Building clinical judgment and confidence at Virginia Commonwealth University

When Virginia Commonwealth University (VCU) launched a new curriculum aligned with the BSN Essentials, faculty saw an opportunity to address a persistent challenge: helping students move beyond memorization to sound clinical decision-making.

“Applying clinical knowledge in real practice settings can be a common challenge for students,” said Andrea Reed, D.N.P., M.S.N., RN, Clinical Assistant Professor. “We wanted to ensure we were putting strategies in place that strengthened students’ ability to think critically and respond effectively in real patient situations.”

With the adoption of Elsevier’s Sherpath Vantage, Shadow Health, and Osmosis, faculty redesigned learning experiences to better prepare students for the complexity of patient care.

Moving from memorization to real-world understanding

One of the biggest hurdles in nursing education is helping students understand that conditions do not present the same way in every patient.

“Not all patients present the same,” Reed explained. “Textbook descriptions provide a foundation, but students may find it challenging to identify how the same condition can appear differently in clinical practice depending on the patient and situation.”

By integrating Sherpath lessons, adaptive quizzing, and case-based learning before class, faculty ensure students arrive prepared with foundational knowledge. This allows class time to focus on application, decision-making, and patient-centered thinking.

Reed has already seen a shift in engagement.

Students are ready to participate in active learning exercises and can move beyond basic recall to develop plans, engage in clinical reasoning, and develop communication strategies.

Preparing students for complex patient interactions

Reed has incorporated Shadow Health’s high-fidelity, screen-based simulations into clinical preparation, particularly for mental health rotations — an area many students find intimidating.

“I love Shadow Health,” she said. “Students complete a Shadow Health activity before going to clinical, especially for mental health, as students may feel uncertain or apprehensive about entering the mental health clinical setting.”

Mental health care carries stigma and uncertainty, and students often have limited exposure.

“Many aspects of mental health remain unfamiliar to students, particularly because mental illness is often portrayed inaccurately in the media and continues to carry significant stigma.”

Shadow Health provides a safe environment where students can practice patient interactions and build confidence.

“They get to spend time with the bipolar case study and experience interacting with a patient in a minimal-risk environment,” Reed said. “You can do the activity as many times as you want to develop comfort, but also competence.”

This preparation translates directly into clinical performance.

“Just asking assessment questions, like a suicide risk screening, gives you comfort bringing it into a clinical setting and translating that knowledge,” she added. “They’re asking those assessment questions. They’re not shying away. They’re not hiding behind their computers. They have that confidence.”

In one clinical experience, students recognized signs of hypomania in a patient — even before the condition had been formally covered in class — demonstrating early clinical reasoning shaped by simulation experience.

Meeting the needs of today’s learners

Today’s nursing students expect interactive, flexible, and visually rich learning experiences.

“We know our learners today are not like the learners we were 10 years ago,” Reed said. “We need to adapt our teaching strategies to the students coming into our classroom.”

Short, illustrated videos from Elsevier's Osmosis provide clarity before students engage with deeper coursework, helping them focus on key concepts and apply knowledge more effectively.

“They’re visual learners,” Reed added, noting how these videos help simplify complex topics like heart failure and diabetes. “When they see that visual description, it just clicks.”

Supporting diverse learners and busy lives

Sherpath and Shadow Health also provide flexibility that supports students balancing work, family responsibilities, and financial pressures.

Many students work long hours and/or care for family members, making anytime access essential.

Having on-demand lessons allows students to revisit material when they have time, whether after a late shift or once children are asleep.

“Learners vary in how they process and apply new information, and some may need added time and repetition. These tools offer an accessible way to support that learning.”

Confidence, engagement, and measurable progress

A key driver of student readiness has been the structured use of Elsevier Adaptive Quizzing (EAQs) as both a pre-class and post-class learning tool.

Students complete EAQs before class to reach a novice level, establishing foundational understanding. After class, they return to the same concepts and work toward an intermediate level — reinforcing knowledge through multiple touchpoints and strengthening clinical reasoning.

This approach ensures students encounter the material repeatedly in different contexts: preparation, active learning, and reinforcement. Reed values how EAQs mirror licensure expectations.

“Students become familiar with NCLEX-style questions and learn how to apply their content knowledge rather than simply recall facts.”

The impact is visible in the classroom. Students arrive prepared, engage more deeply in active learning, and are able to extend their thinking beyond basic concepts.

Preparing practice-ready nurses

At Virginia Commonwealth University, the integration of Sherpath Vantage, Shadow Health, EAQs, and Osmosis is helping transform how students learn — and how they show up in clinical settings.

For Reed, the goal is simple: prepare students not just to pass exams, but to care for real patients in complex, unpredictable situations.

By aligning curriculum, technology, and teaching strategies, VCU is helping future nurses build the competence, confidence, and clinical judgment essential for safe, compassionate care.