Does your Nursing Program Prepare Students to Use Clinical Judgment?

by Susan Sportsman, PhD, RN, ANEF, FAAN

Does your nursing program prepare students to effectively use clinical judgment?  How will you know? 

These are the questions that we are all asking ourselves as the National Council for State Boards of Nursing (NCSBN) continues its work in developing the Next Generation NCLEX (NGN) initiative. As you are aware, in 2017 the NCSBN began to conduct research to determine whether clinical judgment and decision-making in nursing practice can be reliably assessed through the use of innovative test items. Thus far, the research project has included the development of a clinical judgment model representing the internal and external behaviors nurses use to make decisions and construction of test questions to evaluate the novice nurse’s judgment. Currently, item usability, measurement research, and technology build-out for this project is underway.

All faculty members working with pre-licensure students are waiting with bated breath to learn exactly what the new test items will be like so that we can begin to prepare our students for the new testing system. However, the evaluation of these innovations is not yet complete, or public. So where does that leave nursing faculty?

We do know that the focus of the NGN is to test the novice nurse’s ability to use effective clinical judgment in a variety of situations. Knowledge, of course, provides the foundation for effective clinical judgment. However, a nurse must be able to identify and analyze the cues in the specific environment in order to apply the nursing concepts and other biopsychosocial knowledge appropriately. Helping students learn the knowledge is not sufficient; nursing faculty must also provide students with the opportunity to APPLY that knowledge in a particular context.

Application of the appropriate knowledge in a variety of contexts is the essence of clinical judgment.  At the end of their course of study, novice nurses must be able to demonstrate clinical judgment in areas emphasized in Client Need Categories and Integrated Processes outlined in the NCLEX-RN Test Plan. We know that regardless of what the NGN testing processes are, they are testing students’ clinical judgment competency. We must give students every opportunity to hone those skills.

So how do you know that each component of your program is targeted to prepare students to use clinical judgment?  Here are some questions that you and your colleagues should consider in order to assess the extent to which your nursing program is designed to prepare your students to make appropriate clinical judgments:

  • Are faculty members able to discuss the NCSBN Clinical Judgment Model with the students during class, lab, and clinical experiences?
  • Do the program’s admission processes evaluate students’ abilities to comprehend assigned reading material in a timely manner? Independent comprehension of basic nursing knowledge allows class time to be used for application of this knowledge.
  • Do all course objectives require students to apply knowledge presented in the course in a variety of clinical situations?
  • Are faculty members skilled in implementing active learning strategies that reflect course objectives?
  • Do scenarios used in class, lab or simulation experience provide cues students can analyze to develop and prioritize hypotheses as a means to generated solutions?
  • How often in each class period do students have the opportunity to actively solve clinical problems and debrief the effectiveness of their potential solutions?
  • Do the chosen scenarios give students opportunities to factor environmental time pressures into the resolution of clinical problems?
  • Are faculty members skilled in using debriefing in class, lab, simulation and clinical experiences?
  • Do skills experiences offer opportunities for students to explore how the context of a situation may affect their ability to perform a particular nursing skill?
  • Do faculty-made tests reflect the NCLEX-RN Test Plan?
  • Do faculty-made tests require students to identify and analyze cues, develop and prioritize hypotheses, and generate and evaluate actions?
  • Are faculty members knowledgeable about students’ scores on any standardized tests?
  • Does the program have a robust student remediation process?
  • Are students’ scores on faculty-made tests and standardized tests an indicator of the level of remediation students will participate in during any given term?

Answers to these questions can provide clues of areas in your program that may be strengthened. Beginning this process now will prepare students to develop clinical judgment competencies.  When the NGN testing procedures are made public, we will all be ready!

We are eager to hear about your progress.

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