Beyond literacy to clinical competency: A framework for integrating generative AI into nursing education

Health systems are rapidly integrating generative artificial intelligence (GenAI) into clinical workflows, introducing safety risks including hallucinations and automation bias. These risks threaten patient safety when frontline nurses lack preparation to critically verify AI-generated outputs. Nurses are uniquely positioned to serve as safety gatekeepers in AI-augmented care; however, realizing this potential requires strengthened GenAI competencies in nursing education. Current curricula have emphasized academic integrity concerns over clinical preparedness, leaving gaps in verification skills, uncertainty communication, and accountability frameworks essential for safe AI integration.

Established nursing education standards, such as the American Association of Colleges of Nursing (AACN) Essentials, Quality and Safety Education for Nurses (QSEN) competencies, and the Nursing and Midwifery Council (NMC) Future Nurse standards, provide foundational scaffolds for integrating digital and AI-related capabilities into nursing curricula. Yet pedagogical approaches often treat GenAI primarily as a threat to academic integrity rather than as a clinical tool requiring systematic verification, critical appraisal, and accountable use. Integrating GenAI-specific competencies into nursing education is therefore essential for prepare practitioners who can use these technologies while maintaining professional accountability and patient safety.

This discussion paper proposes the Generative AI Nursing Competency (GANC) framework, offering educators and health-system leaders a standards-aligned pathway for preparing nurses to use GenAI without relinquishing professional judgment. The framework specifies seven competency domains: patient-centered assessment, safety-critical clinical reasoning, therapeutic communication, evidence verification, documentation integrity, interprofessional collaboration, and ethical accountability. These domains are translated into observable indicators and assessment exemplars, including simulation and objective structured clinical examination (OSCE) stations. By embedding generative-system risks within routine workflows and emphasizing manual-mode readiness when AI reliability is compromised, GANC provides practical guidance for cultivating nurses as accountable clinical validators in AI-augmented practice environments.