Stepping up in practice: registered nurses’ and nursing assistants’ competence development through two-level internal training – A mixed method study

Background The increasing complexity of healthcare requires managers to ensure continuous competence development among nursing staff. While formal education provides a foundation, internal training plays a critical role in meeting the specific demands of emergency care. For registered nurses (RNs) and nursing assistants (NAs), structured internal programmes at different levels offer opportunities to enhance both theoretical knowledge and practical skills necessary for high-quality, person-centred care. This study investigates the effects and experiences of self-assessed competence among registered nurses (RNs) and nursing assistants (NAs) before and after completing internal training at two levels: basic and advanced. Methods A mixed-methods retrospective descriptive design was used, combining quantitative analysis of pre- and post-training web surveys with qualitative content analysis of open-ended responses. Participants were RNs and NAs working in somatic care settings at a university hospital in Sweden. The internal training programmes were profession-specific and structured according to themes aligned with learning outcomes, pedagogical activities, and clinical relevance. Data were analysed using chi-square tests, t-tests, and Fisher’s exact test for statistical comparison. Krippendorff’s method was used to guide the qualitative content analysis. Results A total of 62 participants (57 NAs, 5 RNs) completed both pre- and post-training surveys. Quantitative findings indicate a significant increase in self-assessed competence across several domains, particularly in clinical reasoning, symptom recognition, and documentation. Qualitative analysis revealed that participants experienced increased confidence, knowledge integration, and a greater understanding of person-centred care. Challenges included limited time for reflection and varying digital learning conditions due to COVID-19. Conclusion The results suggest that internal training at both basic and advanced levels contributes positively to self-assessed competence among RNs and NAs. Profession-specific content combined with structured pedagogical design can enhance clinical readiness and support competence planning in healthcare organisations. Leadership engagement and protected time for learning remain crucial to maximise training outcomes. Trial registration Clinical trial number: not applicable.