Embracing the New Essentials: Our Transition to Competency-Based Education

In rapid response to updated AACN guidelines, LSU Health Sciences Center New Orleans School of Nursing is ushering in a new era of learning for its students: competency-based education, emphasizing experiential learning to better prepare nurses.

A nurse educator and nursing student in medical attire work on a manikin patient in a hospital bed, practicing physical examination skills.

Sherry Rivera, DNP, APRN, ANP-C, FNKF, FAANP; Program Director, Adult Gerontology Primary Care, Nurse Practitioner Concentration, and Assistant Professor of Clinical Nursing – pictured here teaching physical examination skills to student Jaron Allen (DNP ’21) – has already emphasized experiential learning with nursing students.

LSU Health Sciences Center New Orleans School of Nursing has a rich tradition of producing exceptional nurses. Now, we are beginning a new chapter designed to further strengthen our graduates: the transition to competency-based education (CBE).

More than 130 courses across both undergraduate and graduate levels will be meticulously aligned to the domains, concepts, competencies and sub-competencies prescribed by The Essentials: Core Competencies for Professional Nursing Education published by the American Association of Colleges of Nursing (AACN) in 2021.

This strategic pivot in educational philosophy positions us at the vanguard of nursing education, helping us to equip our future graduates with the requisite knowledge, skills and abilities to meet evolving needs in the health care delivery landscape.

From Learners to Leaders: Empowering Students with CBE

The transformation to the CBE model promises to redefine the student experience by placing learners at the center of their educational journey. This approach calls for actively engaging students in their own assessment and learning process, fostering open communication with faculty and prompting ongoing self-reflection. Woven throughout the course content, this reflective practice – paired with direct observation, frequent feedback and shared decision-making at assessment points – equips students with a precise understanding of the competencies required to excel.

Rather than limiting students to high-stakes assessments, the CBE model integrates multiple formative evaluations into curriculum, encouraging real-time feedback from faculty and reflective insights from students. This symbiotic exchange of instruction and mentorship nurtures an environment of personalized training and contributes to an individually tailored educational experience. Faculty also collaborate across courses and programs to ensure that students are demonstrating readiness at each stage, embodying a holistic approach that allows us to achieve program objectives that align with the 10 domains outlined by AACN.

In a clinical setting with a hospital bed in the background, a nurse educator is demonstrating practical skills on a volunteer participant to attentive nursing students. The volunteer participant has medical wrappings from their hand to their elbow.
Leanne H. Fowler, DNP, MBA, APRN, AGACNP-BC, CNE, FAANP; Program Director, Nurse Practitioner Programs; Program Coordinator, Adult Gerontology Acute Care, Nurse Practitioner Concentration; and Associate Professor of Clinical Nursing, worked with students to practice clinical skills during one of her courses.

Jolie Harris, DNS, RN, Assistant Professor of Clinical Nursing, says, “Feedback from students on their preparation has been positive, but we know the landscape is changing, and we need to be prepared to adapt. A model that provides individualized learning to meet the unique needs of each student will be invaluable for their future and in building confidence as a new graduate.”

Indeed, as health care continues to evolve with intricate clinical cases, expanding technological domains and heightened awareness of the social determinants of health, the CBE model has been designed to broaden the traditional measures of proficiency. The “backward design” prioritizes the needs of the health system, drawing on inputs from practice partners and population needs to inform competency outcomes, assessment types and curriculum design. Rather than assuming achievement of hiring agencies’ expectations, the CBE model flips the traditional educational framework by beginning with these expectations to guide the creation of program objectives and assessment measures.

In essence, the CBE model places an emphasis not only on what a student can perform but also on how they perform across varied scenarios in didactic, clinical and simulation settings, ensuring that our graduates are not merely competent but also prepared to excel in the dynamic landscape of the nursing profession.

Constructing a Competency-Based Future

The technicalities of transitioning to CBE necessitate careful planning and meticulous execution. In acknowledgment of the transition process’s complexity, the AACN has proposed a realistic timeline of three years or more for full implementation. This will allow ample time for collaboration, adaptation and the embedding of the updated AACN Essentials framework, which encompasses 10 domains and eight core concepts with 434 associated sub-competencies to be integrated into our curriculum.

“To assist us with this project, we are in the process of employing consultants to facilitate and conduct educational workshops and provide curriculum mapping of our academic programs,” says Denise Danna, RN, DNS, NEA, BC, CNE, FACHE, Director of Academic-Practice Partnership, Associate Professor-Adjunct. “We have also initiated discussions with consultants to facilitate the curriculum transformation process.”

The school’s overarching goal is to deliver a curriculum designed around competency-based assessments, active learning strategies and rigorous evaluation methods.

The school’s overarching goal is to deliver a curriculum designed around competency-based assessments, active learning strategies and rigorous evaluation methods. Once gaps in our existing curriculum are identified, new courses will be developed or existing courses revised as needed to successfully incorporate the new AACN Essentials and fully transition to the CBE model.

The principles of CBE have already begun to take root in our institution. Over the past few years, we’ve made a decisive shift in our teaching approach: moving from the traditional “sage on the stage” model to an active-learning design. This shift has occurred most notably within our Nurse Practitioner (NP) program, where our faculty have developed an “unfolding case study” approach that allows students to follow a patient’s journey throughout their education.

“In this approach, a case is presented in an initial course in one setting, allowing students to focus on a clinic patient, who they then follow in subsequent courses through an acute change in condition and then the post-acute and outpatient settings,” says Leanne H. Fowler, DNP, MBA, APRN, AGACNP-BC, CNE, FAANP; Program Director, Nurse Practitioner Programs; Program Coordinator, Adult Gerontology Acute Care, Nurse Practitioner Concentration; Associate Professor of Clinical Nursing. “These cases allow the student to understand the importance of assessment, not only from an acute perspective, but from the perspective of the value of social and environmental factors affecting health and wellness.”

Students can explore the plan of care from the patient’s and family’s perspective as they are trained to be holistic care providers. The intent of scaffolding knowledge and skills across the curriculum is central to the CBE approach as they build from one academic course to the next.

Also in line with CBE principles, we have introduced diverse forms of student assessment, including in-class demonstrations, video essays and digital portfolios. Such assessments reinforce the concept of demonstrating competency as a central theme of learning.

The Revolutionary Future of Nursing Education

The AACN has documented inconsistencies in skill and competency among nursing graduates from all degree levels and programs in the U.S., a concern that the updated Essentials aims to resolve. As nursing education institutions adopt these principles across the nation, the nursing profession will have a uniform educational approach and consistency in program outcome expectations.

The School of Nursing prides itself on maintaining a sterling reputation in the community for nurturing exceptional nursing professionals. Our graduates are esteemed in the community as “well-prepared,” “leaders,” and individuals with “strong clinical skills,” Dr. Harris notes. As we integrate competency-based education into our programs, our goal is to maintain and strengthen this reputation.

Throughout the transition and beyond, we will continue to examine and improve our programs and incorporate feedback from current and previous students. We are also providing educational experiences across multiple settings, including the expansion of outpatient settings, in direct response to the evolving health care landscape and to better equip our students to transition into a broader range of roles than the traditional focus on acute care.

“We are committed to graduating 100% practice-ready students to serve the needs of our community,” Dr. Harris says. “With this transformation of how we prepare our nursing graduates and how we provide nursing care, we can revolutionize nursing education.”

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