Beyond "what works": Realist evaluation as a transformative approach to building evidence in nurse education

The persistent "what works" question in nurse education research conceals a conceptual trap. We seek universal interventions that reliably produce outcomes regardless of context, building an evidence base where promising interventions repeatedly fail to transfer across settings. Critical realism and its methodological offspring, realist evaluation, offers a transformative alternative from the social sciences. Rather than asking "does this work," realist evaluation asks: for whom, in what circumstances, through what mechanisms, producing which outcomes? This Big Ideas paper introduces the Context Mechanism Outcome (CMO) configuration framework as analytical architecture for understanding how educational interventions operate. Using Resilience Based Clinical Supervision as an exemplar, I demonstrate how realist approaches generate middle range theories - conditional, contextualised knowledge about what tends to work for whom in what circumstances. Nurse education's characteristic features (diverse student populations, constitutive context, complex interventions, multiple stakeholders) make realist approaches essential rather than optional. The transformation required is epistemological: abandoning false universalism to build cumulative knowledge about how mechanisms operate under varying conditions. This produces an evidence base adequate to nursing education's complexity, offering practitioners sophisticated conceptual resources for contextually intelligent implementation rather than simplistic prescriptions.