Clinical Judgment on the Licensure Exam, Fewer Hospital Placements and an Older Population: Three Trends Reshaping a Practical Nursing Curriculum
[Student Name]
University of Phoenix
NSG/532: Innovative Curriculum Design
Week 4 Assignment
[Instructor Name]
[Date]
The college, the program and its circumstances are a composite written for a model paper.
In the first three weeks of this course, I examined the alignment of our practical nursing curriculum, proposed a stakeholder process and used student and faculty feedback to decide on changes. This paper steps back to look at the national trends that make those changes necessary and shape how they should be made. Three trends matter most for our program.
Trend 1: Clinical Judgment on the Licensure Exam
What it is. The national licensure examinations for registered and practical nurses now include items based on a clinical judgment measurement model. The model describes clinical judgment as a sequence of thinking steps, from recognizing and analyzing cues, through forming and ranking hypotheses and choosing solutions, to acting and then evaluating what happened. Items present unfolding case studies in which candidates must work through these steps rather than recall isolated facts.
Evidence. Dickison et al. (2019) described the model and how educators can integrate it with existing frameworks, noting that it aligns with established models of nursing judgment such as Tanner's and can be used to design teaching and assessment across a curriculum.
Implications for our program. The Week 1 map showed that our curriculum introduces judgment early and assesses it late but does not practice it in between, and our licensure item analysis showed weakness on judgment items. The trend makes the Week 3 decision to convert test items essential rather than optional. It also means that clinical post-conferences should use the model's steps, case studies in every course should unfold over time and faculty need development in writing judgment-based items. For a practical nursing program, the challenge is teaching judgment within the practical nurse's scope, focused on recognizing changes, acting within that scope and reporting, rather than on independent diagnosis.
Trend 2: Scarcity of Clinical Placements
What it is. Nursing programs compete for a limited number of clinical placements, and hospitals in our region have reduced placements for practical nursing students as they have reduced their employment of practical nurses. Faculty shortages add to the problem, since each clinical group requires an instructor.
Evidence. The national council of state nursing boards conducted a longitudinal, randomized study of prelicensure students in which up to half of traditional clinical hours were replaced with simulation. Students whose clinical hours were partly replaced with high-quality simulation, run by trained faculty with structured debriefing, achieved outcomes comparable to those of students in traditional clinical settings, including licensure pass rates (Hayden et al., 2014). The study involved registered nurse programs, and state boards set their own limits on simulation.
Implications for our program. The rebalancing of clinical hours toward long-term care, decided in Week 3, depends on long-term care sites accepting more students. Simulation offers a partial solution for the acute care hours we are reducing: scenarios on acute deterioration, sepsis recognition and emergency response can preserve acute care exposure without hospital placements. Any use of simulation must stay within our state board's limits, meet quality standards and include debriefing, and faculty would need simulation training.
Trend 3: An Aging Population and Long-Term Care Workforce Needs
What it is. The population of older adults is growing, and so is the number of people living with dementia and multiple chronic conditions. Long-term care and home health settings face persistent staffing shortages, and licensed practical nurses make up a large share of the licensed nursing workforce in those settings, often supervising nursing assistants and managing large resident groups.
Evidence. Our own graduate follow-up survey showed that nearly three in four respondents care for older adults outside hospitals, and their lowest preparation ratings were for dementia care, supervising nursing assistants and managing large groups. National competency statements for practical nursing graduates call for graduates who promote human flourishing and make judgments in varied settings, including those serving older adults (National League for Nursing, 2010).
Implications for our program. Gerontology must be threaded through every course, as decided in Week 3, and should include dementia care and behavioral symptoms, chronic disease over months rather than days, end-of-life care and the practical nurse's role in care planning. Leadership content should prepare graduates to supervise nursing assistants, delegate appropriately and manage a unit's work on a shift.
How the Trends Interact
The trends reinforce each other. Clinical judgment is best practiced in settings where students care for the same residents over time and notice subtle changes, which long-term care placements provide. The shift of placements to long-term care answers both the placement shortage and the workforce need. And simulation fills the acute care gap that the shift creates. Together they point to one curriculum design: judgment practiced in every course, clinical time concentrated where graduates will work and simulation for high-risk events students may not see.
A Fourth Trend to Watch: Competency-Based Education
A related trend is the move toward competency-based education, in which programs define the competencies graduates must demonstrate and assess them directly, sometimes allowing students to progress at different speeds. Baccalaureate education has moved in this direction with its national competency framework, and practical nursing programs may follow. Our program is not ready for a full competency-based model, which would require new assessment systems and state board approval, but the revision can move toward it by writing course outcomes as observable competencies and assessing them directly in clinical settings. That step also supports the licensure trend, since judgment is a competency best assessed through performance.
Issues to Manage
The trends also raise issues. Faculty who have taught acute care for years may need support to teach in long-term care settings and to write new test items. Long-term care sites may have fewer nurses available to support students, so instructors may need to be present more. Simulation requires equipment, space and trained staff that a small technical college may not have; a partnership with the regional hospital's simulation center is one option. Each issue will be addressed in the implementation plan.
What the Trends Mean for Faculty Roles
Together, the trends change what faculty do. Faculty will spend less time delivering content and more time coaching judgment in case studies and debriefings, more time in long-term care settings and some time in simulation. Recognizing this shift in faculty workload and development needs, and funding it, is part of planning a curriculum that responds to trends rather than only naming them. Faculty who are asked to teach differently without time or training to learn how will, understandably, teach the way they always have.
Conclusion
Clinical judgment on the licensure exam, the scarcity of clinical placements and the aging population are national trends with direct consequences for our program. Each supports the revision decided in Week 3, and together they point to a curriculum that practices judgment throughout, concentrates clinical time in long-term and community settings and uses simulation for acute events. Week 5 will examine delivery modalities and technology.
References
Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing clinical judgment model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72-78. https://doi.org/10.3928/01484834-20190122-03
Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2 Suppl.), S3-S40. https://doi.org/10.1016/S2155-8256(15)30062-4
National League for Nursing. (2010). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, master's, practice doctorate, and research doctorate programs in nursing.
How this NSG 532 Week 4 example is structured
The NSG/532 description asks learners to analyze current trends and issues in curriculum design. This paper treats each trend in the same way, what it is, the evidence behind it and its specific consequences for the program under revision, so that trends are tied to curriculum decisions rather than listed. Students search this week as NSG 532 Week 4, NSG532 Wk 4 or NSG/532 Wk 4; all three are the same assignment.
NSG/532 Week 4 questions, answered
What does NSG/532 Week 4 usually ask for?
The course description asks learners to analyze current trends and issues in curriculum design. Many sections ask students to examine several trends and explain their implications for a curriculum.
What is the clinical judgment measurement model?
A model developed for nursing licensure testing that describes clinical judgment as recognizing cues, analyzing them, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.
Can simulation replace clinical hours?
A national study found that replacing up to half of traditional clinical hours with high-quality simulation produced comparable outcomes, but state boards set their own limits, and quality standards must be met.
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