Educators’ Perceptions of the Development of Clinical Judgment of Direct-Entry Students and Experienced RNs Enrolled in NP Programs

Patrick Lavoie, Sean P. Clarke

Research output: Contribution to journalArticlepeer-review


Background: Nurse practitioner (NP) education was originally reserved for experienced nurses, but it has gradually opened to nurses with little to no clinical experience at the registered nurse (RN) level as well as to non-nurses. The existence of multiple paths to NP training and practice raises questions about the role of generalist RN experience in learning clinical decision-making and other aspects of the NP role. Purpose: To describe educators’ perceptions of the role of prior nursing experience in the development of clinical judgment during NP graduate education. Methods: In this qualitative descriptive study, 27 NP faculty from four universities participated in individual interviews. Transcripts were analyzed using a thematic approach. Results: According to participants, previous nursing experience—or any relevant experience—can either be helpful or detrimental in the development of NP students’ clinical judgment. Three themes were generated: variations in students’ baseline knowledge and skills, different frames of reference to grasp new content and skills, and challenges related to professional identity. In addition, participants described factors that they believe can affect the impact of different types of experience. Conclusion: Students with and without prior nursing experience face distinct challenges in learning NP-level clinical decision-making and judgment, but they reach similar end-of-program competence. Educators are confronted with contradictions between generally held wisdom, their professional socialization, and first-hand observations regarding the role of experience (inside and outside nursing) in preparing students to become NPs.

Original languageEnglish (US)
Pages (from-to)4-15
Number of pages12
JournalJournal of Nursing Regulation
Issue number4
StatePublished - Jan 2022


  • Nurse practitioners
  • clinical decision making
  • clinical judgment
  • entry-to-practice
  • graduate entry
  • graduate nursing education

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Nursing (miscellaneous)


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