Closing the Competency Gap: How Ready are New Grads to Take on Nursing Responsibilities?

New graduate nurses now account for more than 10% of hospital staff nurses, and that percentage is expected to grow as patient populations increase and baby boomer nurses begin to retire.

Now that hospitals are increasingly relying on inexperienced staff, the question becomes: How ready are new graduates to assume an independent professional role, and what skills do they need to learn and practice in order to provide safe nursing care?

That question has two very different answers depending on whom you ask. School of Nursing (SON) deans express full confidence in their graduates’ abilities. Hospital nursing executives? Not so much. Ninety percent of nursing school leaders believe that new grads are ready to provide safe and effective patient care, but only 10% of hospital nursing executives agree.

Both groups , however, agree on this: More can be done to prepare nursing students for professional practice and to close the competency gap between nursing school and nursing practice.

To help pinpoint the most important areas where new graduate nurses need help, the Advisory Board’s Nursing Executive Center commissioned a survey that asked participants to rank new graduate nurses’ competency in 36 areas that are considered essential to safe and effective practice.

Clinical Knowledge

  1. Understanding of the principles of evidence-based practice
  2. Knowledge of pathophysiology of patient conditions
  3. Knowledge of pharmacological implications of medications
  4. Interpretation of physician and interprofessional orders
  5. Compliance with legal and regulatory issues relevant to nursing practice
  6. Understanding of quality improvement methods

Technical Skills

  1. Conducting patient assessments, including history, physical examination and vital sign measurements
  2. Documentation of patient assessment data
  3. Conducting clinical procedures, such as changing a sterile dressing and administering IV therapy
  4. Use of clinical technologies, such as IV Smart Pumps and medical monitors
  5. Administration of medication
  6. Use of information technologies, such as computers and electronic medical records

Critical Thinking

  1. Recognition of changes in patient status
  2. Ability to anticipate risk
  3. Interpretation of assessment data, including history and examination findings and laboratory test results
  4. Decision making based on the nursing process
  5. Recognition of when to ask for assistance
  6. Recognition of unsafe practices by self and others


  1. Rapport with patients and families
  2. Communication with interprofessional team
  3. Communication with physicians
  4. Patient education
  5. Conflict resolution
  6. Patient advocacy


  1. Ability to work independently
  2. Ability to work as part of a team
  3. Ability to accept constructive criticism
  4. Customer service
  5. Accountability for actions
  6. Respect for diverse cultural perspectives

Management of Responsibilities

  1. Ability to keep track of multiple responsibilities
  2. Ability to prioritize
  3. Delegation of tasks
  4. Completion of individual tasks within expected time frame
  5. Ability to take initiative
  6. Conducting appropriate follow-up

For nurse administrators who are working with limited resources focusing on all 36 competencies may not be a realistic goal. However, the study offers a starting point for nurse administrators to set priorities for new graduate orientation and performance based on what is most important for their facility.

These skills are the focus of nursing’s preparation–practice gap. The hope is that by clearly identifying the skills that new graduates lack, academics and healthcare organizations can find agreement on how to bridge this gap.

For more information about helping new graduates transition into competent professional nurses, check out the online Mosby’s Preceptor course or call 866-416-6697.


Nursing Executive Center. Bridging the Preparation-Practice Gap, Volume I: Quantifying New Graduate Improvement Needs. Washington, D.C.: The Advisory Board Company, 2008.

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