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The First Results of the Next Generation NCLEX® – Thoughts to Ponder

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The NCLEX® pass rates for Quarter 2, 2023 represent the results of the first administration of the Next Generation NCLEX® (NGN). As expected, everyone interested in the effect of the NGN on pass rates was pleasantly surprised! It seemed unbelievable that a new exam can bring such stunningly positive results! For many schools currently experiencing difficulty meeting the required NCLEX® pass rates as set by their state regulatory body, this was a welcomed relief. Many schools that are currently on monitoring status in their states are looking forward to this status changing if these results continue.

Of course, the real reason for teaching nursing students how to think at higher levels than what nursing schools have achieved in the past is for the sole purpose of better nursing care and improving patient outcomes. NCLEX® pass rates is always an important measure because it: (1) provides the graduate with a license to practice, and (2) it reflects on the quality of the nursing program (in theory). But I believe, as do all nurse educators with whom I consult, that the real reason for everything that is done in a nursing program is to provide excellent nursing care and improve patient outcomes. That’s the bottom line.

With that in mind, the higher NCLEX® results do help with #1. However, the real issue is #2 – are new graduates actually able to engage in better clinical judgment resulting in higher quality of care than prior to the NGN?

In my work with nursing schools across the United States, I asked many faculty and administrators what they believe may have impacted these results. The two initial responses were:

  1. “It’s the scoring. It’s the partial credit scoring that helped increase scores.”
  2. “The evidence is in! What schools have been doing to improve clinical judgment is working!”

Regarding #1 Above

The issue raised by many faculty about the new partial credit scoring is definitely something to consider. Because this involves the psychometrics implemented by the NCSBN, this is an issue/concern for the NCSBN to consider and I’m confident they are.

Regarding #2 Above

Was teaching clinical judgment really all that simple based on the typical message from many third-party vendors related to teaching clinical judgment which was:

Use lots of case studies! Use lots of quality simulations, especially high-fidelity simulation! That is how students learn to think.

My question always was: But isn’t that what we have been doing for years and the research on the clinical judgment abilities of new graduates is extremely poor – to the point of calling it a crisis? The research also showed a decline in thinking abilities across the last decade just as the use of high-fidelity simulations drastically increased (Kavanagh & Sharpnack, 2021; Kavanagh & Szweda, 2017).

How can doing more of the same thing be the true answer? Perhaps it was the “unfolding” case studies that made the difference? But, isn’t that what high-fidelity simulation is all about; and schools have been using high-fidelity simulation for well over a decade.

Additionally, this focus on teaching for better clinical judgment started before April 1, 2023. If it was the additional educational focus on thinking, why didn’t the NCLEX® pass rates for Quarter 1, 2023 increase? The detailed NCLEX® test plan always stated the exam tested “critical thinking”. So, if these efforts to teach higher level thinking is the answer, why did it not affect the Quarter 1 results?

So Where Does This Leave Us?

Seems to me there is more to consider with the Quarter 2 NCLEX® pass rate results than the above issues. What other issues/concerns should nurse educators be considering?

Keep in mind there is no evidence that the increased Quarter 2, 2023 pass rates are due to anything that schools believe they did in preparation for the NGN. To conclude that changes made resulted in increased NCLEX® pass rates requires research. Research that measured the school’s graduates’ ability to engage in clinical judgment with each cohort, perhaps from 2019, 2020, 2021, and 2022 would be needed. Then faculty could consider those results relative to the cohort’s NCLEX® pass rates. Did the clinical judgment abilities change across those years? Did the NCLEX® pass rates correlate to the changed clinical judgment abilities? I have not seen any such research.

In the absence of solid research about the effects of changes in teaching practices, here are some ideas to consider:

  1. During the recent 2023 Virtual NCLEX® Conference, the NCSBN stated they will be continuing research on the NCLEX® in the same manner they always do. For the 2026 version of the NCLEX®, they will consider the passing standard based on their research, and if the passing standard needs to change. This is something to closely watch. I’ll share with you my decades old mantra that relates to the possibility of the passing standard increasing, “Teach students to think at such a high level the NCLEX® has to catch up with you! Doing so takes the worry out of the possibility of the NCSBN raising the passing standard. It won’t matter!”
  2. Also reported at the 2023 Virtual NCLEX® Conference, the NCSBN shared that the Q2 results were likely due to (a) “seasonal” variations that occur every year (they had a graph that showed this), and (b) recovery of pass rates post pandemic. If the seasonal variation is one influence, it will be important to monitor this variation because it implies pass rates may decline. Pass rates are likely to increase post-pandemic especially with the return to face-to-face, synchronous instruction which, for prelicensure nursing students, is much more effective teaching.
  3. Although the increase in the NCLEX® pass rates is a relief for many schools, the true measure of the results of efforts to teach clinical judgment comes on the practice side. Does the research indicate those who passed the NGN can actually think at higher levels than those who passed the pre-NGN version of the NCLEX®? After the Q2 results were published I talked with one of the main researchers who studied the poor state of new graduates’ thinking. She shared with me that anecdotally the new hires who passed the NGN did not fare any better on measures of clinical judgment than those who passed the NCLEX® pre-NGN. Of course, this comment is preliminary and anecdotal. Those involved with this research must conduct repeat studies that provide evidence of improved thinking before we as nurse educators can draw any conclusions about the effect of anything we are doing in education to improve clinical judgment. This is important research to watch. If the research demonstrates new graduates are still unable to think at acceptable levels, what will the NCSBN do? Will it take action to change the NCLEX® in its efforts to protect the public? If ensuring new graduates are able to think at acceptable levels, but the NGN is not actually demonstrating that, what needs to change?
  4. The NCSBN itself also reported at the 2023 Virtual NCLEX® Conference that they are continuing their research addressing the new graduates’ ability to engage in clinical judgment. The NCSBN has reported on such research in the past (Muntean, n.d.). We should all be looking forward to, and monitoring, these studies before we can draw any real conclusions about the success of educational strategies used to address clinical judgment.

Final Thoughts

The bottom-line question remains: How are new graduates who passed the NGN performing on measures of clinical judgment administered in the practice setting? My final thought about this amazing increase in Quarter 2, 2023 NCLEX® pass rates is this:

As the old saying goes, “The jury is still out.” Nursing educators must not let down their guard. We must always be dedicated to improving our students’ ability to engage in clinical judgment – even if our NCLEX® pass rates are well above what is required. Patients deserve the best.

New Ways of Doing

As you are looking for new ways of “doing” please consider my student textbook Think Like a Nurse: The Caputi Method for Learning Clinical Judgment. There is also an additional online course: The Caputi Online Clinical Judgment Course that teaches your students everything in the textbook and more! Why adopt? The answer is: Because teaching clinical judgment is more than giving students “lots of practice” with case studies and simulations and asking them to use clinical judgment they never precisely learned. The “hope they get it with enough practice” approach has proven totally ineffective in the past. The best approach is this:

  1. First teach students clinical judgment using a detailed framework that teaches actual thinking skills (Tyo & McCurry, 2019). This is the step we have been missing for decades.
  2. Then require students to use the framework and the specific thinking skills when working through case studies and to think through issues during high-fidelity simulations.

To learn more please visit my website at: https://LindaCaputi.com and click on the Clinical Judgment tab.

Thank you for reading my blog! Please contact me if you have any questions by either clicking on the Contact tab on my website or emailing me at Linda@LindaCaputi.com.

Disclaimer: The ideas expressed in this blog are solely those of Linda Caputi and not those of the National Council of State Boards of Nursing.


References

Kavanagh, J. M., Sharpnack, P. A. (January 31, 2021) Crisis in competency: A defining moment in nursing education, OJIN: The Online Journal of Issues in Nursing, 26. (1), Manuscript 2.  DOI: 10.3912/OJIN.Vol26No01Man02

Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses’ clinical reasoning. Nursing Education Perspectives, 38, (2), 57-62.

Muntean, W. J. (nd) downloaded from: https://www.ncsbn.org/public-files/Nursing_Clinical_Decision_Making_A_Literature_Review.pdf

Tyo, M. B., & McCurry, M. K. (2019). An integrative review of clinical reasoning teaching strategies and outcome evaluation in nursing education, Nursing Education Perspectives, 40(1), 11-17.