Clinical learning in the first semester of nursing school is often challenging and difficult for students to assimilate multiple subjects while applying clinical skills. One college of nursing created a first semester simulation experience that helped students to enhance clinical reasoning by aligning content in multiple courses, allowing for application of information, and linked clinical skills learned each week to the concept of total patient care. The resulting change to course structure combined basic physical assessment and fundamental nursing care to one course allowing students to understand the application of assessment to nursing practice and skill.

ver the last decade, nursing has seen a significant decrease in the preparation of newly graduated students from nursing programs to enter practice. Kavanagh and Szweda 1 reported in 2017 that a mere 23% of newly graduated nurses were competently prepared for residency programs. In 2021, new graduate nurse preparedness had not improved and, in fact, had significantly dropped from 23% of nurses prepared to transition to practice to 9%. 2 Scholars have been advocating for a revolutionary change in nursing education to meet the increasingly complex demands in health care for many years. Benner and colleagues 3 had called for a radical transformation of nursing education over a decade ago that included an emphasis on clinical reasoning and integrating knowledge into the context of practice.Considering these reports and a need to better measure clinical judgment to determine whether entry-level nurses can provide safe and quality care, the National Council of State Boards of Nursing (NCSBN) updated the National Council Licensure Examination (NCLEX). The new examination will incorporate a case study approach to evaluate the critical thinking and clinical judgment skills of new nurses through the Next Generation NCLEX (NGN) project in April 2023. 4 Concurrently, the American Association of Colleges of Nursing (AACN) 5 developed The Essentials: Core Competencies for Professional Nursing Education in 2021, outlining essential competencies expected of graduates of baccalaureate, master's, and doctor of nursing practice (DNP) programs to meet the changing demands of the nursing profession using a competency-based approach to nursing education. 5 The AACN's Essentials provides a progressive framework of domains and competencies needed to practice nursing professionally and competently in the 21st century. 5 A competency-based approach can facilitate the synthesis and transfer of knowledge to clinical practice in an increasingly diverse and global