JONA Volume 49, Number 10, pp 503-508 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. THE JOURNAL OF NURSING ADMINISTRATION Change Over Time in Ratings of New Nurses on the Appraisal of Nursing Practice Heather Becker, PhD Chipo Ndlovu, PhD, RN-BC Ya-Ching Huang, PhD, RN Toni Rowin, MSN, RN OBJECTIVE: To examine changes in new nurses' competencies across the 1st year of practice. BACKGROUND: Competency assessment is a chal- lenge for nurse residency programs and often focuses on skills checklists and confidence self-reports. The Appraisal of Nursing Practice, an observational rat- ing based on Quality and Safety in Nursing Education standards, was developed to help evaluate an RN res- idency program. METHODS: Preceptors, nurse educators, and/or unit managers from various units rated new nurse residents. Ratings were compared for 353 nurses at 3 points: within the 1st month in the program (T1), at 5 months (T2), and at month 11 (T3). RESULTS: Competency ratings increased significantly for all subscales from T1 to T2. Ratings continued to increase significantly from T2 to T3, although at a slightly slower rate. Teamwork and evidence-based practice increased the most. CONCLUSIONS: Future studies should explore fac- tors affecting the trajectory in developing nursing competencies within various settings. Nurse competency has been defined as “an expected level of performance that integrates knowledge, skills, abilities, and judgment.” 1 Previous research has shown that a lack of nurse competence is correlated with negative patient outcomes and patient safety. 2 Newly graduated nurses face particular challenges, including increased patient acuity and prioritization of time, lack of confidence in performance, unfamiliarity with equipment, and coordination of care with other disciplines. 3,4 The Institute of Medicine has recommended im- plementation of structured and accredited nurse resi- dency programs (NRPs), lasting 6 to 12 months, to enhance new nurse competencies and transition to practice. 5 NRPs have decreased nursing turnover by improving new nurse competencies to organize and prioritize work; communicate with team members, patients, and families; and increase self-confidence. 6 Barnett and colleagues 7 reported that many hospitals have recognized their importance and effectiveness, and NRPs are now offered in approximately 48% of hospitals. New nurse competencies can be difficult to assess and are often based on self-reports of confidence in the nurses' knowledge and skills or on skills checklists measured once or twice during a residency program. 8-10 As a complement to these assessment methods, the Appraisal of Nursing Practice (ANP) instrument was designed as an observational tool for preceptors, clin- ical educators, and managers to use in monitoring the development of nursing practice competencies. The ANP's content areas reflect the Quality and Safety Ed- ucation for Nurses competencies 11 that operationalize the recommendations of Institute of Medicine for patient-centered care, teamwork and collaboration, evidence-based practice (EBP), quality improvement, safety, and informatics. 12 The development of the ANP and the initial anal- ysis of pre/post change over 5 months were described previously. 13 The purpose of this article is to extend the initial investigation to a larger sample followed during the 1st year of practice. The research question Author Affiliations: Research Scientist (Dr Becker), Graduate Re- search Assistant (Dr Huang) School of Nursing, The University of Texas at Austin; and Network Clinical Education Manager (Dr Ndlovu), Regional Director, Clinical Professional Development (Ms Rowin), Seton Healthcare Family Hospital System, Austin, Texas. The authors declare no conflicts of interest. Correspondence: Dr Becker, School of Nursing, The University of Texas at Austin, 1700 Red River St, Austin, TX 70712 (hbecker@mail.nur.utexas.edu). DOI: 10.1097/NNA.0000000000000794 JONA  Vol. 49, No. 10  October 2019 503 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.