Certified Nurse Educator Exam

This chapter explains how to write measurable learning outcomes using Bloom's taxonomy and the other learning domains, and how to align outcomes with teaching strategies and assessments so each supports the others. Alignment is a frequent theme on the CNE exam because it connects facilitating learning with assessment and curriculum.

Programs use slightly different vocabulary. Learning outcomes usually describe what the learner will be able to do at the end of a course or program; objectives often describe narrower, shorter-term targets for a unit or class session; competencies describe integrated knowledge, skills and attitudes demonstrated in practice. Whatever the label, the exam expects that each target describes learner performance, not teacher activity, and that it can be observed and measured.

A well-written outcome contains one action verb that names an observable behavior, the content, and when useful a condition and a criterion. One way to remember the components is audience, behavior, condition and degree.

Faculty Scenario: A new faculty member writes, "Students will understand the care of patients with heart failure." A mentor helps revise it: "Given an unfolding case of a patient with acute decompensated heart failure, the student will prioritize three nursing actions and justify each with assessment data." The revision names an observable verb (prioritize, justify), a condition (given an unfolding case) and a criterion (three actions, each justified).

Verbs such as understand, know, learn, appreciate, be aware of and be familiar with describe internal states that cannot be observed directly. They may appear in broad program goals, but in course or unit outcomes they should be replaced by observable verbs. Each outcome should contain one primary verb; "identify and evaluate" mixes two levels and makes measurement ambiguous.

Bloom's original cognitive taxonomy was revised by Anderson and Krathwohl, who changed the levels to verbs and placed create at the top.

Revised Bloom's Cognitive Levels

Some verbs can sit at more than one level depending on context; "prioritize" is commonly treated as analysis, and "explain" can be understanding or, when it requires justification, evaluation. The exam is less concerned with any single verb's level than with whether the outcome's level matches the teaching and the assessment.

Krathwohl's affective domain describes values and attitudes: receiving (attending), responding (participating), valuing (expressing commitment), organizing (integrating values and resolving conflicts between them) and characterizing (acting consistently from an internalized value system). An outcome such as "The student will advocate for a patient's right to refuse treatment during clinical conference" targets valuing or higher. Affective outcomes are assessed through observation, reflective journals and discussion, and are often evaluated formatively because attitudes are difficult to grade fairly.

The psychomotor domain describes skill performance. Simpson's levels progress from perception and set through guided response, mechanism and complex overt response to adaptation and origination. Dave's levels are imitation, manipulation, precision, articulation and naturalization. A first-semester student imitating a demonstrated injection is early in the domain; an experienced nurse who adapts technique smoothly for a cachectic patient is near the top.

Constructive alignment, a term associated with Biggs, means that the intended outcome, the teaching and learning activity and the assessment all target the same performance at the same level. Misalignment is common and is a favorite exam scenario.

Alignment Check for One Outcome

If the outcome asks for analysis but the exam tests recall, students will learn to memorize, and the grade will not tell faculty whether the outcome was met. If the outcome asks for demonstration of a skill but assessment is a written test, the evidence does not match the claim.

Exam Tip: When an item reports that students score well on unit exams but perform poorly at prioritization in clinical or on standardized tests, look for an alignment problem. The best answer often revises the teaching strategy or the assessment to match the outcome's cognitive level.

Choosing a strategy begins with the outcome's domain and level. Remember and understand outcomes can be supported efficiently by a well-organized mini-lecture, reading and retrieval practice. Apply and analyze outcomes call for cases, practice problems and clinical reasoning activities. Evaluate and create outcomes call for projects, debates, care-plan design and complex simulations. Psychomotor outcomes require demonstration, deliberate practice and feedback. Affective outcomes are served by role play, reflection, narrative pedagogy, values clarification and role modeling.

Other factors then refine the choice: learner characteristics (novice or experienced, prior knowledge, size of the group), setting (classroom, online, skills lab, clinical), resources (time, space, equipment, faculty), and delivery mode (face to face, synchronous online, asynchronous online, hybrid).

Common Trap: An attractive option may propose a sophisticated strategy (an escape room, a high-fidelity simulation) for an outcome that is simply recall. Fit to the outcome beats novelty.

Measurable outcomes state learner performance with one observable verb, plus condition and criterion when useful.

Avoid understand, know, appreciate and learn in course and unit outcomes; they cannot be observed.

Krathwohl's affective levels: receiving, responding, valuing, organizing, characterizing; psychomotor uses Simpson or Dave.

Constructive alignment means outcome, teaching activity and assessment target the same performance and level.

Choose the strategy from the outcome first, then adjust for learners, setting, resources and delivery mode.