Connecting clinical learning: Placements, simulation, and competency in nursing education

Growing healthcare complexity, faculty shortages, limited placement availability, and variation in student learning opportunities create challenges for clinical nursing education. Clinical practice models offer different approaches to organizing learning, but questions remain about how these experiences support competency development. This paper critically examines clinical practice models in undergraduate nursing education and considers how the intentional integration of clinical placements and simulation can support competency development. Using a narrative and conceptually integrative approach, we draw on purposively selected literature to examine existing models, their contributions and limitations, and evidence relevant to simulation integration. Clinical placements provide participation in authentic patient care and workplace relationships, while simulation offers planned opportunities for practice, feedback, and assessment. Implications include mapping competencies across settings, sequencing learning experiences, and aligning assessment, while addressing faculty preparation, resources, accessibility, and regulatory requirements. An integrated approach should preserve the distinctive contributions of clinical placements and simulation, with further research examining competency attainment, transfer to practice, workforce readiness and patient outcomes.