Methods for Measuring Healthcare Worker Competence: An Integrative Literature Review

Background The measurement of clinical competence is fundamental to ensuring patient safety, optimizing health outcomes, and strengthening healthcare systems. As healthcare delivery increasingly relies on task-shifting, competency-based approaches, and expanded roles for nursing leadership, rigorous assessment methods are essential for workforce development and quality assurance. Objective This integrative review synthesizes evidence on methods for measuring healthcare worker competence, examining theoretical foundations, methodological approaches, psychometric properties, and practical applications across diverse healthcare settings, including emerging evidence on nurse manager competencies. Methods An integrative literature review was conducted following Whittemore and Knafl's methodology, guided by PRISMA reporting guidelines. Electronic databases including PubMed, CINAHL, Scopus, Web of Science, and Embase were searched from January 2000 to January 2025. A total of 2,847 records were identified, with 65 studies (18 systematic reviews and 47 primary studies) meeting inclusion criteria after screening. Quality appraisal used AMSTAR 2 for systematic reviews and COSMIN guidelines for primary studies. Results The review identified multiple assessment methodologies including medical record review, direct observation, standardised patients, clinical vignettes, Objective Structured Clinical Examinations, workplace-based assessments, and simulation-based training. Contemporary evidence supports programmatic assessment approaches integrating multiple methods within competency-based frameworks such as Entrustable Professional Activities. Recent systematic reviews applying COSMIN guidelines reveal variable but improving psychometric evidence across instruments. For nurse managers specifically, twelve instruments measuring 477 competencies across four domains—strategic management, operational management, clinical competencies, and human resource management—have been identified. Conclusions No single method provides complete competency assessment; triangulation across multiple approaches is essential. The gap between competence and performance remains a central challenge requiring workplace-based assessment integration. Critical research gaps persist regarding validation in resource-limited settings, emerging competency domains including digital health and interprofessional collaboration, and standardization of terminology for managerial competencies.