Beginning, Developing, Accomplished: A Program-Level Plan to Assess Clinical Judgment in Every Semester With One Rubric, Level Targets, Case Items and a Portfolio That Shows Growth
Student Name
American College of Education
NUR6043: Fostering Clinical Judgment Through Curriculum and Evaluation
Module 5 Assignment
Instructor Name
October 7, 2030
What the Plan Must Do
Module 1 proposed that our curriculum use Tanner's model to structure clinical judgment across four semesters, with each semester emphasizing one aspect while practicing all four. An assessment plan must match that design. It must assess all four aspects in every semester, show whether students progress from one semester to the next, give students feedback they can use and give the program evidence that the curriculum works. Our current assessments do none of this: each course uses its own clinical evaluation tool, clinical judgment appears only as a general item, and examination items are almost entirely recall and simple application.
The plan also has to be affordable in faculty time. Assessing 110 students a semester with a detailed rubric in both simulation and clinical settings is a real workload, and a plan that asks too much will be completed carelessly, which is worse than not completing it. The design below keeps the number of rated events to three per student per semester and uses the same rubric throughout, so that faculty learn one instrument well rather than several poorly.
One Rubric Across the Program
The center of the plan is one instrument used in every semester: the Lasater Clinical Judgment Rubric, which Lasater (2007) built from Tanner's model while observing students in simulation. It describes development in each of the four aspects across eleven dimensions, such as focused observation, recognizing deviations from expected patterns, prioritizing data, calm and confident manner, clear communication and commitment to improvement, at four levels: beginning, developing, accomplished and exemplary. Because it is built on the same model as the curriculum, its results can be read directly against the semester emphases.
The rubric has reliability evidence when raters are prepared. Summarizing three approaches to its psychometrics in simulation, Adamson et al. (2012) reported an interrater reliability of 0.889 using an intraclass correlation in one study, percent agreement between 92% and 96% in a second and levels of agreement ranging from 57% to 100% in a third, and concluded that the findings supported the validity of the rubric for assessing clinical judgment in simulated patient care. The range in the third study is a warning that agreement depends on how raters are trained and how the rubric is used.
Targets by Semester
Using one rubric for four semesters only makes sense if expectations rise. The committee set target levels for each semester, reflecting both the overall progression and the semester emphasis. By the end of semester one, students are expected to reach developing on the noticing dimensions and beginning or developing on the others. By the end of semester two, developing on all dimensions, with interpreting dimensions such as making sense of data at developing or above. By the end of semester three, accomplished on responding dimensions such as calm and confident manner and clear communication, and developing or above on the rest. By graduation, accomplished on all dimensions, with reflecting dimensions such as evaluation and self-analysis at accomplished. No target is set at exemplary, which describes experienced nurses. A student rated accomplished in semester one is not a prodigy; it is a sign that the rater has not understood the scale.
The rubric will be used in two settings each semester: one simulation scored by trained faculty, and the clinical rotation, scored by the clinical instructor at midterm and at the end. Simulation gives a controlled, comparable measure across students; clinical ratings show performance with real patients, though with less consistency.
Examination Items and the Portfolio
The rubric assesses judgment in performance; examinations can assess it in reasoning. Each course's examinations will include case-based item sets written to the NCSBN Clinical Judgment Measurement Model, whose cognitive operations can be targeted by specific items (Dickison et al., 2019). The proportion of case-based items will rise from 20% of examination items in semester one to 50% in semester four, matching the licensure examination's emphasis as students approach it.
Each student will keep a clinical judgment portfolio across the program: the rubric ratings from each semester's simulation and clinical rotation, the scores on case-based items, and one written reflection per semester analyzing a clinical situation using Tanner's four aspects. In the final semester, the student and the capstone faculty review the portfolio together and identify the student's strongest and weakest aspects, which become goals for the student's first year of practice.
One Student Across Four Semesters
An illustration shows how the pieces fit for one student. In semester one, a composite student's simulation ratings are developing on focused observation and recognizing deviations, meeting the noticing target, but beginning on making sense of data. Her clinical instructor notes that she collects thorough assessments but reports them as lists. Her case-item scores are average. The portfolio reflection describes a patient whose confusion she recorded but did not connect to his low sodium. In semester two, her interpreting ratings rise to developing, meeting the target, after concept maps in the adult health course; her case-item scores on analyzing cues improve, but those on prioritizing hypotheses remain low. The remediation conversation focuses on ranking explanations rather than listing them.
In semester three, her responding ratings reach accomplished on clear communication but only developing on calm and confident manner; in the deterioration simulation she chose the right action but hesitated for two minutes before calling for help. The instructor's feedback and a second, focused simulation address escalation. By graduation, her ratings are accomplished on all dimensions, and her capstone reflection analyzes a moment when she noticed a subtle change in a postoperative patient, interpreted it as early bleeding and escalated promptly, and then reflected on what she would have missed two years earlier. Her portfolio review identifies escalation under uncertainty as her goal for the first year of practice.
The illustration shows what the plan makes visible that the current assessments do not: which aspect of judgment is lagging, when it improves and what teaching helped. The same data aggregated across a cohort show the program where its teaching is working.
Rater Training and Use of Results
Given the variable agreement found in the psychometric work, rater training is essential. Every faculty member who uses the rubric will complete a two-hour calibration session each year, rating three recorded simulations independently, comparing ratings and discussing differences until they agree on how each dimension's levels look in practice. In each simulation, a second rater will score 20% of students, and agreement will be reported to the committee each semester; if agreement for any dimension falls below 80%, that dimension will be the focus of the next calibration.
Results will be used at two levels. For students, rubric ratings below the semester target will trigger a remediation conversation and a focused simulation before the next semester, rather than failure. For the program, the proportion of each cohort meeting targets in each semester will show where the curriculum is building judgment and where it is not. If many students miss the interpreting targets in semester two, for example, the concept courses in that semester will be reviewed. The plan's purpose is not only to grade judgment but to show where teaching needs to change.
References
Adamson, K. A., Gubrud, P., Sideras, S., & Lasater, K. (2012). Assessing the reliability, validity, and use of the Lasater Clinical Judgment Rubric: Three approaches. Journal of Nursing Education, 51(2), 66-73. https://doi.org/10.3928/01484834-20111130-03
Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72-78. https://doi.org/10.3928/01484834-20190122-03
Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. https://doi.org/10.3928/01484834-20071101-04
How this NUR 6043 Module 5 example is structured
NUR 6043 Module 5 commonly plans assessment of clinical judgment across program levels; your classroom's instructions decide the tools. This example chooses instruments grounded in the program's model, reports their psychometric evidence, sets expected performance by level, combines several methods, plans rater training and describes how results will be used for students and the program.
NUR6043 Module 5 questions, answered
What does NUR6043 Module 5 usually ask for?
NUR6043 Module 5 commonly asks you to plan how clinical judgment will be assessed across the levels of a nursing program, with instruments, expected performance and use of results. Your classroom's instructions decide the tools.
Which instrument assesses clinical judgment?
The Lasater Clinical Judgment Rubric, built on Tanner's model, is widely used in simulation and clinical settings and has published reliability evidence when raters are trained.
How do I show progression across levels?
Use the same instrument throughout, set rising target levels for each semester, and collect results in a portfolio that follows each student to graduation.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official American College of Education document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.