Developing a competency model for clinical nurse educators to support nursing career ladder advancement: A grounded theory study.

BACKGROUND: Clinical nurse educators greatly impact the development of high-quality clinical learning experiences. However, globally, the role remains inconsistently defined, and competency frameworks are rarely integrated with structured career ladder systems, limiting professional development and workforce sustainability. OBJECTIVE: This study aimed to develop an empirically grounded competency model for clinical nurse educators integrated with a structured career ladder to support progressive professional development in clinical education settings. METHODS: A qualitative study using a Straussian grounded theory approach was conducted in two teaching hospitals in Indonesia. Data were collected through focus group discussions with 16 clinical nurse educators, in-depth interviews with 9 clinical education coordinators, and participant observations. Initial purposive sampling was followed by theoretical sampling. Data were analyzed concurrently using open, axial, and selective coding and the constant comparative method. The competency subdomains generated from the grounded theory findings were subsequently validated through a two-round Delphi process involving 28 experts. Experts rated the subdomains using a 4-point Likert scale, with consensus predefined as ≥70% agreement. RESULTS: Six overarching themes were identified: qualifications for becoming a clinical nurse educator; specialized competencies; lack of clarity in nurse mentoring programs; regulation of student clinical guidance by higher education institutions; limited managerial support; and expectations for clearer role definitions and career pathways. These themes were synthesized into five core competency domains: Ethical, Legal, and Cultural Clinical Practice; Leadership and Clinical Education Management; Clinical Teaching Competencies; Research and Evidence-Based Practice; and Social Competence. The two-round Delphi process with 28 experts established consensus for 171 competency subdomains across these five domains and informed a four-level career ladder. CONCLUSION: The resulting model integrates pedagogical, clinical, ethical, managerial, research, and social competencies with progressive career development. It provides an empirically grounded and expert-validated framework to clarify the clinical nurse educator role and support structured career development in hospital-based clinical education.