Date of Award

Summer 2016

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Bratt, Marilyn

Second Advisor

Frenn, Marilyn

Third Advisor

McCarthy, Donna


Delivery of clinical education using the traditional model involving faculty supervision of students in a hospital setting has become increasingly difficult for schools of nursing due to factors such as increased student enrollment and decreased clinical site availability. Simulated learning experiences (SLE) have increasingly been used as a supplement or replacement for a portion of nursing students’ traditional clinical learning experiences (CLE). There has been a call for research to ensure that new models for delivery of clinical education are built on a foundation of research. Although SLE have been increasingly used as a supplement to CLE, it is unknown if the sequence in which these learning experiences occur affects nursing students’ clinical competency development. This study was guided by the NLN/Jeffries’ Simulation Framework and employed a crossover design to explore the effects of age and sequence of blocks of SLE and CLE on clinical competency development. Forty-eight nursing students in their first medical surgical practicum rotation participated. Participants were randomly assigned to one of two group sequences of simulated and clinical practicum learning experiences over the course of one semester. Clinical competency assessment using the Creighton Competency Evaluation Instrument (CCEI) occurred at three time periods: (1) During a designated simulation vignette at the end of participants’ SLE rotation; (2) During a preselected clinical day/single patient encounter occurring in the final week of participants’ CLE rotation; and (3) After completion of the semester during a follow up simulation vignette. Repeated measures analysis of variance was used to determine if CCEI total scores or subscale scores differed over the three measurement time points within or between the two groups. Results demonstrated no significant differences in CCEI total or subscale scores between the two groups across the three data collection points. There was also no significant effect of age and group on CCEI total scores or subscales. The use of sequences of blocks of SLE and CLE may help address barriers in delivery of traditional clinical education faced by schools of nursing such as increased student enrollment and lack of clinical site availability, but further study is needed.