Next Generation NCLEX® (NGN) Educator WebinarPart 1
Aly Brenton RN, MSN, CNLEmily K. Petersen MS, MJ, RN, APRN, CPNP
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Objectives
• Discuss NCSBN clinical judgment research
• Present the NCSBN Clinical Judgment Measurement Model
• Review NGN case study and item prototypes
• Identify NGN resources and FAQs
Nursing and Clinical Judgment
Increased Demand for Competent
Clinical Judgment
Increasing Client Age
Increasing Client Acuity
Changes in Health Care
Kavanaugh and Szweda (2017) have identified a deficit in clinical judgment exists with entry-level nurses.
The Beginnings
NEC* 2012: Is the NCLEX® measuring the right things?
2015: Strategic Practice Analysis
Pilot Study
*NCLEX Examination Committee
• Education regarding critical thinking, clinical decision making, and clinical judgment has already become a standard part of nursing curricula
• Clinical judgment is important for public safety
Literature Review Findings
novice nurses involved in nursing errors
50% errors
attributed to poor clinical decision making
65% employers satisfied
with clinical decision making skills of novice nurses
20%
Top 3 Areas Identified:1. Clinical Judgment2. Professional Communications3. Active Listening
Recent Evidence to Support NGN Research 2012
Functional Job Analysis (RNs)
• 2,522 SMEs• 24 Practice Settings• All 4 Geographic Regions• 50 States and/or U.S.
Territories• Tenure ranges 0 – 45 years
2015Strategic Job Analysis (RNs)
• 90 SMEs• 20 Practice Settings• All 4 Geographic Regions• 33 States• Tenure ranges 2 – 45 years
Evaluation of Current Item Types
Item Formats
Multiple choice
Multiple response
Drag and drop
Hot spot
Audio
Graphics
Exhibit
Clinical Judgment Skills
Cue recognition
Hypothesis generation
Communication
Consequences/risks
Task complexity
Time pressure
Distractions/interruptions
Current NCLEX® Item Bank: Clinical Judgment Domain Distribution
Recognize Cues
Analyze Cues Prioritize Hypotheses
Generate Solutions
Take Action
Evaluate Outcomes
Audio
Drag and Drop
Exhibit
Graphic
Hot Spot
Multiple Choice
Multiple Response
Conclusions
Clinical judgment is an important and necessary skill for the novice nurse
The current NCLEX exams address clinical judgment indirectly and are limited by the item types available
Providing a more direct, evidence-based measure of clinical judgment requires both additional research and the use of new item types
NCSBN Clinical Judgment Measurement Model
• Designed to test clinical judgment and decision-making in a large-scale, high-stakes setting
• Supports the development of test content for the Next Generation NCLEX
• Can be adapted by educators to classroom settings, including clinicals
Clinical Judgment Overview
Recognize Cues
Analyze Cues
Prioritize Hypotheses
Generate Solutions
Take Action
Evaluate Outcomes
Clinical Decision Making
Recognize Cues
Analyze Cues
Prioritize Hypotheses
Generate Solutions Take Action Evaluate
Outcomes
Layers 3 and 4 of the Clinical Judgment Measurement Model
Layer 3
Layer 4
Environment
Client observation
Medical Record
Resources
Task Complexity
Time Pressure
Cultural Considerations
Consequences & Risks
Environmental Factors Knowledge
Skills
Specialty
Candidate Characteristics
Prior Experience
Level of Experience
Individual Factors
Recognize Cues
• Setting & Resources
• Demographics & History
• Normal & Abnormal Findings
• Special Equipment
• Time Pressure(s)
Analyze Cues
• What impacts data analysis?• Demographics• History
• What pathophysiology relates to the clinical presentation?
• What are the client needs?
• Potential Complications
Prioritize Hypotheses
• What is the priority need?
• What are the other needs of the client?
• What impacts the needs of the client?• Resources• Demographics• History
Generate Solutions
• What interventions are needed to address the client’s needs?
• Are there any interventions that are inappropriate?
• What impacts the list of interventions?• Resources• Demographics• History
Take Action
• What action(s) should be taken?
• Is there a priority action?
• What impacts the action(s) chosen?• Resources• Demographics• History
Evaluate Outcomes
• What outcomes are expected?
• Were the outcomes achieved?
• Are resources needed to evaluate the outcomes?
• What should be assessed?
• What should be reassessed?
New NGN Item Types: Clinical Judgment Measurement Model Domain Distribution
Recognize Cues
Analyze Cues Prioritize Hypotheses
Generate Solutions
Take Action
Evaluate Outcomes
Cloze
Enhanced Hot Spot
Extended Drag and Drop
Extended Multiple Choice
Extended Multiple Response
Matrix
NGN Special Research Section
• Intention is to collect data on new item types that could enhance the measurement of nursing clinical judgment
• Participation is optional and is offered to candidates who still have enough time in their exam appointment to complete the special research section
• Does not impact the NCLEX score
Test Design Considerations
• The majority of the NCLEX items will remain the same
• The NCLEX will also include special case studies and other items that focus specifically on clinical judgment
• Some item types will change
Scoring NGN Items
• NCSBN continues to perform research and development of final scoring and test design
• Partial credit scoring model is in development for new NGN items
• Exams will include both current NCLEX knowledge items and new clinical judgment items
• NCLEX knowledge items will be scored dichotomously
• More information will be provided once scoring model is finalized
NGN ResourcesQuarterly Newsletters: https://www.ncsbn.org/ngn-resources.htm
NGN Presentations & Talks:https://www.ncsbn.org/ngn-talks.htmNext Generation NCLEX FAQs: https://www.ncsbn.org/11449.htmMeasuring the Right Things, In Focus article:https://www.ncsbn.org/12021.htm
NGN Research Publications
All available on NCSBN NGN Resources page: https://www.ncsbn.org/ngn-resources.htm