Competency Based Distance
Nursing Education: Clinical
Testing vs. Clinical Teaching
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Mary Lee Pollard, PhD, RN
Associate Dean
Kim Hedley, MS, RN, CPHQ,
Senior Program Director
Excelsior College School of Nursing
History of Excelsior College
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Founded in 1971 by New York State
Board of Regents
Chartered by the Regents as an
independent institution in 1998
Formerly Regents College
Changed name in 2001 to Excelsior
College
History of the AD Nursing Program
 First faculty came together in 1970
 Purpose was to block this innovative
model
 Once convinced of worthiness of the
model, faculty “made sure it was done
right”
 Faculty represented nationally known
nurse leaders
 40 year history of success
 Graduates exceeding 33,000
Excelsior College Philosophy
What you know is more important than
where or how you learned it.®
Excelsior College Mission
Expand educational opportunity with a
particular concern for those historically
underrepresented in higher education
by focusing on the needs of the
individual student and offering flexible,
self-paced academic options.
Competency Based Education

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Learner focused rather than teacher
focused
Documentation rather than
assumption
Outcome focused rather than process
focused
Competence rather than completion
Competency Based Education is
Based on Principles of Adult
Learning
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Treat the learner as an adult
Learners have individual learning
needs
Learners are self-directed and
motivated
Learners are responsible for their own
learning
Competence and Competency
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Competence is defined as having the
knowledge, skills and abilities required
to perform the job.
Competency is defined as the ability to
perform required skills in accordance
with established standards.
Clinical Education Models

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Traditional- apprenticeship; focus on
process of instruction and repetition,
faculty drive the teaching and
evaluation
Non-traditional- assessment,
competency-based; focus on outcomes
of learning
Traditional Clinical Evaluation Method

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Clinical grade equated with observed
clinical competency
Use formative evaluations to make
judgments about practice ability
Doesn’t address the demand for
accountability in higher educationmeasurable outcomes
Competency Based Distance
Nursing Education
Challenges:
 Changes way of thinking
 Need clear and specific language
related to evaluation criteria
 Pilot testing and working out the
“glitches” essential
Competency Based Distance
Nursing Education
Opportunities:
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Increase student and faculty
satisfaction
Increase objectivity and minimize bias
Responsive to demands for more
accountability
Criticisms of Competency Based
Education
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Grounded in behaviorist pedagogy
(content driven curriculum with
specific outcomes and objectives)
Focus on work related knowledge and
skills at the expense of broader
analytical skills
Difficult to justify liberal education in
competency based model
How Excelsior College Assesses
Learning and Competencies
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Criterion referenced
-theory examinations that measure
nursing knowledge
-performance examination that
includes the use of simulations and
real-time performance appraisal
Concepts and Perspectives
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Teaching versus Learning
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Theory versus Performance
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Evaluation versus Examination
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Assumption versus Documentation
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Completion versus Competence
Concepts of Performance Exam vs.
Traditional Clinical Evaluation
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Examination versus Instruction
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Areas of Care versus Specific Tasks

Critical Elements versus Steps in
Procedure
Concepts of Performance Exam vs.
Traditional Clinical Evaluation
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Objectivity versus Subjectivity
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Sampling versus Total Content
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Acceptability versus Ideal
Concepts of Performance Exam vs.
Traditional Clinical Evaluation
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Consistency versus Variability
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Flexibility versus Rigidity
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Systematized Conditions versus
Spontaneous Arrangements
Clinical Performance in Nursing
Examination (CPNE®)
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The capstone of Excelsior College’s external
associate degree in nursing program.
Given over 2 ½ days in one of 21 testing
sites throughout the country.
Students must successfully pass:
– 4 Nursing Simulation Laboratories
– 2 Adult Patient Care Situations (PCS)
– 1 Pediatric Patient Care Situation (PCS)
CPNE® Domain of Nursing
Practice
Nursing
Process/Critical
Thinking
Areas of Care
Comprised of
Critical
Elements
Psychomotor
Skills
Nursing Process/Critical
Thinking
A problem solving that involves:
 Assessment
 Analysis
 Planning
 Implementation
 Evaluation
Areas of Care
Clusters of nursing activities that
incorporate similar principles or
competencies.
Areas of Care (cont)
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Overriding Areas of Care: Tested during
the Patient Care Situations (PCS) and the
Nursing Simulation Laboratory
Required Areas of Care: Tested in every
PCS
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Selected Areas of Care: Sampled
throughout the PCSs. Medication administration
must be tested at least once during the PCSs
Each Area of Care is comprised of critical
elements
Critical Elements
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Single, discrete, observable behaviors used
in measuring the student’s performance
Minimum requirements for beginning RN
practice
CPNE® Roles – Clinical
Associate (CA)
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Coordinates and supervises the
administration of the CPNE
Ensures the CPNE is conducted in a
manner consistent with the
information published in the CPNE
Study Guide
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Reviews and verifies failures
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CPNE® Roles – Student
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Performs in a manner consistent with
expected standards for ethical and
professional practice.
Complies with the Academic Honesty
Policy
Perform all aspects of the simulations
and nursing care under the direct
observation of the Clinical Examiner
CPNE® Roles – Clinical
Examiner (CE)
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Promotes a collaborative relationship with
nursing staff
Orients the student to the nursing unit and
equipment necessary to complete the PCS
Selects patients according to established
guidelines
Acts as a silent observer.
Observes student’s performance at all
times.
Promotes positive neutrality
Acts as a Patient Advocate
Clinical Examiner (CE) Training
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Clinical Examiners undergo the same
rigorous training, retraining and
evaluation geared towards controlling
bias and maximizing equitable
treatment of the candidates.
Master’s prepared nurse educators,
experienced in performance
assessment and the administration of
the CPNE, conduct the training.
Clinical Examiner Training
(cont)
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Training in offered in 3 phases and the
CEs:
– Are grounded in the principles of
performance assessment.
– Learn the administration protocols for the
NSL stations and PCS.
– Learn to differentiate between clinical
evaluation (focus on learning) and clinical
performance assessment (systematic data
collection via testing)
Clinical Examiner Training
(cont)
– Learn the function and accurate use of
the scoring tools.
– Learn to provide neutral and consistent
communication
– Learn the expectations for dealing with
both pass and fail circumstances.
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CEs and CAs participate in the Annual
Update during which changes in
examination structure or process are
reviewed and issues or concerns from
test sites are discussed.
Excelsior College Outcomes
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Higher than average NCLEX first time pass
rate
for 2004-2008
National average 86.34%
Excelsior College 87.85%
Students perceive the program as rigorous
yet very workable; it fits their lifestyle and
they develop a strong sense of selfconfidence as a result of their efforts
Costs/Benefits to a
Competency Based Model of
Evaluation
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Costs
-training of faculty examiners
-quality assurance measures
-ongoing research
-letting go of what is familiar and
comfortable and doing things
differently
Costs/Benefits to a
Competency Based Model of
Evaluation
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Benefits
-addresses issues of limited clinical
placements
-addresses issues of faculty
shortage
-valid and reliable; minimizes
opportunity for bias
-student satisfaction
Summary- Competency Based
Distance Nursing Education:
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Competency based curriculum
Derived using expert educators and
practitioners
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Focus on outcomes
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Clearly articulated competencies
Summary- Competency Based
Distance Nursing Education:
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Publicized expectations of learners
Criterion referenced evaluation
methods
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Remediation cycle
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Learner centered
What Does the Research Say?
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The large majority of nurse
supervisors surveyed rated the overall
clinical competence of Excelsior
College AD nursing graduates as the
same or higher than other associate
degree nurses (Gwatkin, Hancock, &
Javitz, 2009).
What Does the Research Say?

Mentor/preceptors rated the overall
clinical competence of Excelsior
College AD nursing graduates as
slightly higher compared to other
associate degree graduates (Darrah, &
Humbert, 2009).
both studies available via :
www.excelsior.edu/excelsior_college/publications
Darrah, M., Humbert, R. (2009).
Excelsior College final evaluation
report. ProEvaluators.
Gwatkin, L., Hancock, M., & Javitz, H.
(2009). As well prepared, and often
better: Surveying the work
performance of Excelsior College
associate degree in nursing graduates.
SRI International.