Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Dr. Mary-Anne Andrusyszyn

2nd Supervisor

Dr. Mickey Kerr

Joint Supervisor


Introduction: Role competence and patient safety (PS) competence among healthcare professionals are rapidly developing issues due to increasing patient acuity and complexity in the healthcare system. Upon graduation, nurse practitioners (NPs) provide autonomous healthcare for populations with complex health needs, thus role and PS competence is imperative. In Canada, few studies have examined NP education and role development specific to NP role competence and PS competencies. This study addresses this gap in the research examining educational experiences of new NP graduates.

Aim: The aim of this study is to test a hypothesized model of the relationships between educational structural empowerment, psychological empowerment, NP role competence, and PS competence among newly practicing NPs. Educational structural empowerment, partially mediated by psychological empowerment was hypothesized to positively influence the development of NPs’ role competence and their competence to safely engage in health care work.

Methods: The sample was drawn from newly graduated NPs from across Canada, accessed through twenty professional nurse registering bodies and associations. A theoretical model of educational structural empowerment mediated by psychological empowerment on NP role competence and PS competence was developed and tested. The study survey included socio-demographic questions, the Conditions of Learning Effectiveness Questionnaire, the Psychological Empowerment Scale, the NP Competence Survey, and the Health Processional Education in PS Survey. The study’s comprehensive analytic framework included descriptive statistics analyses, exploratory factor analysis, confirmatory factor analyses and structural equation modeling.

Results: One hundred and ninety Canadian educated NPs who completed their studies in the preceding 2-year time period responded. The study model tested the effect of educational structural empowerment on NP role competence and PS competence partially mediated by PE. PE partially mediated the positive relationship for educational SE and PS competence, yet no mediation effect occurred for educational SE and NP role competence.

Conclusions: Nurse educators need to consider educational structural empowerment strategies as NPs’ positive perceptions of role competence have the potential to influence greater levels of PS competence. Further, identifying factors and self-perceptions important for competence in an education program offers insights that can address NP role and PS educational needs prior to healthcare professionals beginning to practice.