Contents lists available at ScienceDirect Applied Nursing Research journal homepage: www.elsevier.com/locate/apnr Original article Deliberate practice and nurse competence Melissa Bathish a,⁎ , Colwick Wilson b , Kathleen Potempa c a University of Michigan School of Nursing, Ann Arbor, MI, United States b Oakwood University, Huntsville, Alabama, United States c University of Michigan School of Nursing, Ann Arbor, MI, United States ARTICLE INFO Keywords: Nursing Competence Deliberate practice ABSTRACT Background: Increasing demand for accountability in health care requires that we understand how nurses continually increase their expertise. Development of expertise has been linked to deliberate practice in many domains but little is known about how deliberate practice impacts the expertise of registered nurses. Objectives: Evaluate the relationships among experience, education, deliberate practice, and competence as an empirical referent of expertise, and to identify which of the independent variables makes the highest con- tribution to competence. Methods: Cross-sectional, descriptive, correlational study design was used. A purposive sample of RNs from one large, Midwestern teaching hospital was surveyed. Results: After taking into consideration demographic variables, education and experience, deliberate practice made the greatest contribution to competence. No significant relationship was found between years of experi- ence or education and competence. Conclusion: This study provides empirical evidence for the relationship of deliberate practice to competence, a promising concept for explaining the development of skill acquisition in nursing. Nursing expertise is fundamental to quality patient care (Benner, 1984; McHugh & Lake, 2010). In an era of increasing demand for ac- countability in health care it is important to understand how nurses continually increase their expertise as both knowledge expands and expectations for better outcomes rise. While the contributions of years of experience and education to better outcomes have been demon- strated (Aiken et al., 2011; Blegen, Goode, Park, Vaughn, & Spetz, 2013; Bobay, Gentile, & Hagle, 2009; Cho et al., 2015; Clarke, Rockett, Sloane, & Aiken, 2002; Estabrooks, Midodzi, Cummings, Ricker, & Giovannetti, 2005; Tourangeau et al., 2007), the relative role of de- liberate practice in affecting nursing expertise has not been explored (Altmann, 2007; English, 1993; Ericsson, Whyte, & Ward, 2007). Although no ubiquitous definition of nursing expertise exists, it is well established that the nurse expert presents advanced knowledge and skill. Competence is a measure of performance that is the active, behavioral expression of expertise lying on a continuum from novice to expert (Benner, 1984; McMullan et al., 2003). High levels of compe- tence are not guaranteed with experience alone (Dunn & Shriner, 1999; Ericsson, 2006; Ericsson et al., 2007; Feltovich, Prietula, & Ericsson, 2006). Activities aimed at improving one's competence and leading to expertise are called deliberate practice (Ericsson, Krampe, & Tesch- Römer, 1993). Whereas other disciplines and occupations have addressed deliberate practice to explain the continued development of expertise (Charness, Tuffiash, Krampe, Reingold, & Vasyukova, 2005; Dunn & Shriner, 1999; Ericsson et al., 2007; Ward, Hodges, Starkes, & Williams, 2007) the health professions including nursing have little understanding of how clinicians garner continuously refined levels of expertise. The purpose of this report is to provide information about the re- lationships among deliberate practice, competence, education level, and years of experience in professional nurses by: (1) evaluating the relationships among experience, education, deliberate practice, and competence as an empirical referent of expertise, and (2) identifying which of the independent variables makes the highest contribution to competence. This is the second analysis performed of a larger study. The previous publication refers to the deliberate practice instrument development (Bathish, Aebersold, Fogg, & Potempa, 2016). 1. Methods 1.1. Study design, sampling and setting A cross-sectional, descriptive, correlational design was used. A purposive sample of only registered nurses (RN) working in adult https://doi.org/10.1016/j.apnr.2018.01.002 Received 16 September 2017; Received in revised form 15 January 2018; Accepted 19 January 2018 ⁎ Corresponding author at: University of Michigan School of Nursing, 400 North Ingalls, Room 2345, Ann Arbor, MI 48109, United States. E-mail address: mbathish@umch.edu (M. Bathish). Applied Nursing Research 40 (2018) 106–109 0897-1897/ © 2018 Published by Elsevier Inc. T