2026 Theses Doctoral

Simulation-Based Education, Simulation Standards, and Competency-Based Education in Family Nurse Practitioner Programs Across New York State: An Exploratory Descriptive Study

Kavanaugh, Alanna Elizabeth

This exploratory descriptive study examined the current status of simulation-based education (SBE) in Family Nurse Practitioner (FNP) programs across New York State (NYS), with particular attention to how simulation is implemented, the extent to which programs adhere to the International Nursing Association for Clinical Simulation (INACSL) and Learning Healthcare Simulation Standards of Best Practice, and how competency-based education (CBE) assessment principles are incorporated into simulation-based learning.

The study was conducted in response to persistent challenges in nurse practitioner education, including limited clinical placement opportunities, increasing enrollment, increased pressure to prepare practice-ready clinicians and a growing movement towards CBE.

Guided by the National League for Nursing Jeffries Simulation Theory and informed by the INACSL Standards and CBE assessment framework, this exploratory descriptive study used an embedded mixed-methods design. An online survey was distributed to all accredited FNP programs in NYS (n = 29), targeting program administrators or simulation coordinators with knowledge of simulation implementation.

The survey collected quantitative data on program characteristics, simulation modalities, curricular integration, adherence to INACSL Standards, and incorporation of CBE assessment principles, while embedded open-ended questions provided qualitative insights regarding implementation strategies, perceived benefits, barriers, and future plans for simulation use. Quantitative data were analyzed using descriptive statistics, and qualitative responses were analyzed using thematic coding to contextualize and elaborate upon the quantitative findings within the embedded design.

Ten of the 29 eligible FNP programs responded to the survey (34% response rate), of which eight reported using simulation. Among these eight programs, simulation was most commonly implemented through standardized patient encounters and was typically integrated as a supplemental educational or evaluative strategy rather than as a substitute for direct patient care clinical hours. While many programs reported incorporating elements aligned with the INACSL Standards, implementation varied across programs, and the systematic application of CBE assessment principles was inconsistent. Integrated findings suggested that programs often implemented practices without fully creating the broader systems needed for sustained implementation. These results suggest that although SBE is an important component of graduate nursing education, variation remains in how simulation is operationalized and evaluated within FNP programs.

This study contributes new knowledge regarding the program-level integration of simulation in nurse practitioner education. The findings suggest that future progress in simulation integration may depend not only on increasing access to simulation itself, but also on strengthening the systems, faculty preparation, and assessment processes that support high-quality implementation. The findings also highlight opportunities for greater standardization, faculty development, and research to support the effective integration of simulation and CBE assessment in graduate nursing curricula.