Active Learning in Nursing Education: What the Science Says
Practical Ways to Design Instruction That Matches How the Brain Learns
As every nurse educator knows, students can score well on an exam yet struggle to apply that same knowledge in practice. Learning science helps explain why. Durable learning requires effort, engagement, and opportunities for students to actively work with information. They need to be more participant than recipient.
Here’s what the science says — and how educators can design for it.
The Science of Learning
The science of learning identifies how people acquire and understand new ideas and how that process reshapes the brain.
“Each time we learn something new, neural pathways strengthen and new connections form,” said Kelly Simmons, DNP, RN, CNE, a nursing strategist at ATI Nursing Education. “This process requires a multisensory approach to teaching.”
Learning that is effortful, engaging, and reflective is more likely to endure than learning that feels easy or is passive, she said. In fact, a powerful yet counterintuitive strategy for building long-term learning incorporates intentional challenges into the process.1 It’s known as desirable difficulty.
Learning that is easy is like writing in the sand — here today, gone tomorrow. “It’s the struggle — the desirable difficulty — that signals the brain to engage and retain information,” Dr. Simmons said. “When instructional design aligns with how the brain builds and strengthens knowledge, students are better prepared to reason, adapt, and act in complex clinical settings.”
Why Active Learning Builds Clinical Judgment
When the principles of desirable difficulty are applied in nursing education, they help demonstrate why active learning is so closely linked to the development of clinical judgment.
The real value of active learning runs deeper than engagement. Active learning applies the cognitive science showing that learning is most effective when students are required to retrieve information, apply it across contexts, and reflect on their own thinking.
Research shows that among nursing students, active learning promotes critical thinking, strengthens clinical reasoning, and supports the transfer of theoretical knowledge to practice.2-4
“Effective learning isn’t passive,” Dr. Simmons said. “The brain is constantly organizing information, looking for patterns, and linking new knowledge to what’s already there. Our job as educators is to design experiences that support that process.”
Clinical judgment depends on much more than recall. Students must practice recognizing cues, analyzing information, prioritizing actions, and evaluating outcomes. These skills develop only through repeated, structured practice in varied situations. Active learning creates those practice opportunities by asking students to think for themselves rather than simply receive information.
“When students are accountable for pulling information out of their own heads,” Dr. Simmons says, “that’s when learning really takes hold.”
4 Learning Principles That Make Knowledge Stick
Cognitive science consistently points to several core principles that explain why active learning supports durable, transferable knowledge. These principles are reflected in 4 practical learning approaches that support long-term retention and application: retrieval practice, spacing, interleaving, and metacognition.
1. Retrieval Practice: Learning by Pulling Information Out
Retrieval practice strengthens learning by requiring students to recall information from memory rather than re-reading or reviewing notes. This process reinforces neural connections and helps learners identify gaps in understanding.5
“Retrieval is not an assessment tool. It’s a learning strategy,” Dr. Simmons said.
She recommends using a variety of techniques to elicit retrieval. These can include:
- quizzes after a reading or lecture
- polls using clickers or digital apps
- brief case prompts
- reflection activities.
“Over time, these moments help students build confidence and fluency in applying what they know,” she said. “The struggle to recall information improves and strengthens memory. This is the goal of retrieval practice — it really helps identify gaps in knowledge.”
2. Spacing: Learning Over Time, Not All at Once
Spaced learning fosters long-term retention because students review material over an extended period. Allowing time between learning encounters gives the brain an opportunity to consolidate memory and strengthen connections.
“When learners revisit information at different intervals, they’re not just re-reading,” Dr. Simmons said. “They’re actively strengthening long-term retention.”
Spacing is especially powerful in nursing education because concepts must connect across courses, labs, and clinical experiences. Threading prior content into new learning situations helps students move from short-term familiarity to lasting competence.
For example, an educator could present a concept or disease process one day and follow up two days later with a discussion board assignment on the material. For greatest impact, spaced learning should have a wide span, pulling from content across semesters as well.
“What a great way to thread all that content through your curriculum,” Dr. Simmons said. “Make it low stakes or no stakes. The goal is learning — and the more spacing, the better.”
3. Interleaving: Learning to Choose the Right Strategy
Interleaving mixes related concepts or problem types and prompts students to decide how to approach each situation. It’s designed to avoid repeated application of the same strategy.
By comparing and contrasting related concepts, such as oxygenation and perfusion or different dosage calculation methods, students learn to discriminate between similar situations and apply the appropriate response. This mirrors clinical practice.
“Interleaving practice forces students to choose a strategy based on the problem itself,” Dr. Simmons said. “It’s very similar to work problems on a cumulative exam or on NCLEX. You may give them an addition problem, then a multiplication problem, then a subtraction, then a division problem. You're mixing them up so they have to stop and think, ‘what is the strategy to answer the question?’”
One example of an interleaving activity is to create quizzes based on dosage calculations:
- dosages for tablets or capsules based on a specific client presentation
- dosages for an IV based on a client's weight.
Another example is to create an assignment comparing and contrasting oxygenation and perfusion for students in a nursing fundamentals class. “I think that's a great way of interleaving,” she said.
4. Metacognition: Learning How You Learn
Metacognition encourages students to reflect on what they know, where they are unsure, and how they can adjust their approach.
“Metacognition helps students become accountable for their learning,” Dr. Simmons said. “It’s ongoing, and it’s incredibly powerful.”
Educators can encourage metacognition with reflection activities, debriefs, and guided self-assessments. These help students recognize patterns in their thinking, which is an essential step in developing sound clinical judgment.
“It's intentional learning,” Dr. Simmons said. “It means stepping back and asking, ‘What do I know? What do I need to learn? And how can I improve the next time?’”
Students should use these awarenesses to adjust their behaviors, which improve their outcomes on assignments and tests.
Creating the Conditions for Learning to Stick
Even the most effective learning strategies rely on the environment in which they are used. Research shows that students are more willing to engage, reflect, and take intellectual risks when they feel supported and psychologically safe.
“No one can learn when they’re intimidated,” Dr. Simmons said. “That’s why creating an inclusive, supportive environment matters so much.”
When mistakes are treated as part of the learning process rather than failures, students are more likely to persist, adjust their thinking, and grow. Both are essential to the development of clinical judgment.
Preparing Students for Practice, Not Just Exams
The ultimate goal of active learning is not engagement for its own sake. It is preparing students to think clearly and act effectively in complex clinical situations.
“Using active learning strategies, we can design learning experiences that align with how the brain processes and strengthens knowledge and develops clinical judgment skills over time,” Dr. Simmons said. “We prepare students not just to pass an exam, but for real-world success.”
By grounding instruction in the science of learning and designing experiences that require effort, reflection, and application, nurse educators can help students build the clinical judgment skills they will use throughout their careers.
References
- Nelson A, Eliasz KL. Desirable Difficulty: Theory and Application of Intentionally Challenging Learning. Medical Education. 2022;57(4). https://doi.org/10.1111/medu.14916
- Cite: Kalu F, Wolsey C, Enghiad P. Undergraduate Nursing Students’ Perception of Active Learning Strategies: A Focus Group Study. Nurse Education Today. 2023. https://doi.org/10.1016/j.nedt.2023.105986
- Franco-Tantuico MA. Active Learning: A Concept Analysis with Implications for Nursing Education. Nursing Education Perspectives. 2022;43(4):233–237. https://doi.org/10.1097/01.NEP.0000000000000895
- Bristol T, Hagler D, McMillian-Bohler J, Wermers R, Hatch D, Oermann MH. Nurse educators' use of lecture and active learning. Teaching and Learning in Nursing. 2019; 14(2):94–96. https://doi.org/10.1016/j.teln.2018.12.003
- Serra MJ, Kaminske AN, Nebel C, Coppola KM. The Use of Retrieval Practice in the Health Professions: A State-of-the-Art Review. Behavioral Science (Basel). 2025;15(7):974. doi: 10.3390/bs15070974