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Competency-based education in transitioning nurse practitioner students from education into practice

Hodges, Ashley L. PhD, WHNP-BC, FAANP (Professor, Associate Dean)1; Konicki, Annette Jakubisin PhD, ANP-BC, FNP-BC, FAANP (Associate Professor, Director)2; Talley, Michele H. PhD, ACNP-BC, FAANP (Associate Professor, Assistant Dean)1; Bordelon, Curry J. DNP, MBA, NNP-BC, CPNP-BC, CNE (Assistant Professor, Coordinator)3; Holland, Aimee C. DNP, WHNP-BC, FNP-BC, FAANP (Associate Professor, Assistant Dean)1; Galin, F. Shawn PhD (Associate Professor)4

Journal of the American Association of Nurse Practitioners: November 2019 - Volume 31 - Issue 11 - p 675–682
doi: 10.1097/JXX.0000000000000327

Competency-based education (CBE) provides a framework for nursing programs including those educating nurse practitioners (NPs). The basic assumption of CBE is that the student will demonstrate acquisition of the identified essential knowledge, skills, and attitudes expected for the designated educational process before leaving the learning environment. The work done to date in developing competencies and progression indicators provides the critical basis to move toward a common language and clear expectations for the continuum of linear progression of proficiency. Entrustable professional activities (EPAs) are built on competencies and stated as measurable activities that providers can be expected to do, at varying levels of competence or trust or supervision, and allow the faculty member, preceptor, or supervisor to make decisions as to what teaching methods and level of supervision are needed. Numerous methods are used to measure competency in clinical skill knowledge, performance, and practice readiness including clinical preceptor feedback, objective structured clinical examination, and simulation, just to name a few. NP programs continue to struggle with the education practice gap between theory and the actual provision of care. The discussion about novel and reliable methods for measurement of competencies must address the strategic importance of a consensus about when, where, and how students can obtain the appropriate amount and type of experience and supervision required in the transition to independent practice. There is also a significant need for processes and standardized guidelines that can contribute to EPA development.

1Graduate Clinical Education, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama

2Family Nurse Practitioner Primary Care Track, University of Connecticut School of Nursing, Mansfield, Connecticut

3MSN/DNP Core Courses, University of Alabama at Birmingham School of Nursing, Birmingham, Alabama

4Department of Medicine, Division of Pulmonary and Critical Care, Office of Standardized Patient Education, University of Alabama at Birmingham, Birmingham, Alabama

Correspondence: Ashley L. Hodges, PhD, WHNP-BC, FAANP, Graduate Clinical Education, University of Alabama at Birmingham School of Nursing, 1720 2nd Ave S., NB 406A, Birmingham, AL 35294. Tel: 205-996-7608; Fax: 205-996-7177; E-mail:

Competing interests: The authors report no conflicts of interest.

Authors' contributions: All authors wrote distinct sections of the manuscript and revised for submission.

Received April 28, 2019

Received in revised form August 07, 2019

Accepted August 12, 2019

© 2019 American Association of Nurse Practitioners
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