Nurses' Competence Development During the First 5 Years of Practice

More than 2,000 practice anecdotes e-mailed by new nurses during their first 5 years of practice were analyzed to describe nurses' definitions of competence and how it developed over time. Nurses defined competence as efficient care amid complex priorities; rapid response to subtle changes in patients' conditions; seeing the big picture and working the system on patients' behalf; interpersonal warmth, respect, and authority; and a committed desire to learn and improve. Support for development of these qualities may promote nursing care quality in high-acuity practice environments.