From Task Executor to Decision-Maker: Competency Transfer in Oncology Cardiopulmonary Rehabilitation Nurses-A...

Outcome-based education (OBE) is increasingly used to develop advanced nursing competencies, yet how these competencies transfer into complex clinical practice-particularly in oncology cardiopulmonary rehabilitation (CP-Rehab)-remains poorly understood. This study explored nurses' lived experiences of competency transfer and professional role transition within an OBE-structured oncology CP-Rehab training program.

This COREQ-guided descriptive phenomenological study purposively sampled 14 registered-nurse trainees who completed the inaugural OBE specialist program and additionally interviewed 3 clinical tutors for triangulation. All trainees and tutors provided written informed consent. Semi-structured interviews were analysed using Colaizzi's seven-step framework. Routine training assessment data were used only for complementary descriptive triangulation.

Three core trajectories emerged: (1) cognitive reconfiguration and role transition-visualised OBE goals acted as a cognitive scaffold, shifting nurses from passive task executors to evidence-based decision-makers; (2) a three-dimensional stressor system-competency transfer was hindered by overlapping time, resource, and baseline-competence pressures, exacerbated by diluted mentorship across clinical areas; and (3) contextual synergy versus stagnation-competency actualisation depended on clinical empowerment, with supportive environments enabling advanced practice and resource-constrained settings contributing to role conflict and burnout.

OBE supported professional role transition, but sustained competency transfer was constrained by structural and contextual barriers. The findings suggest that implementation may benefit from an integrated support model combining simulation, longitudinal practice opportunities, digital mentorship, and psychological support. This study-derived recommendation, termed an "OBE+ Smart Ecosystem", was not the framework implemented in the evaluated program and requires prospective evaluation.