Abstract
-
Purpose
This study aimed to identify differences in perceived task performance, task importance, and educational needs for novice-level tasks among neonatal intensive care unit (NICU) nurses with varying levels of clinical experience and to provide foundational data for developing systematic educational programs to strengthen the competencies of novice nurses.
-
Methods
Participants were recruited from the NICUs of three hospitals—one university-affiliated hospital and two general hospitals located in Busan, South Korea. Using convenience sampling, 116 staff nurses with at least 3 months of NICU experience were surveyed between March and November 2025. For comparative analysis, participants were divided into three career groups based on their NICU experience: <3 years, 3–9 years, and ≥9 years. Data were analyzed using descriptive statistics, analysis of variance, and the Scheffé test with IBM SPSS ver. 25.0, and importance–performance analysis (IPA) was conducted to prioritize educational needs.
-
Results
Across all career groups, the “direct nursing performance” domain showed the highest task performance. Novice nurses with <3 years of experience reported significantly higher performance in central line care and transfusion management than those with ≥9 years of experience. The IPA identified central line management, and transfusion management as priority areas for improvement, while vital sign monitoring, respiratory surveillance and discharge education for parents were common educational needs regardless of experience level.
-
Conclusion
Educational programs for novice NICU nurses should focus on strengthening patient safety–related competencies and should be progressively structured with simulation and case-based learning to enhance clinical performance.
-
Key words: Clinical competence; Neonatal intensive care units; Nursing education
INTRODUCTION
The average maternal age in South Korea rose steadily from 29.49 years in 2002 to 33.5 years in 2022 [
1,
2]. Accordingly, the proportion of mothers aged 35 years and older grew from 17.1% in 2010 to 33.8% in 2020, and the number of individuals who received infertility treatment increased from 185,000 in 2010 to 242,000 in 2018 [
1,
3]. The proportion of multiple births (twins or more) resulting from assisted reproductive procedures also rose from 3.9% in 2017 to 5.4% in 2021. Among these, preterm births (<37 weeks) increased from 5.8% in 2010 to 8.5% in 2020, and the incidence of low-birthweight infants rose from 4.9% in 2010 to 6.8% in 2020 [
1,
4]. Preterm and low-birthweight infants are classified as high-risk neonates and are typically admitted to neonatal intensive care units (NICUs) for specialized medical management [
5]. High-risk neonates are defined as infants with higher-than-average morbidity or mortality due to birth-related complications or difficulty adapting to extrauterine life, regardless of gestational age or birth weight [
6]. Once classified as high-risk, they require prolonged intensive care in NICUs to sustain life and promote growth and development [
7,
8].
To provide safe and effective care for high-risk neonates, NICU nurses must be able to distinguish neonatal characteristics, recognize the importance of nursing interventions, and plan specialized care accordingly. As they deliver complex and developmentally appropriate care that directly affects neonatal outcomes and family adaptation, NICU nurses must demonstrate a high level of professional competence [
9]. Nursing competence in NICUs represents an essential internal capability that enables nurses to provide appropriate clinical care in practice [
10]. NICU nurses provide therapeutic and nursing care to neonates with a range of health conditions, including postnatal complications, congenital heart defects, surgical diseases, and physiologic immaturity [
11]. Furthermore, they help parents build attachment to their infants, provide emotional or palliative support for critically ill neonates, and educate families on continuing appropriate care at home after discharge [
12,
13]. Hence, NICU nurses must possess sufficient knowledge, technical skills, and judgment to deliver highly specialized nursing care tailored to the developmental needs of high-risk neonates and their families [
9,
10,
14].
However, pediatric clinical practice in South Korea remains limited [
15], and NICU placements for nursing students is often restricted due to infection control concerns related to high-risk neonates [
15]. Consequently, opportunities for nursing students to acquire essential neonatal intensive care skills (such as neonatal resuscitation) are minimal, rendering it difficult to evaluate their preparedness for NICU practice [
16]. Owing to these constraints, novice nurses who lack adequate hands-on experience, are sometimes assigned to NICUs and may show adverse effects in clinical reasoning, technical performance, and adaptation to demanding clinical setting [
8]. A systematic, structured approach is needed to strengthen the competence of novice NICU nurses and to ensure the delivery of safe, optimal care to high-risk neonates. Identifying the core competencies required by novice NICU nurses is a necessary first step.
The “novice to expert” theory by Benner [
17] provides a theoretical foundation for understanding how nurses develop from novices to experts through experiential learning [
18]. According to this framework, NICU nurses evolve from an initial stage of relying on objective rules and medical equipment [
18] to a level of expertise in which they gain the intuitive ability to detect subtle clinical signs in critically ill neonates through their accumulated experience [
10,
19].
Mid-level and senior nurses with extensive clinical experience are well positioned to identify the gap between theory and practice and guide novice nurses in acquiring the essential competencies required for NICU practice [
20]. Similarly, Ibrahim et al. [
21] found that experienced nurses serving as preceptors could accurately assess the performance of novice nurses and provide stage-appropriate education, thereby facilitating their adaptation and skill development. These findings suggest that perceptions of competence differ according to clinical experience, underscoring the need for educational programs that reflect such differences to support professional growth and clinical adaptation among novice nurses [
17,
20,
22].
In addition, importance–performance analysis (IPA) is a simple yet highly practical method for evaluating the task importance and performance of novice nurses based on their NICU experience. By simultaneously considering both dimensions, IPA visually clarifies the “concentrate here” quadrant areas requiring immediate improvement within the high-pressure environment of the NICU. This approach provides a strategic framework for developing effective educational and intervention programs tailored to urgent clinical needs. By visually presenting the results on a two-dimensional grid, IPA facilitates a clear understanding of the characteristics of nursing tasks performed by novice NICU nurses and helps identify areas requiring improvement [
23].
In this study, we aimed to examine perceptions of the task performance, task importance, and educational needs of novice NICU nurses among both novice and experienced nurses, and to provide foundational data to build educational programs for novice nurses in the NICU.
We aimed to identify task importance, task performance, and educational needs regarding novice-level nursing tasks, as perceived by NICU nurses with various level of experience in South Korea, focusing on the competencies required for novice NICU nurses
We specifically aimed to (1) examine the general characteristics of the participants; (2) identify differences in the perceived task performance, task importance, and educational needs of novice NICU nurses according to the participants’ NICU clinical experience; and (3) determine the priority order of the educational needs of novice NICU nurses based on the participants’ NICU clinical experience.
METHODS
Ethical statements: This study was approved by the Institutional Review Board of Kosin University, Busan, South Korea (IRB No. KU IRB 2024-0047). Informed consent was obtained from all participants.
1. Study Design
We employed a descriptive survey to identify the task performance, task importance, and educational needs of novice nurses working in NICUs. We followed the guidelines outlined in the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement [
24].
The participants were nurses working in the NICUs of Kosin University Hospital, Good Moonhwa Hospital, and Busan St. Mary's Hospital in Busan Metropolitan City, South Korea. We used convenience sampling; to ensure systematic recruitment, the nursing managers of each unit distributed questionnaires to the staff. All participants received a detailed explanation of the study’s purpose and procedures, and data collection proceeded only after obtaining written informed consent. The inclusion criteria were as follows: (1) nurses who understood the purpose and procedures of the study’s and provided written informed consent; (2) nurses employed as full-time staff with at least 3 months of NICU experience. We excluded nurses in managerial positions above the head nurse level who were not directly involved in patient care.
We determined the required sample size using G*Power ver. 3.1.9.4 (Heinrich-Heine-Universität Düsseldorf). Given a significance level of .05, a medium effect size of .30, and power of .80, the minimum sample size was 111. Considering an expected dropout rate of 10%, 123 questionnaires were distributed. After excluding seven incomplete responses, we used data from 116 participants for the final analysis.
3. Instruments
1) Task performance, task importance, and educational needs of NICU nurses
We measured NICU nursing competency using the scale developed by Choi [
25]. This 22-item instrument comprises three subdomains: (1) knowledge enhancement for nursing car (nine items); (2) direct nursing care (10 items); and (3) quality improvement (QI) in nursing care (three items). Each item is rated on a 5-point Likert scale across three dimensions: task importance, task performance, and educational needs. While we assessed task importance and performance using the original tool’s parameters, we specifically verified content validity for educational needs. Content validity was evaluated by a panel of five experts comprising two nursing professors and three clinical experts with over 10 years of experience in the NICU. We retained only items with an item-level content validity index (I-CVI) of .80 or higher; the final scale achieved a scale-level CVI (S-CVI) of .90, ensuring high content relevance. As for reliability, the original study by Choi [
25] reported a Cronbach’s α of .80. In this study, the Cronbach’s α coefficients for task importance, task performance, and educational needs were .94, .94, and .96, respectively, indicating excellent internal consistency.
2) Data collection procedure
Data were collected over a 5-month period from March to November 2025. Prior to participation, all participants were informed in detail about the study’s purpose and procedures, the confidentiality of their data, voluntary participation, and potential risks and benefits. To ensure ethical rigor, we included only participants who voluntarily checked the consent box at the beginning of the online survey. To maintain anonymity and confidentiality, all responses were processed anonymously and no personally identifiable information was collected. To minimize response bias, the participants were explicitly informed that their data would be strictly used for research purposes and that nursing managers would have no access to individual responses, thereby guaranteeing that participation would not influence their performance evaluations. The self-administered questionnaire required approximately 15–20 minutes to complete, and the respondents received a small token of appreciation upon completion.
3) Data analysis
We analyzed the data using IBM SPSS Statistics for Windows ver. 25.0 (IBM Corp.). We examined the participants’ general characteristics using descriptive statistics, including frequencies, percentages, and means. Differences in the perceived task performance, task importance, and educational needs of novice NICU were based on the “novice to expert” theory by Benner [
17] and clinical experience. After verifying that the underlying assumptions of normality and homogeneity of variance were satisfied, we studied the data using analysis of variance and Scheffé post-hoc tests to compare differences among groups. We examined the relationship between task importance and task performance using IPA to determine the order of priority of educational needs. In the IPA matrix, the x-axis represents task performance and the y-axis denotes task importance. We plotted each item into four quadrants based on the mean scores for importance and performance.
(1) Quadrant I (keep up the good work): high importance and performance
The items in this quadrant are considered areas of competitive strength where current standards should be maintained.
(2) Quadrant II (possible overkill): low importance but high performance
These items indicate that resources may be allocated to areas of lower significance; thus, efforts should be redirected elsewhere.
(3) Quadrant III (low priority): low importance and low performance
These items are of secondary concern and do not require immediate intervention or resource allocation.
(4) Quadrant IV (concentrate here): high importance but low performance
These items represent the highest priority for improvement as they are perceived as significant but lack sufficient proficiency.
The IPA enabled us to identify priority areas for improvement and educational interventions to enhance nursing competence and performance [
23].
RESULTS
1. General Characteristics of the Participants
Table 1 presents the participants’ general characteristics. A total of 116 nurses participated in this study. Most held bachelor’s degrees (n=90; 77.6%) and were single (n=71; 61.2%). In terms of age, the largest group was younger than 30 years old (n=53; 45.7%), followed by the 30–39 age group (n=48; 41.4%). Nurses with ≥9 years of clinical experience constituted the largest proportion of the sample (n=54; 46.6%).
As for total clinical experience, 54 participants (46.6%) had ≥9 years of experience, and 47 (40.5%) had ≥9 years of experience in their current NICU. The most common reason participants gave for working in their current unit was “not by personal preference” (n=61; 52.6%). Regarding the duration of NICU clinical practice during undergraduate nursing education, 74 participants (63.8%) reported having practiced for 1–2 weeks, and 32 (27.6%) had no NICU experience. Among those without NICU experience, 15 (46.9%) reported being satisfied with their overall pediatric nursing practicum. Among those with NICU experience, 41 (48.8%) feeling satisfied (
Table 1).
1) Differences in the perceived task performance, task importance, and educational needs of novice NICU nurses by clinical experience in the NICU
The analysis revealed significant differences in task performance based on overall NICU experience regarding central line management (F=4.92,
p=.01) and transfusion management (F=4.56,
p=.01). Post-hoc Scheffé tests showed that nurses with ≥9 years of NICU experience perceived higher task performance than those with <3 years of experience (
Table 2). As for differences in perceived task importance, we noted a significant difference in parents’ discharge education (F=5.58,
p<.001). Post-hoc analysis indicated that nurses with 3–9 years of experience in the NICU rated this item significantly lower in importance than those with ≥9 years of experience (
Table 3).
The analysis of perceived educational needs also showed statistically significant differences based on total NICU experience (F=7.29, p<.001), particularly in the subdomain of direct nursing care (F=7.62, p<.001). We noted significant differences in the following items: central line management (F=5.34, p=.01); transfusion management (F=3.63, p=.03); nutrition management (F=6.00, p<.001); developmental supportive care (F=3.63, p=.03); jaundice care (F=5.37, p=.01); pain management (F=5.73, p<.001); infection control based on standard guidelines (F=4.70, p=.01); discharge education for parents (F=8.72, p<.001); physical assessment of admitted neonates (F=4.35, p=.02); interdepartmental collaboration (F=9.11, p<.001); parental/family support (F=10.76, p<.001); developmental stage-based care (F=3.32, p=.02); protocol development (F=3.64, p=.03); nursing service improvement activities, including QI (F=3.64, p=.03); and leadership and teamwork (F=4.79, p=.01).
Post-hoc comparisons indicated that for most items, including central line management, leadership, and teamwork, nurses with ≥9 years of experience scored significantly higher on educational needs than those with 3–9 years of experience (
Table 4).
2) IPA of novice NICU nurses based on NICU clinical experience
Figure 1 illustrates the perceptions of novice NICU nurses regarding task importance and performance based on their clinical experience. We divided the quadrants in the IPA matrix by a crosshair centered on the overall mean scores of importance and performance across all participants. Below, we describe the results for quadrants I (“keep up the good work”) and IV (“concentrate here”) in detail.
For nurses with <3 years of experience, we categorized nursing competency items were categorized as follows: In Quadrant I (keep up the good work), items with high importance and performance included: enhancing one’s knowledge of nursing care (i.e., observation of changes in vital signs, the definition of high-risk neonates, the importance of intake and output, respiratory system monitoring, nutrition management, developmental supportive care); direct nursing care (i.e., jaundice care, assessment of neonatal severity, pain management, infection control based on standard guidelines, discharge education for parents, the management of high-risk medications, physical assessment of hospitalized neonates, collaboration with other medical staff, family support for parents, supportive nursing according to developmental stage); and QI in nursing care (i.e., demonstrating leadership and teamwork).
In Quadrant IV (“concentrate here”), items where importance is high relative to perceived performance, indicating a need for prioritized improvement, include central line management, transfusion management, and cardiopulmonary resuscitation (CPR).
For nurses with 3–9 years of experience, we classified nursing competency items as follows. In Quadrant I (“keep up the good work”), items with high importance and high performance include: enhancing one’s knowledge (i.e., observation of changes in vital signs, the importance of intake and output, respiratory system monitoring, developmental supportive care); nursing performance (i.e., discharge education for parents, management of high-risk medications, collaboration with other medical staff); and improvement of nursing quality (i.e., improvement of nursing services through research, QI, leadership and teamwork). In Quadrant IV (“concentrate here”), items with high importance relative to perceived performance include CPR, the importance of intake and output, family support for parents, and development of protocols related to nursing practice.
For nurses with ≥9 years of experience, we classified nursing competency items as follows. In Quadrant I (“keep up the good work”), items with high importance and high performance include enhancing one’s knowledge (i.e., observation of changes in vital signs, the definition of high-risk neonates, the importance of intake and output, respiratory monitoring) and nursing performance (i.e., jaundice care, assessment of neonatal severity, infection control based on standard guidelines, discharge education for parents, physical assessment of hospitalized neonates). In Quadrant IV (“concentrate here”), items where importance is high relative to perceived performance include central line management, transfusion management, and the arrangement and differentiation of high-risk medications.
Overall, priority areas for improvement differ according to clinical experience. For nurses with <3 years of experience, central line management, transfusion management, and CPR are priority areas. For nurses with 3–9 years of experience, CPR, the importance of intake and output, parent/family support, and protocol development are included. In contrast, for nurses with ≥9 years of experience, central line management as well as the arrangement and differentiation of high-risk medications are priority areas for improvement.
DISCUSSION
This study was designed such that NICU nurses with various levels of experience evaluated task importance, task performance, and educational needs related to novice NICU nursing tasks. We built an IPA matrix to identify strategies to enhance nursing competencies in neonatal intensive care.
We explored the differences in perceptions of task importance, task performance, and educational needs related to novice NICU nursing tasks among nurses with varying levels of clinical experience.
Analysis across the three levels of experience revealed that regardless of clinical experience, “direct nursing performance” was recognized as the most important and frequently performed task domain for novice NICU nurses. This finding may be attributed to the characteristics of NICU nursing in South Korea, which relies heavily on continuous direct observation and individual nurses’ clinical judgment, regardless of clinical experience [
7,
9,
14]. In addition, the NICU setting tends to prioritize immediate intervention and technically focused procedures over QI activities or organizational-level roles [
10,
14]. This context helps explain why direct clinical care remains the core focus of nursing practice across all levels of experience.
Among the specific tasks, jaundice care was perceived to have the highest performance across all three groups. The second most highly rated task was observation of changes in vital signs among nurses with less than 3 years and ≥9 years of experience, and intake and output monitoring for those with 3–9 years of experience. Thus, jaundice care emerged as the most prominent direct nursing performance task across all groups, and observation of changes in vital signs was consistently recognized as a critical component of neonatal nursing skills.
The finding that nurses with <3 years of experience perceived higher performance in central line management and transfusion management than those with ≥9 years of experience is consistent across the abstract and results. This outcome may be interpreted in various ways depending on the organizational structure of nursing work.
In this study, nurses with <3 years of clinical experience performed better on certain procedural nursing tasks than the more experienced groups. This finding may be tentatively explained by potential differences in nursing work organization. For example, in functional nursing systems, novice nurses may be assigned a greater proportion of direct procedural tasks. Conversely, in the team or primary nursing models commonly utilized in NICUs, experienced nurses are more likely to assume responsibility for patients with higher acuity and more complex clinical needs. Although we did not directly measure specific nursing delivery models, these organizational factors offer a possible context for understanding the observed variation in perceptions of performance [
10,
14,
17].
Nevertheless, the higher perceived performance reported by novice nurses is more likely to reflect self-assessment bias whereby nurses in the early stages of clinical practice tend to judge their performance based on the frequency of procedural experience rather than on complex clinical judgment or overall clinical competence [
8,
17,
22].
Moreover, given the prevalence of respiratory disorders (such as jaundice and respiratory distress syndrome) among high-risk neonates and their physiologically immature immune function, infection prevention and vigilant monitoring are crucial. Providing optimal care requires sufficient knowledge to recognize and interpret changes in vital signs, particularly those associated with respiratory distress [
6]. Thus, simulation-based education should be actively implemented among novice NICU nurses and undergraduate students with limited exposure to clinical practice, focusing on assessment of vital signs, central line management, transfusion management, intake/output evaluation, jaundice care, infection control, physical assessment, and respiratory monitoring.
The analysis of task importance revealed that both the <3-year group and ≥9-year group assigned the highest ratings to direct nursing performance, respiratory monitoring, infection control, and CPR; the ≥9-year group assigned the highest ratings to physical assessment of neonates, observation of changes in vital signs, and jaundice care. Although the rankings varied slightly, tasks commonly perceived as important by at least two groups included the observation of changes in vital signs, infection control, and physical assessment of neonates. These findings highlight the importance of developing skills that allow novice nurses to recognize physiological changes, manage infections in immunologically fragile infants, and conduct comprehensive physical assessments, all of which are essential abilities for safe and effective neonatal nursing practice.
We also noted a significant difference in discharge education for parents, with the 3–9-year group rating its importance lower than the ≥9-year group did. This finding aligns with that of Shin and Bang [
16], who found that more experienced nurses tend to recognize the long-term value of family-centered care. Experienced nurses should grasp the importance of empowering parents in managing post-discharge health and developmental issues in high-risk neonates. Consequently, educational programs should reinforce discharge education as a key element of family-centered nursing care—even for novice nurses. Interestingly, although intake and output monitoring have high performance scores, they have relatively low importance ratings. This suggests that nurses may perceive standardized, repetitive, basic nursing tasks as less critical than complex interventions directly related to patient survival. However, previous studies indicate that consistent performance of core nursing care directly contributes to patient safety and quality outcomes [
10,
14,
26]. Accurate intake and output measurements provide essential data for managing fluid balance, calculating medication dosages, and assessing renal function. Hence, educational initiatives should aim to strengthen nurses’ understanding of the significance of fundamental nursing activities as the basis for advanced neonatal care.
Overall, we found that direct clinical performance remains the cornerstone of neonatal intensive care nursing across nurses with different levels of experience. However, the scope of perceived importance evolves with experience, from procedural proficiency in the early stages to integrative competencies such as patient and family education, leadership, and participation in QI activities in later stages. Thus, structured and progressive educational programs tailored to the clinical experience levels of individual nurses are vital for fostering both technical expertise and reflective professional growth in NICU settings.
According to the analysis of educational needs based on current unit experience, nurses with <3 years of experience in their current NICU reported the highest mean score.
We observed significant differences among the groups in terms of central line management, nutrition management, jaundice care, pain management, infection control based on standard guidelines, discharge education for parents, physical assessment of hospitalized neonates, interdepartmental collaboration, parental/family support, transfusion management, and developmental supportive care. Post-hoc analysis showed that the 3–9-year group rated their educational needs significantly lower than the ≥9-year group for most items, including central line management, nutrition, jaundice care, pain management, infection control, discharge education, physical assessment, collaboration, and parental/family support.
This outcome may be attributed to the fact that senior nurses, through their extensive clinical experience, have developed heightened awareness of the limitations of basic nursing in preventing unexpected complications. In addition, it is possible that more experienced nurses maintain higher professional standards and a greater sense of accountability, leading them to perceive a continuous need for regular, advanced education [
17,
22,
26].
In contrast, the 3–9-year group perceived transfusion management and developmental supportive care as higher priorities by than the <3-year group. Prior research supports this finding, noting that transfusion management involves not only technical skills but also complex clinical judgment and patient safety considerations [
17,
26], whereas developmental supportive care requires an integrative approach that encompasses environmental optimization, pain control, and stress management for both infants and families [
9,
26]. Experienced nurses may perceive these skills as essential due to their direct impact on patient safety and long-term neonatal outcomes.
In this study, based on the results of IPA, we have discussed the differences in perceived educational needs for novice NICU nurses’ tasks according to NICU clinical experience.
The IPA provides further insight into experience-based differences in the perceived educational priorities of novice NICU nurses’ tasks. Among nurses with <3 years of experience, items classified in Quadrant I indicate that novice nurses perceive direct clinical performance as both important and good. Across all groups, observation of changes in vital signs, respiratory monitoring, and discharge education for parents were consistently identified as core nursing competencies. These shared priorities represent fundamental skills essential for neonatal safety and should thus be emphasized not only in NICU orientation programs but also in undergraduate nursing curricula that incorporate simulation- or case-based learning.
Overall, nurses with less clinical experience tended to perceive direct nursing performance as the most important and best-performing domain, supporting the need for practice-oriented education in the early stages of clinical development [
10,
14,
17,
20]. In contrast, as clinical experience increased, perceived priorities shifted toward system-level competencies such as participation in research, QI activities, and education.
This transition appears to align with the changes in role perception and cognitive patterns described in the “novice to expert” model by Benner [
17]. For the purposes of conceptual interpretation in this study, nurses with <3 years of experience may be seen as corresponding to the novice or advanced beginner stages, those with 3–9 years of experience to the competent stage, and those with ≥9 years of experience to the proficient or expert stages. Please note that this mapping is a conceptual framework intended to facilitate the interpretation of our findings, rather than a classification based on a direct measurement of clinical competency stages.
Analysis of Quadrant IV revealed experience-based differences in educational needs.
The <3-year group prioritized improvement in CPR, while the ≥9-year group identified management of high-risk medications as a key area for improvement. Central line management and transfusion management were emphasized by the <3-year and ≥9-year groups. These findings suggest that, as clinical experience increases, nurses place greater importance on skills aimed at reducing clinical errors and enhancing patient safety.
In particular, the tasks classified in Quadrant IV can be directly translated into targeted educational strategies. These priority tasks may be addressed through simulation-based training modules that enable repeated practice in high-risk scenarios, competency-based checklists to systematically assess and reinforce essential skills, and staged training programs that progressively increase complexity according to clinical experience. This approach allows novice nurses to focus on procedural proficiency, while more experienced nurses can advance toward error prevention, clinical judgment, and patient safety-oriented skills.
For this study, we proposed a career-based, stage-specific educational model grounded in the “novice to expert” developmental framework by Benner [
17], integrating the results of IPA analysis with differences in educational needs according to clinical experience. Thus, a stepwise educational program for novice NICU nurses that reflects the differences in educational needs according to clinical experience is required. Stage 1 should focus on high-risk procedures directly related to patient safety such as CPR, central line management, and transfusion management, reflecting the educational priorities of nurses with <3 years of experience. Stage 2 should be designed for nurses with 3–9 years of experience and should emphasize the development of integrative clinical judgment skills, including pain management, nutrition management, and comprehensive physical assessment. Stage 3, based on the perceptions of nurses with ≥9 years of experience, should expand the educational scope to family-centered and system-level nursing roles by incorporating family support and participation in QI activities.
In sum, this diagrammatic educational model, grounded in the theory by Benner [
17], clearly differentiates educational priorities across phases of clinical experience and provides a structured framework to support safe clinical adaptation for novice NICU nurses while facilitating the progressive development of professional expertise and organizational contribution among experienced nurses.
This study has several limitations. First, all findings are based on self-reported data derived from participants’ views, and convenience sampling from hospitals located in a single metropolitan area limits the generalizability of the results. In addition, the cross-sectional design precluded a thorough examination of the causal relationships between clinical environmental factors and nursing performance. Future studies should adopt longitudinal designs with multi-center samples and incorporate objective indicators linked to actual performance to more precisely investigate NICU nursing competencies and educational needs.
CONCLUSION
We analyzed the differences in the perceptions of task importance, task performance, and educational needs regarding novice NICU nursing tasks among NICU nurses with varying levels of clinical experience. Based on these perceptions, we proposed educational priorities using IPA. The findings revealed that central line management and transfusion management are priority areas (Quadrant IV, “concentrate here”). Both the analysis of educational needs and the IPA results identified the observation of changes in vital signs and respiratory monitoring (Quadrant I, “keep up the good work”) as core educational priorities across all experience groups, suggesting that these skills should be emphasized as essential components of novice nurse training curricula. In conclusion, our findings underscore the need for a stepwise educational program for novice NICU nurses that reflects the differences in educational needs according to clinical experience. Educational priorities should be structured to progress gradually, beginning with the priorities identified by nurses with <3 years of total NICU experience and advancing in depth and complexity in accordance with the priorities of nurses with 3–9 years and ≥9 years of experience, respectively. This tiered approach ensures that skills development aligns with evolving roles and cognitive patterns observed across the different stages of one’s career.
This study is meaningful as we analyzed the perceived task performance, task importance, and educational needs of novice nurses from the perspectives of experienced NICU nurses, and we applied IPA to identify career-based, stage-specific educational priorities. By proposing a diagrammatic educational model grounded in the “novice to expert” developmental framework by Benner [
17], this study provides theoretical and practical foundations for educational designs that simultaneously support safe clinical adaptation for novice nurses and the expansion of professional expertise among experienced nurses. Our findings study may serve as foundational evidence for the development of NICU nursing education curricula and programs to enhance nursing competencies.
ARTICLE INFORMATION
Figure 1.(A–C) Importance-performance analysis (IPA) matrix regarding novice neonatal intensive care unit nursing tasks as perceived by nurses. The crosshairs (intersection of the axes) in the IPA matrix are based on the overall means of importance and performance across all participants (N=116).
Table 1.General characteristics of study participants (N=116)
|
Characteristic |
N (%) |
|
Age (yr) |
|
|
<30 |
53 (45.7) |
|
30–39 |
48 (41.4) |
|
40–49 |
13 (11.2) |
|
≥50 |
2 (1.7) |
|
Sex, female |
116 (100.0) |
|
Marital status |
|
|
Single |
71 (61.2) |
|
Married |
45 (38.8) |
|
Education level |
|
|
Associate degree |
12 (10.3) |
|
Bachelor’s degree |
90 (77.6) |
|
Master’s degree or higher |
14 (12.1) |
|
Total clinical experience (yr) |
|
|
<3 |
35 (30.2) |
|
3–9 |
27 (23.3) |
|
≥9 |
54 (46.6) |
|
Experience in current department (yr) |
|
|
<3 |
44 (37.9) |
|
3–9 |
25 (21.6) |
|
≥9 |
47 (40.5) |
|
Motivation for working in the NICU |
|
|
Not by preference |
61 (52.6) |
|
By preference |
55 (47.4) |
|
Duration of NICU clinical practice (wk) |
|
|
0 |
32 (27.6) |
|
1–2 |
74 (63.8) |
|
10 |
10 (8.6) |
|
Satisfaction with undergraduate pediatric nursing practicum (by NICU practicum experience) |
|
|
Without NICU practicum experience (n=32) |
|
|
Dissatisfied |
5 (15.6) |
|
Neutral |
12 (37.5) |
|
Satisfied |
15 (46.9) |
|
With NICU practicum experience (n=84) |
|
|
Dissatisfied |
10 (11.9) |
|
Neutral |
33 (39.3) |
|
Satisfied |
41 (48.8) |
Table 2.Differences in perceived performance regarding novice NICU nursing tasks by participants’ NICU experience level
|
Item (current department experience) |
<3a
|
3–9b
|
≥9c
|
F (p) |
ANOVA |
|
(n=44) |
(n=25) |
(n=47) |
Scheffé |
|
Nursing care-related knowledge acquisition (n=9) |
4.15±0.76 |
3.90±0.64 |
3.92±0.87 |
1.19 (.30) |
|
|
1. Central line management |
4.09±0.91 |
3.52±0.96 |
3.53±0.95 |
4.92 (.01) |
a>c |
|
2. Observation of changes in vital signs |
4.52±0.76 |
4.12±0.93 |
4.38±0.80 |
1.96 (.15) |
|
|
3. Transfusion management |
4.14±0.88 |
3.64±1.15 |
3.40±1.39 |
4.56 (.01) |
a>c |
|
4. CPR |
3.57±1.34 |
3.72±1.17 |
3.53±1.35 |
0.18 (.84) |
|
|
5. Definition of high-risk neonates |
4.18±0.92 |
4.08±0.81 |
4.23±0.89 |
0.25 (.78) |
|
|
6. Importance of intake and output |
4.27±0.87 |
4.24±0.72 |
4.21±0.78 |
0.06 (.94) |
|
|
7. Respiratory system monitoring |
4.34±0.86 |
4.20±0.76 |
4.23±1.00 |
0.25 (.78) |
|
|
8. Nutrition management |
4.25±0.75 |
3.96±0.79 |
4.00±1.08 |
1.17 (.31) |
|
|
9. Developmental supportive care |
4.00±1.01 |
3.64±0.70 |
3.83±1.13 |
1.04 (.36) |
|
|
Direct nursing performance (n=10) |
4.22±0.72 |
3.90±0.60 |
4.08±0.80 |
1.53 (.22) |
|
|
10. Jaundice care |
4.52±0.70 |
4.36±0.76 |
4.49±0.75 |
0.41 (.66) |
|
|
11. Assessment of neonatal severity |
4.09±0.86 |
3.72±0.84 |
4.13±0.88 |
2.03 (.14) |
|
|
12. Pain management |
4.02±0.98 |
3.56±0.77 |
4.02±1.13 |
2.07 (.13) |
|
|
13. Infection control based on standard guidelines |
4.39±0.75 |
4.08±0.91 |
4.32±0.86 |
1.12 (.33) |
|
|
14. Discharge education for parents |
4.30±0.98 |
4.08±1.00 |
4.26±1.01 |
0.39 (.68) |
|
|
15. Management of high-risk medications |
4.09±1.03 |
3.80±1.00 |
3.74±1.13 |
1.31 (.28) |
|
|
16. Physical assessment of hospitalized neonates |
4.39±0.84 |
4.16±0.90 |
4.34±0.94 |
0.53 (.59) |
|
|
17. Collaboration with other medical staff |
4.11±0.92 |
3.80±0.87 |
3.85±1.00 |
1.23 (.30) |
|
|
18. Family support for parents |
4.30±0.85 |
3.92±0.95 |
3.85±1.18 |
2.37 (.10) |
|
|
19. Supportive nursing by developmental stage |
4.05±1.03 |
3.52±0.87 |
3.81±1.12 |
2.08 (.13) |
|
|
Improvement of nursing quality (n=3) |
3.52±1.17 |
3.14±1.04 |
3.12±1.13 |
1.61 (.20) |
|
|
20. Development of protocols related to nursing practice |
3.32±1.44 |
2.84±1.11 |
2.66±1.26 |
3.02 (.05) |
|
|
21. Improvement of nursing services through research and QI |
3.39±1.28 |
3.16±1.25 |
3.23±1.22 |
0.31 (.74) |
|
|
22. Demonstrates leadership and teamwork |
3.86±1.11 |
3.44±1.12 |
3.49±1.20 |
1.60 (.21) |
|
|
Total |
4.09±0.76 |
3.79±0.65 |
3.89±0.83 |
1.44 (.24) |
|
Table 3.Differences in perceived task importance among novice nurses by NICU experience level
|
Item (current department experience) |
<3a
|
3–9b
|
≥9c
|
F (p) |
ANOVA |
|
(n=44) |
(n=25) |
(n=47) |
Scheffé |
|
Nursing care-related knowledge acquisition (n=9) |
4.40±0.71 |
4.28±0.51 |
4.41±0.70 |
4.34 (.01) |
|
|
1. Central line management |
4.45±0.70 |
4.32±0.69 |
4.41±0.80 |
0.69 (.50) |
|
|
2. Observation of changes in vital signs |
4.64±0.69 |
4.36±1.08 |
4.72±0.62 |
1.90 (.15) |
|
|
3. Transfusion management |
4.48±0.76 |
4.20±0.91 |
4.23±1.03 |
1.09 (.34) |
|
|
4. CPR |
4.25±1.08 |
4.44±0.65 |
4.28±0.99 |
0.33 (.72) |
|
|
5. Definition of high-risk neonates |
4.30±0.93 |
4.28±0.74 |
4.47±0.78 |
0.65 (.53) |
|
|
6. Importance of intake and output |
4.36±0.84 |
4.28±0.68 |
4.55±0.65 |
1.36 (.26) |
|
|
7. Respiratory system monitoring |
4.43±0.87 |
4.56±0.65 |
4.57±0.68 |
0.46 (.63) |
|
|
8. Nutrition management |
4.41±0.69 |
4.04±0.61 |
4.36±0.87 |
2.09 (.13) |
|
|
9. Developmental supportive care |
4.27±0.85 |
4.08±0.76 |
4.23±0.87 |
0.44 (.64) |
|
|
Direct nursing performance (n=10) |
4.42±0.61 |
4.11±0.56 |
4.44±0.58 |
7.61 (<.001) |
|
|
10. Jaundice care |
4.52±0.70 |
4.24±0.66 |
4.60±0.61 |
2.47 (.09) |
|
|
11. Assessment of neonatal severity |
4.30±0.82 |
4.12±0.73 |
4.43±0.68 |
1.37 (.26) |
|
|
12. Pain management |
4.30±0.85 |
3.92±0.76 |
4.40±0.77 |
3.07 (.05) |
|
|
13. Infection control based on standard guidelines |
4.73±0.54 |
4.48±0.65 |
4.57±0.65 |
1.45 (.24) |
|
|
14. Discharge education for parents |
4.52±0.59 |
4.04±0.68 |
4.55±0.72 |
5.58 (<.001) |
b<c |
|
15. Management of high-risk medications |
4.39±0.84 |
4.24±0.78 |
4.36±0.79 |
0.28 (.76) |
|
|
16. Physical assessment of hospitalized neonates |
4.57±0.70 |
4.44±0.71 |
4.77±0.52 |
2.40 (.10) |
|
|
17. Collaboration with other medical staff |
4.30±0.79 |
3.84±0.85 |
4.15±0.91 |
2.27 (.11) |
|
|
18. Family support for parents |
4.36±0.72 |
3.92±0.81 |
4.30±0.72 |
3.10 (.05) |
|
|
19. Supportive nursing by developmental stage |
4.23±0.94 |
3.84±0.90 |
4.28±0.74 |
2.33 (.10) |
|
|
Improvement of nursing quality (n=3) |
3.97±0.89 |
3.73±0.92 |
3.87±0.91 |
4.21 (.17) |
|
|
20. Development of protocols related to nursing practice |
3.84±1.20 |
3.56±1.12 |
3.57±1.14 |
0.75 (.47) |
|
|
21. Improvement of nursing services through research and QI |
3.82±0.99 |
3.80±1.04 |
3.87±1.13 |
0.05 (.95) |
|
|
22. Demonstrates leadership and teamwork |
4.25±0.84 |
3.84±0.85 |
3.84±0.85 |
1.85 (.16) |
|
|
Total |
4.35±0.66 |
4.12±0.52 |
4.35±0.62 |
1.27 (.28) |
|
Table 4.Differences in perceived educational needs of novice nurses by NICU experience level
|
Item (current department experience ) |
<3a
|
3–9b
|
≥9c
|
F (p) |
ANOVA |
|
(n=44) |
(n=25) |
(n=47) |
Scheffé |
|
Nursing care-related knowledge acquisition (n=9) |
4.64±0.52 |
4.34±0.49 |
4.68±0.45 |
4.34 (.29) |
|
|
1. Central line management |
4.64±0.65 |
4.24±0.60 |
4.68±0.47 |
5.34 (.01) |
b<c |
|
2. Observation of changes in vital signs |
4.77±0.60 |
4.60±0.87 |
4.81±0.58 |
0.86 (.43) |
|
|
3. Transfusion management |
4.73±0.54 |
4.24±1.13 |
4.55±0.58 |
3.63 (.03) |
a>b |
|
4. CPR |
4.77±0.48 |
4.60±0.65 |
4.68±0.52 |
0.88 (.42) |
|
|
5. Definition of high-risk neonates |
4.57±0.73 |
4.16±0.80 |
4.66±0.67 |
4.10 (.02) |
|
|
6. Importance of intake and output |
4.55±0.76 |
4.40±0.71 |
4.72±0.62 |
1.90 (.15) |
|
|
7. Respiratory system monitoring |
4.66±0.61 |
4.72±0.54 |
4.89±0.37 |
2.54 (.08) |
|
|
8. Nutrition management |
4.55±0.70 |
4.12±0.73 |
4.66±0.52 |
6.00 (<.001) |
b<c |
|
9. Developmental supportive care |
4.50±0.76 |
4.00±0.96 |
4.49±0.78 |
3.63 (.03) |
|
|
Direct nursing performance (n=10) |
4.52±0.59 |
4.09±0.59 |
4.61±0.51 |
7.62 (.00) |
b<c |
|
10. Jaundice care |
4.55±0.70 |
4.24±0.72 |
4.77±0.56 |
5.37 (.01) |
b<c |
|
11. Assessment of neonatal severity |
4.45±0.79 |
4.28±0.74 |
4.70±0.62 |
3.12 (.05) |
|
|
12. Pain management |
4.41±0.79 |
4.04±0.84 |
4.66±0.64 |
5.73 (<.001) |
b<c |
|
13. Infection control based on standard guidelines |
4.82±0.54 |
4.40±0.71 |
4.79±0.55 |
4.70 (.01) |
b<c |
|
14. Discharge education for parents |
4.64±0.65 |
4.16±0.55 |
4.77±0.56 |
8.72 (<.001) |
b<c |
|
15. Management of high-risk medications |
4.61±0.72 |
4.36±0.76 |
4.64±0.74 |
1.30 (.28) |
|
|
16. Physical assessment of hospitalized neonates |
4.75±0.61 |
4.40±0.82 |
4.85±0.51 |
4.35 (.02) |
b<c |
|
17. Collaboration with other medical staff |
4.41±0.73 |
3.72±0.79 |
4.45±0.72 |
9.11 (<.001) |
b<c |
|
18. Family support for parents |
4.50±0.76 |
3.76±0.93 |
4.57±0.62 |
10.76 (<.001) |
b<c |
|
19. Supportive nursing by developmental stage |
4.16±0.99 |
3.52±1.05 |
3.94±0.96 |
3.32 (.02) |
a>b |
|
Improvement of nursing quality (n=3) |
4.08±0.88 |
3.96±1.14 |
3.98±0.81 |
4.21 (.29) |
|
|
20. Development of protocols related to nursing practice |
4.07±0.95 |
3.56±1.23 |
4.21±0.88 |
3.64 (.03) |
b<c |
|
21. Improvement of nursing services through research and QI |
4.07±0.95 |
3.56±1.23 |
4.21±0.88 |
3.64 (.03) |
b<c |
|
22. Demonstrates leadership and teamwork |
4.16±0.96 |
3.60±1.04 |
4.32±0.89 |
4.79 (.01) |
b<c |
|
Total |
4.51±0.45 |
4.35±0.82 |
4.51±0.40 |
7.29 (<.001) |
b<c |
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