The Role of Confidence In Clinical Practice

Confidence might not be the very first quality that comes to mind when describing a professional nurse. Its surplus has been systematically negatively correlated with expertise and is currently known as Dunning–Kruger effect (1). Nevertheless, numerous studies dedicated to measuring confidence among the nursing staff and the ways to enhance it signal that the characteristic is seemingly indispensable for successful clinical practice (2). For instance, among nurse students and beginning medical professionals, confidence is a factor enabling them to perform their duties adequately in a clinical setting (3). In this way, confidence is vital for effective clinical practice.

When I started working as a bedside nurse in 2000, I was not used to trusting in my knowledge upon which the life of another person would depend and needed to double-check myself continually. The distrust disappeared over the years, notably after receiving a specialty degree and becoming a certified wound care nurse. This is not a unique situation as many nurses at the beginning of their career need to overcome a sense of incompetence (4). A study performed by Makarem et al. (2019) demonstrates that professional confidence in clinical nurses who worked for over ten years is significantly higher than nurses’ confidence with less than ten years of experience (5). Professional experience seems like the most secure method to become more confident.

In my experience, developing quality allowed me to be a better communicator, which is significant in clinical practice. Confidence earned with the years of experience enabled me to express health concerns related, for instance, to the efficacy of a treatment to the nurse manager or a responsible doctor. Hence, I became a better patient advocate, representing their and their families’ interests. Even though patient advocacy is a somewhat controversial concept, many nursing theorists consider it fundamental to the profession (6). In addition to being a better patient advocate, the increased confidence allowed me to be more assertive and prevent malpractice.

Professional confidence is of great significance not only to health care workers but also to patients. Nurses’ confidence directly influences nurse-patient communication, which in its turn positively influences “various patient health measures, such as compliance with medical treatments, symptom resolution, and pain control” (7, p. 155). Furthermore, professional confidence potentially facilitates building trusting patient-nurse relationships, vital to clinical practice, and health outcomes. There are numerous, scientifically approved methods to increase confidence. Thus, in an educational setting, repeated simulations have been linked to increased confidence (8). Based on personal background, gaining experience is vital to be more self-assured to an adequate extent. In addition to expertise, continuous self-improvement, genuine interest in one’s work, and learning from seniors are also helpful.

Even though being overly confident could be detrimental to clinical practice, an appropriate self-confidence level is vital for nurses. Professional confidence empowers medical professionals to perform their duties more efficiently. For nurses specifically, the quality facilitates patient advocacy and avoiding treatment issues that might have been left unsaid otherwise. Additionally, the quality has been associated with improved patient outcomes. Thus, professional confidence is indispensable, yet it seems to be gained through practice and constant learning.


  1. Gignac G, Zajenkowski M. The Dunning-Kruger effect is (mostly) a statistical artefact: valid approaches to testing the hypothesis with individual differences data. Intelligence. 2020;80:101449.
  2. Zieber M, Sedgewick M. Competence, confidence and knowledge retention in undergraduate nursing students – a mixed method study. Nurse Education Today. 2018;62:16-21.
  3. Panduragan S, Abdullah N, Hassan H, Mat S. Level of confidence among nursing students in the clinical setting. Procedia – Social and Behavioral Sciences. 2011;18:404-407.
  4. Van Horn E, Christman J. Assessment of nursing student confidence using the clinical skills self-efficacy scale. Nursing Education Perspectives. 2017;38(6):344-346.
  5. Makarem A, Heshmati-Nabavi F, Afshar L, Yazdani S, Pouresmail Z, Hoseinpour Z. The comparison of professional confidence in nursing students and clinical nurses: a cross-sectional study. Iranian Journal of Nursing and Midwifery Research. 2019;24(4):261-267.
  6. Water T, Ford K, Spence D, Rasmussen S. Patient advocacy by nurses – past, present and future. Contemporary Nurse. 2016;52(6):696-709.
  7. Hecimovich M, Volet S. importance of building confidence in patient communication and clinical skills among chiropractic students. Journal of Chiropractic Education. 2009;23(2):151-164.
  8. Cummings C, Connelly L. Can nursing students’ confidence levels increase with repeated simulation activities?. Nurse Education Today. 2016;36:419-421.