HealthFebruary 22, 2017

Electronic Clinical Tracking Systems in Nursing Education

Recently, ECTSs have been gaining increased prominence in academic nursing settings. What does this refer to?

Electronic clinical tracking systems (ECTSs) are an educational technology used to track students” clinical information for review and analyses by nursing school faculty. ECTSs are used in many nursing schools to document advanced practice registered nursing (APRN) students” clinical experiences. The clinical experiences are based off the National Organization of Nurse Practitioner Faculties (NONPF) core competencies.

The use of ECTS is supported by the Institute of Medicine and Technology Informatics Guiding Education Reform initiatives, which support the use of electronic health records (EHRs) to provide quality and safety in APRN education. ECTS provides students with experience documenting patient encounters in clinical settings.

A recent study that appeared in the September 2016 issue of CIN: Computers, Informatics, Nursing evaluated the use of ECTS to validate students” clinical experiences in meeting national core competencies.


Formative program evaluation was used to determine if ECTS is effective in meeting core competencies for the APRN program. A formative program evaluation is defined as the evaluation of a program in process to determine an outcome. Formative program evaluation consists of inputs, activities, outputs, outcomes, and impacts.

Inputs, or resources, in this evaluation are ECTS and core competencies. Activities describe ECTS documentation properties of students” clinical experiences and are paired to the core competencies. Outputs are demonstrated by developing a side-by-side table matching core competencies to corresponding ECTS documentation. Outcomes are found in the results and report specific ECTS documentation to meet core competencies. Impacts were determined by discussing how well core competencies were met.


ECTS for APRN education focuses on providing students with substantive clinical experiences. ECTS allows for clinical logs, complete data sets, and real-time evaluations of students” clinical experiences. Cumulative data of students” clinical encounters are available to faculty throughout program progression.

The NONPF published the first set of core competencies in 1990 for APRN practice. These documents have been published as national guidelines for APRN education. Updates and modifications have occurred to meet educational needs of an ever-changing healthcare environment. The NONPF supports credentialing bodies in serving the public through the application of core competencies, which set standards for higher education in nursing. The APRN programs are obligated to develop specialty practice didactic and clinical experiences for students that reflect the integration of core competency areas.


ECTS was able to document individual student encounters, including demographic information, encounter times, vital signs, advanced practice examination skills, evaluation/management services, International Classification of Diseases (ICD) diagnostic codes, and Current Procedural Terminology (CPT) code assignments. Other documentation includes patient counseling provided, medications prescribed, and interdisciplinary consultations. ECTS also provides a venue for clinical note templates used in students” documentation of program-specific clinical encounters. These functions within ECTS allow for faculty review and overview of students” clinical experiences to meet program outcomes, which reflect the core competencies.


Researchers compared the alignment of ECTS documentation to specific core competencies in the areas of leadership and independent practice. Each competency component was reviewed. Then, ECTS documentation was subjectively determined by the authors to meet respective components.


Students” clinical documentation in ECTS were evaluated to meet core competencies. The results were categorized into each core competency being directly met, indirectly met, or not met. The documentation element was found to meet core competencies. Leadership and independent practice elements were partially met.


In this formative program evaluation, impacts were determined by evaluation of students” clinical documentations in ECTS as they relate to core competencies. Core competencies can be illustrated through students” clinical ECTS documentations in one of three ways: directly met, indirectly met, and not met using students” documentations in ECTS.


This report supports the use of ECTS in facilitating APRN accreditation and program outcome goals. There is ample evidence that ECTS documentation has a positive role in APRN programs in meeting most entry into practice competencies.

The authors recommend further studies to include aggregate data from multiple graduate nursing programs across geographic regions, which would add to the evidence in supporting generalizability of ECTS to meet core competencies.

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