1 Department of Medical‑Surgical Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran

2 Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

3 Thalassemia Research Center, Hemoglobinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran

4 Geriatric Care Research Center, Department of Geriatric Nursing, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran

5 School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta, Canada

6 Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran, Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran


BACKGROUND: One of the most important steps in increasing the nurses’ professional competence 
and consequently improving the quality of nursing care is to evaluate nurses’ clinical competency 
and then take effective actions to enhance it. This study aimed at exploring the clinical competence 
of Iranian nurses and factors related to it.
MATERIALS AND METHODS: In this systematic review and meta‑analysis, PubMed, Scopus, Web 
of Science, Scientific Information Database, and Iranmedex databases and Google Scholar search 
engine were searched to February 14, 2020.
RESULTS: After screening, a total of 25 articles were included. In general, the level of clinical 
competence of Iranian nurses was at a desirable level. After meta‑analysis of the mean score of nurses’ 
clinical competence, the combined mean was 161.13 (95% confidence interval [CI]: 137.78–184.48;
P < 0.001; I
2 = 99.8%; P value for heterogeneity = P < 0.001) by the Competency Inventory for 
Registered Nurses (CIRN) questionnaire. The summarized mean of clinical competency measured 
by the Nurse Competence Scale (NCS) questionnaire was 70.75 (95% CI: 60.80–80.70; P < 0.001; 
2 = 99.9%; P value for heterogeneity = P < 0.001). Factors affecting nurses’ clinical competence were 
age ≥33 years, nursing work experience ≥9 years, and a master’s degree in nursing. However, the 
clinical competence of nurses had a significant negative relationship with job stress.
CONCLUSION: The level of clinical competence of Iranian nurses was desirable. Studies that used 
the CIRN, reported the highest and lowest clinical competence in clinical care and professional 
development dimensions, respectively. Studies that used the NCS, reported the highest and lowest 
clinical competence in dimensions of work role and ensuring quality, respectively.


  1. Hadian M, Raeissi P, Shali M, Khalilabad TH, Niknam N. 
    Investigating the effects of human health resource changes on 
    the basic health indicators in Iran: An econometric study. J Educ 
    Health Promot 2019;8:207.
    2. Karami A, Farokhzadian J, Foroughameri G. Nurses’ professional 
    competency and organizational commitment: Is it important for 
    human resource management? PLOS One 2017;12:e0187863.
    3. Tohmola A, Saarnio R, Mikkonen K, Kyngäs H, Elo S. 
    Development and psychometric testing of the Gerontological 
    Nursing Competence (GeroNursingCom) instrument. J Adv Nurs 
    4. World Health Organization. Global Strategic Directions for 
    Strengthening Nursing and Midwifery 2016-2020. Switzerland; 
    Health Workforce Department; World Health Organization; 2016.
    5. BahreiniM, Shahamat S, Hayatdavoudi P, MirzaeiM. Comparison 
    of the clinical competence of nurses working in two university 
    hospitals in Iran. Nurs Health Sci 2011;13:282‑8.
    6. Ghanbari A, Hasandoost F, Lyili EK, Khomeiran RT, Momeni M. 
    Assessing emergency nurses’ clinical competency: An exploratory 
    factor analysis study. Iran J Nurs Midwifery Res 2017;22:280‑6.
    7. Baraz S, Memarian R, Vanaki Z. Learning challenges of nursing 
    students in clinical environments: A qualitative study in Iran. 
    J Educ Health Promot 2015;4:52.
    8. KukkonenP, Leino-KilpiH, KoskinenS, SalminenL, Strandell-LaineC. 
    Nurse managers’ perceptions of the competence of newly graduated 
    nurses: A scoping review. J Nurs Manag 2020;28:4‑16.
    9. ParkK, AhnY, KangN, SohnM. Development of a simulation‑based 
    assessment to evaluate the clinical competencies of Korean 
    nursing students. Nurse Educ Today 2016;36:337‑41.
    10. Downes MJ, Brennan ML, Williams HC, Dean RS. Development 
    of a critical appraisal tool to assess the quality of cross‑sectional 
    studies (AXIS). BMJ Open 2016;6:e011458.
    11. Meretoja R, Isoaho H, Leino-Kilpi H. Nurse Competence 
    Scale: Development and psychometric testing. J Adv Nurs 
    12. Liu M, Yin L, Ma E, Lo S, Zeng L. Competency inventory for 
    registered nurses in Macao: Instrument validation. J Adv Nurs 
    13. Soheilipour K, FarajzadehZ. Evaluating the clinical competence of 
    junior nursing staff based on self‑assessment in Valiasr Hospital 
    of Birjand in 2015‑16. Mod Care J 2016;13:e10089.
    14. ImaniB, VanakiZ, Mohamdkhan KermanshahiS, KarampourianA. 
    The correlation between nurses’ clinical competency and 
    emotional intelligence in nurses of health care units in Hamadan 
    University of Medical Sciences hospitals. Quarterly J Nurs Manag 
    15. Saadati S, Emami S, Chehrzad M, Kazemnegad LE. Pediatric 
    nursing clinical competency from the viewpoints of nurses and 
    headnurses. J Sabzevar Univ Med Sci 2018;25:883‑75.
    16. Mobasher‑Amini K, Rezaei B, Esmaeilpour‑Bandboni M. Nurses’ 
    competence and job related factors among nurses in university 
    hospitals: A cross sectional descriptive design. Adv Nurs 
    Midwifery 2019;28:28‑34.
    17. JafariH, Taghavi LarijaniT, GhadirianF, Emamzadeh GhasemiHS. 
    The association of competence and critical thinking in the nurses 
    in Imam Khomeini Hospital, Affiliated to Tehran University of 
    Medical Sciences, Iran. Iran J Nurs 2019;32:26‑37.
    18. Karimi‑Moonaghi H, Gazerani A, Vaghee S, Gholami H, 
    Salehmoghaddam AR, Gharibnavaz R. Relation between spiritual 
    intelligence and clinical competency of nurses in Iran. Iran J Nurs 
    Midwifery Res 2015;20:665‑9.
    19. Mazlum S, Rashede Nejad M. Investigate the relationship between 
    clinical competence and self‑efficacy in Nursing University of 
    Medical Sciences of Zahedan. Res J Med Sci 2016;50:669‑75.
    20. Habibzadeh H, Ghorbanzadeh K, Khalkhali H, Mohamadpor Y. 
    The relationship between nurses quaiity of work life and their 
    clinical competency. Nurs Midwifery J 2013;10:1‑8.
    21. Abdi A, Assadi P, Mohammadyari T, Miri J. General 
    decision‑making style and clinical competence of nurses working 
    in the educational hospitals affiliated to Kermanshah University 
    of Medical Sciences in 2014. J Nurs Educ 2015;4:19‑29.
    22. Komeili‑Sani M, Etemadi A, Boustani H, Bahreini M, Hakimi A. 
    The relationship between nurses’ clinical competency and job 
    stress in Ahvaz University Hospital, 2013. J Clin Nurs Midwifery 
    23. Naji S, Khanian A. The relationship between clinical competence 
    and job satisfaction in Shahid Montazery hospital nurses, 
    Najafabad city, Iran. International Healthcare Management 
    Conference 2015. p. 283-88.
    24. Heydari A, Kareshki H, Armat MR. Is nurses’ professional 
    competence related to their personality and emotional 
    intelligence? A cross‑sectional study. J Caring Sci 2016;5:121‑32.
  2. 25. Mahdavisaeb F, Roohani M, Hanifi N, Kamali K. Comparison 
    of critical care nurses clinical competency using self‑assessment 
    method and assessment by head nurses Zanjan 2014. Prev Care 
    Nurs Midwifery J 2016;6:72‑82.
    26. Abbasi A, Bahreini M, Yazdankhah Fard MR, Mirzaei K. Compare 
    clinical competence and job satisfaction among nurses working 
    in both university and non‑university hospital in Bushehr 2015. 
    Iran South Med J 2017;20:77‑89.
    27. Hassani P, Abdi A, Jalali R, Salari N. Relationship between the 
    use of intuition in clinical practice and the clinical competence of 
    critical care nurses. Int J Evid Based Healthc 2017;15:171‑7.
    28. Kalantary S, Kord F, Kazemi SB, Rahimian Sh AF, Jalali T. 
    Determination of nurse’s clinical competence in critical care ward 
    in Golestan Hospital. J Res Dev Nurs Midw 2017;7:49‑56.
    29. Elhami S, Ban M, Mousaviasl S, Zahedi A. Self‑evaluation of 
    nurses clinical competency based on Benner theory. World Fam 
    Med J 2018;99:1‑7.
    30. Goliroshan S, Babanataj R, Aziznejadroshan P. Investigating 
    the self‑assessment of clinical competency of nurses working in 
    Babol University of Medical Sciences hospitals. World Fam Med 
    J 2018;99:1‑6.
    31. Hassankhani H, Hasanzadeh F, Powers KA, Zadeh AD, Rajaie R. 
    Clinical skills performed by Iranian emergency nurses: Perceived 
    competency levels and attitudes toward expanding professional 
    roles. J Emerg Nurs 2018;44:156‑63.
    32. Adib Hajbaghery M, Eshraghi Arani N. Assessing nurses’ clinical 
    competence from their own viewpoint and the viewpoint of head 
    nurses: A descriptive study. Iran J Nurs 2018;31:52‑64.
    33. Khodadadi N, Salehi S. Relationship between organizational 
    commitment and nurses’ clinical competency. Quarterly J Nurs 
    Manag 2018;7:18‑28.
    34. Faraji A, Karimi M, Azizi SM, Janatolmakan M, Khatony A. 
    Evaluation of clinical competence and its related factors among 
    ICU nurses in Kermanshah‑Iran: A cross‑sectional study. Int J 
    Nurs Sci 2019;6:421‑5.
    35. Faraji A, Karimi S, Ghobadi A, Abdi A. Evaluation of the clinical 
    competency level among nurses working in Kermanshah 
    University of Medical Sciences affiliated hospitals. Int J BioMed 
    Public Health 2019;2:1‑7.
    36. Habibzadeh H, Khalkhali HR, Mohamadpor Y. The relationship 
    between nurses quality work life and their clinical competency. 
    J Urmia Nurs Midwifery Fac 2013;10:1‑8.
    37. Cheng CY, Tsai HM, Chang CH, Liou SR. New graduate nurses’ 
    clinical competence, clinical stress, and intention to leave: 
    A longitudinal study in Taiwan. Sci World J 2014;2014:748389.
    38. O’leary J. Comparison of self-assessed competence and experience 
    among critical care nurses. J Nurs Manag 2012;20:607‑14.
    39. Ying L, Kunaviktikul W, Tonmukayakal O. Nursing competency 
    and organizational climate as perceived by staff nurses in a 
    Chinese University Hospital. Nurs Health Sci 2007;9:221‑7.
    40. Numminen O, Meretoja R, Isoaho H, Leino-Kilpi H. Professional 
    competence of practising nurses. J Clin Nurs 2013;22:1411‑23.
    41. Cruz J. Quality of life and its influence on clinical competence 
    among nurses: A self-reported study. J Clin Nurs 2017;26:388‑99.
    42. Lima S, Newall F, Kinney S, Jordan HL, Hamilton B. How 
    competent are they? Graduate nurses self‑assessment of 
    competence at the start of their careers. Collegian 2014;21:353‑8.
    43. Meretoja R, Numminen O, Isoaho H, Leino-Kilpi H. Nurse 
    competence between three generational nurse cohorts: 
    A cross-sectional study. Int J Nurs Pract 2015;21:350‑8.
    44. Rodgers S. The extent of nursing research utilization in general 
    medical and surgical wards. J Adv Nurs 2000;32:182‑93.
    45. Salonen AH, Kaunonen M, Meretoja R, Tarkka MT. Competence 
    profiles of recently registered nurses working in intensive and 
    emergency settings. J Nurs Manag 2007;15:792‑800.
    46. Hwang J, Park H. Factors associated with nurses’ informatics 
    competency. Comput Inform Nurs 2011;29:256‑62.
    47. Thompson C, Cullum N, McCaughan D, Sheldon T, Raynor P. 
    Nurses, information use, and clinical decision making--the real 
    world potential for evidence-based decisions in nursing. Evid 
    Based Nurs 2004;7:68-72.
    48. Heydari A, Emami Zeydi A. Barriers to and Facilitators of 
    Research Utilization among Iranian Nurses: a Literature Review. 
    J Caring Sci. 2014;3:265-75.
    49. Drennan J. Critical thinking as an outcome of a Master’s degree 
    in Nursing programme. J Adv Nurs 2010;66:422‑31.
    50. Wangensteen S, Finnbakk E, Adolfsson A, Kristjansdottir G, 
    Roodbol P, Ward H, et al. Postgraduate nurses’ self‑assessment 
    of clinical competence and need for further training. A European 
    cross‑sectional survey. Nurse Educ Today 2018;62:101‑6.
    51. Clark L, Casey D, Morris S. The value of Master’s degrees for 
    registered nurses. Br J Nurs 2015;24:328‑34.
    52. Hole GO, Brenna SJ, Graverholt B, Ciliska D, Nortvedt MW. 
    Educating change agents: A qualitative descriptive study of 
    graduates of a Master’s program in evidence‑based practice. BMC 
    Med Educ 2016;16:1‑9.
    53. Karimi Moonaghi H, Emami Zeydi A, Mirhaghi A. Patient 
    education among nurses: Bringing evidence into clinical 
    applicability in Iran. Invest Educ Enferm. 2016;34:137-151.
    54. Kol E, Ilaslan E, Turkay M. Training needs of clinical nurses at an 
    university hospital in Turkey. Nurse Educ Pract 2017;22:15‑20.
    55. Ahanchian MR, Emami Zeydi A, Armat MR. Conflict management 
    styles among Iranian critical care nursing staff: A cross-sectional 
    study. Dimens Crit Care Nurs. 2015;34:140-5.