Position Statements

Rapid changes in the healthcare landscape, emerging practice trends, and advances in nursing education have required innovative approaches and models to clinical education for nursing students over the past decade. Recognizing this need, this paper aims to clarify expectations for clinical/practicum experiences in prelicensure, post-licensure, graduate, and clinical doctorate programs for ACEN-accredited programs.

Introduction

At every level of nursing education, students are expected to acquire a certain practical proficiency. Clinical practice is the rich, deep repository that underpins the nursing discipline, allowing students to transfer theoretical knowledge and other didactic learning experiences to care for patients with complex, multidimensional health problems (Oermann, Gaberson, and De Gane, 2024). Clinical learning experiences provide a foundation for nursing education, ensuring that students are ready for future practice. As such, the ACEN firmly believes that all nursing program options at the prelicensure, post-licensure, graduate, certificate, and clinical doctorate levels must include clinical/practicum experiences that 1) align with the anticipated role responsibilities and 2) facilitate student achievement of the course-specific and the end-of- program student learning outcomes (SLOs) upon graduation.

While the ACEN does not require a minimum number of clinical/practicum hours for programs at the practical, diploma, associate, and baccalaureate education levels, minimum hour requirements are applicable for graduate and doctor of nursing practice (DNP) programs with APRN foci. The total number of clinical/practicum hours must be sufficient to allow students to achieve the identified SLOs while providing opportunities to practice role-specific responsibilities, to receive performance feedback, and to improve performance over time. The ACEN Report to Constituents is a source of information regarding the average clinical hours for all ACEN-accredited program types.

Clinical learning experiences typically occur in, but are not limited to, traditional (e.g., direct instructor-led cohort), partnership (e.g., instructor-supervised dedicated education unit), or precepted clinical models. Practicum learning experiences completed using a precepted clinical model can occur in prelicensure (e.g., at the end of the program of study or clinical courses throughout the curriculum), post-licensure RN-to-BSN, graduate, and doctoral nursing programs. Practicum learning experiences not directly linked to care provision are also common in nursing education programs; however, these experiences are not sufficient to fulfill the total required clinical/practicum hours embedded within a program of study (Moran, Burson, & Conrad, 2023).

The following terms (Table 1), derived from the ACEN Glossary and literature, are used throughout this paper. Please note that these terms may vary depending on the type of nursing education program, geographic setting, context, or other educational/clinical institutional factors:

Table 1

Definitions

‍

Clinical/Practicum Experiences in Prelicensure Nursing Programs

Immersion in the clinical learning environment provides students with opportunities to strengthen the cognitive, psychomotor, and affective attributes that establish their identity as nurses. Prelicensure experiences should include direct engagement with patients and health care team members to impact health outcomes. Students develop clinical judgment, skill acquisition, and professionalism as they contribute to the care of the individual, family, community, and/or population in a variety of settings (Fowler et al., 2018).

Students enrolled in prelicensure nursing programs must meet the clinical/practicum requirements of the program’s state board of nursing or its jurisdictional agency.

Examples of clinical/practicum experiences for prelicensure nursing programs/program options include (but are not limited to):

• Clinical care across the lifespan with geriatric, adult, maternal-newborn, and pediatric patients/clients.
• Clinical care across the wellness-illness continuum including health promotion, maintenance, restoration, palliation, and hospice experiences.
• Clinical experiences focused on population health and social determinants of health.
• Clinical experiences in nursing specialty areas such as medical-surgical, mental health, emergency, critical care, and home health nursing.

Clinical/Practicum Experiences in Post-Licensure RN-to-BSN and Graduate Nursing Programs

Clinical/practicum learning experiences for students in post-licensure programs/program options are expected to align with the anticipated competencies post-graduation. Post-licensure clinical/practicum hours should have an actual or potential direct impact on patient care (i.e., individuals, families, groups, communities, and populations). These hours should include direct engagement with others who supervise, provide, or are preparing to provide direct patient care (e.g., staff nurses, nursing students, nurse managers) in settings consistent with the level of post-graduation role responsibilities (American Association of Colleges of Nursing, 2024).

Learning activities completed by the student in isolation with no direct link to care provision (e.g., a windshield survey with no additional connection to care provision) and that do not include interaction with patients and/or other interdisciplinary health care team members are not considered sufficient to fulfill all required clinical/practicum hours embedded in a program of study. Clinical/practicum experiences provide opportunities for students to integrate new knowledge and skills into practice and support students’ attainment of the identified end-of- program SLOs.

Clinical/Practicum Experiences in RN-BSN Post-Licensure Nursing Programs

The baccalaureate degree in nursing can serve as a foundation for entry to a graduate nursing program and/or provide access to career growth and advancement. As such, clinical experiences for students enrolled in an RN-BSN post-licensure program should provide opportunities to apply theoretical concepts consistent with new role responsibilities.

The focus of clinical education at the post-licensure RN-BSN level consists of strengthening understanding of leadership and management principles, evidence-based practice and quality improvement, population and global health, and information technology.

Clinical/Practicum Experiences in Graduate Nursing Programs

The focus of clinical education at the graduate level consists of preparing nurses for advanced practice registered nursing (APRN) roles and specialty practice roles, such as administration, nursing education, and informatics. The ACEN accredits all APRN and non-APRN program options at the master’s and DNP levels (see the ACEN Position Statement Related to Graduate Nursing Education Programs (2023) for further information).

Students enrolled in graduate nursing programs must meet clinical/practicum requirements pursuant to the certifying program’s Nursing Regulatory Body (NRB) or jurisdictional agency. Additionally, graduate programs with APRN (nurse practitioner) options will need to meet the National Task Force Standards for Quality Nurse Practitioner Education (2022) minimum (required) 750 direct patient care clinical hours in addition to any clinical/practicum requirements of the NRB, jurisdictional agency, and/or certifying body administering the nurse practitioner certification examination.

Non-APRN program options in a master’s nursing program are required to have hands-on practicum experiences. The ACEN does not have a minimum number of hours required. Faculty should ensure that the practicum hours facilitate the student’s achievement of the end-of- program student learning outcomes as well as the role-specific nursing competencies specific to the program option/track. See the ACEN Report to Constituents for the average number of practicum hours for non-APRN options.

The ACEN requires that all DNP programs with APRN program options have at least 1,000 post–baccalaureate clinical/practicum hours, some of which can be obtained through the DNP scholarly project. For students enrolled in a post-master’s APRN DNP program option, the faculty members must conduct a gap analysis of coursework and clinical hours from the student’s previous graduate program to ensure that students obtain the required 1,000 post-master’s or post-baccalaureate clinical/practicum hours upon graduation. Beginning in July 2025, students admitted to an APRN DNP program option should have 750 direct patient care hours; the remaining 250 hours required to achieve a minimum of 1,000 hours may include hours towards the DNP project.

The ACEN requires that all DNP programs with non-APRN program options have at least 500 clinical/practicum hours at the DNP level, which may include hours towards the DNP project. Non-APRN program options are not required to have 1000 hours; however, programs may elect to require this of all students regardless of whether the program option is non-APRN or not. If the full 1000 hours are required, then the program should have a gap analysis and elective/independent study courses that would enable students to obtain the number of hours needed. See the ACEN Report to Constituents for the average number of practicum hours for non-APRN options.

These clinical hours should be distributed to support advanced-level education, role competencies, and population needs for individuals and families across the lifespan in primary or acute care as appropriate (National Task Force [NTF] on Quality Nurse Practitioner Education, 2022, p. 13).

Examples of Clinical/Practicum Experiences for Post-licensure Nursing Programs (Including RN-to-BSN, Graduate, and non-APRN Program Options)

Leadership

• Shadow an organizational leader noting skills used to achieve organizational goals.
• Observe interprofessional leadership committees and/or grand rounds and write a self-reflection on how the committees influence baccalaureate nursing practice.
• Implement a staff-development education module that has been designed to address an identified learning need.
• Develop clinical guidelines and/or protocols for a health system.
• Conduct a stakeholder analysis, needs assessment, and/or gap analysis for healthcare system quality improvement initiative.

Research, Quality Improvement, & Evidence-Based Practice

• Observe an Institutional Review Board (IRB) meeting and write a summary related to how the nurse ensures human subjects protection.
• Interview a Principal Investigator of a research study or leader of a translational science project.
• Audit the required documentation for an active evidence-based practice or quality improvement project.
• Complete a collaborative patient care project (e.g., evidence-based practice or quality improvement).
• Develop a policy that will improve nursing care and health outcomes.

Community

• Attend a community resource meeting focused on the health and wellbeing of the local community.
• Conduct a community needs assessment related to health priorities in a local community.
• Interview a community leader who is actively working to address a community’s health-related issue(s).
• Interview government leaders within the community and explore how these leaders create budgets to support the health and wellbeing of their constituents.
• Implement a community-focused education module to address an identified community need.

Nursing Education

• Implement a virtual education module to address student learning needs.
• Design guided learning sessions for clinical, classroom, and/or simulated settings that are then facilitated.
• Facilitate post-conference or debriefing in clinical and/or simulation settings.
• Develop an evaluation method to assess student learning.

Informatics

• Interview informatics personnel regarding nursing support of unit-based technology.
• Collaborate with informatics personnel to explore patient’s satisfaction with selected healthcare technology.

Policy

• Conduct a critical appraisal and analysis of health policy.
• Partner with legislative leaders on advocacy campaigns.
• Provide public testimony on a policy issue (e.g., state, local, federal).
• Attend Board or Advisory Council meetings (e.g., Board of Nursing, specialty boards, etc.).
• Complete a Policy Internship (e.g., American Nurses Association, National Council of State Boards of Nursing, White House, White House Advocacy & Research).

Clinical experiences should reflect evidence-based nursing practice, should be appropriate for the level of education, and should facilitate achievement of the end-of-program SLOs. In addition, graduate clinical/practicum learning environments and experiences should facilitate the achievement of the identified role-specific nursing competencies. As such, the ACEN expects that a variety of clinical learning environments and experiences with sufficient clinical hours will be required by the program.

ACEN-accredited international programs are expected to similarly adhere to the requirement that all levels of nursing education include practice experiences. These experiences should be compliant with any regulatory body and governmental agency requirements while meeting the ACEN expectation that they engage nursing students in the cognitive, affective, and psychomotor work of nursing appropriate for the level at which students are being prepared.

Conclusion

Robust clinical/practicum experiences provide opportunities for students at all levels of nursing education to integrate theoretical knowledge and nursing practice. These experiences promote the development of new skills, the validation of new competencies, and assist students with internalizing professional expectations. In addition to the examples provided throughout this document, the AACN (2024) white paper, Practice Experiences in Entry-Level Post-Licensure Nursing Programs, offers additional clarity, guidance, and creative examples for post-licensure practice experiences within the context of competency-based curricular models.

The ACEN expects all nursing students enrolled in any undergraduate or graduate programs to complete clinical/practicum experiences consistent with the level of academic study and their roles and responsibilities after graduating.

For programs with additional questions concerning clinical/practicum experiences, please contact the ACEN office at (404) 975-5000, and one of the Directors will gladly assist those with inquiries.

Additional Resources

‍ACEN Glossary

ACEN Position Statement Related to Graduate Nursing Education Programs

ACEN Practicum Requirements for Graduate Nursing Programs

References

American Association of Colleges of Nursing.(2024). White Paper: Practice experiences in entry-level post-licensure nursing programs. https://www.aacnnursing.org/news-data/position-statements-white-papers/

American Association of Colleges of Nursing. (n.d.). Master’s Education. https://www.aacnnursing.org/students/nursing-education-pathways/masters-education/

American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). AmericanNurses Enterprise. https://www.nursingworld.org/practice-policy/scope-of-practice/

Fowler, S.,Knowlton, M., & Putnam, A.(2018). Reforming the undergraduate nursing clinical curriculum through clinical immersion: A literature review. Nurse Education in Practice, 31, 68–76. https://doi.org/10.1016/j.nepr.2018.04.013/

Moran, K., Burson, R., & Conrad, D. (2023). The Doctor of Nursing Practiceproject: A framework forsuccess (4th ed.). Jones & Bartlett Learning. 

National Task Force.(2022). The National Task Force Standards for Quality Nurse PractitionerEducation (6th ed.). https://www.nonpf.org/page/NTFStandards 

Oermann, M., Gaberson,K., & De Gane, J. (2024). Evaluation and testing in nursing education (7th ed.). Springer.