Interesting day! I do enjoy listening to all the NCSBN staff to be truly informed about the NCLEX and how it works. I always learn something new. Of course, with the Next Gen NCLEX, there is always something new! However, we also need to keep in mind this year that a new detailed NCLEX-RN and NCLEX-PN test plan go into effect on April 1, 2023 as well. Following are some notes from the conference that relate to the test itself and teaching clinical judgment.
Alert! Testing clinical judgment is not limited to the new Next Gen type items, but will be applied across all items. This is a major factor to consider. Originally, the idea was that clinical judgment would be measured with Next Gen Clinical Judgment Questions. Well, clinical judgment will actually be tested across all item types – new test items and traditional test items.
Clinical judgment is now an integrative process applied throughout the test plan. Other integrative processes that have been in place for quite some time include the nursing process; caring; communication and documentation; teaching/learning; and culture and spirituality. Cognitive processes are processes that are fundamental to the practice of nursing and are integrated throughout the client needs categories and subcategories. Clinical judgment is an integrated process throughout the entire exam, in case studies or clinical scenarios and traditional items.
So, remember, clinical judgment will be tested in all forms of questions including:
- The unfolding case studies.
- The stand-alone clinical judgment items.
- The traditional type of NCLEX questions that will continue to be on the exam.
Therefore, the ability to engage in clinical judgment is important for the current item types as well the new Next Gen NCLEX items.
Length of the Exam
The minimal number of items starting April 1, 2023 will be 85 items (70 scored and 15 pretest items) and the maximum number of items will be 150 items (135 scored and 15 pretest items). In the minimal number of items (85) students will have 3 case studies with 6 scored items each. If they need more than 85 items to determine if they pass or fail, they will continue to take items until the determination is made. Some of those will be clinical judgment questions. If they take the maximum number of items, they may receive up to 10 additional clinical judgment items.
Traditional Items versus Next Gen Items
The NCSBN speaker shared that traditional (current) NCLEX type questions are focused on one place in time. They are a short version of what is going on with the client. The items may offer some client information but not to the degree that a clinical judgment item does. A traditional NCLEX item presents and asks about a particular point in time.
One of the things that you will see that differentiates clinical judgment items from traditional items is the scenario surrounding the client. The item is usually more aggressive in content and the level of analysis required to answer the question. Next Gen NCLEX questions have much more relevant clinical information to sort out and analyze then determine what to do (apply clinical judgment for all these processes). They present a much more thorough scenario that more closely reflects reality.
Names of Medications
All medications names will be given in the generic with the Next Gen NCLEX as they are now. Classifications of medications might be used. No brand names are used.
If the question includes a specific lab result, the lab ranges will be provided. Therefore, the student does not need to decide if the lab value is within normal limits. If there is an exam item that says the “glucose is elevated”, there is no reason to include a reference range in that test item. If the item specifically presented a number associated with a lab value, then the normal range is listed with the item. What is important is not if students can remember the normal range of a laboratory test, but what would the nurse DO with that information. Also remember, an out-of-range laboratory result may not be a bad sign, but may be a good indicator depending on the other information the student has to sort through and analyze. It may indicate an improving situation.
Percentages of Categories of Content
None of the category percentages are changing on the NCLEX-PN. Three category percentages are changing for the NCLEX-RN. These are:
- Management of Care in 2019 was 17-23%. For 2023 the proposed change is to 15-21%.
- Safety and Infection Control in 2019 was 9-15%. For 2023 the proposed change is to 10-16%.
- Pharmacological Therapies in 2019 was 12-18%. For 2023 the proposed change is to 13-19%.
These changes are slight adjustments for NCLEX-RN, but the NCSBN speaker noted to be sure to pay attention to those sections.
The passing standard for both the NCLEX-RN and NCLEX-PN will be determined in December, 2022 when voted on by the NCSBN Board. The new test plans also will be out in December.
- A new and updated NCLEX tutorial allows candidates to interact with new item types before taking the next generation NCLEX.
- If a student fails the NCLEX between now and April 1, 2023 and they repeat the NCLEX after April 1, they will take the Next Gen NCLEX.
These are NCSBN websites that provide lots of great information:
The NCSBN shared these websites that have resources available including a sample pack of next-generation case studies and questions that a candidate or educator can go through as well as a tutorial to experience a lot about the Next Gen NCLEX. The NCSBN staff shared that any new information that will be coming out about the NCLEX will be featured on these various websites.
The candidate does not need to have had accommodations during their nursing program. They need to submit their documentation for the need for accommodation to the regulatory board. The NCSBN will not know if the candidate received accommodations during their nursing program.
Teaching Clinical Judgment in the Classroom
The speaker (Keith, RN) talked about teaching clinical judgment, but he didn’t drill down to the detail. Lots of information shared, but still missing the critical piece – the actual, detailed thinking that is used in clinical judgment. He talked about “Clinical Skills/Competencies” but these competencies were not actual thinking skills. For example, he listed “Obtain information from the chart”, “Focused observation/assess patient”, and “Perform skill/procedure”. These are actions, they are not thinking competencies. For example, “Obtain information from the chart” requires the student to apply clinical judgment thinking competencies such as:
- Determining important information to collect, and
- Assessing systematically and comprehensively
If students can’t apply these thinking skills (actual clinical judgment competencies), how will they know what information not obtain from the chart? Students must learn thinking skills which are clinical judgment competencies.
So, here it comes, once again, the most important part of teaching clinical judgment is getting into the detailed thinking! That’s what needs to be taught – the specific clinical judgment competencies. Here at the LindaCaputi.com website click on “Clinical Judgment” and then “About the Book” then click on “Access a Preview of the Book”. Teach your students the actual thinking that is required to engage in clinical judgment! Using all the Keith, RN materials is fine, but only after students actually learn how to think and learn clinical judgment competencies which is what I provide in the student textbook Think Like a Nurse: The Caputi Method for Learning Clinical Judgment and the Caputi Online Clinical Judgment Course. The textbook is available in the US version for US schools and a Canadian version for Canadian schools. The online course is only for the US market at this time.
Scoring Rules for the Next Gen NCLEX
The speaker explained the various ways the items will be scored. I think for my purposes it is best for me to refer you to the PPT available at the NCSBN.org website: https://www.ncsbn.org/public-files/presentations/2022NCLEX_wmuntean_main_stage.pdf
Thank you for reading my blog! Please contact me if you have any questions or email me at Linda@LindaCaputi.com.
Disclaimer: The contents of this blog are notes taken by Linda Caputi and not a publication of the National Council of State Boards of Nursing.