Competency Based Distance Competency Based Distance Nursing Education: Clinical Nursing Education: Clinical Testing vs. Clinical TeachingTesting vs. Clinical Teaching

Mary Lee Pollard, PhD, RN Associate Dean Kim Hedley, MS, RN, CPHQ, Senior Program Director

Excelsior College School of Nursing

History of Excelsior History of Excelsior CollegeCollege

Founded in 1971 by New York State Board of Regents

Chartered by the Regents as an independent institution in 1998

Formerly Regents College Changed name in 2001 to

Excelsior College

History of the AD Nursing History of the AD Nursing ProgramProgram First faculty came together in 1970 Purpose was to block this

innovative model Once convinced of worthiness of

the model, faculty “made sure it was done right”

Faculty represented nationally known nurse leaders

40 year history of success Graduates exceeding 33,000

Excelsior College Excelsior College PhilosophyPhilosophy

What you know is more important than where or how you learned

it.®

Excelsior College MissionExcelsior College Mission

Expand educational opportunity with a particular concern for those historically underrepresented in higher education by focusing on the needs of the individual student and offering flexible, self-paced academic options.

Competency Based Competency Based EducationEducation

Learner focused rather than teacher focused

Documentation rather than assumption

Outcome focused rather than process focused

Competence rather than completion

Competency Based Competency Based Education is Based on Education is Based on

Principles of Adult LearningPrinciples of Adult Learning

Treat the learner as an adult Learners have individual learning

needs Learners are self-directed and

motivated Learners are responsible for their

own learning

Competence and Competence and CompetencyCompetency

Competence is defined as having the knowledge, skills and abilities required to perform the job.

Competency is defined as the ability to perform required skills in accordance with established standards.

Clinical Education ModelsClinical Education Models

Traditional- apprenticeship; focus on process of instruction and repetition, faculty drive the teaching and evaluation

Non-traditional- assessment, competency-based; focus on outcomes of learning

Traditional Clinical Evaluation Traditional Clinical Evaluation MethodMethod

Clinical grade equated with observed clinical competency

Use formative evaluations to make judgments about practice ability

Doesn’t address the demand for accountability in higher education- measurable outcomes

Competency Based Distance Competency Based Distance Nursing EducationNursing Education

Challenges: Changes way of thinking Need clear and specific language

related to evaluation criteria Pilot testing and working out the

“glitches” essential

Competency Based Distance Competency Based Distance Nursing EducationNursing Education

Opportunities:

Increase student and faculty satisfaction

Increase objectivity and minimize bias Responsive to demands for more

accountability

Criticisms of Competency Criticisms of Competency Based EducationBased Education

Grounded in behaviorist pedagogy (content driven curriculum with specific outcomes and objectives)

Focus on work related knowledge and skills at the expense of broader analytical skills

Difficult to justify liberal education in competency based model

How Excelsior College How Excelsior College Assesses Learning and Assesses Learning and

CompetenciesCompetencies Criterion referenced

-theory examinations that measure nursing knowledge

-performance examination that includes the use of simulations and real-time performance appraisal

Concepts and Concepts and PerspectivesPerspectives

Teaching versus Learning

Theory versus Performance

Evaluation versus Examination

Assumption versus Documentation

Completion versus Competence

Concepts of Performance Exam Concepts of Performance Exam vs. Traditional Clinical vs. Traditional Clinical

EvaluationEvaluation

Examination versus Instruction

Areas of Care versus Specific

Tasks

Critical Elements versus Steps in

Procedure

Concepts of Performance Exam Concepts of Performance Exam vs. Traditional Clinical vs. Traditional Clinical

EvaluationEvaluation

Objectivity versus Subjectivity

Sampling versus Total Content

Acceptability versus Ideal

Concepts of Performance Exam Concepts of Performance Exam vs. Traditional Clinical vs. Traditional Clinical

EvaluationEvaluation

Consistency versus Variability

Flexibility versus Rigidity Systematized Conditions versus

Spontaneous Arrangements

Clinical Performance in Clinical Performance in Nursing Examination Nursing Examination

(CPNE(CPNE®)®)

The capstone of Excelsior College’s external associate degree in nursing program.

Given over 2 ½ days in one of 21 testing sites throughout the country.

Students must successfully pass:– 4 Nursing Simulation Laboratories– 2 Adult Patient Care Situations (PCS)– 1 Pediatric Patient Care Situation (PCS)

CPNECPNE®® Domain of Nursing Domain of Nursing PracticePractice

Nursing Process/Critical Nursing Process/Critical ThinkingThinking

A problem solving that involves: Assessment Analysis Planning Implementation Evaluation

Areas of CareAreas of Care

Clusters of nursing activities that incorporate similar

principles or competencies.

Areas of Care (cont)Areas of Care (cont)

Overriding Areas of Care: Tested during the Patient Care Situations (PCS) and the Nursing Simulation Laboratory

Required Areas of Care: Tested in every PCS

Selected Areas of Care: Sampled throughout the PCSs. Medication administration must be tested at least once during the PCSs

Each Area of Care is comprised of critical elements

Critical ElementsCritical Elements

Single, discrete, observable behaviors used in measuring the student’s performance

Minimum requirements for beginning RN practice

CPNECPNE®® Roles – Clinical Roles – Clinical Associate (CA)Associate (CA)

Coordinates and supervises the administration of the CPNE

Ensures the CPNE is conducted in a manner consistent with the information published in the CPNE Study Guide

Reviews and verifies failures

CPNECPNE®® Roles – Student Roles – Student

Performs in a manner consistent with expected standards for ethical and professional practice.

Complies with the Academic Honesty Policy

Perform all aspects of the simulations and nursing care under the direct observation of the Clinical Examiner

CPNECPNE®® Roles – Clinical Roles – Clinical Examiner (CE)Examiner (CE)

Promotes a collaborative relationship with nursing staff

Orients the student to the nursing unit and equipment necessary to complete the PCS

Selects patients according to established guidelines

Acts as a silent observer. Observes student’s performance at all

times. Promotes positive neutrality Acts as a Patient Advocate

Clinical Examiner (CE) Clinical Examiner (CE) Training Training

Clinical Examiners undergo the same rigorous training, retraining and evaluation geared towards controlling bias and maximizing equitable treatment of the candidates.

Master’s prepared nurse educators, experienced in performance assessment and the administration of the CPNE, conduct the training..

Clinical Examiner Training Clinical Examiner Training (cont)(cont)

Training in offered in 3 phases and the CEs:– Are grounded in the principles of

performance assessment.– Learn the administration protocols for

the NSL stations and PCS.– Learn to differentiate between clinical

evaluation (focus on learning) and clinical performance assessment (systematic data collection via testing)

Clinical Examiner Training Clinical Examiner Training (cont)(cont)

– Learn the function and accurate use of the scoring tools.

– Learn to provide neutral and consistent communication

– Learn the expectations for dealing with both pass and fail circumstances.

CEs and CAs participate in the Annual Update during which changes in examination structure or process are reviewed and issues or concerns from test sites are discussed.

Excelsior College OutcomesExcelsior College Outcomes

Higher than average NCLEX first time pass ratefor 2004-2008

National average 86.34%Excelsior College 87.85%

Students perceive the program as rigorous yet very workable; it fits their lifestyle and they develop a strong sense of self-confidence as a result of their efforts

Costs/Benefits to a Costs/Benefits to a Competency Based Model of Competency Based Model of

EvaluationEvaluation Costs

-training of faculty examiners-quality assurance measures-ongoing research-letting go of what is familiar

and comfortable and doing things differently

Costs/Benefits to a Costs/Benefits to a Competency Based Model of Competency Based Model of

EvaluationEvaluation Benefits

-addresses issues of limited clinical placements

-addresses issues of faculty shortage-valid and reliable; minimizes opportunity for bias-student satisfaction

Summary- Competency Summary- Competency Based Distance Nursing Based Distance Nursing Education:Education:

Competency based curriculum Derived using expert educators

and practitioners

Focus on outcomes

Clearly articulated competencies

Summary- Competency Summary- Competency Based Distance Nursing Based Distance Nursing Education:Education:

Publicized expectations of learners Criterion referenced evaluation

methods

Remediation cycle

Learner centered

What Does the Research What Does the Research Say?Say?

The large majority of nurse supervisors surveyed rated the overall clinical competence of Excelsior College AD nursing graduates as the same or higher than other associate degree nurses (Gwatkin, Hancock, & Javitz, 2009).

What Does the Research What Does the Research Say?Say?

Mentor/preceptors rated the overall clinical competence of Excelsior College AD nursing graduates as slightly higher compared to other associate degree graduates (Darrah, & Humbert, 2009).

Darrah, M., Humbert, R. (2009). Excelsior College final evaluation report. ProEvaluators.

Gwatkin, L., Hancock, M., & Javitz, H. (2009). As well prepared, and often better: Surveying the work performance of Excelsior College associate degree in nursing graduates. SRI International.

both studies available via :www.excelsior.edu/excelsior_college/publications