By Laura Gonzalez, VP, Sentinel U®, President, INACSL

Last year, the American Association of Colleges of Nursing (AACN) dramatically re-envisioned the field of nursing education after releasing an updated version of “Essentials,” a new framework for the development of nursing curricula. As opposed to aligning with an academic degree (i.e. baccalaureate, master’s, doctorate), the revised framework outlines a competency-based learning model and accounts for the role of education throughout a nurse’s entire professional career.

This new approach is a conscious move away from a learning system that requires rigid schedules and in-person classes and clinicals. The competency-based model allows students to master skills at their own pace, on their own time; and with advances in simulation technology, students can demonstrate their proficiency of concepts and complete clinical hours in risk-free virtual environments.

“Given changes in higher education, learner expectations, and the rapidly evolving healthcare system…new thinking and new approaches to nursing education are needed to prepare the nursing workforce of the future.” – American Association of Colleges of Nursing. (2021, April) The Essentials: Core Competencies for Professional Nursing Education

Nursing Education Must Change to Attract New Students.

Strains on the current system are the main driver behind AACN’s reimagined “Essential” guidelines. It is well-known that the United States is in the midst of a massive nursing shortage as the number of retirees outpace new entrants to the field. According to AACN’s annual survey conducted last fall, enrollment in key programs, particularly advanced practice students, saw significant declines. The number of students in RN to BSN programs fell by nearly 10 percent, master’s programs decreased by nearly 4 percent, and DNP programs continued to see declines as well. A main problem identified in the survey is that qualified applicants are getting turned away from nursing programs, with nearly 92,000 qualified applications not being accepted in 2021 due to insufficient clinical placement sites, faculty and preceptor shortages, limited classroom space and budget cuts.

Making matters worse, nursing degrees are expensive, especially advanced degrees. According to a report by “Nurse Journal,” a master’s in nursing can range from $35,000-$75,000 and a doctor of nursing costs between $40,000-$70,000 on average.

This financial barrier to entry is exacerbated by growing disillusionment about higher education among America’s younger generations. ECMC Group has reported that only 51 percent of Gen Z teens are interested in pursuing a four-year degree – down 20 percent since May 2020 – and many teens are interested in exploring learning pathways outside of the traditional university experience. This is where the competency-based education model can play a big role in attracting the next generation of nursing students.

Sentinel U Nursing Simulations Research Grant

Leveraging Virtual Clinicals in Competency-Based Education

Competency-based education is inherently student-centered and anchored to the outputs of an educational experience, with clearly delineated performance expectations. Requiring nursing graduates to demonstrate their competency in certain areas as opposed to “passing a class” gives students a greater sense of responsibility and bridges the gap between study and practice. Adding competency-based virtual simulations to this mix puts the power back in students’ hands, enabling them to overcome issues like accessibility, availability, and affordability.

Currently, there is wide variability in nursing graduate capabilities, even for nurses that have the same degree. Simulations remove physical barriers to education like location and limited on-site clinical opportunities and can also play a significant role in closing the skills gap.

According to the Nurse Practitioner Task Force (NONPF), “NPs require curricular integration of new knowledge skills, attitudes, and behaviors.” Simulation provides a tool to evaluate cognitive and clinical proficiency in a realistic setting and must align with the NP curriculum to support advanced practice competencies defined by the AACN and NONPF.

NONPF states “curriculum integration of simulation should be based on the ultimate goal of preparing the learner at the highest level and meeting the competency standards set forth by AACN and NONPF.”

With clinical simulations, nurses at any point in their career can study on their own time and explore new areas. Sentinel U’s Advanced Practice Series™, for example, offers immersive real-world experiences with 55 unique patient encounters in 11 specialty areas. Each module introduces a diverse patient population from a variety of ethnicities and backgrounds exhibiting common complaints in various clinical areas, such as typical and complex adult and pediatric care, women’s health, mental health, cardiology, oncology, and gerontology. Using evidence-based scenarios created by subject matter experts, learners advance through clinical encounters while reviewing the patient inquiry, history and physical (H&P) examination, and review of systems (ROS) within the electronic health record (EHR).

The theoretical underpinning for virtual simulation, including the Advanced Practice Series, is based on increasing order of difficulty, requiring nurses to master specific skills prior to advancing onto the next level. Each simulation includes real-world context and a set passing standard for each encounter. Likewise, by receiving continuous feedback from the program, the learner can reflect on their individual performance and identify opportunities for improvement in a safe environment.

Unlike in clinical rotations, learners can repeat an experience within virtual simulation, which encourages deliberate practice for mastery (McGaghie, et al.,2015, Gonzalez & Kardong-Edgren, 2017). Learners can control their pace and advance as they demonstrate mastery. Deliberate practice under the right conditions can help the learner improve skill performance and retention, and repeated performance results in optimal performance (Foronda, 2020).

Within the context of how AACN is re-envisioning nursing education to meet modern healthcare needs, virtual simulations are an essential way that educators can deliver tangible results. As we move towards competency-based education for all, virtual simulation will only continue to grow in importance.