By Lindsey Luther, DNP, FNP-C, CNE

New academic standards for nurse practitioner programs have moved competency-based education, curriculum relevance, and increased clinical practice experiences into priority focus. Meeting these and other requirements in the 2022 Standards for Quality Nurse Practitioner Education (NTF Standards, 6th edition) requires faculty to rethink and reshape multiple aspects of education programs. This article is the first in a series that provides information on how faculty can take these steps.

Setting the framework for the future of NP education

The 2022 NTF Standards were developed by the 6th National Task Force on Quality Nurse Practitioner Education, which consisted of 19 member organizations invested in improving nurse practitioner program outcomes. The National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) served as facilitators for the panel’s work, which incorporated input from certification boards and specialty associations for nurse practitioners. Find an overview of the standards in this NP Insider article published in 2022.

Significant national influences on nursing education are reflected in the NTF Standards. They include the:

• APRN Consensus Model
• movement toward competency-based education
• value of interprofessional experiences
• increasing role of simulation in healthcare education
• integration of diversity, equity, and inclusion (DEI) in nursing education.

These influences and other factors helped shape the task force decision to require NP programs to adhere to standards for mission and governance, resources, curriculum, and evaluation. The NTF Standards apply to all NP education programs, regardless of academic degree or population focus area.

Standard I: Mission and Governance

The first standard requires NP programs to:

• ensure program alignment with the institution’s mission and values
• implement and provide evidence of DEI practices at the institution
• appoint track leads who are certified in their track specialty.

Each NP program should be able to demonstrate how it interweaves the institution’s mission and values into the curriculum, and that the workload for NP faculty is appropriate and includes support for clinical practice.

Standard I also states that an NP academic program should be an integral part of the community that it serves. Demonstrating this might include asking patients from the community to give feedback about the quality of NP graduates, or inviting comments from administrators from the hospitals where students perform clinical hours.

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Standard I ⮕ 3 steps to get started

1. Aggregate feedback from community stakeholders (e.g., preceptor evaluations of students, alumni surveys, etc.)
2. Ensure that each NP population track has a faculty lead with the appropriate credentials.
3. Represent the college of nursing by participating in institutional governance councils or committees.

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Individual faculty members have responsibilities in several areas identified in Standard I. For example, faculty can help identify stakeholders in the community, participate in planning and governance, and evaluate clinical practice experiences that contribute to measurable learning outcomes.

Another element of Standard I is a new requirement for feasibility planning of proposed NP tracks. Programs will have to demonstrate the need for new tracks — as well as the availability of faculty members and preceptors for them. This will limit the opening of NP tracks that are not sustainable.

With regard to policies and procedures at an institution, Standard I requires that policies and procedures for absences, grading, and other education activities are accessible and are communicated clearly.

Standard II: Resources

The second standard requires that NP programs have sufficient fiscal resources to support students, staff, faculty, and program operating expenses, and that programs have sufficient and appropriate preceptors, clinical sites, technologies, and faculty to support the clinical progression of students.

Standard II provides clear guidelines about faculty-to-student ratios. Programs must demonstrate that when enrollments rise, they have a pool of adjuncts or other faculty to meet teaching needs at that time and for students in the pipeline.

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Standard II ⮕ 3 steps to get started

1. Recruit and mentor new NP faculty to ensure they have adequate support. Notify your program director or administrator of any gaps in the orientation process.
2. Identify and evaluate resources for student remediation and support, including library and electronic resources, student health and wellness resources, and new learning technologies.
3. Schedule a meeting with the student-preceptor dyad at the beginning of the clinical practicum to set individualized goals for student learning.

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Individual faculty will be called on to help meet Standard II in several ways. They can recommend friends and colleagues to fill faculty gaps, help ensure that new faculty are properly recruited, oriented, and mentored, and attest to whether the institution adequately supports faculty in all aspects of their roles. In addition, faculty will be tasked to help identify appropriate clinical sites for students.

Documentation is another area where faculty members will provide key support. Recording and storing details about site visits, cataloging program resources, and filing syllabi in appropriately secure locations help ensure that accreditors can view resources required for accreditation.

Standard III: Curriculum

The third NTF standard requires the most substantive changes because it addresses the core of every program: curriculum. Faculty members will be key in designing, reviewing, and revising curriculum to ensure it meets the new requirements.

For curriculum, Standard III requires that:

• the curriculum is relevant to NP standards and competencies
• courses are sequenced to promote clinical readiness
• guidance is established for dual-track and postgraduate programs
• the curriculum includes interprofessional education experiences.

For clinical practice experiences, Standard III requires:

• a minimum of 750 hours of direct patient care in the student’s specialty
• academic-practice partnerships that provide clinical experiences.

To meet these standards, NP faculty will need to demonstrate:

• how curriculum correlates with standards and competencies for NP practice
• the rationales for how courses are sequenced
• student completion of required clinical hours and interprofessional hours.

Academic-practice partnerships will be integral to the structure of competency-based learning. They can include preceptorship models and flexible practicum planning.

Why the emphasis on competency-based education?

The NTF emphasis on competency reflects an overall goal for nursing preparation at all levels: competency-based education (CBE). This change will require NP faculty to create learning experiences that are competency-based, not time-based.

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Standard III ⮕ 3 steps to get started

1. Identify whether your program’s curriculum provides the 750-hour minimum for direct patient care hours. If not, work with your program director to develop a plan for expanding clinical hours.
2. Review your institution’s policies related to curriculum revision. In particular, identify what changes require formal approval through a curriculum committee or other governance structure.
3. Consider how depth, breadth, and type of clinical experiences are evaluated within your current program.

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The American Association of Colleges of Nursing (AACN) formalized the goal of CBE in The Essentials: Core Competencies for Professional Nursing Education in 2021. CBE is an education approach that has existed since 1997 — when it was pioneered at Western Governors University — but it has not been used in many nursing programs. As the AACN Essentials and the NTF Standards progress to implementation, all RN and NP programs will incorporate CBE.

To meet CBE requirements, NP faculty will be tasked with determining ways to assess competency. An assessment of competency cannot be performed in isolation. Instead, faculty must look for behaviors that represent competency and assess them. Faculty will identify the behaviors of a competent NP and then match them with assessments that demonstrate whether the student has those behaviors.

Academic-practice partnerships will be important in determining competencies when students perform their clinical hours. These partnerships can help avoid the gaps and backlogs that can occur when clinical placements are made at a range of locations. When an academic program enters into a contract with a hospital or other clinical setting, the process should be smoother and produce the necessary competency evaluations.

To help NP programs meet the CBE requirements, the National Organization of Nurse Practitioner Faculties (NONPF) formed a work group to draft a competency implementation guide for faculty. The final version of the guide is expected later in 2024.

Another difference introduced in the curriculum standard is in simulation, a longstanding teaching tool whose definition and execution can vary among institutions. The NTF Standards specify that simulation cannot replace direct patient care hours. This could create challenges for programs that have difficulty providing enough clinical hours to cover every clinical area.

For example, for an FNP student who needs a few more hours with pediatric patients, a program might allow the student to perform a simulated pediatric exam to demonstrate their ability to provide a safe encounter. When the NTF Standards are in effect, this is not likely to be acceptable.

To meet Standard III, programs will identify the depth and breadth they consider adequate for clinical experiences. How these parameters are set will depend on the institution’s policies.

Standard IV: Evaluation

The fourth and final NTF standard addresses outcomes evaluation. It requires faculty to examine whether students are meeting the program’s stated learning objectives, whether the curriculum is mapped and up to date (avoiding drifting), and more.

Curricular consistency is a starting point for faculty in meeting this standard. This is an opportunity to use backward design, a technique commonly used in competency-based methodology. In backward design, the desired learning outcomes guide the selection of teaching and evaluation strategies. Assessments are selected based on how well they capture the desired learning outcomes; learning activities are then chosen to prepare students for the assessment. The focus of backward design is on authenticity to the real-world application of knowledge and skills.

Curriculum mapping is a first step to ensuring that a program is meeting its learning objectives. In this process, faculty members focus on each course and determine how its contents link back to the outcomes expected. Consider: How does this link to the assignments that students are doing, and how does it link to their exam at the end of the semester? (For more information on curriculum mapping, see this article.)

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Standard IV ⮕ 3 steps to get started

1. Document the use of stakeholder feedback in the revision of courses and the curriculum as a whole. Course evaluations by students and faculty should be accessible and timely to allow for the integration of feedback into upcoming courses.
2. Engage preceptors and students in the development of student-centered learning experiences designed to progress the student towards mastery of specific skills or concepts.
3. Review the program curriculum, course materials, and policies to ensure that they meet best practices for diversity, equity, and inclusion (DEI). The DEI review should be multifaceted, looking at the holistic institutional environment, the structure of the NP program, and the content within individual nursing courses.

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The outcomes for each course should reflect the core competencies for nurse practitioners and the advanced-level nursing essentials. As each student progresses through a program, competency levels must increase. At the beginning of a program, they sometimes meet the competencies. Later in the program, they meet them more consistently. By the end of the program, they always demonstrate these competencies.

Two of the other benefits of curriculum mapping are that mapping can identify inadvertent duplication, and it can identify gaps that need to be addressed in course material.

The NTF Standards provide guidance for the development of postmasters NP students’ programs of study. The NTF Standards require faculty to perform gap analysis, a comparison of the student’s first graduate program’s curriculum to the curriculum of the NP program in which the student is enrolling. If any content gap is greater than 70% or 80%, the faculty should determine whether the student should repeat the course or otherwise demonstrate competency.

Clinical experiences should be customized for postmaster’s students as well. For example, an adult-gerontology primary care NP who is admitted to a family NP postmaster’s program may be able to demonstrate competency in adult primary care with fewer direct care hours than an NP who is certified as an adult gerontology acute-care nurse practitioner. However, both students may need additional practice hours in pregnancy, women's health, and pediatrics.

Competency-based education has the potential to shorten the postmaster’s process to what is essential for the new role — a hidden benefit of sorts to this change. For now, the minimum requirement remains at 750 direct practice hours in the specialty focus of the program.

The 2022 NTF Standards were upfront about the reality that graduate programs, regulatory agencies, and certifying bodies aren’t quite ready to implement competency-based education. A NONPF task force is actively working on a document that will provide faculty with guidance on the observable behaviors relevant to NP practice. Additionally, the task force will provide example assessments that can be used to evaluate the student’s progression towards mastery of the NP competencies and learning resources to support competency development.

The best way to prepare for the integration of these assessments and learning activities is to review the current curriculum, identifying the existing mismatches and gaps between learning activities, assessments, course/program outcomes, and NP and advanced-level nursing competencies. Often, learning outcomes focus on the cognitive domain (i.e., what the student knows). Pay special attention to whether there is adequate representation of affective (e.g., attitudes and socioemotional skills) and psychomotor competencies (coordination and motor skills) within course and program outcomes.

Assuring high-quality nurse practitioner education

The 2022 NTF Standards are a major step toward the assurance of high-quality nurse practitioner programs. Although resources for program implementation are still forthcoming, faculty can begin preparing for the transition now.

Advanced Practice Education Associates has developed standardized competency-based summative assessments, tools for aggregate data analysis, and other resources to assist faculty in meeting the NTF Standards. For information on these solutions, email requestinfo@apea.com.

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