Creating Assignments That Prepare NP Students for Real Clinical Practice

Despite what students may think, NP faculty (or any nursing faculty) are not sitting around thinking, How can I create pointless busywork today? We’re trying to balance course objectives, accreditation, grading time, and the very real pressure of preparing students for clinical practice. And somewhere in that mix, assignments quietly drift away from what actually happens in clinic or get used year after year without any meaningful updates.

The moment I started rethinking assignments was the moment I asked myself this question: Would this help a student on their first day as an NP? 

Not pass boards.

Not earn an A.

But could it correlate to a real patient encounter?

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Come with me on a quick trip down memory lane... Picture it (cue Sophia from Golden Girls)... It's 2015 and I'm a brand new NP in a family medicine clinic. I can't even remember what the specific patient concern was but I remember thinking, "I don't know the exact diagnosis. What am I going to do?" I took my concerns to my collaborating physician down the hall and presented the patient's case. And with his wisdom of 30+ years in practice, he calmly reminded me that I had already passed boards. Life is not a nursing exam where there is only one right answer and one right path forward. He reminded me that it's okay to do some testing or try a treatment and then bring that patient back for a follow-up.

Why didn't I think of that? I think it's because I was conditioned to think that I had to know a diagnosis and plan for every patient at every encounter, just like all the scenarios I was presented with in my NP program. Now, 10+ years into my NP clinical practice, I get that I don't always know everything. I've learned to have those conversations with patients about gathering more information, ordering tests, and short term follow-up.

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Now back to the present. How well do we prepare students for real life clinical practice? Most of clinical practice isn’t about recalling isolated facts. It’s about sorting through messy information, deciding what matters most right now, and explaining your thinking to someone else—whether that’s a preceptor, a colleague, or the patient sitting in front of you. So when assignments focus primarily on producing a “perfect” answer, we miss the chance to develop that kind of thinking.

In real life, clinicians don’t start with certainty. They start with a differential diagnosis, ruling out red flag conditions, and a plan that can evolve. Assignments that ask students to walk through their reasoning, defend their decisions, and reflect on uncertainty tend to map far better to actual practice than assignments that reward memorization or flawless formatting.

Another shift that makes a huge difference is using formats students will recognize after graduation. SOAP notes, case summaries, referral justifications, patient education materials—these aren’t just academic exercises. They’re the tools students will use over and over again in practice. When an assignment looks like something they might actually document or say out loud in clinic, engagement goes up almost immediately.

And then there’s AI. Whether we like it or not, students are already using it. And guess what? Clinicians are using it, too. Pretending students won't use it, or ignoring it altogether, doesn’t make assignments more rigorous—it just makes expectations unclear. The more productive approach is to be explicit about how AI can and can’t be used. When students are allowed to use AI for brainstorming or structure but are still responsible for clinical reasoning, judgment, and justification, the assignment becomes more realistic. That’s exactly how AI is showing up in healthcare settings anyway—as a tool, not a decision-maker. Interestingly, once assignments emphasize reasoning and context, AI becomes far less useful for shortcuts. It’s one thing to generate text. It’s another to explain why this patient, in this situation, needs this plan. That kind of thinking still has to come from the student.

One of the biggest misconceptions in NP education is that more assignments equal better preparation. How many discussion boards do you have in your course? In reality, a small number of well-aligned, thoughtfully designed assignments often do far more than a long list of one-off tasks. When students recognize the structure of an assignment, they can spend their energy on critical thinking instead of deciphering instructions. Faculty benefit too—grading becomes more focused, and feedback is more meaningful.

At the end of the day, NP education isn’t about creating perfect papers. It’s about developing clinicians who can think under pressure, communicate their reasoning, use tools responsibly, and recognize their limits. When assignments are built with that reality in mind, students feel it immediately. They stop seeing coursework as something to get through and start seeing it as practice for the role they’re stepping into.

If you read over an assignment and think, This feels like something I actually do in clinic, that’s usually your best sign you’re on the right track.