Does experience undermine expertise? The paradoxical relationship between clinical tenure and narrative competence in psychiatric nursing

Background Globally, psychiatric nurses practice in high-stress clinical environments that pose a heightened risk of burnout, making narrative competence a critical skill for establishing therapeutic alliances. Although clinical experience is traditionally considered to enhance such competencies, this assumption has not been adequately examined in high-demand healthcare settings. This study aimed to assess the level of narrative competence among psychiatric nurses in China, with particular focus on evaluating the roles of education, systematic training, and clinical experience as its key predictors. Methods A cross-sectional survey was conducted among 525 registered nurses from a tertiary psychiatric hospital in Beijing. Participants completed the Narrative Competence Scale for Medical Practitioners (NCSMP). Data on demographic characteristics, educational level, systematic narrative training, and years of psychiatric work experience were collected. Multiple linear regression analysis was employed to identify factors influencing narrative competence. Results The nurses demonstrated a significant gap between narrative cognition (81.81% of maximum score) and narrative behavior (76.97%), with peer communication being the weakest area. Multiple linear regression revealed that higher education (β = 0.144, p = .002) and systematic narrative training (β = 0.127, p = .003) were positive predictors of narrative competence. Contrary to conventional wisdom, a longer tenure in psychiatry unexpectedly predicted lower competence (β= -0.188, p < .001).The regression model explained 7.6% of the variance (Adjusted R² = 0.076). Conclusion This study challenges the foundational assumption that experience alone fosters narrative skills, revealing that prolonged clinical exposure without structured support can erode core humanistic capacities. This erosion effect underscores the urgent need for healthcare institutions to integrate sustained, systematic narrative training into lifelong professional development. Specific strategies including reflective practices and Balint groups are critical to counteract this trend, safeguard nurse well-being, and ensure the delivery of empathetic, relationship-centered care.