Date Created

5-2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

College of Natural and Health Sciences, Nursing, Nursing Student Work

First Advisor

Copeland, Darcy

First Committee Member

Henry, Melissa L.

Second Committee Member

Pool, Natalie M.

Third Committee Member

Cieminski, Amie

Abstract

Nursing competence is essential for the provision of quality, ethical, legal, safe patient care. NRBs serve a critical role in establishing standards for nurses that lead to the protection of the public. While most NRBs mandate some measure of ongoing competence, there is notable variation in NRB competence regulations. While competence regulations should reduce the need for nursing discipline, there is limited evidence regarding the effectiveness of these regulations in promoting public protection.

The purpose of this study was to explore how continued competence regulations impact the disciplinary rate of registered nurses. The following research questions guided this study:

Q1 Do NRBs with continued competence requirements experience differences in registered nurse disciplinary rates when compared to NRBs with no continued competence requirements?

Q2 Are the regulated indicators of continued competence associated with NRB disciplinary rates?

Q3 Are required continuing education hours associated with NRB disciplinary rates?

Q4 Are required continuing education topics associated with NRB disciplinary rates?

This quantitative non-experimental correlational study analyzed secondary data from the National Council of State Boards of Nursing, the National Nursing Database, and the National Practitioner Data Bank. Competence regulations and registered nurse disciplinary rates for fifty nursing regulatory bodies were included.

Findings from an independent t-test revealed no significant difference in disciplinary rates between NRBs requiring competence measures and those that do not (t(48) = -0.273, p = 0.786). Multiple regression analyses indicated that two competence indicators, practice hours (B = 9.1%, p = .005) and competency evaluations (B = 14.9%, p = < .001), were positively associated with increased disciplinary rates (R2 = .447, p < .001). A second multiple regression analysis, including only sufficient cases and theoretically distinct indicators, also demonstrated practice hours (B = 9.4%, p = .005) were positively associated with increased disciplinary rates (R2 = .184, p = .018). A one-way ANOVA of CE hour groupings demonstrated no significant differences between required CE hours and disciplinary rates (F= 0.130, p = 0.942). Multiple regression of mandated CE topic requirements and disciplinary rates also yielded no statistically significant associations (R2 = 0.59, p = 0.593)

These findings underscore the complexity of regulating competence and highlight the need for evidence-informed regulations. The association of certain competence indicators to an increased disciplinary rate is a cause for concern and suggests that NRBs should evaluate their regulatory outcomes. Future research should explore alternative indicators of nursing competence, how NRBs can partner with employers of nurses in ensuring competence for role and setting, and examine nursing and patient outcomes beyond disciplinary rates to better inform regulatory policy and enhance public protection.

Abstract Format

html

Keywords

competence; continued competence; regulation; nursing regulatory bodies; continuing education

Language

English

Extent

119 pages

Rights Statement

Copyright is held by the author.

Digital Origin

Born digital

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