From Hours to Outcomes: Moving a Baccalaureate Nursing Curriculum Toward Competency-Based Education
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Master of Science in Nursing Program, Aspen University
N584: Curriculum Development, Implementation and Evaluation
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Month Day, Year
From Hours to Outcomes: Moving a Baccalaureate Nursing Curriculum Toward Competency-Based Education
When a composite baccalaureate nursing program prepared its accreditation self-study, faculty could document how many credit hours and clinical hours each student completed, which courses covered which topics and how many students passed the licensure examination. What they could not document was what each graduate could reliably do. Clinical evaluation tools differed from course to course, and a student could pass every course while never being observed managing a deteriorating patient. The faculty began discussing whether to move the curriculum toward competency-based education.
This paper compares competency-based education with the time-based model most nursing programs use, explains how professional standards now push nursing education in that direction, describes what the change would involve for courses, assessment and progression, and proposes a phased plan for the program.
Two Models of Curriculum
In a traditional, time-based curriculum, the organizing unit is the course. Students progress by completing a set number of credit and clinical hours with passing grades, and competence is inferred from time spent and content covered. The model is familiar, administratively simple and compatible with semester schedules, but it assumes that equal time produces equal learning, and it often leaves the overall competence of graduates undocumented.
Competency-based education reverses the logic. Frank et al. (2010), writing about medical education, defined it as an outcomes-based approach to the design, implementation, assessment and evaluation of educational programs, organized around a framework of competencies, which de-emphasizes time-based training in favor of demonstrated ability. The curriculum begins with the competencies graduates must have, works backward to design learning experiences and assessments that develop and document them, and allows learners to progress when they demonstrate competence. Ten Cate (2013) added the idea of entrustable professional activities, units of professional work that can be entrusted to a learner once competence has been shown, which make competencies observable in practice.
Why Nursing Is Moving This Way
New Essentials adopted in 2021 explicitly call for competency-based education (American Association of Colleges of Nursing [AACN], 2021). Their ten domains cover what a nurse must know and do, including person-centered and population care, scholarship, quality and safety, interprofessional and systems practice, informatics, professionalism and personal leadership, and for each domain the document sets competencies and sub-competencies for entry-level and advanced-level practice. The domains are meant to be demonstrated, not merely covered. For a baccalaureate program, this shifts the accreditation question from "where is this topic taught?" to "how does the program know each graduate can do this?"
What Changes in the Curriculum
Three changes matter most. The first is curriculum mapping: every entry-level sub-competency must be mapped to the courses where it is introduced, practiced and assessed, which usually reveals gaps and redundancies. The second is assessment. Competency-based programs need assessments that observe performance in authentic tasks, such as simulated and clinical encounters scored with common tools across courses, portfolios that collect evidence over time and milestones that describe expected performance at each stage. A common clinical evaluation instrument used in every clinical course, rather than a different form for each, allows faculty to track a student's progress on the same competencies across the program.
The third change concerns progression. Pure competency-based education allows students to advance at different speeds, which conflicts with semester-based financial aid, faculty workloads and clinical placement schedules. Most nursing programs therefore adopt a hybrid: courses and semesters remain, but progression within and between them depends on demonstrated competencies, and students who have not yet demonstrated a competency receive targeted remediation and reassessment rather than simply a lower grade.
A Phased Plan for the Program
The program should move in phases over three years. In the first year, faculty map the current curriculum against the entry-level Essentials sub-competencies, identify gaps and select a small set of program-level entrustable activities, such as managing care for a group of patients during a shift, performing a focused assessment and escalating a concern, and administering medications safely to a patient assignment. In the second year, faculty develop and pilot a common clinical evaluation tool and a student competency portfolio in two clinical courses, calibrating raters and refining milestones. In the third year, the tool and portfolio extend to all clinical courses, and progression policies are revised so that demonstration of key competencies, not only course grades, determines readiness for the final practicum.
Faculty development runs throughout, since competency-based assessment requires skills many faculty have not used, and the program should involve clinical partners, who observe students daily and can help define what entrustable performance looks like.
Students also need to understand the change. Competency-based assessment asks them to collect evidence, reflect on their progress and seek feedback, habits that time-based courses rarely require. The program should introduce the portfolio in the first semester with clear examples, schedule advising conversations each semester around the student's competency profile and explain how remediation works, so that students see a competency not yet demonstrated as a step in learning rather than a failure. Early cohorts can be asked for feedback on the tools, which will improve them and give students a stake in the new curriculum.
Challenges and Evaluation
The transition carries real costs. Mapping and new assessments take faculty time, assessment of performance requires more observation than written examinations, and students and faculty may be uncertain during the change. The evidence base for competency-based education in nursing is still developing, much of it drawn from medical education, so the program should evaluate its own transition. Useful measures include the proportion of Essentials sub-competencies with at least one documented assessment, agreement between raters on the common clinical tool, students' progression and attrition, licensure pass rates and employers' ratings of new graduates' readiness.
Conclusion
A time-based curriculum can show what students were taught; a competency-based curriculum aims to show what graduates can do. The 2021 Essentials make that shift an expectation for professional nursing education, and competency-based education offers a model built for it, organized around outcomes, observed performance and progression by demonstrated competence. For the program that could count hours but not document competence, a phased, hybrid transition with shared assessment tools, portfolios and faculty development offers a practical path from hours to outcomes.
References
American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf
Frank, J. R., Snell, L. S., Cate, O. T., Holmboe, E. S., Carraccio, C., Swing, S. R., Harris, P., Glasgow, N. J., Campbell, C., Dath, D., Harden, R. M., Iobst, W., Long, D. M., Mungroo, R., Richardson, D. L., Sherbino, J., Silver, I., Taber, S., Talbot, M., & Harris, K. A. (2010). Competency-based medical education: Theory to practice. Medical Teacher, 32(8), 638-645. https://doi.org/10.3109/0142159X.2010.501190
ten Cate, O. (2013). Nuts and bolts of entrustable professional activities. Journal of Graduate Medical Education, 5(1), 157-158. https://doi.org/10.4300/JGME-D-12-00380.1
How this N 584 Module 2 example is structured
Aspen does not publish N584 module prompts, so check your classroom for the exact instructions. This example states the program's accreditation gap, contrasts the two curriculum models from foundational sources, explains why nursing standards now call for competency-based education, describes three curriculum changes, proposes a phased plan and addresses challenges and evaluation.
N584 Module 2 questions, answered
What does N584 Module 2 usually ask for?
Aspen's N584 description focuses on designing nursing curriculum using evidence-based theories and standards, so a paper comparing curriculum models and applying one to a program is a typical early assignment. Check your classroom for the models required.
What is competency-based education?
An outcomes-based approach in which a curriculum is organized around the competencies graduates must demonstrate, with assessment of observed performance and progression based on demonstrated competence rather than time alone.
What are the 2021 AACN Essentials?
The American Association of Colleges of Nursing's framework for professional nursing education, organized into ten domains with competencies at entry and advanced levels, and intended to be implemented through competency-based education.
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