by Susan Sportsman, PhD, RN, ANEF, FAAN
Nurse educators involved in RN pre-licensure programs are waiting with bated breath for updates on the progress of the Next Generation NCLEX (NGN) project, designed to develop more sophisticated methods to assess the ability of candidates to effectively use clinical judgement to care for patients. (See an overview of this project here and complete information from the National Council of State Boards of Nursing here.)
As the NGN project continues, the NCSBN has been clear that while the progress on this research process is positive, there will be no change in the NCLEX Test Design until at least 2023. As the NCSBN develops and evaluates new test-item prototypes as part of this project, we will all need to learn ways to develop our own test items that reflect the new testing approach. We will be covering this topic in the coming months.
Given this time frame, are there any changes that nursing faculty should make today to prepare for a revised NCLEX-RN that has not yet been introduced? The answer to this question is an unqualified YES! First, let’s consider why the NCSBN has taken on this ambitious task.
The findings from the NCSBN Strategic Practice Analysis, a part of the Next Generation NCLEX project, confirm the importance of sound clinical judgment skills to a significant number of tasks performed by entry-level nurses. The research found that clinical judgment, problem solving, and critical thinking were reported among the top five skills required of entry-level RNs. Clinical judgment was linked directly to more than 46% of tasks performed by entry-level nurses, while problem solving and critical thinking were linked to more than 30% of tasks performed by these nurses. Regardless of the time frame for the implementation of NGN, these skills are needed now.
It’s also important to note that while 2023 sounds a long way off, students admitted as Freshmen to Baccalaureate nursing programs in Fall, 2019 will be graduating and taking the NCLEX examination in 2023. The future will be here sooner than we think!
Consequently, we must increase our emphasis on fostering students’competence in clinical judgment in the curriculum and in teaching-learning activities in class, lab/simulation and clinical experiences. Certainly, today’s nursing curricula provide opportunities for students to develop critical thinking, problem solving, and clinical judgement skills. However, there has been confusion about the exact meaning of those words, making it difficult to effectively evaluate students’ competencies.
Fortunately, the NCSBN research has given us a clear understanding of the definition of clinical judgment and its relationship to critical thinking and problem solving.
This definition outlines the mental mechanisms that make up clinical judgment. This is important as it provides faculty with a road map to develop and implement specific teaching-learning activities that give students practice in the steps necessary for clinical judgment. Let’s explore ways that the faculty might use these mental mechanisms to develop specific teaching-learning and evaluation activities.
Conclusion
While nurse educators do not yet know how the NCLEX-RN will change as a result of the Next Generation NCLEX project, we DO know that novice nurses will increasingly be expected to effectively integrate clinical judgment into their practice as soon as possible after graduation. We have been given a road map to help us structure teaching and learning activities to build students’ competencies in this area. Let’s all resolve to use this road map in new ways to prepare our students for nursing practice. I am sure that many of you have great ideas for class, lab/simulation, and clinical teaching-learning strategies that will help students to develop clinical judgment. Please share those ideas with us (susy@collaborativemomentum.com) and we will post them on the Collaborative Momentum Consulting website.
References:
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. https://www.ncsbn.org/AssessingHigherorderCognitiveConstructs_2016.pdf Last accessed, November,2018.
National Council of State Boards of Nursing (2018) Strategic Practice Analysis. NCSBN Research Brief. https://www.ncsbn.org/18-Strategic-Practice-Analysis.pdf. Last accessed, November, 2018.
Next Generation NCLEX Project. Available at: https://www.ncsbn.org/next-generation-nclex.htm. Last accessed, December, 2018.