DIGITAL BADGES TO RECOGNIZE CLINICAL SKILLS	1

DIGITAL BADGES TO RECOGNIZE CLINICAL SKILLS	24


 
 
  
 
 
 
 
Use of Digital Badges to Recognize Nurse Practitioner Students’ Clinical Skills: 
A Pilot Project


Kun Huang
College of Nursing, East Carolina University
Doctor of Nursing Practice Program
Dr. Jan Tillman
October 4, 2023











Notes from the Author 
I would like to take a moment to thank my ECU College of Nursing faculty: Dr. Tillman, Dr. Hodges, and Dr. Skipper. This project and paper would not have been possible without their enduring guidance and tremendous support. 
I dedicate this project to my wife Yan; to my son Zhengchao; to my daughter Jiayu; and to my parents. Your love and support over the last three years have given me the courage and strength to overcome the difficulties and barriers. I can’t wait to see all of your beautiful faces.
















Abstract
Students in nurse practitioner programs are required to learn many clinical skills and procedures. Digital badges were chosen as ways to recognize clinical skills and provide students with means to represent their clinical skill validation on their resumes. 
The university/project site offers four immersion experiences. Different clinical skills and procedures were taught during the first three immersion experiences. During the fourth immersion, faculty validated students’ skills and awarded them digital badges. A post-survey was conducted to aggregate students’ opinions on receiving the badges. A total of eight badges were created. The overall response rate was 94% for the post-award survey. Over 80% of NP students believed the badges would be a meaningful addition to their resumes and a quick way for future potential employers to see their clinical skills. 
Faculty in the nursing college played essential roles in the processes of skills validation and awarding badges. The author strongly recommends using digital badges to recognize students’ clinical skills in higher education. There are many opportunities for further exploration to expand the utilization of digital badges. The project’s limitations included the small sample size and the lack of a survey to gather potential employers’ opinions toward the utilization of digital badges.  
Keywords: micro-credentialing, digital badges, nurse practitioner students, clinical skills





Table of Contents
Abstract………………………………………………………………………………………….. 3
Section I: Introduction ..………………………………………………………………………….6
	Background………………………………………………………………………………6
	Organizational Needs Statement…………………………………………………………6
	Problem Statement……………………………………………………………………….7
	Purpose Statement………………………………………………………………………..7
Section II: Evidence…………………………………………………………………………...…8
	Literature Review………………………………………………………………………...8
	Current State of Knowledge……………………………………………………………...8
	Current Approaches to Solving Population Problem(s)…………………………………9
	Evidence to Support the Intervention……………………………….………….………..10
	Evidence-Based Practice Framework……………………………………………………11
	Ethical Consideration and Protection of Human Subjects……………………………….11
Section III: Project Design……………………………………………………………………….13
	Project Site and Population………………………………………………………………13
Description of the Setting………………………………………………………………..13
Description of the Population……………………………………………………………13
	Project Team……………………………………………………………………………..13
	Project Goals and Outcomes Measures…………………………………………………..14
	Description of the Methods and Measurement…………………………………………..14
            Discussion of the Data Collection Process………………………………………………14
	Timeline………………………………………………………………………………….15
Section IV: Results and Findings………………………………………………………………..16
	Results…………………………………………………………………………………...16
	Discussion of Findings…………………………………………………………………..17
Recommendations for Future Application and Exploration ……………………………18
References……………………………………………………………………………………….20
Appendices………………………………………………………………………………………24
	Appendix A: Digital Badges…………………………………………………...……......24
Appendix B: Qualtrics Survey Data …………………………………………………….25















Section I.  Introduction 
Background
East Carolina University (ECU) is a public university in Greenville, North Carolina. The ECU College of Nursing offers degrees at various levels and enrolls more than 1,200 students across all degree programs. Its mission is “to serve as a national model for transforming the health of rural underserved regions through excellence and innovation in nursing education, leadership, research, scholarship and practice” (College of Nursing, n.d.). The Nurse Practitioner programs at ECU College of Nursing offer various types of clinical skill training during the face-to-face on-campus immersion experiences. 
A recent trend in higher education in the United States is developing and adopting digital badges (Olcott, 2022). Digital badges, also known as micro-credentials, are considered innovative approaches to represent competency-based achievements. They engage and motivate learners, recognize informal learning, increase students’ knowledge, and facilitate individualized learning pathways (Dyjur, 2017; Noyes, 2020; Newby & Cheng, 2020; Fields, 2015).
Organizational Needs Statement
Nurse practitioners (NPs) are advanced practice registered nurses (APRNs) who must acquire advanced clinical skills to work proficiently within the scope of their practice. To help students gain additional clinical skills, the ECU College of Nursing has established four face-to-face on-campus clinical skill training sessions. All nurse practitioner students are required to attend one training session each semester and have their skills validated. However, the skills obtained were untraceable as students were not qualified for any specific certificate or credential after the completion of the training. 
The nursing college faculty expressed the need to integrate micro-credentialing with these training sessions. By showcasing students’ clinical skills with digital badges, potential employers would be able to more quickly identify the skills they expected, thus decreasing the time spent on finding the right candidate for the job vacancy. This would help alleviate the healthcare provider shortage and address the Quadruple Aim by enhancing the process of care provider recruiting to improve provider satisfaction and reduce healthcare costs (Institute for Healthcare Improvement [IHI], 2021). The decrease in infectious disease, injury, and death through nurse practitioner staffing helped meet the Healthy People 2030 overarching goals (Office of Disease Prevention and Health Promotion, n.d.). 
Problem Statement 
The ECU College of Nursing lacked ways to recognize and represent the skills that nurse practitioner students obtained during immersion experiences. Further exploration was needed to establish possible means for clinical skill recognition.  
Purpose Statement
This project aims to obtain approval for micro-credentials in the form of digital badges to recognize nurse practitioner students’ clinical skills and provide a portfolio with digital badges that represent their clinical skill validation on resumes. As part of the project, digital badges will be created, and criteria for the badges will be discussed with and approved by the nursing college faculty.




Section II. Evidence
Literature Review 
	A literature review was conducted to identify articles on utilizing digital badges to recognize performance and learned skills. Databases used included PubMed, CINAHL, and ECU One Search. The search conducted in ECU One Search was limited to scholarly & peer-reviewed articles. Keywords used were digital-badge, digital-badging, micro-credentials, micro-credentialing, microcredentials, microcredentialing, student, employee, staff, training, and professional. The search resulted in 365 records. Fifty-six full-text articles were retrieved after a thorough review of titles and abstracts. Based on an examination of the 56 remaining articles, five duplicates were removed, and 40 were excluded after inclusion/exclusion criteria applied. Exclusion criteria include a) studies focusing on only the motivation aspect of digital badges, b) studies concentrating on secondary or primary school students, c) articles that only addressed the design of digital badges. Inclusion criteria include English language; recognition of employability performance/skills was addressed. Of the initial 365 search results, 11 articles were retained for the literature review. Levels of evidence ranged from level V to VI.
Current State of Knowledge 
The literature on the implementation of digital badges in higher education is limited. There was little literature that utilized digital badges to recognize students’ or staff’s employability skills. No articles regarding recognizing nurse practitioner students’ clinical performance/skills with digital badges were found. There was little literature to support the design and implementation of digital badges in healthcare education (Noyes et al., 2020). 
Badge providers, learners, and employers are three major stakeholders in the badge ecosystem. More work is needed to identify the competencies employers value and promote the familiarity and awareness of digital badges (Mathur et al., 2018). A survey conducted by Ashcroft et al. (2021) indicated that familiarity with micro-credentials among students and employers was low. In another study interviewing college admissions officers and human resources and hiring personnel, the stakeholders that might admit students and hire professionals found that only 20% of participants had directly used and were aware of the uses of badges (Pitt et al., 2019). The major obstacles to implementing digital badges include a) the establishment of credibility, b) the investment of time, effort, and money for implementation, and c) the triviality of badges (Pitt et al., 2019).
Current Approaches to Solving Population Problem(s)
Digital badges can be used to recognize skills and competencies that are not presented in traditional curricula or transcripts (Selvaratnam et al., 2021). The credentials can be stored and shared instantly via social media, attached to a resume, and listed in a digital portfolio (Mathur et al., 2018). Digital badges can be added as an important component of a portfolio. The pairing of the portfolio with digital badges facilitates the demonstration of the skills acquired and the transfer of learning beyond the campus (O Neill et al., 2021). The review of current literature did not provide an approach to recognize nurse practitioner students’ clinical performance/skills. However, the evidence from other programs and professionals suggests that credentials are usually successful if they meet current and future employers’ hiring requirements (Selvaratnam et al., 2021). Collaborating among stakeholders to establish the categories and criteria for badges will increase their value (Selvaratnam et al., 2021; Felton et al., 2022; Cheng et al., 2018). The value of a badge also becomes greater if it provides data about the learning process and the evidence or answers that an employer needs (Trepule et al., 2021). 
Iafrate (2017) identifies the process of issuing a badge includes a) determining what performance or skills to recognize, b) establishing the criteria for earning the badge, c) provision of curriculum/courses, d) evaluating learners and awarding a badge to the individual who met the criteria. Several included studies demonstrate the application of digital badges to recognize the achievement and skills of students or staff (Felton et al., 2022; Copenhaver et al., 2017; Hensiek et al., 2016; Pitt et al., 2019; Maina et al., 2022; Mathur et al., 2018).
Evidence to Support the Intervention
The benefits of digital badges for students and potential employers are their portability, shareability, longevity, and verifiability (Quigley, 2022). Digital badges represent achievements that students can add to their electronic resume and LinkedIn profile to showcase marketable professional skills and improve their employment prospects (Mathur et al., 2018; Copenhaver et al., 2017). Integration of digital badges into students’ training facilitates the acquisition of employability skills. Felton et al. (2022) found that students who completed industry-specific badges were guaranteed an interview. By contrast, students with only traditional credentials risk looking unprepared or unattractive to hiring companies for their competitive positions.
A study by Maina et al. (2022) explores micro-credentialing methodology to improve the recognition of employability skills. The results indicate that micro-credentialing in higher education promotes skills visibility, transparency, and trustability. The paper states that badges awarded enrich students’ resumes and provide evidence of their learned skills. It is also beneficial for employers to identify the skills they expect from candidates using the digital badges issued by a university and backed up by trustable endorsement and a transparent recognition process (Maina et al., 2022). Applying digital badges to recognize marketable skills enhances learners’ preparedness to enter the workforce. An increasing number of employers are using micro-credentials to make the recruiting and hiring process more efficient (Mathur et al., 2018; Maina et al., 2022).
Evidence-Based Practice Framework
This project utilized Deming’s Plan-Do-Study-Act (PDSA) cycle to guide the design and award of badges and develop criteria for badges. The PDSA cycle is a four-step cyclical model that was introduced as an improved Shewhart cycle in 1986 and then modified as the PDSA cycle in 1993 (Deming, 1986; Moen, n.d.). PDSA cycles are widely used for quality improvement in healthcare (Taylor et al., 2014; Knudsen et al., 2019; Burgin, 2022; Ralph et al., 2022). The Plan (P) step identifies goals and objectives and determines what change is needed and how to measure and actualize the change (The Deming Institute, n.d.). In this phase, the criteria for badges and the checklists to assess the student’s performance/skills were developed. The Do (D) step implements the plan (The Deming Institute, n.d.). The digital badges were delivered to qualified students during this step. The Study (S) step examines the progress and success of change and the areas that should be improved (The Deming Institute, n.d.). The criteria for badges and the badge award process were examined in this step. The Act (A) step integrates the evidence created in all four steps, identifies areas that need to improve, adjusts goals, and closes the cycle (The Deming Institute, n.d.). This step made necessary adjustments to the criteria and the process of delivering digital badges. The entire cycle can be repeated as a never-ending cycle of continual improvement for badge design and delivery.
Ethical Consideration and Protection of Human Subjects 
	The purpose of this project was to utilize digital badges to recognize NP students’ clinical performance/skills. The intervention was equal for all target NP students. There are no ethical considerations for this project. No potential harm was identified. There was no potential that anyone in the target population could be taken advantage of during implementation as no personal information was retained.
           The project lead completed the modules required for all social/behavioral research investigators and key personnel from the Collaborative Institutional Training Initiative (CITI) program. The project lead completed the IRB QI/Program Evaluation Self-Certification Tool required by the university, discussed the results with project faculty, revised accordingly, and then submitted the tool online with site faculty approval. The site champion approved the project. No additional review for approval was required.















Section III. Project Design
Project Site and Population 
	This DNP project was conducted within one nursing college in eastern North Carolina. The population participating in the project included one student cohort in a primary care nurse practitioner program in the last of four primary care clinical practicums. The project was supported by the DNP Project, clinical faculty, and a librarian within the university. 
Description of the Setting
	The nursing college enrolls more than 1,200 students across different degree programs – baccalaureate, master’s, and practice and research doctorates. The college employs more than 150 faculty and staff members. It serves as the top producer of new nurses among all the four-year educational institutions in North Carolina. The MSN and DNP programs were established in 1977 and 2013, respectively. All programs are accredited by the Commission on Collegiate Nursing Education.    
Description of the Population
	The population included nurse practitioner students enrolled in one course in the spring semester. Participants were in their last clinical rotation for the program. Clinical skills are taught and validated in face-to-face on-campus immersion experiences across semesters one, two, and three. In the last of four clinical semesters, students demonstrated clinical skills during the final immersion experience. At that time, faculty determined if students were proficient in diverse skills and procedures common to primary care.
Project Team
	The project team consisted of the DNP student and two faculty who served as content experts. Faculty and a librarian provided advice on the literature review. Faculty mentored the student during development of the project plan and badges, implementation of the project, the creation of a post-validation survey, and the analysis of the survey results. 
Project Goals and Outcome Measures 
	The pilot project aimed to explore possible approaches and provide nurse practitioner students with the means to represent their clinical skill validation on their resumes. The deliverable for this project was the creation of badges to be awarded to students during the fourth on-campus skills and procedures validation. The outcomes measure was the percentage of students awarded with the badges and the results of a post-award survey. The post-award survey was conducted to gather participants’ perceptions of the benefits of receiving the badges. The survey data was collected via Qualtrics. The university institutional review board (IRB) did not require IRB review for the project. 
Description of the Methods and Measurement
	The clinical skills for which badges were awarded were determined in collaboration with clinical faculty. A total of eight skills were selected. These clinical skills include shoulder injection, knee joint injection, casting, splinting, ECG interpretation, pelvic exam, diabetic foot exam, and suturing. Badges were designed and created using Adobe Express. The post-award survey, which consisted of multiple choice questions, was developed, and a QR code was generated to allow students access to the survey. Students were provided with the QR code during immersion and in their Canvas course. Final skill validation was performed by clinical faculty prior in Spring 2023. Correlating badges were awarded based on skills attained. The post-award survey was available following skill validation at the on-campus immersion. 
Discussion of the Data Collection Process
	Clinical faculty provided the total number of students required to participate in skills validation and the number of students awarded badges during the skills validation. The post-award survey was administered during the Clinical Immersion. The post-award survey results were downloaded and analyzed in collaboration with the project faculty.
Timeline
	Project planning and pre-approval began in June 2022. A scoping literature review on micro-credentialing was conducted in September 2022. Final project approval was granted in December 2022. During February 2023, the badges and the post-award survey were created. Final skill and procedure validation was in March 2023. Badges were awarded, and the post-award survey was distributed at that time. The post-award survey was available for three days. The results of the project implementation, outcomes, and post-award survey were analyzed in April 2023. The project outcomes were formally presented in July 2023. 
	










Section IV. Results and Findings 
Results
A total of eight badges were created (See Appendix A). The post-award Qualtrics survey responses are shown in Figure 1. The overall response rate was 94% (31 out of 33 students). Eighty-one percent of students believed the badges would be a meaningful addition to their resumes and a quick way for potential employers to see their clinical skills. Eighty-four percent of students reported the badges would allow employers to quickly see their skillsets. Seventy-four percent of students reported that they would place their badges on their resumes, believing that the badges would make their resumes stand out and allow employers to understand their clinical skillsets. Most students (55%) reported they would like to have had the opportunity to earn more badges during their clinical experience at the college. Ten percent of participants did not intend to use the badges in the future.











Figure 1
Digital Badges Post-Award Survey Responses

Note. Data represents number of survey respondents per item.
Discussion of Findings
This pilot project examined the process of micro-credentialing in higher education. It was the first project at the university to explore the application of digital badges in recognizing nurse practitioner students’ clinical skills.
The findings support that digital badges can be easily created and readily available. Software such as Adobe Express facilitates the creation of badges. However, the implementation of the badges rests heavily on the faculty teaching the courses within the program. Faculty must validate what students have accomplished and award the badges based on the results of skill validation. Therefore, faculty engagement and their willingness to collaborate with students are crucial in establishing and maintaining the digital badging system.
The findings from this pilot project also demonstrated preliminary support for the implementation of digital badges. Overall, the survey respondents had positive attitudes toward using micro-credentialing in the form of digital badges to recognize clinical skills. They believed that building their resumes with these badges is beneficial for improving their employment prospects. There are several benefits to implementing micro-credentialing. To begin with, the award of badges enriches students’ resumes and provides evidence of their learned skills. In addition, the skills training during the application of digital badges can promote learners’ preparedness to start their work and make the transition from students to practitioners easier. Furthermore, the shareability and visibility allow students to add digital badges to their electronic resume and LinkedIn profiles to showcase marketable professional skills. Finally, potential employers can identify the skills they expect quickly from candidates using the digital badges and reduce the time to hire the right employee. 
Recommendations for Future Application and Exploration
We strongly recommend utilizing micro-credentialing in higher education to meet students’ need for building a strong resume profile in higher education. This pilot project set the foundation for the future development of a digital badging system. Other students or faculty may continue further developing this project to its full potential.
Nursing colleges, students, and future employers are major stakeholders in the micro-credentialing system. We did not explore the perspectives of possible future employers in this pilot project. For future study, the authors recommend expanding the survey to explore the opinions of potential employers about having badges on applicants’ resumes.  
The possibilities for expanding the utilization of digital badges are endless. One potential is that digital badges can be used during the entire program, from admission to graduation. For example, when utilize digital badges on a semester-by-semester basis, faculty for the next semester can easily track what a student has accomplished in the previous semester(s). Another possibility is that digital badges can be used to reflect other clinical skill sets and performance. Faculty could award badges to students in clinical didactic and practicum courses for good clinical decision-making and clinical knowledge, for writing good history and physical narratives and the subjective, objective, assessment and plan (SOAP) notes, and more. Therefore, the author recommends ongoing utilization of microcredentialing and integration of the process in diverse courses throughout the nurse practitioner specialties.















References   
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College of Nursing. (n.d.). Mission. https://nursing.ecu.edu/about/mission/
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Deming, W. E. (1986). Out of the crisis. Cambridge, MA: Massachusetts Institute of Technology, Center for Advanced Engineering Study.
Dyjur, P., & Lindstrom, G. (2017). Perceptions and uses of digital badges for professional learning development in higher education. TechTrends, 61(4), 386-392. https://doi.org/10.1007/s11528-017-0168-2
Felton, S. D., Whitehouse, G., Motley, C., Jaeger, D., & Timur, A. (2022). How I stopped fearing micro-credentials and began to love digital badging - A pilot project. Industry and Higher Education, 0(0), 1-9. https://doi.org/10.1177/09504222221117951
Fields, E. (2015). Making visible new learning: Professional development with open digital badge pathways. Partnership: The Canadian Journal of Library and Information Practice and Research, 10(1), 1-10. https://doi.org/10.21083/partnership.v10i1.3282
Hensiek, S., DeKorver, B. K., Harwood, C. J., Fish, J., O Shea, K., & Towns, M. H. (2016). Improving and assessing student hands-on laboratory skills through digital badging. Journal of Chemical Education, 93(11), 1847-1854.
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Maina, M. F., Guàrdia Ortiz, L., Mancini, F., & Martinez Melo, M. (2022). A micro-credentialing methodology for improved recognition of HE employability skills. International Journal of Educational Technology in Higher Education, 19(1), 10. https://doi.org/10.1186/s41239-021-00315-5
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Appendix A
Digital Badges


Appendix B
Qualtrics Survey Data
Questions for Post-Award Survey:
Q1 - Choose all that apply:
1. I will use my badges when applying for a nurse practitioner position after graduation
2. The badges will be a meaningful addition to my resume
3. The badges will make my resume stand out
4. The badges are a quick way for future employers to see my clinical skills.
5. I would like to have had the opportunity to earn more badges during my clinical experience at ECU.
6. Potential employers will know more about my clinical skillset by seeing the badges.
7. I do not intend to use the badges in the future.
8. None of these apply.

Q2 - Please share why you do not see the importance of the badges or why you will not share the badges.

Q3 -  Please share any information that you would appreciate us to know.


I do not intend to use the badges in the future	Potential employers will know more about my clinical skillset by seeing the badges	I would like to have had the opportunity to earn more badges during my clinical experience at ECU	The badges are a quick way for future employers to see my clinical skills	The badges will make my resume stand out	The badges will be a meaningful addition to my resume	I will use my badges when applying for a nurse practitioner position after graduation	3.0	23.0	17.0	26.0	23.0	25.0	23.0	


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