• Torunn Kitty Vatnøy, Tor-Ivar Karlsen, and Bjørg Dale.
• Centre for Caring Research, Southern Norway and Department of Health and Nursing Science, University of Agder, Grimstad, Norway.
• J Clin Nurs. 2019 Sep 1; 28 (17-18): 3339-3352.

AimTo identify critical aspects of nursing competence to care for older patients in the context of municipal in-patient acute care.BackgroundAn increasingly complex and advanced primary healthcare system requires attention to the extent of nursing competence in municipal services. However, competence in complex and advanced care settings must be explored using perspectives which acknowledge the complexity of nurses' performance.DesignA phenomenological hermeneutic, qualitative approach with individual in-depth interviews was used. COREQ reporting guidelines have been applied.MethodsA sample of eight nurses and two physicians employed in municipal in-patient acute care units (MAUs) were purposively recruited to participate. Data were collected between May and June of 2017. Analysis and interpretation were conducted systematically in three steps: naïve reading, structural analysis and comprehensive understanding.FindingsTwo main themes were revealed. The first was the following: "The meaning of the individual nursing competence" including the themes "Having competence in clinical assessments, decision-making, and performing interventions"; "Having competence to collaborate, coordinate and facilitate"; and "Being committed." The second was the following: "The meaning of environmental and systemic factors for nursing competence," included the themes "Having professional leadership"; "Having a sufficiently qualified staff"; and "Working in an open, cooperative and professional work environment."ConclusionIndividual nursing competence in MAUs should include the capability to detect patient deterioration and to care for older patients in a holistic perspective. In addition, the professional environmental culture, supportive leadership and systemic factors seemed to be crucial to success.Relevance To Clinical PracticeThis study illustrates the nurses' responsibility for older patients' safety and quality of care in the MAUs. These findings can act as a foundation for the development and adaptation of educational programmes to accommodate requirements for nursing competence in MAUs. The broad perspective of nursing competence can give directions for quality improvements in MAUs.© 2019 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

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