents of R esearch in Nursing.4th edition.St. Louis: Mosby.UYS, H.H.M. & BASSON, A.A. (1983).N a v o rs in g s m e to d o lo g ie in die v e rp le e g k u n d e .P ro to ria :H a u m .Verklarende Afrikaanse woordeboek; redigeerders: Kritzinger, M.S.B.; LABUSCHAGNE, F.J. & PIENAAR, P.DE V. (1972).Pretoria: Van Schaik.Verslag van die Wetenskapkomitee van d ie P r e s id e n ts r a a d oor d e m o g ra fie se te n d e n s e in S u id -A frik a , (1983).K aap stad : Government Printers.W A N D ELT, M.A. & STEW ARDT, D .S .(1975).S la te r n u rsin g competencies rating scale.New York: Appleton-Century-Crofts. W E IS M A N , C .S .;D E A R , M .R .AIEXANDER, C.S. & CHASE, G.A. (1981).Employment patterns omong newly hired hospital staff nurses.Nursing Research.30, 3,188-191.R. TROSKIE D.Litt et Phil (UNISA) Associate Professor, Department of Nursing Science, UNISA

Table 4 Competency of the newly qualified nurse to work with others Competency Level
is "professionally knowledgeable, up to date a n d co m p eten t, who is administratively adept, who projects the true role m odel image o f a first-line manager and professional registered nurse, and who is a worthy and devoted preceptor to the student body and her subordinates, who is a loyal colleague o f the doctor and of other members o f the health team, who knows her own worth to the community, who serves the hospital authority with diligence and loyalty and who above all truly fulfils her role as custodian and advocate o f the patient, is a pearl without price in the hospital service and indeed in the whole health service"(Searle 1980:9).M A R R IN E R -T O M E Y , A. (1990).Nursing management practice, theory, and research.St. louis: Mosby.
With correct guidance and support the newly qualified nurse could emulate Searle's description of the ward sister as one whoSCRIMA, D.A. (1987).Assessing staff competency.The Journal of Nursing Administration.17, 2,41-45.