Barriers and facilitators of clinical competency acquisition and maintenance among nurses in Ghana: a mixed methods systematic review

Clinical competency is essential for safe, high-quality nursing care, yet its acquisition and sustained maintenance remain challenging in Ghana due to fragmented Continuing Professional Development systems, theory–practice gaps, and resource constraints. Evidence on how nurses in Ghana develop and maintain competence has been scattered and insufficiently synthesized. Therefore, this study synthesized evidence on the barriers and facilitators to clinical competency acquisition and maintenance among nurses in Ghana. We conducted a convergent integrated mixed-methods systematic review following the Joanna Briggs Institute methodology and PRISMA guidelines. Searches were conducted across MEDLINE, CINAHL, Scopus, and Embase, covering publications from 2000 to 2026. Twelve eligible empirical studies involving nurses, midwives, and nurse educators in Ghana were included. Data were synthesized narratively, guided by Benner’s Novice-to-Expert Model and Situated Learning Theory. Out of the 379 articles retrieved, 12 studies comprising 2,662 participants were included in this review. The most frequently reported barriers included inadequate structured clinical training, workforce shortages, resource constraints, limited managerial support, and inconsistent competency assessment. Key facilitators included structured mentorship and preceptorship programs, continuous professional development, supportive leadership, competency-based curricula, and positive workplace learning environments. Nurses in Ghana face multilevel, system-driven challenges in acquiring and sustaining clinical competence. The Nursing and Midwifery Council of Ghana should strengthen competency-based regulation by institutionalizing structured mentorship and preceptorship programs, competency validation, and nationally coordinated continuing professional development. Implementing these reforms is essential to developing a competent, resilient, and practice-ready nursing workforce in Ghana and other resource-constrained settings.