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Simulation
Simulation experiences represent an important component of clinical education, serving as a
valuable augmentation to direct and indirect care within healthcare settings. Laboratory and
simulation experiences provide an effective, safe environment for learning and demonstrating
competencies. However, care experiences with actual individuals or groups continue to be the
most important component of clinical education. A landmark study conducted by the National
Council of State Boards of Nursing concluded that for pre-licensure students “substituting highquality simulation experiences for up to half of traditional clinical hours produces comparable
end-of-program educational outcomes” (Hayden et al., 2014, p. S3). Simulation cannot
substitute for all direct care practice experiences in any one sphere or for any one age group.
Also, simulation learning experiences should align with best practice standards such as those
developed by the International Nursing Association for Clinical Simulation and Learning (INACSL)
or the Society for Simulation in Healthcare (SSH). The use of simulation in the curriculum as
a replacement of direct patient clinical/practice hours or experiences is also determined by
requirements of regulatory entities (i.e., licensing and accrediting bodies).
Practice Synthesis Experience/Immersion
Development of competency attainment is facilitated through use of focused and sustained
practice experiences. Immersion experiences provide the learner with the opportunity to
integrate the Level 1 sub-competencies. Entry-level professional nursing programs (pre-and
post-licensure) must develop immersion or synthesis experiences that allow students to
integrate learning and gain experience that facilitates transition into practice. Such experiences
provide opportunities to enact principles of the nursing discipline and for building clinical
reasoning, management of care, and assessment of clinical outcomes. These opportunities
increase the student’s self-confidence, professional identity, and sense of belonging within
the profession. Immersion experiences also allow students to integrate previous learning and
demonstrate competencies in more complex situations and contexts. Immersion experiences
may afford the student an opportunity to focus on a population of interest and clinical role. The
immersion experience may occur towards the end of the program as a culminating synthesis
experience; and/or there may be one or more immersion experiences at various points in a
curriculum. The key is to provide for a concentrated practice experience that approximates
professional practice expectations (Fowler et al., 2018; Tratnack et al., 2011).

Advanced-Level Nursing Education
Nursing programs preparing nurses to advance their education beyond entry-level professional
nursing practice will incorporate advanced-level nursing education (Level 2) sub-competencies.
Advanced-level nursing education programs (degree granting and advanced nursing practice
post-graduate certificate programs) intentionally build on Level 1 sub-competencies. Although
Level 2 sub-competencies have been written with doctoral education in mind, the actual
differentiator for the degree attained does not lie within the sub-competencies themselves, but
rather the degree/program requirements – such as the DNP project (described below), role/
specialty requirements, and other requirements set by the faculty and institution. While it is
not expected that every sub-competency and concept will be applied in every course, subcompetencies are not to be isolated in one or two courses and then disregarded for the rest of
the program.
THE ESSENTIALS: CORE COMPETENCIES FOR PROFESSIONAL NURSING EDUCATION 21