Evidenced-based educational practices propose simulation as a valuable teaching and learning strategy to promote situated cognition and clinical reasoning to teach nursing students how to solve problems. A project that uses a structured debriefing activity, the Outcome Present State-Test Model of clinical reasoning following high fidelity patient simulation, is described in this paper. The results of this project challenge faculty to create and manage patient simulation scenarios that coordinate with didactic content and clinical experiences to direct student learning for the best reinforcement of clinical reasoning outcomes. Considerations for the future include incorporating patient simulation activities as part of student evaluation and curriculum development. The arguments for using high fidelity patient simulation in the current educational environment has obvious short term benefits, however, the long term benefit of developing clinical expertise remains to be discovered.

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This study explored RN-BSN students' perceptions of practice differences between nurses prepared with an ADN and BSN. Five themes were identified in 20 students' discussion posts: "a nurse is a nurse" at the bedside, beyond the bedside, BSN wanted, digging deeper, and appraisal. Results illustrate the need for educators to assist nurses in translating the differentiated educational competencies to the practice role of the bedside RN.

In recent years, the nursing profession in the United States (U.S.) has made new efforts to advance the education of registered nurses (RNs) who provide direct patient care to the baccalaureate degree in nursing (BSN). This renewed focus is partially due to current research noting that an RN's education is positively correlated with improved patient outcomes. In spite of the research and efforts, multiple educational pathways for entry into RN practice continue to thrive throughout the U.S. and around the globe. The purposes of this paper are to present three historical cases describing the original intent of the graduates' differentiated practice role for entry-level RN educational pathways in America and evaluate the current efforts to advance the education of RNs within the U.S. for practice differentiation by education. Lack of practice differentiation among differently prepared RNs has persisted in America for more than a century and until recently hospitals often disregarded the RN's education when hiring direct care nurses. Lack of practice differentiation by education has affected the quality of nursing care as shown by the recent research. The current efforts to advance the education of the RN do not differentiate the practice of the differently prepared RNs. The present context provides the nursing profession an opportunity to differentiate RN practice based on education. Thus, the clinical ladder program is proposed as a model to initiate differentiated RN practice at the institutional level. Clinical ladder programs can be revised to meet the needs of the individual regions around the globe.