NGR6910C Research

Nursing Open. 2024;11:e2233.  | 1 of 10 https://doi.org/10.1002/nop2.2233

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Received: 7 May 2023  | Revised: 13 March 2024  | Accepted: 21 June 2024 DOI: 10.1002/nop2.2233

E M P I R I C A L R E S E A R C H Q U A N T I T A T I V E

The relationship between general self- efficacy and nursing practice competence for second- year nurses: Empirical quantitative research

Ryozo Tomita

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.

Faculty of Nursing, Musashino University, Tokyo, Japan

Correspondence Ryozo Tomita, Faculty of Nursing, Musashino University, 3- 3- 3 Ariake Koto- ku, Tokyo 135- 8181, Japan. Email: [email protected]

Funding information JSPS KAKENHI, Grant/Award Number: JP20K19002

Abstract Aim: To examine the relationship between general self- efficacy and nursing practice competence for nurses in the second year of employment. Design: A cross- sectional design was used. Data Sources: The study included 596 nurses in their second year of employment at 75 medical facilities across Japan and used an online questionnaire survey for data collection. Results: The covariance structure analysis showed the path from general self- efficacy (latent variable) to nursing practice competence. Positive correlations were found be- tween all factors on both scales. Multiple regression analysis results showed that the general self- efficacy factors of ‘positivity in behavior’ and ‘confidence in social com- petence’ affect nursing practice competence. Conclusion: This study emphasizes the importance of enhancing the general self- efficacy of second- year nurses to improve their nursing practice competence. To achieve this, it suggests developing strategies from the perspective of the factors that comprise general self- efficacy. Implications for the Profession and Patient Care: The findings suggest that improving general self- efficacy can enhance nursing practice competence, which could inform the development of interventions to support nurses in improving their competence. The study provides basic data for improving nurses' practice competence. Impact: This study is the first to establish a relationship between general self- efficacy and nursing practice competence among second- year nurses. It demonstrates the significance of general self- efficacy in enhancing nursing practice competence, par- ticularly for second- year nurses worldwide who may be struggling with their nurs- ing practice competence and considering leaving the profession. The findings offer practical implications for stakeholders involved in nursing education and training pro- grams, with potential applications in professional development.

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1  |  INTRODUC TION

Nurses must have the knowledge, competencies and attitudes to meet the health system's needs and address national priority health challenges (World Health Organization, 2021). Generally, compe- tence is essential for guaranteeing high- quality and cost- effective healthcare services (Meretoja et al., 2002) and is closely related to the provision of comprehensive care that meets patients' com- plicated and diverse needs (Fukada, 2018). Moreover, a competent attitude leads to enhanced patient satisfaction, quality of care and safety (Nabizadeh- Gharghozar et al., 2021) and is crucial to practic- ing high- level nursing services that meet patients' needs.

Nurses in their second year of employment are in a critical pe- riod of growth to perform advanced nursing services and become a member of team- based healthcare (Taniwaki, 2006). However, they reportedly struggle with a lack of competence (Kox et al., 2020) and experience difficulties in nursing practice, such as the inability to make decisions and act on what they think (Yoshioka et al., 2017). Furthermore, lack of competence is a factor responsible for nurse turnover (Kox et al., 2020; Tomietto et al., 2015), and lack of nursing practice competence is a pressing issue among second- year nurses.

To develop an effective strategy for addressing the lack of nurs- ing practice competence among second- year nurses, identifying the factors that influence competence is essential. Previous studies tar- geting nurses have shown that self- efficacy influences competence (Huang & Saensom, 2022; Pueyo- Garrigues et al., 2022). Thus, self- efficacy appears to be a predictive factor of competence. However, no previous studies have established a relationship between general self- efficacy and nursing practice. To this end, this study focused on self- efficacy, especially general self- efficacy, identifying a relation- ship between general self- efficacy and nursing practice competence among second- year nurses. By clarifying this relationship, the study hopes to provide basic data for the development of strategies to sup- port the growth of second- year nurses who are struggling with com- petence and considering leaving the profession. The improvement of nursing practice competence through effective strategies is hoped to contribute to improved nursing quality and reduced turnover.

2  |  BACKGROUND

Uchino et al. (2017) reported that in workplace education for young nurses in Japan, first- year nurses receive extensive mentor- ing, while third- year nurses receive guidance from senior nurses in

administrative tasks and other areas. Furthermore, although second- year nurses are not sufficiently skilled in nursing and professional judgement, their mentorship is removed as first- year nurses enter the workforce (Uchino et al., 2017). In this situation, these nurses have concerns regarding being on their own, expanding roles, and nursing practice (Nishi, 2018). In the Netherlands, ‘lack of perceived compe- tence’ has been identified as a reason for leaving the nursing profes- sion within the second year, combined with increased responsibility and over- demanding work. These issues lead to stress and anxiety, ultimately resulting in increased work errors (Kox et al., 2020). In Italy, ‘opportunities for professional development’ have been identified as a factor that decreases nurses' intention to leave within the second year (Tomietto et al., 2015). Thus, second- year nurses face competence- related problems both nationally and internationally. However, con- sidering the dearth of studies on second- year nurses, further research and discussion on how to address this issue are required.

Competency is an underlying individual characteristic that is caus- ally related to criterion- referenced effective and/or superior perfor- mance in a job or situation (Spencer & Spencer, 1993). It consists of five characteristics (i.e. motives, traits, self- concepts, knowledge and skills), among which motives, traits and self- concept prompt behavioural ac- tions based on skills and influence job performance outcomes (Spencer & Spencer, 1993). Competence is a context- dependent, time- dependent (Garside & Nhemachena, 2013) and multidimensional concept that is more complex and broader than technical skills (Nabizadeh- Gharghozar et al., 2021), and it has been studied and discussed in nursing practice (Fukada, 2018; Garside & Nhemachena, 2013; Takase et al., 2011). The definition of competence varies according to the in- dividual (Fukada, 2018; Pijl- Zieber et al., 2014) and can be categorized by level—potential level theory and action level theory. In the potential level theory, competence is regarded as the potential to practice effi- cient and safe nursing and is inferred through actual practice. In the ac- tion level theory, competence includes the potential, the ability to use such potential and the ability to take action (Takase et al., 2011). Takase and Teraoka (2011) have defined competence as the ability of nurses to effectively demonstrate a set of attributes, such as personal character- istics, professional attitude, values, knowledge and skills, and to fulfil their professional responsibility through practice. Similarly, Sullivan et al. (2021) have associated competence in nursing with the ability to implement safe and caring practices with confidence. As competence is a multidimensional concept, it can be influenced by various factors, one of which is self- efficacy.

Self- efficacy refers to people's belief in their ability to organize and execute the course of action required to manage prospective situations

Reporting Method: This manuscript adheres to the STROBE guidelines for the report- ing of cross- sectional studies. Patient or Public Contribution: There was no patient or public contribution.

K E Y W O R D S covariance structure analysis, general self- efficacy, multiple regression analysis, nursing practice competence, second- year nurse

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(Bandura, 1995). Individuals with high self- efficacy set personal goals, think analytically and accomplish tasks and challenges; when faced with the risk of failure, they make the maximum effort required to at- tain their goals with perseverance (Bandura, 1995). Although people understand that they can obtain certain good results if they take cer- tain actions, a lack of self- efficacy hinders people from taking effec- tive action (Bandura, 1977, 1982). Expressly, self- efficacy acts as an antecedent factor for actions and behaviours and as an important cog- nitive variable that determines a person's actions. Self- efficacy is an important factor for competence attainment. Studies on the relation- ship between competence and self- efficacy in nurses have shown that competence correlates positively with self- efficacy, and self- efficacy exerts a positive influence on competence (Huang & Saensom, 2022; Kang et al., 2021; Pueyo- Garrigues et al., 2022). Considering the views of Bandura (1995) and previous research, nurses with high self- efficacy are assumed to increase their competence by applying their skills and capabilities to confront difficulties and continuing to try until they at- tain their goals. Although self- efficacy is an essential factor in improv- ing competence, no studies have examined the relationship between competence and self- efficacy or the factors that comprise the concept.

Self- efficacy can be grouped into two forms based on how it af- fects actions and behaviours, as follows: (1) task- specific self- efficacy, which directly affects the choice of actions in specific situations, and (2) general self- efficacy, which affects generalized individual ac- tions and behaviours over the long term (Bandura, 1977; Sakano & Tohjoh, 1986). In certain specific situations, task- specific self- efficacy is an important factor in the execution of actions, as is an individual's general self- efficacy (Sakano & Tohjoh, 1986). Previous studies have focused primarily on task- specific self- efficacy and less on general self- efficacy (e.g. de Simone et al., 2018; Kim & Sim, 2020; Lee & Ko, 2010; Takashiki et al., 2022). The few studies on general self- efficacy inves- tigated the development of a model that predicts nursing students' competence (Orkaizagirre- Gómara et al., 2020) or examined the rela- tionship between nursing teachers' educational skills and their perfor- mance (Cayır & Ulupınar, 2021). Although these studies have shown a correlation between general self- efficacy and the object concept and its impact, none have covered the relationship between the factors that constitute general self- efficacy, and none have been identified for second- year nurses. Considering the above, the findings of the study focused on second- year nurses' general self- efficacy will pro- vide foundational material for better understanding the relationship between nursing practice competence and self- efficacy. Furthermore, the identification of factors influencing nursing practice competence will serve as an important resource for nurse educators and nursing managers to foster nursing practice competence.

3  |  THE STUDY

3.1  |  Aims

This study aimed to examine the relationship between general self- efficacy and nursing practice competence for nurses in the second

year of employment and to investigate the nature of the relation- ships between the factors that constitute general self- efficacy and competence in nursing practice.

3.2  |  Hypothesis

The study's hypotheses are as follows:

H1. General self- efficacy positively influences nursing practice competence in second- year nurses. H2. Each factor in general self- efficacy is correlated with nursing practice competence in second- year nurses. H3. Each factor in general self- efficacy affects nursing practice competence in second- year nurses.

4  |  METHODS

4.1  |  Design

This study was a cross- sectional online survey and adhered to the STROBE guidelines for reporting cross- sectional studies.

4.2  |  Instrument

4.2.1  |  Background characteristics

Questions were asked regarding participants' age, sex and the main department of their affiliated ward to ascertain their background characteristics.

4.2.2  |  Nursing Excellence Scale in Clinical Practice

The Nursing Excellence Scale in Clinical Practice (NESCP) meas- ured nursing practice competence. It is a self- assessment scale that assesses nursing practice quality (Funashima, 2015). This scale consists of seven factors and 35 items that elicit informa- tion on outstanding standards for nursing practice. The factors are as follows: collecting and using information continuously and efficiently (‘collecting and using information’; 5 items), using spe- cialized knowledge and techniques that reflect the characteristics of the clinical setting (‘using knowledge and techniques’; 5 items), communication that leads to the maintenance and development of relationships with patients and families (‘communication’; 5 items), overcoming adverse conditions in the work environment and individual patients (‘overcoming adverse conditions’; 5 items), demonstrating creativity towards clarifying and resolving prob- lems hidden in the current situation (‘demonstrating creativity’; 5 items), respecting the patient's personality and protecting their dignity (‘respect and protection’; 5 items) and discovering and

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simultaneously advancing multiple roles as members of a medical team (‘discovering and advancing roles’; 5 items).

Each question is evaluated on a five- point scale from 1 (not applica- ble at all) to 5 (very applicable). A higher score indicated a higher quality of nursing practice. The total score ranged from 35 to 175 points. The total scores for each factor ranged from 5 to 25 points. A total score of 141 points and above indicates a high score and a high quality of nursing practice, 104–140 points indicates a moderate score, and 103 points or less signifies a low score (Funashima, 2015). Construct valid- ity was confirmed by factor analysis, and Cronbach's α was 0.96 for the overall scale (Funashima, 2015). Cronbach's α for the overall scale in this study was 0.95 and ranged from 0.79 to 0.85 for the factors.

As high- quality nursing practice signifies high competence, it was judged that measuring the quality of nursing practice would enable indirect measurement of nursing practice competence, and this scale was adopted as a result. Permission to use the scale was obtained from the developer.

4.2.3  |  General Self- Efficacy Scale

The General Self- Efficacy Scale (GSES) was used to measure gen- eral self- efficacy. This scale measures the strength of general self- efficacy by determining how high or low an individual per- ceives self- efficacy in general (Sakano & Tohjoh, 1986). This scale consists of three factors and 16 yes- or- no items. The fac- tors are as follows: positivity in behaviour (‘positivity’; 7 items), anxiety about failure (‘anxiety’; 5 items) and confidence in social competence (‘confidence’; 4 items). ‘Anxiety’ is reverse scored. A higher total scale score indicated higher general self- efficacy. Total scores range from 0 to 16 points. The total score for each factor ranges from 0 to 7 for ‘positivity’, 0 to 5 for ‘anxiety’ and 0 to 4 for ‘confidence’. The scale scores can be standardized, rang- ing from 23 to 68 points. In this study, a standardized score was used. Re- testing (r = 0.83, p < 0.01), split- half methods (r = 0.84) and internal consistency studies (confidence coefficient r = 0.74) in Kuder–Richardson formula 21 have shown that this scale is highly reliable. Additionally, sufficient validity has been confirmed by investigating factorial, comorbid and clinical validity (Sakano & Tohjoh, 1986). The Cronbach's α for the overall scale in this study was 0.82 and ranged from 0.55 to 0.72 for the factors. Permission to use the scale was obtained from the developer.

4.3  |  Participants' requirements and recruitment

The participants' requirements were nurses in the second year of em- ployment with clinical experience from medical institutions with at least 200 general beds. One of the scales used in this study targeted nurses who worked in hospital wards; thus, nurses in outpatient and operating rooms were excluded. The participants were selected via convenience sampling from a list of hospitals across Japan. Research requests were made to the manager of each facility, and consent was

subsequently obtained. All nurses in the second year of employment with clinical experience working in the wards of the facilities were sent an online survey request by the manager. The participants responded voluntarily. The online survey was conducted from September 2021 to February 2022, and data were managed using ID numbers.

4.4  |  Sample size

Covariance structural analysis was conducted to test the hypothesis. The sample size required for conducting covariance structure analy- sis varies depending on the size and complexity of the model and es- timation method. Although there are no criteria for absolute sample size, a sample size of at least 100, preferably 200, was recommended (Hirai, 2017; Myers et al., 2011). Therefore, the minimum sample size required for this study was set at 200.

4.5  |  Data analysis

In this study, the data on independent and dependent variables were obtained from the same samples, indicating a possibility of a com- mon method bias. Therefore, Harman's single- factor test was per- formed (Podsakoff & Organ, 1986).

After calculating the descriptive statistics for the participants' background characteristics, the normality of the data and internal consistency of the scale were confirmed. To verify H1, a covariance structure analysis was conducted using the maximum likelihood method to determine the relationship between general self- efficacy and nursing practice competence, including each factor. The latent variables were ‘general self- efficacy’ and ‘nursing practice compe- tence’, and the observed variables were the factors of each scale. After the multiple- index model was created, it was modified, refer- ring to the modification indices and fit indices to create the model with the best fit to the data. Evaluation of the multiple- index model followed the criteria developed by Schermelleh- Engel et al. (2003) and used the goodness- of- fit index (GFI), adjusted GFI (AGFI), com- parative fit index (CFI) and root mean square error of approximation (RMSEA).

Furthermore, to verify H2 and H3, Pearson's correlation coeffi- cient and multiple regression analyses were conducted to confirm the relationship between the total scores of each scale and the fac- tors. In multiple regression analysis, the NESCP total score was used as the dependent variable, and the GSES factors were used as in- dependent variables. A multiple regression analysis was conducted with forced entry. SPSS 24.0 and Amos 24.0 for Windows were used for statistical analysis, with a significance level set at p < 0.05.

4.6  |  Ethical considerations

This study was approved by the Musashino University Faculty of Nursing Institutional Review Board (application number 2103- 5).

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The participants elected to voluntarily participate in the study after the researcher explained the study's details, including its purpose and data anonymity. A section for confirming consent was created on the top page of the online survey, and consent was obtained by completing this section and participating in the online survey.

5  |  RESULTS

5.1  |  Participants

The participants were nurses in the second year of employment with clinical experience; they were selected from 75 medical institutions with at least 200 general beds. Questionnaires were distributed to 2255 nurses, and 607 responded to the questionnaire (response rate: 27%). After excluding 11 participants who withdrew their con- sent after responding to the questionnaire, 596 participants com- pleted the questionnaire without any missing data.

5.2  |  Common method bias

Harman's single- factor test extracted two factors with eigenvalues of one or greater. The rate of dispersion that these two factors ex- plained for all observed variables was 62.4%, with the first factor having the largest eigenvalue of 46.8%. The proportion of variance of all observed variables explained by the first factor with the largest eigenvalue was less than 50%; thus, the problem of common method bias was not serious.

5.3  |  Background characteristics of participants

Table 1 presents the age, sex and main department of the partici- pants' affiliated ward. The average age was 23.9 (SD = 2.88) years, with 568 (95.3%) women and 28 (4.7%) men. The main depart- ments of the affiliated ward were mixed internal medicine and surgical departments (234 people, 39%), single internal medicine departments (121 people, 20%) and single surgical departments (79 people, 13%).

5.4  |  Descriptive statistics and reliability coefficients for each scale

Table 2 presents the descriptive statistics and reliability coefficients for each scale. The total NESCP score range was 103, with a mini- mum of 70, a maximum of 173 and a mean of 123.24 (SD = 16.13). The total GSES score range was 45, with a minimum of 23, a maxi- mum of 68 and a mean of 41.45 (SD = 9.94). The normal Q- Q plots for both scales resembled straight lines, and the scale values were close to normal distributions.

5.5  |  Nursing practice competence and general self- efficacy model construction

A multiple- index model was created based on the hypothesis, and a covariance structure analysis was conducted. The modification indi- ces and fit indices were used as references to modify the multiple- index model. The results are shown in Figure 1 and are as follows: χ2/df = 141.87/31, p < 0.001 and HOELTER0.01 = 219. The fit indices were GFI = 0.955, AGFI = 0.920, CFI = 0.959 and RMSEA = 0.078, and all paths were significant at the 1% level. Additionally, the path co- efficient from the latent variable ‘general self- efficacy’ to ‘nursing practice competence’ was 0.45, which explained 20% of the effect on nursing practice competence.

5.6  |  Correlation of each factor

Table 3 presents the results of the correlation analysis for each fac- tor. The total NESCP score was positively correlated with the total GSES score (r = 0.38, p < 0.01). Positive correlations between the total NESCP score and the scores for each GSES factor (r = 0.22– 0.36; p < 0.01) were observed. There was a positive correlation be- tween the total GSES score and the scores for each NESCP factor (r = 0.24–0.34; p < 0.01).

5.7  |  General self- efficacy factors influencing nursing practice competence

Table 4 presents the results of the multiple regression analysis. The GSES factors of positivity (β = 0.26, p < 0.001) and confidence

TA B L E 1 Background characteristics of participants (N = 596).

M (SD) n %

Age 23.9 (2.88)

Sex

Female 568 95.3

Male 28 4.7

Main department of affiliated ward

Single internal medicine department

121 20

Single surgery department 79 13

Mixed internal medicine and surgery department

234 39

Intensive care unit 59 10

Paramedic care 10 2

Paediatrics 26 4

obstetrics and gynaecology 45 8

Psychiatry 10 2

Infectious diseases 4 1

Other 8 1

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(β = 0.22, p < 0.001) influenced the total NESCP score, explaining 16% of the variance in the total NESCP scores.

6  |  DISCUSSION

This study aimed to test the hypothesis that general self- efficacy affects nursing practice competence in second- year nurses and ex- amine the relationship between the constituent factors of general efficacy and nursing practice competence. A covariance structure analysis demonstrated that the fit indices fell within an acceptable range, thus validating H1. The model can be interpreted as a good fit for the data, and the results are reflective of reality. Furthermore, the analysis revealed a causal relationship, indicating that gen- eral self- efficacy influences nursing practice competence by 20%. Pearson's correlation coefficients indicated that each factor of the NESCP scale and the GSES scale was positively correlated, verifying

H2, and multiple regression analysis revealed that ‘positivity’ and ‘confidence’ of the GSES scale positively influenced nursing practice competence, partially validating H3.

6.1  |  Relationship between general self- efficacy and nursing practice competence

Competence is a context- dependent, time- dependent and multidi- mensional concept that is more complex and broader than techni- cal skills (Garside & Nhemachena, 2013; Nabizadeh- Gharghozar et al., 2021). Therefore, many factors can be postulated to influ- ence nursing practice competence. Concerning H1, the fact that the structural analysis of covariance was able to explain 20% of the positive influence of general self- efficacy on nursing practice com- petence is significant in that it identified a single factor in nursing practice competence. Therefore, changes in general self- efficacy

Min Max Mean SD Cronbach's α

Nursing Excellence Scale in Clinical Practice

Overall scale 70 173 123.24 16.13 0.95

Collecting and using information

10 25 16.88 2.76 0.85

Using knowledge and techniques

8 25 16.60 3.21 0.85

Communication 7 25 19.72 2.88 0.85

Overcoming adverse conditions 6 25 17.39 2.93 0.84

Demonstrating creativity 8 25 15.79 3.06 0.79

Respect and protection 10 25 19.37 2.79 0.85

Discovering and advancing roles

9 25 17.50 3.11 0.80

General Self- Efficacy Scale

Overall scale 23 68 41.45 9.94 0.82

Positivity 23 45 33.31 5.26 0.71

Anxiety 23 40 31.85 4.26 0.72

Confidence 23 37 29.42 2.93 0.55

TA B L E 2 Descriptive statistics and reliability coefficients for each scale (N = 596).

F I G U R E 1 Analysis of multiple- index model. Standardized estimates, N = 596; GFI = 0.955; AGFI = 0.920; CFI = 0.959; RMSEA = 0.078.

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also serve as an important indicator of nursing practice compe- tence development. People with high self- efficacy can fully mobi- lize their capabilities to cope with difficulties and continue making such efforts until they reach their goals (Bandura, 1995). Second- year nurses regain confidence in nursing and experience a change to proactive behaviour (Uchino et al., 2017). In other words, their general self- efficacy increases as they can provide more nursing assistance with more confidence in the second year than in the first year. Furthermore, the increase in self- efficacy prompts ac- tions towards goal attainment. This phenomenon elucidates the influence of general self- efficacy on nursing practice competence.

Concerning H2, the correlation between all factors, despite their low coefficients, is important for a more specific understanding of the relationship between general self- efficacy and nursing practice competence among second- year nurses. Khomeiran et al. (2006) re- ported that personal characteristics (e.g. curiosity, preparation for own work and participation in activities enhancing own skills) and capabilities influence competence enhancement. Moreover, positive affectivity positively affects nursing performance (Lee & Ko, 2010). Therefore, even among second- year nurses, both positivity, which signifies the degree of effort dedicated to nursing practice, and

confidence, which measures the extent of awareness of one's com- petence in general and social situations, correlated with each fac- tor of nursing practice competence. Interestingly, the correlation coefficients for ‘discovering and advancing roles’ and ‘positivity’ or ‘confidence’ tended to be higher than those for other factors. In this regard, second- year nurses experience a search for roles that they can fulfil in the workplace (Uchino et al., 2017). The outcomes of their thoughts and actions on potential practices as team members from the second year are speculated to have led to nursing practice competence, which was demonstrated by the relationship between ‘discovering and advancing roles’ and ‘positivity’ or ‘confidence’. The correlation coefficients tended to be low overall because second- year nurses are in the process of developing professionally. As these nurses have repeated positive and negative experiences (e.g. Nishi, 2018; Saita & Asoshina, 2011; Uchino et al., 2017), such expe- riences may have affected each factor, contributing to the relatively low correlation coefficient.

Additionally, in H3, the ‘anxiety’ factor was not significantly as- sociated with nursing practice competence, which may be because of the influence of the data types. During the early part of their sec- ond year of employment, many nurses experience confusion and

TA B L E 3 Pearson's correlations for each factor (N = 596).

1 2 3 4 5 6 7 8 9 10 11

1 Total NESCP score

2 Collecting and using information

0.77**

3 Using knowledge and techniques

0.80** 0.72**

4 Communication 0.74** 0.46** 0.47**

5 Overcoming adverse conditions

0.77** 0.45** 0.49** 0.61**

6 Demonstrating creativity

0.76** 0.54** 0.53** 0.40** 0.54**

7 Respect and protection 0.78** 0.47** 0.46** 0.62** 0.57** 0.57**

8 Discovering and advancing roles

0.82** 0.57** 0.65** 0.51** 0.53** 0.56** 0.59**

9 Total GSES score 0.38** 0.33** 0.33** 0.30** 0.24** 0.25** 0.28** 0.34**

10 Positivity 0.36** 0.34** 0.32** 0.24** 0.22** 0.25** 0.25** 0.34** 0.89**

11 Anxiety 0.22** 0.17** 0.20** 0.21** 0.12** 0.11** 0.18** 0.18** 0.81** 0.58**

12 Confidence 0.34** 0.29** 0.27** 0.29** 0.24** 0.24** 0.25** 0.30** 0.68** 0.50** 0.39**

**p < 0.01.

TA B L E 4 Multiple regression analysis on the factors influencing nursing practice competence (N = 596).

Independent variable

Unstandardized coefficient

Standardized coefficient Significance probability 95% confidence interval of B

B SE β p Lower limit Upper limit

Positivity 0.81 0.15 0.26 0.00 0.51 1.10

Anxiety −0.08 0.18 −0.02 0.65 −0.43 0.26

Confidence 1.21 0.24 0.22 0.00 0.74 1.68

Note: Adjusted R2 = 0.16.

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anxiety. However, as they gain more experience, they begin to feel more capable and confident in their abilities (Abe & Sekido, 2021). The data collected in this study may have focused on nurses who had already developed effective coping mechanisms, which could explain the poor correlation and the lack of a significant relationship between anxiety and nursing practice competence.

6.2  |  Practical implications

The findings of this study emphasize that enhancing general self- efficacy is necessary to develop nursing practice competence in second- year nurses. Although the results of the analysis did not con- firm the influence of anxiety because of the data types, anxiety is a factor that constitutes self- efficacy. Second- year nurses experience the beginning of their professionalism and a move to action; simul- taneously, they also experience the anxiety of having to stand on their own (Uchino et al., 2017). As the second year is a time of varied experiences, it is important to view general self- efficacy from the perspective of ‘positivity’ and ‘confidence’, including ‘anxiety’.

Factors that enhance self- efficacy include mastery, vicarious experiences, social encouragement and certain physiological and emotional states (Bandura, 1995). General self- efficacy in second- year nurses can be enhanced by creating opportunities for people to acknowledge their successful experiences and to receive positive feedback on their competence from administrators and colleagues. Furthermore, it is important to create an environment that encour- ages people to observe and copy other people's positive actions and behaviour.

Moreover, second- year nurses tend to evaluate themselves more harshly (Saita & Asoshina, 2011). Therefore, adopting an objective view of themselves is crucial for these nurses, and incorporating a ‘meta- cognitive certainty’ perspective when assessing self- efficacy may be beneficial. Metacognitive certainty refers to the assessment that thoughts and attitudes are clear and correct in one's mind; research suggests that thoughts with certainty are better predictors of atti- tudes, and attitudes with certainty are better predictors of behaviours (Horcajo et al., 2022). By applying this perspective to self- efficacy, it may be possible to assess general self- efficacy more accurately and offer support tailored to each individual's needs. The factors that foster a ‘good nurse’ include specialized competencies, self- efficacy and thoughtfulness. The current healthcare environment requires nurses to have high self- efficacy (Park & Park, 2020). Therefore, safe and empathetic nursing care can be promoted by increasing general self- efficacy and developing nursing competencies and quality nurs- ing practice for second- year nurses. Furthermore, it can mitigate the problem of turnover due to insufficient nursing practice competence.

6.3  |  Limitations

Although this research has shown the relationship between nursing practice competence and general self- efficacy in second- year nurses

and contributes to the development of nursing practice competence, several constraints may limit the generalization of the results. First, the data used in this study were obtained from second- year nurses in Japan. Second, the possibility of selection bias in this study can- not be refuted; yet, the current study's 27% response rate cannot be considered extremely low, as past researchers have reported response rates ranging from 6.7% to 37.3% (Hagihara et al., 2006). Third, covariance exists between error variables in the multiple- index model. Fourth, the confidence factor of the GSES showed a low Cronbach's α. Scales with Cronbach's α below 0.50 should not be used (Oshio, 2011), and although the coefficient for the confidence factor was not below 0.5, the possibility of this low coefficient to have influenced the analysis results cannot be overlooked. Based on this, the results of this study should be interpreted from the per- spective of statistical prediction.

6.4  |  Recommendations for further research

Future studies should be conducted in larger samples and with ad- ditional factors of self- efficacy to better define the generalizability. Longitudinal studies would enable the verification of causal relation- ships in these variables as well.

7  |  CONCLUSION

This study highlighted the significant influence of general self- efficacy, particularly the factors of ‘positivity’ and ‘confidence’, on the nursing practice competence of second- year nurses. The find- ings emphasize the importance of increasing general self- efficacy and the need to view general self- efficacy from the perspectives of ‘positivity’ and ‘confidence’ to improve the nursing practice compe- tence of second- year nurses.

Second- year nurses face the problem of inadequate nursing practice competence, leading to increased turnover. To solve this problem, strategies must be considered to improve their nursing practice competence. These strategies can be further strengthened by identifying the factors that contribute to improved nursing prac- tice competence and demonstrating the relationship between them. Doing so will contribute to improving nursing practice competence and mitigating turnover resulting from the competency issue.

AUTHOR CONTRIBUTIONS I am the sole author of this paper.

ACKNOWLEDG EMENTS I would like to express my sincere gratitude to all the nurses and hospital staff who participated in this study. I would also like to thank Editage (www. edita ge. com) for the English language editing. The statistical analysis was checked by ‘Editage Statistical Support team’ and the email address of the expert is ‘publication_support@ editage.com’.

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FUNDING INFORMATION This study was supported by JSPS KAKENHI grant number JP20K19002. The funder had no role in the study design, collection, analysis or interpretation of data, writing of the report or in the deci- sion to submit the article for publication.

CONFLIC T OF INTERE S T S TATEMENT The author has no conflict of interest to declare.

DATA AVAIL ABILIT Y S TATEMENT The data that support the findings of this study are available from the author, upon reasonable request.

E THIC S S TATEMENT This study was approved by the Musashino University Faculty of Nursing Institutional Review Board (application number 2103- 5).

PATIENT CONSENT S TATEMENT The participants elected to voluntarily participate in the study after the researcher explained the study's details, including its purpose and data anonymity. A section for confirming consent was created on the top page of the online survey, and consent was obtained by completing this section and participating in the online survey.

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How to cite this article: Tomita, R. (2024). The relationship between general self- efficacy and nursing practice competence for second- year nurses: Empirical quantitative research. Nursing Open, 11, e2233. https://doi.org/10.1002/ nop2.2233

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