Marilyn W. Edmunds PhD, NP In order to help nurse practitioners (NPs) provide care for the millions of uninsured Americans that will be brought into the health care system as a result of the Affordable Care Act, action plans are being developed that address the recommendations of the Institute of Medicine report on nursing. Among the strategies for change will be curriculum modifications, increased emphasis on quality clinical educational experiences, and even internships to assist in practice and skill mastery. Many NPs who live in states that permit advanced practice registered nurses to lead patient-centered primary care teams will be able to establish nurse-led primary care practices as patient-centered medical homes. This patient-centered model has patients more fully engaged in decision making about their care through better teaching, education, counseling, and communication between NPs and patients. The net result of these 2 efforts, among many other employment, business, and efficiency factors, will be that NPs in the future will work with greater independence, assume greater leadership responsibility, and need stronger skills and competence in their clinical practice. Most importantly, I believe, during this time NPs must practice as NPs, not as mini-physicians or physician assistants. We have said that our care is different, that we are holistic and patient-centered, so now our care must demonstrate that is really the way we practice. To achieve clinical excellence as NPs, we must have strong foundational nursing programs. Thus, I was somewhat dismayed to read the findings in a new book, Academically Adrift: Limited Learning on College Campuses, by sociologists Richard Arum of New York University and Josipa Roksa of the University of Virginia (2011, The University of Chicago Press). This book is based on a longitudinal study of more than 2,300 undergraduates from 24 universities that took the standardized Collegiate Learning Assessment test in their first semester and at the end of their sophomore year. The study found 45% of students show no significant improvement in the key measures of critical thinking, complex reasoning, and writing by the end of their sophomore year, with an average-scoring student scoring only 7 percentage points higher after 2 years. After 4 years, 36% of students did not demonstrate significant improvement on scores. The data collected showed that academic curricula were often not demanding. Half the students did not take a single course requiring 20 pages of writing during their prior semester, and one third did not take a single course requiring even 40 pages of reading per week. The study authors suggest that there are several reasons for these findings: students take easy courses, they don’t study much, and a culture exists at colleges and universities that values research over good teaching. The research also shows that students who studied alone, read and wrote more, attended more selective schools, and majored in traditional arts and sciences majors posted greater learning gains. Those students who spent more time studying with peers and being in a fraternity or sorority system had lower rates of learning. Working off-campus, participating in campus clubs, and volunteering did not impact learning scores. Whether the standardized test really captures learning in specialized majors or whether it is a reliable measure of college performance because so many factors are beyond the researcher’s control, it is clear that nursing faculty must take steps to improve student learning, use evidence to improve instruction, and publicize results if the highest quality education is to be provided.