Development of a Competency Scale for Nurses of a Japanese Community Hospital: The Unnan Ladder
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Updated: Dec 5, 2025

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Published on: June 12, 2009
Satoko Maejima1, Ryuichi Ohta2
1Unnan City Hospital, Japan.
Background And Purpose:
The Japanese Nurse Association (JNA) has established the JNA ladder to assess competency in various clinical nursing settings in Japan. This study developed and tested a specific Japanese community hospital's Nurse Competency Scale (the Unnan ladder).
Methods:
Using the Delphi method, the contents of the Unnan ladder were identified and validated in a four-step approach. A 28-nurse panel approved 66 items; 112 community nurses assessed the content, construct concurrent validity, and internal consistency of the Unnan ladder competency scale.
Results:
The Unnan ladder data were normally distributed. Higher scores on it correlated with higher scores on the Nurse Competency Scale. The Unnan ladder categories showed good internal consistency.
Conclusions:
This ladder's application may lead to improved nursing skills and better patient care.
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