No, Is the Subject Area "Employment" applicable to this article? Medline Google Scholar; 4. Then verbal agreement of the participants was obtained, and they were ensured in terms of confidentiality and anonymity of the data as well as voluntary participation in the study. The inclusion criteria were having Bachelor’s degrees or higher, work experience over 6 months, working in the position of a clinical nurse or a head nurse at the time of data collection and good mental and psychological conditions. In turn, each competency level is categorized into 51 discrete telebehavioral objectives, which are then distinguished by 149 cumulative and measurable telebehavioral practices. The findings of this study demonstrate that intimate care is not facilitated in NEIs and nursing students are not well prepared and supported to provide intimate care to diverse patients competently, confidently and comfortably. There is a need for professionals to demonstrate that they are clinically competent to perform certain roles . Conclusion. The level of significance was considered by 5% and SPSS software (version 18) was employed for data analysis. CNA, C.N.A. The results also showed no statistically significant correlation between the professional competency of the nurses and their organizational commitment. Yes Clinical competency focuses on the behavior needed for capable performance as a nurse and requires bridging the gap between theory and practice. Moreover, there was a significant and direct, but poor, relationship between the normative commitment and the dimensions of clinical care. Yes Aluminum phosphide (AlP) is an efficient and toxic pesticide that is easily available in many Asian countries such as Iran. Resources, The aim of this study is to analyze - through the Nurse Competence Scale - the level of competence of nurses working in oncological settings. Dari penelitian ini didapatkan jumlah perawat yang tidak melakukan implementasi kompetensi sesuai clinical appointment ada 50 perawat yang belum sesuai dan hasil post test didapatkan adanya perbedaan yang signifikan dengan pre test. Supervision, Concrete outcomes for these experiences have not been clearly supported in previous research. 2007;Morris, & Lazenby, 2011;Rodolfa et al. Based this study, there were 50 nurses who did not implement competencies according to clinical appointments, and there were 50 nurses who did not fit in and the results of the post test found significant differences from pre-test. This study had two limitations. https://doi.org/10.1371/journal.pone.0187863.t004. https://doi.org/10.1371/journal.pone.0187863.s001. Moreover, the results of the present study demonstrated that the highest mean score of the professional competency was related to “the legal/ethical practice” dimension and the lowest score was associated with “research aptitude and critical thinking”. and accountability and self-assessment of learners. About 94% of the respondents were employed in the position of a regular nurse and their age (53.9%) was between 30 and 40 years old. In another study, the organizational commitment has decreased levels of work-related stress . Nursing curricula and instruction, Moving from novice to expert - The value of learning in clinical practice: A literature review, Developing professional habitus: A Bernsteinian analysis of the modern nurse apprenticeship. It will empower students to implement intimate care competently, comfortably and confidently, enabling them to establish nurse-patient intimate care relationships based on trust, respect and dignity. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0187863, http://hsr.mui.ac.ir/index.php/jhsr/article/view/982. Yes The results showed that the majority of the respondents were female (65.7%) and married (79.1%). The structure and process of the model were visually portrayed and described. Method: A descriptive study was performed between March and September 2017. The Content Validity Index (CVI) of the Persian version of CIRN was 94% for the entire instrument and more than 83% for all the items. a considerable influence on the values that inform their future professional practise. Iglehart J.K. "Expanding the role of advanced nurse practitioners—risks and rewards" . Drastic changes in science and technology, cost containment and insufficient time to establish relationships with patients can lead to increase in the levels of concerns in nurses about patient safety and security, quality of care, nurse safety and security, as well as nurse competency [2,3]. Formal analysis, The minimum score in this questionnaire was 24 and the maximum score was 120. In another qualitative study, nurses believed that managers acted very weakly in the empowerment of human resource. Nursing competency has been extensively addressed in the literature in terms of safety and quality of nursing care . PLOS ONE promises fair, rigorous peer review, The highest and the lowest mean scores of the organizational commitment were related to “affective commitment and continuous commitment”, respectively (Table 3). A comprehensive literature review was conducted using the CINAHL and MEDLINE databases and the keywords competenc*, portfolios and nursing. There was likewise no significant correlation between other dimensions of the professional competency and the organizational commitment (Table 4). Writing – review & editing, * E-mail: firstname.lastname@example.org (JF); email@example.com (GF), Affiliations However, the distribution of nurses and the organization of healthcare institutions are similar in the whole country because of the centralized healthcare policy-making system in Iran . In terms of the level of education, 93.5% had Bachelor’s degrees; they also had 6 to 15 years of work experience (46.1%). This is a descriptive and crossâsectional study. Nurses' poor competency may lead to some undesirable consequences including nurses' frustration, job dissatisfaction, and their attrition . Nationally validated, these competencies are for entry to practice for all NPs. Furthermore, professional competency is considered as correct judgment and habits in terms of the use of knowledge, technical skills, clinical reasoning, communication, feelings, values and rethinking daily activities aimed at providing services to individuals and the society . The participants were recruited among the nursing staff working in the Day Hospital and the Units of the IRCCS -Regina Elena National Cancer Institute in Rome. Since 1990, the National Organization of Nurse Practitioner Faculties (NONPF) has identified core competencies for all nurse practitioners (NPs). Investigation, The employment of adequately educated staff, able to base clinical decisions on the best scientific evidence, is one of the components required for delivering high quality nursing care in the oncological field. In this respect, the mean scores below 2, 2–3 and above 3 were considered as low competent, moderate and highly competent, respectively. It is suggested that nursing managers should distinguish the importance of the organizational commitment and the professional competency for the high-quality and safety in healthcare. In this respect, lack of attention to professional competency in nurses can cause problems for organizations and question their activities. Han& Chung  have highlighted that nurses’ organizational commitment is an essential precondition not only for the reduction of negative consequences such as conflicts, exhaustion and turnover, but also for the maintenance of patients’ health through a deeper commitment to patients. Aim Another study reported that the nurses were deprived of appropriate professional competency to provide spiritual care . 15-17 Therefore, defining core competencies is a priority in health care education. Organizational commitment as a kind of affective attachment or sense of loyalty to the organization is an effective factor for professional competency. Curriculum redesign occurred because of societal demands for increased accountability of graduates to be able to perform work-related competencies in complex, rapidly changing environments. The results are similar to the previous studies in Iran and other countries that showed a difference between the levels of competency based on work experience [21,26,39]. This annual award was established in 2019 in recognition of … Assessment of graduates and diplomates in practice in the UK - Are we measuring the same level of competence? Software, School resources including technology, simulation laboratories and clinical sites are also evaluated. Results showed that professional competency (Mean±SD: 2.82±0.53, range: 1.56–4.00) and organizational commitment (Mean±SD: 72.80±4.95, range: 58–81) of the nurses were at moderate levels. The Journal for Nurse Practitioners is proud to announce the Marilyn Edmunds JNP Writing Award, which honors excellence in writing and encourages writing for publication.. Congratulations to Cinthya Sotelo, DNP, FNP-C, for her article “Ovarian Ectopic Pregnancy: A Clinical Analysis” in the March 2019 issue. Conceptualization, The first part was a demographic questionnaire including items about age, gender, marital status, work shifts, level of education, type of employment, position and work experience. The results of the evaluation of professional competency demonstrated that 58.3% of the nurses had moderate professional competency and 34.3% achieved high competence professionally. The paper describes a temporal model of the student placement experience in which their focus of attention and effort varies over time. accepts practice hours, continuing nursing education, preceptorship for certiï¬cation renewal (Y. activities continues to be developed (Hobbs, 2005). The article presents a crosswalk of the core competencies of the VA Centers of Excellence in Primary Care Education nurse practitioner residency programs with the Quality and Safety Education for Nurses competencies for graduate education to identify areas to enhance leadership in quality and safety in the curriculum. 2006;Swank et al. Conclusions: In order to determine the reliability of the questionnaire, Cronbach’s alpha coefficient was used in which Cronbach’s alpha of the entire instrument was 0.90, and it was reported in the range of 71–90% for its dimensions . Each set of specialty competencies builds upon this set of core competencies. Conclusions. For decades, healthcare professionals have pondered the best way to develop core competencies for nurse educators to establish consistent educational standards. 1, No. Moreover, the paper considers how the increasing abrogation of 'caring' activities to non-registered staff threatens the very notion of professional habitus in nursing and posits some possible explanations for this. educators and as clinical practitioners. Descriptive statistics (percentage, mean and standard deviation) as well as analytical statistics (Mann-Whitney test, Kruskal-Wallis test and Spearman correlation coefficient) were used. Intravaginal administration of AlP can lead to fetal death and abortion. The exploratory factor analysis supported a threeâfactor solution that accounts for 50.62% of the scale's variance. This descriptive-analytic study was conducted at the hospitals affiliated with a University of Medical Sciences, in the southeast of Iran in 2016. It includes competencies such as facilitating interprofessional collaboration and integrating knowledge to make change and many others. Abstract The competency framework is directly applicable to psychiatry/medicine, psychology, social work, counseling, marriage/family, behavior analysis and other behavioral sciences. The differences between scores can be due to different evaluation methods, various points of views and expectations of the individuals of their own roles . Previous studies in the U.S. , South Korea , Canada  and in Iran [43,44] were also in agreement with the present study in terms of their reports on the moderate levels of the organizational commitment of nurses. By describing and interpreting these themes, the authors show how nursing curricula and instruction should be transformed regardless of clinical setting. The CIRN was scored using the five-point likert scale ranging from 0 to 4, with incompetency (score zero), low competency (score 1), moderate competency (score 2), high or sufficient competency (score 3) and very high competency (score 4). The CTiBS TBH framework organizes seven topic domains and five subdomains according to competency level i.e., Novice, Proficient or Authority. In addition, we suggest to conduct comprehensive qualitative and quantitative studies for exploring the status and gaps of human resource management in healthcare, and also to evaluate the effect of different approaches to enhance the professional competency and the organizational commitment of healthcare providers in different cultures and contexts. With this regard, a few studies have been conducted in Iran; for example, Niazazari et al.,  argued that professional ethics was positively correlated with the organizational commitment. First, the use of questionnaire to assess the professional competency and the organizational commitment may have resulted in exaggerative scores and could be a subject to personal bias. The nursing profession is essentially about care and affection is crucial. Researchers also reported relationships between organizational and personal factors and job satisfaction. In the present study, the lowest mean score for the dimensions of professional competency was related to “research aptitude and critical thinking”. Peer Reviewed Articles Kirkhof College of Nursing 6-25-2010 A Qualitative Study of Role Transition from RN to APN ... core competencies and complexity of the advanced practice nurse role, and that beginning role ... (adult or family nurse practitioner), and … Conceptualization, It outlines the theoretical basis for the development of this trait, regarded as one of the defining characteristics of professional practice, and discusses how its development has shaped the modern nurse apprenticeship with its current emphasis on. Background Professional competency is a fundamental concept in nursing, which has a direct relationship with quality improvement of patient care and public health. Supervisi klinis efektif untuk mengontrol implementasi kompetensi perawat sesuai clinical appointment. Responses to this questionnaire were based on a 5-point Likert scale, with strongly agree (score 5), agree (score 4), neutral (score 3), disagree (score 2) and strongly disagree (score 1). 2009, Melnyk et al. https://doi.org/10.1371/journal.pone.0187863.t002. Initial consideration of the topic revealed the need to clarify the terminology and approaches used to assess competence using portfolios, and therefore the literature review was conducted to inform the study. In another study, Intensive Care Unit (ICU) nurses rated the domain of “ethical activity and familiarity with healthcare laws” as low. In Iran, these results were consistent with the findings of a study , and also disagreed with another study . Tracy (2009) explained direct clinical care is the central competency of advanced practice nursing because it informs and shapes the execution of the other six core competencies that will be discussed later (p. 123). Competency profiles therefore are context-specific and differ between different practice settings. Numerous practical suggestions for achieving an 'enriched' environment of learning that enables students to appreciate the value of care as well as cure are identified. Additionally, modern views to the principles of professionalism emphasize that quality improvement in the health care system is the ethical and professional responsibility of all the medical professions, particularly nurses. The Ethics Committee affiliated with Kerman University of Medical Sciences approved the conductance of this study as well as the consent procedure (Medical Ethic No: ir.kmu.rec.05.1395). Upon ingestion, gastric acid converts phosphides to phosphine gas. The task force behind the 2012 update included various nurse practitioner organization and certification boards, and they created sub-groups of experts for each population focus. In spite of our prejudices in one direction or another, del Bueno's study shows more within-group differences than between-group differences. Methodology, Background. Results How should a profes-, ... Ingesting 500 mg or more AlP could result in death. Moreover, it should be noted that professional competency is a multi-faceted phenomenon, which can be related to nursing education system, views and attitudes of the system to nurses and nursing and socio-economic as well as cultural factors. A number of reasons for and advantages and disadvantages of their use were found, as well as varying ideas about what a portfolios should consist of and how it should be assessed. Objective: The Persian version of the questionnaire was also translated and validated in 2014 by Ghasemi et al., . The transition from discrete specific learning objectives to broader higher-level competency performances was a conceptual change that needed a road map. This study suggests that human resource managers should pursue appropriate strategies to enhance the professional competency and organizational commitment of their nursing staff. e0187863. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/V… Penelitian ini menggunakan desain quasy eksperimen dengan one group pre post test design dengan sampel sejumlah 57 Perawat Klinis II sebagai responden penelitian. V, graduate level and beyond must be offered with increas-, These terms are frequently used interchangeably, Beginning in the early 1980s, many boards of nursing. Moreover, the lowest mean score in this study was related to “continuance commitment”. Therefore, the increasing scores of the professional competency did not have any effect on the increased scores of organizational commitment. Supervision, With regard to portfolios, a number of definitions were again found, but there was a consensus that the theoretical basis of their use is theories of adult learning. The researchers appreciate all of the members of the nursing staff of the teaching hospitals affiliated with RUMS who gave their time so graciously in order to participate in the study. Furthermore, the findings of this study indicated that the level of organizational commitment was at the moderate level. These urology-specific competencies supplement and complement the core competencies and population-focused competencies of generalist nurse practitioners. The consortium's goal is to establish a consistent, effective response to campus sexual assault for participating universities and universities connected with partner organizations. This agrees with a generally accepted view that the affective commitment has the strongest and most consistent relationship with desirable outcomes. Han & Chung  reported that insufficient professional knowledge and skills were affected by marital status. The developed model will assist nurse educators in facilitating the teaching of intimate care in NEIs and in providing continuous support to nursing students. The aim of this study is to assess the validity and reliability of the Compassion Competence Scale Arabic version for Saudi nursing students and interns. It is necessary to develop and implement continuing education programs for school nurses based on the training needs and competency indicators identified in this study. The paper concludes by arguing that a better understanding of professional habitus is required by all within the profession, and suggests that this concept provides the means by which two seemingly disparate concepts, 'professionalism' and 'vocationalism' can be brought together to the benefit of the nursing profession. Competent performance by health care professionals is expected throughout society. In addition, it was concluded that the professional ethics as a dimension of professional competency had the power to predict the organizational commitment of employees. The study was conducted at two nursing education institutions (NEIs) in Gauteng Province. Emergency Nurses Association supports the NONPF core competencies. The Cronbach's alpha of the scale was 0.806, whereas the Cronbach's alpha of the subscales ranged from 0.739 to 0.797. A modified Delphi method was used to engage NPs in achieving consensus for advance care planning competencies. Background: The present study defined school nurse competencies as the knowledge, skills, and attitudes required of school nurses to provide safe school healthcare. This study used the current NP Core Competencies (NONPF, 2017), the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Common Advanced Practice Registered Nurse Doctoral-Level Competencies … Finally, 10 questionnaires were excluded from the study due to their incompleteness (the response rate was 95.83%). Content validity and construct validity through exploratory factor analysis were established. Creation of an excellent organizational climate as a fundamental orientation towards the organization’s missions and strategic goals increases employees’ satisfaction and brings about better conditions for the nurses’ interactions and reduces intention to leave among them . The Core Competency documents provided by the NONPF are presented in the same manner as the CNA NP Framework and likewise, do not provide a guiding or organizing framework or philosophy for NP education.A full curriculum overhaul based on the NONPF competency requirements was performed at a university center in Oregon. A clear outline of core competencies is critical in any health care education setting, as it informs the blueprinting of a curriculum, including learning outcomes, assessment strategies, and graduate attributes. Therefore, the levels of attachment and commitment of nurses towards their affiliated organizations can have impacts on the promotion of their clinical competency . Having competency leads to an improved quality of patient care and an increased patient satisfaction with the nurses and helps promote nursing as a profession and improve nursing education and clinical nursing . Access scientific knowledge from anywhere. Table 2 shows that the mean score of professional competency of the nurses was at the moderate level (2.82±0.64, range: 1.56–4.00). panding assessment, critical thinking, communication, Explicit and clearly aligned with expected competencies, Individualized and providing more opportunities for, Deï¬ning attributes of competency in nursing and nursing. "Nurses as substitutes for doctors in primary care" . Furthermore, the reliability of the questionnaire was calculated through internal consistency method, in which Cronbach’s alpha coefficient for the whole instrument was 0.97 and it was reported between 68–87% for all the dimensions of this inventory . The Canadian Nurse Practitioner Core Competencies Framework identifies leadership as … Methodology, Resources, As more nurse educator programswere developed, the need for consistency in curriculum and standards grew. Salonen et al.,  reported that overall competency and the level of competency in different categories varied between different types of units. In this study, the professional competency in the nurses over15-year work experience was greater than that of other groups. Besides, the affective commitment had statistically poor and direct correlation with the clinical care (ρ = 0.18, P = 0.007). Researcher concluded that the organizational culture, value and the respect of staff members were the most effective on promoting higher levels of the organizational commitment. Yes This descriptive-analytic study was conducted at two teaching and referral hospitals affiliated with Rafsanjan University of Medical Sciences (RUMS) in the southeast of Iran from March to June 2016. This result is in agreement with studies by Liu et al.,  and Karimi-Moonaghi et al., . oner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. Articles published in the period 1989â2001 in English were obtained and their reference lists scrutinized to identify additional references. â¢ It questions whether there is a difference in their level of competence at point of registration and whether it is possible to measure it. Five 'foci' are identified-self as focus, course as focus, professional care as focus, patient as focus, person as focus. Therefore, continuous education was recommended to strengthen such competencies of the nurses. In fact, organizational commitment is a type of psychological attachment to an organization in which a person is involved so that committed employees sometimes obtain their own identity from the organization and benefit from their memberships . Comparison of professional nursing values development between the experimental and control group was completed using the Nurses Professional Values Scale. Ahmad & Oranye  explained that affective commitment appeared to have a more significant influence on job satisfaction among nurses compared with the other two components of the organizational commitment. (Jones, 2006) Kompetensi perawat dalam perawatan pasien secara utuh dan holistik didefinisikan sebagai konsep praktik perawatan yang meliputi pengetahuan, ketrampilan, performance, attitude dan nilai yang diklaim dapat sesuai dengan konsep holistik dan dapat diterima oleh mayarakat dan dapat dikembangkan menjadi sebuah standar kompetensi ("Nursing and competencies -a natural fit: the politics of skill /competency...: EBSCOhost," n.d.; ... "Competence" is an abstract phenomenon that is rather complex to define, evaluate and measure (1). National Organization of Nurse Practitioner Faculties 1615 M Street, NW, Ste. Additionally, this article includes recommendations for pedagogical competencies indicative of aca-demic nurse educator preparation. However, defining what it is and teaching students how to perform competently faces many challenges. 2. In this respect, the duties associated with research activities related to professions including attendance in organizational meetings, participation in research studies and application of their results in practice can strengthen the professional competency at the work place. There were no significant differences in professional competency based on other demographic characteristics (P˃0.05) (Table 1). No significant correlation between the organizational commitment and the professional competency can be investigated from various aspects. The Arabic version has an excellent content validity. Probably, it can be said that professional promotion and nursing competency are affected by the individuals’ personal and socio-economic as well as cultural factors. Nurse practitioner core competencies were created by experts in clinical practice and education. In 1990, for example, the National Organization of Nurse Practitioner Faculties (NONPF) established entry-level core competencies for all NPs, regardless of their specialty area. This article describes the development of nurse practitioner (NP) competencies for advance care planning.Nurse practitioners are well positioned to implement advance care planning with their patients; however, very few patients have an advance care plan. Two studies reported that newly graduated nurses were weak in terms of their clinical competency [29,30]. here. Laurant M., van der Biezen M., Wijers N., et al. Sikorska-Simmons  found that an empowering work environment and organizational culture, job satisfaction, and levels of education were the strongest predictors of the commitment. The second part included competency inventory for registered nurse (CIRN) that was introduced by Liu et al., (2009). No, Is the Subject Area "Nursing science" applicable to this article? The redesigned nursing curriculum at the University of Colorado is presented as an exemplar of a practiceoriented model that requires competent performance among students. Competing interests: The authors have declared that no competing interests exist. This article provides a brief overview of the contemporary focus on competency assessment in nursing education. In line with this study, Squires et al.,  argued that nursing care was still tailored to tradition and the nurses were not willing to undertake research in their area of expertise and failed to use the research findings. â¢ In particular it examines the expectations of the profession of newly registered practitioners at both diploma and degree levels of practice. The analysis of the descriptive survey, sent to approximately 770 preceptors, along with the interpretive analysis of 16 focus groups and 5 interviews, revealed understandings of discovering, learning, and engaging, The aim of this study was to evaluate an innovative approach to teaching and learning community-based nursing. The study showed the use of international service learning as part of clinical was at least equivalent in the development of professional nursing values as traditional clinical. Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran, Department of Angiography, Ali-ibn Abi Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran, Roles Members who are highly committed to their organization tend to earn external as well as internal remuneration (e.g., job satisfaction), to maintain friendly relationships with coworkers, and to perform tasks in favor of the organization. Legal and ethical issues play substantial roles in these new approaches. In addition, it supported the development of professional nursing values through clinical learning overall. The study by Conner  can be also assumed as the one inconsistent with the results of the present study. Clinical supervision is effective for controlling the implementation of nurse competencies according to clinical appointments. Writing – original draft, These reviews confirmed that BH professions lag other healthcare professions in identifying and applying the concept of competencies in their training and practice. This study was conducted to evaluate the nurses´ professional competency and their organizational commitment as well as the relationship between these two concepts. Family nurse practitioners (FNP) earn high salaries working in a variety of settings. Join ResearchGate to find the people and research you need to help your work. In contrast to the results of the present study, the findings of two studies [21,39] showed that the clinical competency was not significantly associated with marital status. 270 Washington, DC 20036 (202) 289-8044 firstname.lastname@example.org Nurse practitioners (NPs) are licensed, independent practitioners who provide primary and/or specialty nursing and medical care in ambulatory, acute and long-term care settings. Six school nurses verify the content validity for the competency framework for continuing education using the content validity index. In this study, the highest mean score belonged to “affective commitment”. Donna Scott Tilley (Research & Sponsored Programs), Abigail Tilton (College of Arts & Sciences), Mark Sandel (Social Work) and Noah Lelek (Drama) have been awarded a three-year grant totaling $750, The recent literature suggests that caring has become increasingly devalued as health systems focus primarily on cure. As compared with a nurse practitioner who takes care of patients (easy to understand), a primary focus of a CNS is to take care of the nurses so they can take care of patients safely and efficiently using the best evidence available. Clearly deï¬ned competen-, ing attributes are met, or a case that is ânot the conceptâ, Characteristics of education focused on competency, An intentional shift from traditional patterns of informa-, tion giving to actively engaging students in real time. Weng et al.,  highlighted that when the organization provides a good career growth platform for their employees by helping them meet career goals and enhance their professional abilities, and rewards them in return via promotions and remuneration, those employees are more apt to reciprocate and develop a sense of moral obligation toward the organization. affective commitment, normative commitment and continuance commitment. â¢ A partnership approach between student, practitioner/assessor and academic could usefully share responsibilities of the assessment of competence and ultimately empower the individual for their life-long learning. Yes Few studies focused on which competencies are relevant to a specific level of palliative care. 2015;Kaslow et al. One of the reasons for the high levels of the professional competency in the legal/ethical practice dimension could be explained by the nature of nursing work that nursing is a profession with inherently legal/ethical practice and these are among the professional values which are frequently highlighted in nursing educational courses and at the work place. The results of this study showed that these nurses had no high professional competency and the organizational commitment.
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