The Determinants of Clinical Competency; A Systematic Review

Abstract

Clinical competency is a fundamental requirement in nursing and healthcare education, ensuring that practitioners possess the necessary knowledge, technical skills, decision-making abilities, and professional behaviors to deliver safe and effective patient care. With recent transformations in healthcare delivery such as the expansion of technology, the adoption of simulation-based learning, the evolution of clinical environments, and rising workforce demands the need to understand the factors influencing competency development has become increasingly urgent across diverse settings. This systematic review synthesizes recent evidence on the determinants of clinical competency among nurses, nursing students, and other healthcare trainees, focusing on behavioral, organizational, educational, and contextual influences. A systematic search of major academic databases was conducted in accordance with PRISMA 2020 guidelines, targeting studies published between 2020 and 2025. Eligible studies were screened based on relevance, methodological rigor, and alignment with the review’s objectives. Data extraction emphasized study characteristics, determinants of clinical competency, and associated outcomes, with a literature review matrix developed to identify common patterns. Findings indicate that clinical competency is shaped by multiple interrelated factors. Behavioral determinants such as self-efficacy, confidence, digital readiness, psychological empowerment, and motivation were found to play a significant role. Organizational and environmental elements including leadership style, clinical learning conditions, staffing levels, work environments, and opportunities for professional development also had a strong impact on competency. Furthermore, educational strategies such as simulation, e-learning, competency-based curricula, and structured mentoring consistently contributed to the development of clinical skills. Higher competency levels were associated with better job performance, reduced burnout, enhanced clinical judgment, improved patient safety, and greater professional satisfaction. Overall, clinical competency emerges as a dynamic and multifaceted construct, evolving through the interaction of personal attributes, organizational support, and innovative educational practices. Strengthening competency in healthcare professionals requires integrated approaches that promote lifelong learning, supportive leadership, effective training, and healthy work environments. These findings provide a comprehensive foundation for guiding policies and practices aimed at fostering a competent, confident, and resilient healthcare workforce.