The overall aim of this thesis was to explore nurses’ professional competence with a focus on scope of practice, content, utilization, and development within the ambulance service in Sweden.

Methods: Integrative review (I), qualitative (II, III) and quantitative methods (IV) were used. The integrative review was based on 25 studies. The qualitative studies were based on interviews with 13 (II) and 16 prehospital nurses (III), and data was analyzed using content analysis (II) and grounded theory (III). In the quantitative study (IV), 105 nurses answered a digital questionnaire and descriptive and analytical statistics were used in the analysis. 

Main findings: Advanced nurses’ and paramedics’ assessments, treatments, and referrals were safe and of high quality and were characterized by a high degree of autonomy. Patients were satisfied with the care provided, reduced waiting times, and the avoidance of unnecessary transportation to hospital (I). Broad medical and nursing competence was required, and personality traits and contextual awareness were emphasized as unique competences (II). Prehospital emergency nurses reported higher levels of professional competence compared to registered nurses or other specialist nurses. No differences were identified between nurses with master’s or bachelor’s degrees, and clinical experience was a predictor of nursing competence (IV). At the start of their careers, the ambulance service represented a developing environment for nurses. When focus, education, roles, responsibilities, and requirements remained the same, continued competence development risked stagnation (III).

Conclusions: Personality, clinical competence, prehospital experience, and contextual competence were emphasized. Academic competence was neglected and not demanded. This thesis provides new knowledge that can contribute to the continued development of the ambulance service and to a more efficient utilization of the full spectrum of nurses’ professional competence.  

Ambulance services are included in changing healthcare systems where nurses have a central role in providing safe and high-quality care. Therefore, it is crucial that prehospital nurses’ professional competence meets the needs of patients and the ambulance service. The overall aim of this thesis was to explore nurses' professional competence with a focus on scope of practice, content, utilization, and development in the ambulance service. Advanced nurses’ assessments, treatments and referrals were safe, of high quality and characterized by a high degree of autonomy. Within Swedish ambulance services, prehospital emergency nurses reported higher competence than registered nurses and other specialist nurses. No differences between nurses with a master's or bachelor's degree were identified, and clinical experience was an important predictive factor for nurse competence. Ambulance services were a developing environment for nurses during the first years. When focus, training, roles, responsibilities, and requirements remained the same over time, continued competence development risked stagnation. This thesis provides new knowledge that can contribute to the continued development of the ambulance services and to a more efficient utilization of nurses' competence.