Expert Insights on Essential Skills in Nursing Education
Turning evidence into practice
If you’re a nurse educator, you likely know that it can be a struggle to create consistent, scalable teaching and assessment opportunities for psychomotor skills in nursing education. And, you might be unsure of which psychomotor skills to prioritize.
In our recent webinar, From Evidence to Practice: Validating Essential Skills in Nursing Education, three experts in nursing education shared new research they’ve conducted on psychomotor skills in nursing education.
They also explored strategies such as scaffolding, simulation-based mastery learning, and data‑informed assessment to help nursing educators ensure learner competence.
In this article, we share some key highlights from the webinar.
Why psychomotor skills in nursing education remain difficult to standardize
“Psychomotor skills are essential for safe practice. [But] evidence shows that students struggle to develop and retain these skills. Inadequate preparation of skills directly compromises patient safety.”
– Beth Hallmark, PhD, RN, CHSE-A, ANEF, FAAN
Professor for the Inman College of Nursing
Belmont University
Despite the widely-known reality that psychomotor skills are critical, programs vary significantly in which skills they prioritize and how they teach and assess these skills.
Dr. Beth Hallmark, Professor for the Inman College of Nursing at Belmont University, explained that national accrediting bodies emphasize outcomes and behaviors, but they rarely specify which psychomotor skills are actually essential. “There’s really no agreed-upon psychomotor skill list,” Dr. Hallmark pointed out.
As a result, programs are left to make their own decisions about which skills matter most, where those skills should be taught, and how competence should be evaluated. This has led to wide variation in curriculum design and assessment practices.
New research sheds light on essential psychomotor skills in nursing education
The presenters conducted a Delphi study focused on essential psychomotor skills for pre‑licensure nurses. They reviewed seven current nursing textbooks and engaged academic and clinical educators in multiple rounds of expert review.
The study has created consensus on 95 psychomotor skills that are essential to teach.
Most of the 95 essential skills fall within four domains:
- Patient safety
- Asepsis and infection control
- Fluid, electrolyte, and acid-base balance
- Medication administration
The study also clarified the areas where programs might focus on formal evaluation. Just under half of the essential skills were recommended for formal competence evaluation in pre-licensure programs.
Where to teach essential skills
“Experts overwhelmingly identified that lab and simulation were the preferred setting for teaching essential psychomotor skills,” shared Dr. Fara Bowler, DNP, APRN, CHSE-A, Associate Professor and Assistant Dean of Clinical Simulation Science at the University of Colorado College of Nursing.
Of the 95 skills that met consensus as essential, participants thought that 92% of them should be taught in simulation.
This result reflects a major shift in how nursing education views simulation. Programs no longer reserve simulation solely for reinforcement. Instead, they increasingly rely on labs and simulation as primary learning environments.
“We found this interesting because 15 years ago, simulation was just evolving as a teaching pedagogy and would not have been considered a primary teaching environment,” Dr. Bowler said.
Cognitive load and the case for scaffolding
Students often perform multiple tasks simultaneously during skills execution, including motor coordination, sequencing, reasoning, communication, and documentation. This cognitive demand can exceed learners’ capacity.
“Even the most capable student will struggle when cognitive demand exceeds the working memory capacity,” Dr. Bowler explained.
To address this challenge, the presenters emphasized scaffolding. Scaffolding structures learning so students build competence progressively rather than all at once.
Dr. Bowler walked through the following steps for effective scaffolding:
- Step 1. Conceptual Foundation: Before touching any equipment, students must understand the “why.” Conceptual content, rationale, and theory need to be in long-term memory so they do not consume working memory later.
- Step 2. Isolated Practice on Task Trainers: Students practice the physical skill in isolation, without a patient, environment, or competing demands. This is where motor patterns are being formed.
- Step 3. Simulation Lab with Mid-Fidelity Manikins: Students begin integrating the skill with basic clinical context. They practice with more realistic cues but still in a controlled, low-stakes space. Peer‑to‑peer practice allows students to rehearse skills together, integrate basic clinical context, and gain confidence in a controlled, low‑stakes environment.
- Step 4. High-Fidelity Simulation: Full clinical environment simulation that includes unexpected variables, interprofessional team dynamics, and time pressure. Students experience complexity without real patient risk.
- Step 5. Supervised Real Patient Care: The student is now ready to apply the skill with a real patient, but with an experienced nurse present to support and intervene if needed.
“Clinical competence is not achieved at step one or two; it is built progressively. Skipping steps does not accelerate competence; it creates fragile performance. So moving through each of these steps is important for the overall learning.”
– Fara Bowler, DNP, APRN, CHSE-A
Associate Professor, Assistant Dean of Clinical Simulation Science University of Colorado College of Nursing
Building competence using mastery learning and deliberate practice
Susan Hébert, PhD, RN, CHSE, Assistant Dean of Simulation for the College of Nursing at the University of Tennessee, Knoxville, honed in on one theory-based approach to competence development: simulation-based mastery learning.
“Simulation-based mastery learning is a competency-based educational approach allowing learners to develop through deliberate practice,” she explained.
Dr. Hébert shared that the features of deliberate practice within mastery learning include:
- Highly motivated learners
- A well-defined task
- Appropriate level of difficulty
- Focused, repetitive practice
- Informative feedback from faculty experts
- Learners monitor level of understanding, correct strategies, and engage in continuous deliberate practice, until ready for evaluation to reach a mastery standard
This approach shifts progression from time‑based practice to demonstrated competence.
Supporting skills practice and assessment with SimCapture
Dr. Hébert described how the University of Tennessee Knoxville uses SimCapture and SimCapture for Skills to support practice and assessment of psychomotor skills.
“We began using SimCapture to start managing not only what we’re doing in our high-fidelity environment to record and evaluate scenario-based performance, but we’re also now starting to use it in what we’re doing in the skills lab space,” she shared.
Some of the ways Dr. Hébert is using SimCapture include:
- Managing simulation and skills data in one system
She uses SimCapture to manage and analyze both high‑fidelity simulation and hands‑on skills performance, helping faculty organize large volumes of evaluation data in one place. “When you’re trying to think about, ’Oh my goodness, this is a whole lot of data that I’m going to have to manage,’ ... our program has used SimCapture for the last five years,” Dr. Hebert said. - Supporting mastery learning at scale
Courses are designed around a mastery learning model that captures every type of skills evaluation, from baseline assessments to final check‑offs and repeat attempts when students need more practice. - Enabling efficient peer‑to‑peer and faculty‑supported practice
With SimCapture for Skills, students can independently record skills practice on their own devices, with peer, self, or faculty evaluation options. - Turning performance data into curriculum insight
Individual and cohort‑level analytics help faculty identify skill gaps, guide curriculum reinforcement, and monitor consistency and fairness across multiple evaluators.
“One of my favorite things that SimCapture can gather for us is that, if I want to look at how a group of students is doing in performance of one specific skill, I can go pull that data ... and I can show which percentage of students for each step has done that correctly,” she said.
“We can take this back to our course coordinators and our curriculum committees to inform where we need to reinforce the learning that the group as a cohort are maybe weak in,” she added.
Key takeaways
At the end of the webinar, Dr. Hébert shared the key learnings that she, Dr. Bowler, and Dr. Hallmark want nursing educators to take away from their session.
Susan Hébert
PhD, RN, CHSE
Assistant Dean of Simulation for the College of Nursing
University of Tennessee Knoxville
- “We want you to use evidence when you’re looking at what skills you’re prioritizing to include in your curriculum.”
- “When you’re looking at including those skills in the curriculum, use intentional curriculum design. Don’t just frontload and put all the skills in the first semester. No doubt if you do that, you’re going to cognitively overload your student. So really think about that educational theory and try to integrate it in an intentional way.”
- “Consider using evidence-based learning approaches. Mastery learning is one example. Undoubtedly, if you are not ready to take that on, there are other approaches you could take. But we have found mastery learning to be an effective way to integrate skill instruction within our curriculum.”
- “Make sure that when you’re evaluating students, you are looking at using data informed tools for individual and program improvement. You are not just taking last-minute check-off lists or evaluation lists for that. You’re doing it in a really intentional way.”
Watch the webinar
Through a combination of research insights and practical examples, the session highlights how skills can be taught, practiced, and evaluated in ways that support learner development, faculty efficiency, and program-level consistency.
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