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A clinical rotation enhanced with simulation provides a rich learning environment without endangering patients. It allows students to experience risk-free problem-solving while giving faculty a more predictable process to assess acquisition of skills.

Nurse educators are challenged with providing meaningful clinical experiences for students. However, patient safety regulations constrain what nursing students are able to accomplish in the pediatric setting. So, what are students actually doing in their clinical rotation? This pilot observational study was undertaken to provide a snapshot of the experiences available to nursing students that develop the six Quality and Safety Education for Nurses (QSEN) competencies. Students were directly observed during pediatric clinical and pediatric simulation rotations, and their time-on-task was calculated and categorized. Three of the six QSEN competencies were observed more often than the others during both the simulation and clinical experiences. Much work needs to be done to include all QSEN-related knowledge and skills into prelicensure clinical rotations.

United States national reports have called for improvement in healthcare professions education to better address patient care outcomes. In response, an initiative titled "Quality and Safety Education for Nurses (QSEN)" has been adopted by nursing programs across the nation, which describes the six main competencies to be included in nursing curricula. As early adopters of the QSEN competencies, the University of San Francisco nursing faculty promptly threaded the material throughout the 4-year Bachelor's of Science in Nursing (BSN) curriculum. Confident that the topics were well covered in the classroom, we then sought to learn how often our students practiced these skills during their assigned clinical rotations.After completing an IRB-approved observational study of junior-level BSN students, we tallied the actual number of minutes spent in each competency area while assigned to the patient care unit. Using a time-on-task author developed QSEN-based tool, we found that our students spent little to no time engaged in quality improvement, evidence based practice, or informatics. This is a very important finding, as it indicates that our students may not be sufficiently developing these particular skills during assigned clinical hours.Weaving the six QSEN competencies throughout the curriculum is a good start, but as we saw in our observational study, all of the competencies are not equally demonstrated in the clinical setting. Continuing to provide QSEN enriched didactic courses, adding targeted simulation experiences, and nourishing academic/practice partnerships may help bridge the gaps.