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

Research and Clinical Judgment Measurement

Model

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

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

NCSBN Clinical Judgment Measurement Model

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?

Next Generation NCLEX Prototypes

Case Study Example

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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

Next Generation NCLEX Updates

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

NGN Research Timeline

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

Next Generation NCLEX Resources

NGN Information on NCSBN Website

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

Future Educational Opportunities

• Webinars • Webex presentations• Updated FAQs

Educator Feedback

For future webinar consideration please email: nclexcontent@ncsbn.org