An evaluation of a competency assessment tool for nursing interns’ clinical practice in Saudi Arabia: a mixed method study

Abstract

Background: Preceptorship is vital in bridging the gap between theoretical knowledge and clinical practice in nursing education. It ensures that newly graduated nurses are competent and confident to deliver safe, high-quality care. In Saudi Arabia, preceptors are central to internship programs. However, variations in their preparation, interpretation of competency, and use of the official national competency assessment tool present challenges for standardising practice. Despite the importance of nursing workforce development under Saudi Arabia’s Vision 2030, limited research has explored preceptorship from multiple stakeholder perspectives.

Aim: This study evaluated the experiences of nursing preceptors, newly graduated nurses, and nurse leaders in assessing nursing interns’ competency in Saudi Arabia. It also examined their perspectives on the official clinical assessment tool and their understanding of “competency” in nursing.

Methods: A mixed-methods sequential exploratory design was used in two phases. Phase 1 applied a qualitative descriptive approach to explore experiences of competency assessment and interpretation among preceptors, newly graduated nurses, and nurse leaders. Phase 1-A involved four separate focus groups, three with preceptors and one with newly graduated nurses, conducted face-to-face in English across three hospitals in the Aljouf region. Phase 1-B included online interviews in Arabic with five nurse leaders from academic and clinical settings in the same region. Phase 2 used a quantitative cross-sectional survey with 400 nurse preceptors from all thirteen regions of Saudi Arabia. The Competency Assessment Questionnaire, originally developed and validated by Butler et al. (2011), was adapted for the Saudi context, pilot-tested, and distributed online.

Results: Integration of qualitative and quantitative findings revealed five main themes: preceptor preparation, interpretation of competency, clarity of the assessment tool, the tool’s ability to measure competency, and the need for tool improvement. Training courses were seen as essential for preparing preceptors, supported by ongoing Ministry of Health initiatives. Preceptors were aware of available programs and valued skills such as teaching, facilitating learning, and assessing competence. Interpretations of ‘competency’ varied by role: nurse leaders viewed it strategically, aligning it with national goals, while preceptors focused on practical skills and clinical performance. The assessment tool was viewed as structured and useful but required refinement in formulation, structure, and grading.

Conclusion: This study provides a comprehensive understanding of competency assessment in Saudi nursing education. It highlights the need for systematic preceptor preparation, protected time, and manageable workloads to ensure effective supervision. Strengthening collaboration between academic and clinical settings is essential for aligning education with practice. Refining the national assessment tool’s structure and grading criteria will enhance reliability and relevance. Structured pre-internship orientation can also support interns’ resilience and role clarity during the transition to practice.