Curriculum Alignment: The Why, The What, The How

By: Tonya Schneidereith, PhD, CRNP, PPCNP-BC, CNE, CHSE and Sabrina Beroz, DNP, RN, CHSE

Historically, nursing education has included clinical rotations where students care for patients in the clinical setting. This gives students an opportunity to apply theory, to develop critical thinking skills, and to deepen learning. However, clinical experiences are fraught with empty downtime and missed opportunities, meaning that the hours spent in the clinical setting learning how to “be a nurse” aren’t providing the education they were designed to provide (McNelis et al., 2014).

Fast forward to 2014 and the release of the findings from the National Council of State Boards of Nursing multisite study (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014).  These findings show that measured outcomes were equivalent when up to 50 percent of traditional clinical experiences were replaced with simulation. Exciting, right? You betcha, but to achieve the same findings, there are important caveats to consider.

According to Alexander et al. (2015), outcomes from the study can be achieved “as long as faculty are adequately trained, committed, and in sufficient numbers; when there is a dedicated simulation lab with appropriate resources; when the vignettes are realistically and appropriately designed; and when debriefing is based on a theoretical model” (p. 41).  In other words, substitution of clinical hours with simulation must be carefully planned and appropriately designed by trained faculty, and curricular alignment is required. Here’s the why, the what, and the how.

The why:

Following the release of the NCSBN study, there was palpable excitement that finally we had evidence to support adding simulations to the nursing curriculum. Now what? Now, we turn to the INACSL Standards of Best Practice: Simulation to provide evidence-based guidelines for implementing simulations.

There are currently nine Standards, but for our purposes, Standard III: Participant Objectives addresses the why of curricular alignment. Participant objectives guide the simulation learning experience, and they should be achievable, correspond with the learner’s level, and align with program outcomes.

The what:

But what is curricular alignment? Curricular alignment is a linear configuration between program outcomes, course outcomes, and simulation outcomes. If program outcomes drive course outcomes, then course outcomes should drive simulation outcomes.

If we design simulations that adhere to the Standards, then all simulations should clearly map back to program outcomes. Simulations are no longer run to compensate for clinical time or replace hours lost to other activities, but instead are designed to address specific course outcomes.

The how:

We now know that we can substitute clinical time with simulation if we adhere to the design of the NCSBN study and the Standards. But how do we make that happen?

An easy way to get started is to create an alignment grid of your program’s outcomes and your course outcomes. Once you have that together, begin to consider what course outcomes can best be achieved through simulation (Hodge, Martin, Tavemier, Perea-Ryan, & Alcala-Van Houten, 2008). Where are the gaps? Is there a particular course concept or thread that can be used to design a simulation scenario? How will implementation happen?

The Maryland Clinical Simulation Resource Consortium uses a curriculum map that readily shows the alignment between simulation, course outcomes, and program outcomes. If you use this or create something of your own, keep a record of this alignment to show program accreditors how simulation has been thoughtfully integrated.

And don’t forget: Through the Simulation Innovation Resource Center, the NLN offers a multitude of helpful resources for educators to develop and enhance their simulation programs, including courses on Simulation Pedagogy and Curriculum Integration.


So, now that we have a better understanding of the why, the what, and the how of curricular integration, it is important to ask: How do my simulations align with my course outcomes? If you can’t show a linear correlation, then perhaps that simulation isn’t best for your course. Maybe it fits better in another course…one that can use it for its own curriculum map.  Happy mapping!


Alexander, M., Durham, C. F., Hooper, J. I., Jeffries, P. R., Goldman, N., Kardong-Edgren, S., . . .Tillman, C. (2015). NCSBN simulation guidelines for prelicensure nursing programs.  Journal of Nursing Regulation, 6(3), 39-41. doi:10.1016/S2155-8256(15)30783-3

Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), S1–S64. doi:10.1016/S2155-8256(15)30062-4

Hodge, M., Martin, C., Tavernier, D., Perea-Ryan, M., & Alcala-Van Houten, L. (2008). Integrating simulation across the curriculum. Nurse Educator, 33, 210-214. doi: 10.1097/01.NNE.0000312221.59837.38

Ironside, P. M., McNelis, A. M., & Ebright, P. (2014). Clinical education in nursing: Re-thinking learning in practice settings. Nursing Outlook, 62(3), 185-191. doi:10.1016/j.outlook.2013.12.004

Lioce, L., Reed, C. C., Lemon, D., King, M. A., Martinez, P. A., Franklin, A. E., . . . Borum, J. C. (2013). Standards of Best Practice: Simulation Standard III: Participant Objectives. Clinical Simulation in Nursing, 9(6), S15-S18. doi:10.1016/j.ecns.2013.04.005

McNelis, A., Ironside, P., Ebright, P., Dreifuerst, K., Zvonar, S. & Conner, S. (2014). Learning nursing practice: A multisite, multimethod investigation of clinical education. Journal of Nursing Regulation, 4, 30-35. doi:10.1016/S2155-8256(15)30115-0

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