Development of a multidisciplinary competency framework for specialist nurses in outpatient dental sedation and anesthesia: a mixed-methods Delphi and AHP study

Background The rapid global expansion of “comfortable dental care” has significantly increased the demand for outpatient sedation. However, the unique challenges of Non-Operating Room Anesthesia (NORA), including shared airways and limited rescue resources, necessitate highly specialized nursing competencies. This study aims to develop and validate a comprehensive competency framework for specialist nurses in outpatient dental sedation and anesthesia to enhance perioperative safety. Methods Guided by the Onion Competency Model, a preliminary framework was established through a structured literature review and Behavioral Event Interviews (BEIs). A two-round modified Delphi consultation was conducted between August and October 2025 with a multidisciplinary panel of 25 experts (anesthesiologists, dental surgeons, and nursing specialists) from nine provinces in China. The Analytic Hierarchy Process (AHP) was employed to determine the relative weights of the indicators, with consistency ratios calculated to ensure logical rigor. Results The final framework comprises 4 primary, 11 secondary, and 40 tertiary indicators. The four primary domains and their respective weights are: Professional Skills (0.361), Professional Knowledge (0.315), Personal Traits (0.179), and Professional Accomplishment (0.151). The expert authority coefficient (Cr) reached 0.847, and Kendall’s W for the second round showed significant consensus ( p < 0.001). Notably, “Risk Warning Management” (0.289) emerged as the most critical secondary competency. The overall AHP consistency ratio was 0.034, indicating high reliability. Conclusion This study establishes a scientifically validated benchmark for the recruitment, training, and evaluation of dental sedation nurses. By prioritizing risk-prevention skills and situational awareness, this framework provides a strategic blueprint for improving patient safety in ambulatory anesthesia settings within the Chinese healthcare context, with potential for cross-cultural adaptation.