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HealthStream Nurse Confidence Survey Now Validated Through Psychometric Analysis

By Kimberly Herold, MBA, BSN, RN, Director, Professional Development Pathways, HealthStream

One of HealthStream’s many solutions focused on improving outcomes is our Nurse Residency Pathway, a structured program to address the preparation of new graduate nurses for successful entry into the profession. One of the keys to developing and retaining new nurses is increasing their confidence. The HealthStream Nurse Confidence Survey, the only validated survey instrument of its kind, is the cornerstone of our effort to measure and strengthen new nurses’ confidence.

Importance of Nurse Confidence

Confidence is an essential characteristic necessary for the holistic development of the nurse. It is an especially important attribute for nurses in their first year as they enter the profession when reality shock and role confusion are prevalent challenges leading to high turnover. Confidence helps nurses feel like they are able to contribute effectively as interdisciplinary team members, and as advocates to their patients. It also helps to bolster the development of critical thinking, so that they are productive, able to make sound decisions for their patients, and can grow into effective leaders.

Why Measure Confidence?

Believing that measuring confidence as well as the effectiveness of measures intended to increase confidence are vital, we created the HealthStream Nurse Confidence Survey. A self-assessment of nursing confidence across five domains of practice, this evidence-based tool was produced by multiple subject matter experts. We use this survey as part our Nurse Residency Pathway, allowing customers to measure nurse confidence at critical intervals in the new nurse journey—at day one, week 12, 6 months, and one year. In each of these domains, you get to look at assessment evaluations for the change in confidence. For instance, HealthStream customer CHRISTUS Southeast Texas-St. Elizabeth saw an across the board 50% increase in nursing confidence from day one to one year.

The Importance of Validation

Validation confirms that an instrument like the Nurse Confidence Survey measures what it is intended to measure. We wanted customers to trust the accuracy of their individual survey findings and be assured that decisions based on them were appropriate. Full results of this analysis indicated that convergent and discriminant validity was strong.

Psychometric Evaluation Summary

I’ve copied the entire summary of the evaluation to share the strength of its findings:

“The purpose of this study was to evaluate the psychometric properties of the Nurse Confidence Survey developed by HealthStream. The Nurse Confidence Survey was administered to 422 new graduate Registered Nurses in their first practice setting.  An exploratory factor analysis was used to determine the underlying domain structure of the instrument.  Five domains emerged from this procedure—Professional Role, Clinical Practice, Assessment & Evaluation, Interprofessional Communication, and Patient-centered Education.  When these five domains were evaluated for internal consistency it was found that all five domains had excellent reliability.  Convergent and discriminant validity were also strong for all five domains.  Lastly, a model of 8 items significantly predicted the Overall Ability item.  In conclusion, the HealthStream Nurse Confidence Survey is a psychometrically sound and reliable and valid instrument.”

Our Validation Method

Psychometric evaluation involved analyzing the factor structure, reliability, and validity of the survey instrument. Reliability has to do with consistency of measurement while validity is related to how accurately the survey measures the constructs for which it was intended. The factor structure has to do with the underlying constructs, domains or factors being measured by the survey. A stepwise regression analysis was also used to determine how well the survey items predict overall ability ratings.

Using Nurse Confidence Survey Results

Our customers can use individual survey results as a basis for their nurse residency curriculum decisions. They can help to delineate areas needing greater focus and affirm what’s being covered successfully. For instance, if in a confidence survey you know that students are having problems in a particular skill in the clinical practice, then you can add that particular skill to a simulation lab or to a skills day with a content expert. The expert can come over and help them to understand the information and actually practice the skill.

Ultimately, the demands of healthcare and our growing patient need require that we figure out to hold on to more of our new nurses. We aren’t going to be able to do that unless we understand how to make them more confident in their ability to provide great care. The Nurse Confidence Survey is our validated effort to help healthcare organizations begin to understand how to close that gap.

Learn more about HealthStream Nurse Onboarding Solutions.


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