A Crisis in Competency: The Strategic and Ethical Imperative to Assessing New Graduate Nurses' Clinical Reasoning.

AIM: The aim of the study was to assess entry-level competency and practice readiness of newly graduated nurses.

BACKGROUND: Literature on success of new graduates focuses primarily on National Council of State Boards of Nursing Licensure Examination (NCLEX-RN) pass rates, creating a false and incomplete picture of practice readiness.

METHOD: Posthire and prestart Performance-Based Development System assessments were administered to more than 5,000 newly graduated nurses at a large midwestern academic medical center between July 2010 and July 2015.

RESULTS: Aggregate baseline data indicate that only 23 percent of newly graduated nurses demonstrate entry-level competencies and practice readiness.

CONCLUSION: New data suggest that we are losing ground in the quest for entry-level competency. Graduates often are underprepared to operate in the complex field of professional practice where increased patient acuity and decreased length of stay, coupled with a lack of deep learning in our academic nursing programs, have exacerbated a crisis in competency.