Letter to the Editor.

Dear Dr. Waldrop,

As the demand for advanced practice registered nurses (APRNs) rises, so has the demand for more efficient, streamlined, and standardized models of educational preparation for APRN students to ensure safe and competent practice. The National Organization of Nurse Practitioner Faculties and certifying bodies, such as the Pediatric Nursing Certification Board, establish competencies and certification requirements for pediatric primary and acute care pediatric nurse practitioners. However, integration and evaluation of these competencies into the educational curriculum is not well defined.

The demand for a competency-based curriculum that further integrates knowledge and skills into measureable outcomes is ever increasing. With decreasing access to clinical sites and availability of preceptors, the student experience may not include exposure to the variety of diagnoses and management required to demonstrate clinical competency. Challenges due to the COVID-19 pandemic and a decrease in economic resources exacerbate this situation. Additionally, the increase in the number of online programs may limit direct faculty evaluation of the clinical site and preceptor–student interaction. A competency-based framework is required that defines, prioritizes, integrates, and evaluates student competency to prepare them for clinical practice.

Competency-based models of nursing education have been presented in the literature, but there are a paucity of articles discussing the implementation of this type of framework across the multiple nurse practitioner specialties. Halas and colleagues acknowledged that clinical hour requirements do not translate to exposure to all core competencies for beginning practice, and some students may require an increase in hours or varied experiences to attain a competency. Medical models focusing on competency-based education have been well received. The National Organization of Nurse Practitioner Faculties core and population-focused nurse practitioner competencies are a starting point. Competency-based models need to be further developed to ensure that graduating students have attained clinical competency.

This competency-based curriculum must be compatible with the broad needs of schools of nursing, students, and stakeholders. It must consider limitations in the assessment of clinical competencies through direct patient care and meet the needs of APRN students, faculty, clinical preceptors, patients, and the health care system. More specifically, prioritization of didactic, clinical and simulation curriculum is required to provide the framework for program development that considers the needs of an entry-level nurse practitioner. Employers hold expectations of entry-level competencies upon hire, and a competency-based model could standardize common procedures and evidence-based diagnosis and treatment of common conditions. APRN specialties, including midwifery and nurse anesthesia, have incorporated competency-based curricula into their educational programs.

Nursing faculty must be knowledgeable in the application of a competency based curriculum and have tools available for implementation and evaluation of this model. Prioritization of competencies with appropriate evaluation methods that guide learning would facilitate this process. Standardized curricula, supported by certifying boards, can promote models of educational excellence. Providing guidance for educational planning would decrease the burden on faculty and provide a foundation for implementation across campuses nationwide for competent entry into practice.

As faculty work to develop and refine standardized competencies for pediatric nurse practitioner education, we encourage a review of best practices within all APRN specialty programs.

Regards,