A Competency-Based Evaluation Index System for Recertification of Breast Specialist Nurses: A Delphi Study in China

Clinical nurse specialists have crucial roles in team development, patient safety, and work quality of nurses. Breast specialist nurses in China are instrumental in managing breast disorders and providing care for patients experiencing complications. However, despite the growing demand for breast specialty care, there are no unified national recertification standards for breast specialist nurses in China, and relevant research in this area remains scarce. This study aimed to develop an evaluation index system for breast specialist nurse recertification and establish a scientific and objective basis for standardizing such systems.

Based on the theory of post competency, literature analysis and a two-round Delphi method were used to prepare a recertification evaluation system for breast specialist nurses. Eighteen nursing experts from 14 tertiary hospitals in Guangdong Province participated, selected based on predefined criteria (≥10 years of clinical experience, intermediate/advanced title, and bachelor's degree or above). Indicator weights at all levels were determined using the proportion allocation method. The mean importance score was ≥ 3.50, and the coefficient of variation (CV) was ≤ 0.25.

The authority coefficients for these rounds were 0.936 and 0.933, and the Kendall coefficients of concordance were 0.245 and 0.406, respectively (P < 0.001). The final evaluation system comprised 7 first-level, 28 second-level, and 105 third-level indicators, with content features specific to breast specialty care-notably, integrative Chinese and Western nursing, lymphedema management, and multidisciplinary team (MDT) collaboration. Among the seven first-level indicators, clinical practice skills, clinical expertise, and critical thinking skills formed a cluster of core clinical competencies with comparable weights, reflecting the balanced emphasis on technical proficiency, specialist knowledge, and clinical judgment. This Delphi study was conducted and reported in accordance with the Conducting and REporting of DElphi Studies (CREDES) guidelines.

The recertification evaluation index system developed here is comprehensive, scientifically robust, and practically applicable. It is a basis for nursing managers to assess the competency and recertification of breast specialist nurses in Guangdong Province, China, supporting the quality and safety of breast cancer care. Furthermore, it offers a reference for future recertification efforts beyond the regional context.