by Susan Sportsman, PhD, RN, ANEF, FAAN
Does the NCLEX-RN™ Examination measure the knowledge, skills, and abilities newly graduated pre-licensure nurses need in order to practice safely in the rapidly evolving practice environment? This was the question the National Council of State Boards of Nursing (NCSBN)’s NCLEX Examination Committee asked the Examination staff in 2016, stimulating an extensive research project to determine the ability of current and potential innovative test items to adequately test nursing clinical judgment.
During this research project, NCSBN representatives have been speaking at a number of nursing conferences, so many nurse educators have heard of this exciting process. However, for those of you who have not heard of the NEXT GENERATION NCLEX –or those who would like a reminder—here is a brief overview, as well as links for easy access to more information.
The importance of clinical judgment in nursing practice and the emphasis on its development in nursing education programs has grown over the last 10 -15 years. For example, the 2013-2014 NCSBN Practice Analysis “confirmed the importance of sound clinical judgement skills to a significant number of tasks performed by entry-level nurses” (Next Generation NCLEX News, Fall, 2017, p.2). So when the Examination Committee considered how well the NCLEX-RN Examination measures current practice, NCSBN developed a research plan to answer the question.
The research plan began with a review of the literature and the development and implementation of a Strategic Practice Analysis, published in the January, 2018 NCSBN Research Brief. The Strategic Practice Analysis identified a comprehensive list of current components of nursing practice, including RN duties, tasks, knowledge, skills, abilities and other personal characteristics, key judgments and consequences of error, as well as tools and equipment used by the RN. Based upon the results of the Strategic Practice Analysis, as well as the literature review, the research team defined the following terms to ensure that going forward, all involved in the project would be using one definition of clinical judgment.
|Clinical Judgment: the skill of recognizing CUES about a clinical situation, generating and weighting HYPOTHESES, taking ACTION, and evaluating OUTCOMES for the purpose of arriving at a satisfactory clinical outcome. Clinical judgment is the observed outcome of two unobserved underlying mental processes:
· Problem Solving—developing and evaluating interventions to resolve complex problems within the context of nursing.
· Critical Thinking—the skill of using logic and reasoning to identify the strengths and weaknesses of alternative health care solutions, conclusions or approaches to clinical or practice problems.
NCLEX-RN Examinations Analysis and Research (Winter, 2018)
NCSBN brought together experts from the areas of measurement, test content and technology to imagine types of test items that could effectively measure clinical judgment. A team of nurses began to write item prototypes that were consistent with the Clinical Judgment Model.
|· Extended Multiple Responses
· Extended Drag and Drop
· CLOZE items
· Enhanced Hot Spot
· Dynamic Exhibit
· Constructed Response(Item Development for Next Generation NCLEX (NGN)-Winter, 2018
Because of the difference in design of current NCLEX items and the new prototypes, NCSBN recognized the importance of evaluating these items to ensure that they were easy to understand and simple to use. They wanted the item difficulty of the new items to be driven by the identified nursing skills rather than irrelevant features of the item’s presentation. To that end, a group of nursing students were invited to answer prototypes of these new types of questions. Experienced nurse educators reviewed the items to identify possible design problems. As a focus group, the nurse educators also provided “talk aloud” feedback regarding the content of the items. This ensured that the content represented current practice scenarios requiring clinical judgment that entry-level practitioners would be required to address (The Next Generation NCLEX Usability Studies- Spring, 2018).
Nurses, psychometricians, content developers, and a systems engineer used an iterative process to review these item prototypes. The NCSBN also began to hold test development workshops to develop Next Generation NCLEX (NGN) test items. These workshops were similar to the item writing and review panel meetings used to develop new items for the current NCLEX-RN examination. (Item Development for the Next Generation NCLEX (NGN)-Winter, 2018). The Summer, 2018 Next Generation NCLEX NEWS noted that the more recent workshops have focused on writing items for specific components of the Clinical Judgment Model.
Beginning in July, 2017, the NCLEX-RN Examination included a special research section, made up of newly created test items. These sample questions were estimated to take 30 minutes for new graduates to complete. If these test-takers completed their NCLEX-RN exam in time to complete these newly developed questions, they were given the opportunity to answer them (The test-takers were not required to take these questions and their answers were not reflected in their NCLEX-RN scores.) This process continues in each offering of the NCLEX-RN test. The responses are being used to “continuously gather validity evidence to support the inference based on the data.” (Test Validity, Fall, 2018)
This article provides you with an overview of the exciting NCSBN research designed to measure the clinical judgment abilities of entry-level nurses. I would encourage each of you to review the information provided by NCSBN on the Next Generation NCLEX found in the references. At the NLN Summit in Chicago this past September, Dr. Phil Dickison, Chief Officer, Operations and Examinations, National Council of State Boards of Nursing, indicated that the board had determined that there would be no changes in the NCLEX-RN test plan for 2019, as the NCSBN research team continues to move through the Next Generation NCLEX research process. (Everyone can breathe a sigh of relief here!) The measurement research will continue and if all goes well, there will be a focus on building appropriate technology for the new test items—for example, how will these new test items be scored? Assuming the challenges of operationalizing the new testing approach can be met, there will also be Alpha and Beta tests before a new NCLEX-RN Examination can be launched. I would recommend that you all registered for the NCSBN News communication updates at https://www.ncsbn.org/news.htm.
We do not yet know exactly how test items will be configured because the NCSBN research team continues to evaluate each step of the NGN research process. If the evaluation continues to be positive, the NCSBN anticipates that the Next Generation NCLEX will replace the current examination no sooner than 2023. However, it is not too early to prepare students for this type of testing. What can we do right now to prepare faculty and students for the Next Generation NCLEX? We must emphasize opportunities to develop competency in critical thinking through intentional activities in class, lab and simulation, and clinical experiences. I will have some suggestions for you in next month’s Collaborative Momentum Consulting blog article. So, stay tuned!
Dickison, P., Luo, X., Kim, D., Woo, A., Muntean, W., Bergstrom, B. (2016) Assessing Higher-Order Cognitive Constructs by Using an Information-Processing Framework. Journal of Applied Testing Technology 17 (1) 1-19. Available at: https://www.ncsbn.org/AssessingHigherorderCognitiveConstructs_2016.pdf
Muntean, W.J. (2017) Nursing Clinical Decision-Making: A Literature Review. Available at: https://www.ncsbn.org/11507.htm
Next Generation NCLEX Project. Available at: https://www.ncsbn.org/next-generation-nclex.htm
Next Generation NCLEX (NGN) Resources. Available at: https://www.ncsbn.org/11435.htm
- NCSBN (2017) Welcome: What is the Next Generation NCLEX (NGN)? Next Generation NCLEX NEWS. Fall. Available at: https://www.ncsbn.org/11805.htm
- NCSBN (2018) NCLEX-RN Examinations Analysis and Research. Next Generation NCLEX News. Winter. Available at: https://www.ncsbn.org/11998.htm
- NCSBN (2018) The Next Generation NCLEX Usability Studies. Next Generation NCLEX News. Spring. Available at: https://www.ncsbn.org/12129.htm
- NCSBN (2018) Item Development for the Next Generation NCLEX (NGN) Summer. Available at: https://www.ncsbn.org/12720.htm
- NCSBN (2018) Test Validity. Next Generation NCLEX NEWS. Available at: https://www.ncsbn.org/13083.htm
NCSBN (2018) Strategic Practice Analysis. https://www.ncsbn.org/11995.htm