Factors Affecting Medication Competence in Nursing

What is Medication Competence?

Here we have explained some most important Factors Affecting Medication Competence in Nursing. Medication Competence is the blend of theoretical knowledge, practical experience and decision-making ability in the medication process. It is not limited to the assessment of a patient’s need of medication and its administration, but it also includes provision of medication education, evaluation, and monitoring of drug effectiveness.

Medication Competence and Nursing Important?

Nurses are an integral part of health care system linked to the medication process so their knowledge and competence in medication process is of utmost importance. Focus on education increases the knowledge and competence (Drug IQ) level of nurses and a competent nurse must have a strong grip on critical thinking, leadership quality, case management, in-patient and out-patient patient services and health promotion as it is believed by The American Association of Colleges of Nursing (AACN).

Importance of Medication Competence

Medication competence at nursing level requires knowledge of pharmacology and medication management so the nursing students must be given the opportunities and adequate education to become a competent nurse. Medication competence in nursing leads to;

  • Safe Drug Administration as Drug administration is performed by nurses and any error will directly affect the patients’ safety.
  • Evidence base care to the patients to maximize clinical outcomes
  • Reduced medication errors; Application of Five Rights reduce the medication errors and avoid adverse drug reactions. These are right patient, right route, right dose, right drug and right time for the drug.

Factors Affecting Medication Competence in Nursing

Various factors have been identified that are associated with the medication competency of nurses and nursing students. These factors are;

  • Individual factors as age, stage of nursing education, self-confidence, learning strategy, mathematical knowledge.
  • Clinical learning environment has supervision and learning opportunities
  • Educational Institution has medication education

Individual factors:

  • Stage of nursing education: Medication competence is directly related to the stage of nursing education. A study revealed that first year registered nurses had inadequate knowledge and the mean score in pharmacology knowledge was 55.8% in 363 participants. This study also revealed that longer the experience of working as registered nurse and studying in graduation program, better the score in pharmacology knowledge.
  • Mathematical Knowledge: Effective and safe drug administration requires accurate dose calculation. Nurses’ mathematical skills and knowledge of dose calculation are of significant importance as most errors occur during this stage. A study was carried out in England comprising of registered nurses and nursing students for the evaluation of numerical and drug calculation ability. Numerical test showed the failure of 55% students and 45% nurses whereas drug calculation test showed the significant failure of 89% nurses and 92% students. This study emphasizes the importance of regular practice and assessment of nurses’ mathematical skills.
  • Self Confidence: Nursing students or sometimes nurses lack the confidence of using their theoretical knowledge in clinical practice. This lack of confidence affects their competency. A study involving nursing students’ showed that while solving mathematical test and questionnaire, the results were affected by students’ education and confidence level.
  • Learning Strategy: Medication competence of nurses and nursing students is dependent on their learning strategy. Shortcomings in teaching methodology and poor commitment to studies make the students less competent in clinical settings. Research interviews were conducted in public hospital of Australia to assess the knowledge of pharmacology. Results showed that inadequate learning and teaching opportunities are affecting the knowledge of graduating nurses.

Clinical Learning Environment:

  • Learning Opportunities: Medication competence among nursing students can be increased by providing them the opportunities to learn and practice skills in clinical settings. A university in South Africa carried out research that compares the learning opportunities and medication competence among nursing students. The results showed that students who were given more opportunities to administer medication perceived themselves to be more competent as compared to students who were given minor opportunities to practice their skills.
  • Supervision: Continuous supervision and guidance by the mentor always lead to extraordinary results. Unusual expectations and uninterested behavior of supervisors or coordinators has negative impact on students’ learning and performing ability, as shown in study. Interviews of nursing students and lecturers were conducted to explore the learning and teaching issues and evaluate the perceptions and experience. The findings revealed the inadequacies in educational initiatives and course content that affect the competence of students’ nursing skills.

Educational Institution

  • Medication Education: Studies have revealed that medication education and medication competence are interrelated. Theory and practice both are important in medication competence. Educational institutions must provide opportunities and pharmacological and mathematical knowledge to its students for working in clinical setting. A study was conducted to evaluate the pharmacological and mathematical knowledge of nursing students of 28 nursing schools in Belgium and it was found to be 55% for pharmacology and 66 % for calculation in bachelor students and 52% and 53% respectively for diploma students. So it was concluded that schools must overcome the short comings in providing medication education to make its students competent in clinical setting.

Identifying and overcoming the weakness:

By considering the factors affecting the medication competence among nurses and nursing students, the deficiencies can be highlighted that include;

  • Lack of Mathematics Knowledge
  • Inadequate Pharmacology knowledge
  • Learning opportunities/Strategies

A research was carried out in Finland’s nursing students at the beginning and end of their education to evaluate their medication competence. The main idea was to explore the practical, theoretical and decision making approach of students to evaluate their medication competence. Theoretical knowledge based on medication subjects, showed no considerable improvement at the start and end of their nursing graduation. Only improvement seen was in knowledge of common medical abbreviations and medicine package information. Practical medication competence showed better results but it still needed the improvement in teaching and assessment opportunities. Decision making approach showed that still there is a need to develop deeper knowledge of pharmacology and patient education among nursing students.

Higher Education

Medication knowledge in registered nurses and nursing students can be increased by providing them a higher education focusing on practical and theoretical experience. A study carried out on 21 University HealthSystem Consortium hospitals, revealed that by increasing the numbers of registered nurses with Baccalaureate degree or even higher resulted in better patient outcomes. There were less cases of mortality by heart failure, ulcers, post-operative deep vein thrombosis, and shorter length of stays. So, by increasing the education level, you will also increase the competence and confidence of nurses and nursing students.


Discipline among any profession is the key to success. Disciplined and responsible nurse is a heart of health care profession as he/she performs the duty with full dedication and without any negligence. A review of literature was conducted for the determining the characteristics of disciplined nurses in 6 states of USA including Ohio, Texas, New York, Tennessee, Louisiana and Colorado. The results showed that nurses with higher level of education as associate degree are more disciplined as compared to the nurses with diploma.

Pharmacotherapeutic Knowledge

Nurses have the responsibility of pharmacotherapeutic activities that includes medication safety, adherence to monitoring and reporting adverse drug reaction. A study showed that nurses with bachelor’s degree have better pharmacotherapeutic knowledge and they were found to be 35% more likely to be reporting adverse drug reaction as compared to diploma holders.


Accurate calculation of doses is the crucial step in promoting safe drug usage. Enhancing the knowledge of calculation can ensure safe dose calculation and this can be achieved by introducing interventions in teaching methods as revealed in a study. The study showed that by introducing the intervention of improving students’ knowledge of calculation, drug formulas and concepts of doses, there was an enhancement in students’ mathematical knowledge. They were able to identify the correct formula and errors in calculations.

Self Confidence

Students who are good in theoretical medication knowledge are found to be more self-confident. A study showed that students with anxiety of math and computer showed poor results in learning of dose calculation, so there is a need to develop strategies to build their confidence and competence in calculation of doses.

Teaching/ Education Interventions:

  • Transition Programs for nurses:

To overcome the shortage of competent nurses and medication competence among new nurses, many hospitals in USA have developed transition programs for nurses. This includes orientation, nursing residency and internships programs. These programs of longer duration will help build the self-confidence and pride learning opportunities for nurses to develop and implement their clinical skills. Transition programs will help in developing the skills of decision making, critical thinking, communication, leadership, organization skills, patient care and self-confidence. A systematic model is proposed in a review for further research and outcomes to link transition programs with patient safety.

  • Nursing Education Research for nursing students:

By considering the inadequate medication competence in nursing students, nursing education research must be carried out to develop the study designs to promote effective teaching methods and students’ motivation. Methodologies to increase self-regulated learning and application of healthcare learning might be an effective approach to improve the medication competence among nursing students.

Medication competence is directly linked with nurses’ knowledge, skills and patient outcomes. Nurses and nursing students need to improve their mathematical skills and pharmacology knowledge to safely administer drugs in right dosages. A study was carried out in hospital of England among junior and senior nurses to evaluate their pharmacology knowledge. Results showed the inadequate pharmacology knowledge regarding mechanism, drug interactions and common drugs administration. The provision of the extra pharmacology education in clinical scenario was recommended.

Nurses need to upgrade and test their medication knowledge or Drug IQ as continuous learning is the key in health care system to be competent. Educational programs, practice sessions and refresher courses or self-learning with Drug Trivia should be started. Practical assessment of drug administration skills of nurses must be measured to ensure patient safety. These remedial education services will not only help in overcoming the knowledge deficits but will also give confidence for safe drug administration and management.

Harper Madison 

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