Nurse Competence Scale (NCS)

The Nurse Competence Scale (NCS) was developed to assess nurses’ generic competence in different phases of their careers and in a variety of clinical settings. It was developed to overcome competence instruments’ shortcomings in early 2000s, i.e. their lack of a strong theoretical background and rigorous psychometric testing.

The 73-item NCS is a structured questionnaire and comprises seven competence categories. The level of competence is measured with a visual analogue scale (VAS 0-100) and the frequency of the use of competencies with a four-point scale.

The NCS is currently widely used internationally. The scale has been translated into 20 languages and have been used over 30 countries. It has been used for competence level assessments, investigating associated individual and organisational variables and studying the effects of educational interventions. Development and testing was conducted as part of the doctoral thesis of docent Riitta Meretoja. Further research has been done in a long-lasting cooperation with Professor Helena Leino-Kilpi.

See the summary of the development and psychometrics of NCS:

Flinkman M, Leino-Kilpi H, Numminen O, Jeon Y, Kuokkanen L, Meretoja R. 2017. Nurse Competence Scale: a systematic and psychometric review. Journal of Advanced Nursing 73(5), 1035-1050.

Nurse Competence Scale is currently in use in PROCOMPnurse and COMPEUnurse Research Projects.

From education to work-life project

In this part,  nurse competence, its development and the organizational and individual workhealth factors connected were studied. Target group was especially nurses in the beginning of their career.

Study was done in three phases.
Nurses’ competence in worklife was analyzed in the first phase 2010-2012.
Nurses’ competence development during education was analyzed in the second phase 2010-2012.
In the third phase, the competence of nurses in the beginning of their career and the factors contributing to the workhealth in a long-term study were studied.

This part was funded by The Finnish Work Environment Fund.

Currently, the postdoctural study of PhD Mervi Flinkman is continuing in this field.

Selected publications

Kajander-Unkuri S. Nurse Competence of Graduating Nursing Students. Doctoral Thesis. University of Turku 2014, D1158

Meretoja R, Isoaho H & Leino-Kilpi H. 2004. Nurse Competence Scale: development and psychometric testing.  Journal of Advanced Nursing 47(2), 124-133.

Meretoja R, Leino-Kilpi H & Kaira A-M. 2004. Comparison of nurse competence in different hospital work  enviroments. Journal of Nursing Management 12, 329-336.

Meretoja, Riitta. 2003. Nurse competence scale. Annales Universitatis Turkuensis, D579, University of Turku,  Turku, Finland

Meretoja R & Leino-Kilpi H. 2003. Comparison of competence assessments made by nurse managers and  practising nurses. Journal of Nursing Management 11, 404-409.

Meretoja R, Eriksson E & Leino-Kilpi H. 2002. Indicators for competence nursing practice. Journal of Nursing  Management 10 (2), 95-102.

Meretoja R & Leino-Kilpi H. 2001.  Instruments for Evaluating the Nurse Competence. JONA 31 (7/8), 346?352.

Other publications for Nurse Competence Scale (NCS)

Kajander-Unkuri S, Meretoja R, Katajisto J, Leino-Kilpi H. & Suikkala A. (2020) Students’ Self-assessed Competence Levels during Nursing Education Continuum – A Cross-sectional Survey. International Journal of Nursing Education Scholarship 17(1).
Luostarinen P, Meretoja R. & Niemi A. (2019) Sairaanhoitajien ammattipätevyys polikliinisessä hoitotyössä ja tulevaisuuden pätevyyshaasteet. Tutkiva hoitotyö 17(2), 30-39.
Meretoja R, Lindfors K. & Kotila J. (2019) Professional Practice Competence Framework for the Nurse Leader. In: Hafsteinsdóttir T., Jónsdóttir H., Kirkevold M., Leino-Kilpi H., Lomborg K., Rahm Hallberg I. (eds) Leadership in Nursing: Experiences from the European Nordic Countries. Springer, Cham.
Strandell-Laine C, Saarikoski M, Löyttyniemi E, Meretoja R, Salminen L. & Leino-Kilpi H. (2018) Effectiveness of mobile cooperation intervention on students’ clinical learning outcomes: A randomized controlled trial. Journal of Advanced Nursing 74(6), 1319–1331.
Numminen O, Leino-Kilpi H, Isoaho H. & Meretoja R. (2017) Development of Nurses’ Professional Competence Early in Their Career: A Longitudinal Study. Journal of Continuing Education in Nursing 48(1), 29–39.
Kajander-Unkuri S, Leino-Kilpi H, Katajisto J, Meretoja R, Räisänen A, Saarikoski M, Salminen L. & Suhonen R. (2016) Congruence between graduating nursing students’ self-assessments and mentors’ assessments of students’ nurse competence. Collegian 23(3), 303–312.
Kuokkanen L, Leino-Kilpi H, Numminen O, Isoaho H, Flinkman M. & Meretoja R. (2016) Newly graduated nurses’ empowerment regarding professional competence and other work-related factors. BMC Nursing 15, 22.
Numminen O, Leino-Kilpi H, Isoaho H. & Meretoja R. (2016) Newly graduated nurses’ occupational commitment and its associations with professional competence and work-related factors. Journal of Clinical Nursing 25(1–2), 117–126.
Numminen O, Ruoppa E, Leino ‐ Kilpi H, Isoaho H, Hupli M. & Meretoja R. (2016) Practice environment and its association with professional competence and work-related factors: perception of newly graduated nurses. Journal of Nursing Management 24(1), E1–E11.
Meretoja R, Numminen O, Isoaho H. & Leino-Kilpi H. (2015) Nurse competence between three generational nurse cohorts: A cross-sectional study. International Journal of Nursing Practice 21(4), 350–358.
Numminen O, Leino-Kilpi H, Isoaho H. & Meretoja R. (2015) Ethical climate and nurse competence – newly graduated nurses’ perceptions. Nursing Ethics 22(8), 845–859.
Numminen O, Leino-Kilpi H, Isoaho H. & Meretoja R. (2015) Congruence between nurse managers’ and nurses’ competence assessments: A correlation study. Journal of Nursing Education and Practice 5(1), 142-150.
Numminen O, Leino-Kilpi H, Isoaho H. & Meretoja R. (2015) Newly Graduated Nurses’ Competence and Individual and Organizational Factors: A Multivariate Analysis. Journal of Nursing Scholarship 47(5), 446–457.
Kajander-Unkuri S, Meretoja R, Katajisto J, Saarikoski M, Salminen L, Suhonen R. & Leino-Kilpi H. (2014) Self-assessed level of competence of graduating nursing students and factors related to it. Nurse Education Today 34(5), 795–801.
Koskinen L, Likitalo H, Aho J, Vuorio O. & Meretoja R. (2014) The professional competence profile of Finnish nurses practising in a forensic setting. Journal of Psychiatric & Mental Health Nursing 21(4), 320–326.
Numminen O, Laine T, Isoaho H, Hupli M, Leino-Kilpi H. & Meretoja R. (2014) Do educational outcomes correspond with the requirements of nursing practice: educators’ and managers’ assessments of novice nurses’ professional competence. Scandinavian Journal of Caring Sciences 28(4), 812–821.
Numminen O, Meretoja R, Isoaho H. & Leino-Kilpi H. (2013) Professional competence of practising nurses. Journal of Clinical Nursing 22(9–10), 1411–1423.
Hamström N, Kankkunen P, Suominen T. & Meretoja R. (2012) Short hospital stays and new demands for nurse competencies. International Journal of Nursing Practice 18(5), 501–508.
Meretoja R. & Koponen L. (2012) A systematic model to compare nurses’ optimal and actual competencies in the clinical setting. Journal of Advanced Nursing 68(2), 414–422.
Silvennoinen A-S, Salanterä S, Meretoja R & Junttila K. (2012) Sairaanhoitajan ammatillinen pätevyys perioperatiivisessa toimintaympäristössä. Tutkiva hoitotyö 10(3), 22-31.
Istomina N, Suominen T, Razbadauskas A, Martinkėnas A, Meretoja R. & Leino-Kilpi H. (2011) Competence of nurses and factors associated with it. Medicina 47(4), 230–237.
Dellai M, Mortari L. & Meretoja R. (2009) Self-assessment of nursing competencies–validation of the Finnish NCS instrument with Italian nurses. Scandinavian Journal of Caring Sciences 23(4), 783–791.
Heikkilä A, Ahola N, Kankkunen P, Meretoja R, & Suominen T (2007) Nurses’ competence level in medical, operative and psychiatric specialized health care. Hoitotiede 19(1), 3–12.
Mäkipeura J, Meretoja R, Virta-Helenius M, & Hupli M (2007) Nurse working in neurological settings. The competence, frequency of using competencies and challengies [sic] of continuing professional development. Hoitotiede 19(3), 152–162.
Salonen AH, Kaunonen M, Meretoja R. & Tarkka M-T. (2007) Competence profiles of recently registered nurses working in intensive and emergency settings. Journal of Nursing Management 15(8), 792–800.
Vuorinen R, Heino E. & Meretoja R. (2009) Endoscopy nurse as a patient care coordinator: the expanded role of the competent nurse in the gastroenterology setting. Gastroenterology Nursing : The Official Journal of the Society of Gastroenterology Nurses and Associates 32(6), 410–413.

See selection of international studies using Nurse Competence Scale here.

Studies that are part of PROCOMPnurse-research, please see here.

Developer of the Nurse Competence Scale

Riitta Meretoja PhD, RN, Professor (h.c.)

​Research team

Olivia Numminen, RN, PhD, Researcher,
Helena Leino-Kilpi, RN, PhD, Professor (emerita), Department of Nursing Science, University of Turku
Liisa Kuokkanen, RN, PhD,
Satu Kajander-Unkuri, RN, PhD, Teacher of Medicine, Savonia University of Applied Sciences, Department of Nursing Science, University of Turku
Mervi Flinkman, RN, PhD, Postdoc Researcher, Department of Nursing Science, University of Turku
Jeon Yunsuk, RN, PhD, Clinical researcher, Hospital District of Helsinki and Uusimaa; Department of Nursing Science, University of Turku