Next Generation NCLEX: The Importance of Cues

Given the buzz around Next Generation NCLEX (NGN), you probably already have a good understanding of what NGN is and what you can be doing now to start preparing for this increased focus on clinical judgment. (If not, check out our recent articles on these topics.) This month we will drill down into the use of cues as a means of providing opportunities for nursing students to practice clinical judgment throughout their educational experience.

The NCSBN Clinical Judgment Model describes the identification and analysis of cues as the preliminary skill that builds clinical judgment. This analysis is then used to develop skill in generating hypotheses.  These hypotheses are then prioritized, actions are taken, and outcomes are evaluated.  This iterative process corresponds with the nursing process, which is introduced early in nursing programs and emphasized throughout.  However, the identification and analysis of cues are not specifically highlighted in the nursing process.  When this component of the Clinical Judgment Model is emphasized, it provides specific direction for teaching-learning activities which we may not have focused on in the past. 

Throughout a nursing program, students must develop nursing knowledge consistent with the role of a novice nurse in order to develop and implement safe care to patients. To address this need, nursing faculty often spend significant time in class delivering pertinent knowledge, often through teacher-centered lectures. The goal is to prepare students to connect specific symptoms to nursing care. The questions become: “Is this time well spent?” “Will our saying the information ensure that students remember it and, more importantly, will they be able to apply it effectively in clinical situations?”

Certainly, the acquisition of nursing knowledge is critical to developing into a safe, practicing nurse.  However, it is not simply the ability to regurgitate this knowledge that makes a nurse an effective practitioner. Rather, it is using the knowledge to recognize and appropriately analyze cues as a means of developing actions that meet the need. Dickason, Luo, et al. (2016) note that if a nurse’s knowledge base is limited or impaired, fewer decision cues can be recognized, resulting in decisions based on partial information. This often leads to less effective practice decisions. Although clinical experience adds to the practical and functional knowledge needed for complex nursing decisions, novice nurses may not have sufficient relevant experience in clinical settings for this analysis. This poses limitations on their ability to recognize relevant information cues when they enter practice.

In addition, there are other internal factors, as well as a number of external factors, that influence nurses’ awareness of cues. Dickison, Luo, et. al (2016) suggests the following internal (to the nurse) and external factors which can impact cue identification:

Nurse faculty must expand teaching-learning opportunities that focus on the identification and analyses of cues. These skills are critical to developing competencies in clinical judgment. What can nurse educators do to prepare our students to use cues effectively?  Here are some suggestions:

  • Develop learning opportunities that integrate external factors into the clinical situation, giving students the opportunity to identify various cues in spite of these distractions.
  • Propose “mini-case” studies during class, asking students, perhaps in small groups or a “pair-and share” exercise, to differentiate between relevant and irrelevant cues.
  • Include the documentation of cue identification and analysis in all assigned case studies.
  • Feature relevant and irrelevant cues in all simulation activities.
  • Integrate the identification and analysis of cues into the documentation of all assessments (patient, family, or aggregates/communities) in lab, simulation, or clinical experiences.
  • During simulation debriefing, ask students to identify and analyze cues previously highlighted in the scenario.
  • In each test or examination include questions that highlight cue identification and analysis.
  • Ask students to compare the impact of the internal and external factors that may have influenced cue identification and analysis during a clinical experience.

Preparation for the NCSBN Next Generation NCLEX project suggests a variety of new opportunities to prepare students for successful practice.  We would love to hear ideas you may have to develop clinical judgment competencies in our students. Please leave us a comment below!


Brenton, A. (2018) Next Generation NCLEX Project.  National Council of State Boards of Nursing. .  Last Accessed, January, 2019.

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: .

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