The Shift Toward Competency-Based Education
Introduction
The challenge of preparing novice nurses to deliver safe, effective care is not new. New graduates, faculty and practice partners alike have all recognized that safety should be the hallmark of a nurse entering the profession- regardless of their practice setting. However, in today’s complex health care environment, accurately assessing whether a novice nurse is truly prepared is no simple task. With increasing patient acuity, expanding scopes of practice, and evolving healthcare roles, nursing education must continuously adapt to ensure graduates have the necessary capabilities for real-world practice. For the last 25 years, a variety of efforts have been made by the profession to quantify specific competencies essential for nurses. Table A gives examples of efforts to evaluate the behaviors of a competent nurse in various roles and settings.
Table A: Selected Efforts to Support Integration of Nursing Competency into Practice
Current literature suggests the Nurse Competency Scale (both the original and shortened version) is the most commonly used self-assessment instrument to measure the generic competence of registered nurses. The scale, based on Benner’s from Novice to Expert model, is used to evaluate the nurse’s ability to integrate knowledge, skills, attitudes, and values in specific context. The nursing behaviors identified in the scale includes the nurse’s helping role, teaching-coaching, diagnostic functions, managing situations, therapeutic interventions, ensuring quality, and worker role. (Meretoja, et. al, 2004).
The Shift Toward Competency Based Nursing Education
In response to the 2021 of American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education, many baccalaureate and graduate nursing programs seeking accreditation by the Commission on Collegiate Nursing Education (CCNE) today are in the process of integrating Competency Based Education into their curriculum. AACN recognizes that complete integration of these competencies into baccalaureate and graduate education will take time. As a result, the AACN website has a plethora of resources to help faculty make the transition.
Other accrediting bodies also support using identified competencies as measures for evaluation. For example, in Standard VC, the Commission on Nursing Education Accreditation (CNEA) states that “Program curriculum is sequenced, designed, and implemented to progressively support student achievement of learning outcomes and acquisition of relevant competences (Shellebarger, 2022). Similarly, the Accreditation Commission for Education in Nursing (ACEN) defines competence assessment as the systematic evaluation of nursing students’ ability to demonstrate mastery of critical nursing skills, knowledge and behaviors, as defined by ACEN Standards, through various assessment methods (exams, simulations, clinical practice, evaluation and self-reflection) to insure they are prepared for professional practice upon graduation. In addition, many nursing professional organizations, such as the Emergency Nurses Association, National League for Nurses, American Medical Surgical Nurses, and American Organization of Nurse Leaders have designated core competencies for nurses working in their specialty, further emphasizing the shift toward competency-based assessment.
Differentiation of Terms
For educators beginning the process of integrating competences into your curriculum, a strong starting point is establishing clear definitions. Table B provides key distinctions among terms such as competence, competencies, and competence-based education, all of which will be helpful in your journey to ensure that your new graduates (at any level) are prepared to practice safely in their new roles post program completion.
Table B: Competency Definitions
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These definitions provide the building blocks for integrating the assessment of student competences into the educational process. While some educational programs use a time-variable approach in determining when students must demonstrate specific criteria for particular competencies- most still organize content by courses laid out by semesters or terms. The AACN, in moving to a competence-based approach, does not expect programs to move to time-variable education, believing that student competence can be identified through course learning outcomes.
Principles of Competence-Based Education
The process of defining the behaviors required to demonstrate competence in a particular area is critical to establishing a foundation for nursing education curriculum. (Fukada, 2018). However, this process requires thoughtful planning and execution. The two key principles guiding successful competency-based curricula are below.
What’s Next?
Implementing competency-based nursing education requires a concerted effort, but resources are available to support faculty in this process. Throughout 2025, Collaborative Momentum Consulting will provide additional tools and guidance to help nursing educators effectively integrate competency-based strategies into their programs.
By embracing competency-based education, nursing programs can ensure that new graduates enter the workforce not just with theoretical knowledge, but with the practical skills and confidence to provide safe, high-quality patient care from day one.
Good luck on this adventure! I look forward to walking this journey with you.
Susy
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We provide tailored nursing education consulting services to programs across the U.S., helping you achieve better outcomes and address key challenges. Contact us today to discover how we can support your program’s success.
References
Fukado, M. (2018) Nursing Competency: Definition, Structure and Development Yonago Acta Medical Journal of Medical Science. March 28. 61(1) 1-7.
Johnstone, SM, Soares. L. (2014) Principles for developing competency-based education programs. Change: The Magazine for Higher Education. 46(2). https://www.tandfonline.com/doi/full/10.1080/00091383.2014.896705#d1e163. Accessed, 2025
Meretoja, R., Isoaho, H., Leino-Kilipi, H., (2024) Nurse competency scale: Development and psychometric testing. Journal of Advanced Nursing. 47(2) 124-133.
Shellenbarger, T., (2022) Accreditors stepping up to the future-Reimagining the future of Nursing,Teaching-Learning in Nursing. April 15. (17(3) 253-256.
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