Enhancing ICU Nurse Competence: A Systematic Review of Influencing Factors

ICU nurses work in high-stakes environments where competence, defined as the integration of knowledge, skills, attitudes, values, and experience, is essential for ensuring patient safety, reducing mortality rates, and providing effective critical care.

Following the PRISMA 2020 guidelines, we searched critical care and nursing education journals in PubMed, Scopus, Web of Science, Embase, and CINAHL from 2015 to June 2025 for qualitative and quantitative studies on ICU nurse competence. The search strategy incorporated terms such as "educational frameworks for critical care education," "critical care nursing orientation," and "competency-based critical care nurse education." JBI tools were used to assess quality, and narrative synthesis was applied.

Of the 1800 studies that were identified, 15 were included in the analysis. This analysis involved 2500 ICU nurses from 9 different countries. Competence is multidimensional. Facilitators such as simulation-based learning improve clinical decision-making, and ethical attitudes promote holistic care. Barriers include workloads that cause burnout and post-COVID infection gaps that lead to errors. Competence levels are high for clinical skills but low for research and family-centered care. Novices struggle in complex ICUs.

This review suggests that combining the adoption of standardized, competency-based frameworks, particularly the AACN Synergy Model and the 2021 AACN Essentials, with objective, simulation-enhanced assessment tools can effectively address identified gaps and improve the competence of ICU nurses worldwide.