Better, Not Yet Good Enough: A Data-Driven Revision Proposal After the First Cohort of the Redesigned Accelerated BSN, Focused on Delegation, Pharmacology and Clinical Coaching
Student Name
American College of Education
NUR5233: Curriculum Development, Assessment, and Evaluation in Nursing
Module 6 Assignment
Instructor Name
August 15, 2028
Results Against Targets
The first cohort to complete the redesigned curriculum graduated in May, and the evaluation plan's measures are now available for most outcomes. Completion within 24 months was 89%, above the target of 85%. The first-time licensure pass rate was 90.2%, above the previous three-year average of 88% but below the program's target of 92%. Among the program outcome measures, the capstone clinical evaluation found 84% of students at the proficient level for clinical judgment, below the target of 90%, and the six-month employer survey, returned by 38 of 48 managers, rated 72% of graduates at or above the expected level for setting priorities and recognizing deterioration, below the target of 80%. The population health, evidence-based practice and professional development outcomes met their targets. Under the plan's trigger rules, the three missed targets are first-year misses and require an analysis and a committee decision rather than a mandatory action plan, but they point in the same direction, and the task force recommends acting now.
The results are encouraging. The previous curriculum's graduates had no employer survey at all, and the pass rate has risen. The redesign moved the program in the right direction; the data show where it stopped short.
What the Data Point To
The task force examined three sources to find where the shortfalls arise. The licensure examination's program report, which breaks results down by content area, showed the cohort performing below the national mean in two areas: management of care, which includes delegation, prioritization and assignment, and pharmacological therapies. Performance in physiological adaptation and in reduction of risk potential was at or above the mean, which suggests the integrated clinical judgment courses are working.
The capstone clinical evaluation data showed that most students rated below proficient fell short on one rubric element: delegating tasks to assistive personnel and following up. Preceptors' comments repeated the point; students tended to do everything themselves, which worked for three patients and failed for five. The employer survey's free-text comments said the same, adding that new graduates were hesitant to call providers about changes in condition.
The curriculum map explained why. Delegation and assignment are introduced in the third semester and assessed for mastery in the capstone, but between them there is only one simulation in which students work with an assistive person. Pharmacology is well integrated in the first two semesters through the Foundations courses, but the third and fourth semester courses assume it rather than revisiting it, and the weekly mechanism-prediction items stop after the second semester.
Three Proposed Changes
First, a delegation and multi-patient simulation thread. In the third and fourth semesters, each student will complete four simulations in which they manage three to five simulated patients with an assistive person and a provider available by phone, practicing assignment, delegation, follow-up and escalation. The simulations will replace an equivalent amount of acute care clinical time in those semesters. The national simulation study provides support for this substitution: in a randomized, controlled study across ten prelicensure programs, students who had up to 50% of their traditional clinical hours replaced by high-quality simulation had outcomes comparable to those of students with traditional clinical experience, including clinical competency ratings and licensure pass rates (Hayden et al., 2014). The simulations will follow the standards used in that study, with trained facilitators and structured debriefing.
Second, a continuing pharmacology thread. The mechanism-prediction quiz items from the Foundations courses will continue weekly in the third and fourth semesters, applied to the drugs used for the conditions studied in those courses, and each clinical judgment worksheet will include a medication section asking students to predict the monitoring each patient's drugs require. This extends a method that already works in the first year rather than adding a separate course.
Third, clinical coaching development. Part-time clinical instructors supervise most students in the capstone, and several told the task force they were unsure how to coach delegation rather than simply allowing students to do everything. A four-hour workshop, followed by one observed coaching session per instructor each semester, will prepare them to use the clinical judgment rubric and to coach delegation and escalation explicitly.
Resources and Implementation
The simulations require about 160 hours of simulation center time per cohort, within the center's unused capacity identified in Module 1, and two trained facilitators, drawn from current faculty whose clinical supervision hours decrease as simulation replaces clinical time. The pharmacology items require roughly 40 hours of faculty time to write and review, using the item-writing rules from Module 4. The coaching workshop requires funding for part-time instructors' attendance, estimated at 6,400 dollars a year. The changes can be implemented for the next cohort's third semester, in September, if the curriculum committee approves them this month. Because they change clinical hours, the school will notify the state board of nursing as its regulations require.
Sharing the Results and the Proposal
Evaluation data are most useful when the people who produce and use them see them. Lewallen (2015) emphasizes gathering data from students, graduates, alumni and employers and organizing the evaluation process so that results reach those who can act on them. The task force will therefore share this proposal, and the data behind it, in three places before the curriculum committee votes. The full faculty will receive the results table and the analysis at the September faculty meeting, including the finding that the integrated Foundations courses appear to be working, because faculty who built those courses deserve to know it and because the proposed changes ask the third and fourth semester teams to extend their methods. Members of the advisory board, among them the hospital nursing executives who sent the employer survey to their managers, will see the survey results and the proposed response, closing the loop on the concern that began the redesign. And the current students will hear a short summary from the associate dean, because the changes will affect their third and fourth semesters and because students who see that their feedback and performance data lead to changes are more likely to complete evaluations honestly in the future. Each audience will be asked the same question: does this proposal address what you see? Their answers will be reported to the curriculum committee with the proposal.
Judging the Revision
The changes will be judged with the evaluation plan's existing measures, so no new data collection is needed. The targets remain the same: 92% for the first-time pass rate, 90% proficient on the capstone clinical judgment evaluation and 80% of employer ratings at or above expected level. In addition, the committee will watch the licensure program report's management of care and pharmacological therapies scores and the delegation element of the capstone rubric, the specific measures the changes aim to move. The committee will review the results with the second cohort's data next September and decide whether further revision is needed. Keating and DeBoor (2018) describe curriculum development and evaluation as a continuous cycle rather than a periodic event, and this proposal is the first turn of that cycle for the redesigned program.
References
Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2, Suppl.), S3-S40. https://doi.org/10.1016/S2155-8256(15)30062-4
Keating, S. B., & DeBoor, S. S. (Eds.). (2018). Curriculum development and evaluation in nursing education (4th ed.). Springer Publishing.
Lewallen, L. P. (2015). Practical strategies for nursing education program evaluation. Journal of Professional Nursing, 31(2), 133-140. https://doi.org/10.1016/j.profnurs.2014.09.002
How this NUR 5233 Module 6 example is structured
NUR 5233 Module 6 frequently closes with a curriculum revision proposal driven by evaluation data; your classroom's instructions decide the audience and format. This example summarizes results against targets, analyzes the causes of shortfalls using the curriculum map and assessment data, proposes specific changes with evidence and rationale, describes implementation and resources, and states how success will be judged.
NUR5233 Module 6 questions, answered
What does NUR5233 Module 6 usually ask for?
NUR5233 Module 6 frequently asks for a curriculum revision proposal based on program evaluation data: what the data show, where the curriculum falls short and what should change, with evidence and a plan for measuring the effect. Your classroom's instructions decide the audience and format.
How do I connect evaluation data to curriculum changes?
Use more than one source to locate the problem, then use the curriculum map to find where in the curriculum it arises. Propose changes at that point rather than general additions.
Can I propose replacing clinical hours with simulation?
Yes, if you cite the evidence, follow your state board of nursing's rules and describe how the simulations will meet recognized standards. State the proportion of hours replaced.
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