1. Next Generation NCLEX® (NGN) Project
NCSBN and the
Next Generation NCLEX® (NGN) Project
Alyson Brenton, MSN, RN, CNL
Emily Petersen, MS, MJ, RN, APRN, CPNP

2. Copyright © 2018 National Council of State Boards of Nursing, Inc
Copyright © 2018 National Council of State Boards of Nursing, Inc. (NCSBN®)
All rights reserved. NCLEX®, NCLEX-RN® and NCLEX-PN® are registered trademarks of NCSBN® and may not be used or reproduced without written permission from NCSBN. No part of the 2018 NCLEX Conference materials may be reproduced, stored in a retrieval system or transmitted in any form by any means (electronic, mechanical, photocopying, recording, or otherwise now known or to be invented) for any commercial or for profit use or purpose without written permission from NCSBN. Inquiries in writing to NCSBN Permissions, 111 E. Wacker Drive, Suite 2900, Chicago, IL or via at

3. Objectives Review NCSBN history
Discuss NCSBN Clinical Judgment research
Define Clinical Judgment Model
Review NGN item prototypes
Identify NGN resources and FAQs

4. patient safety and public protection.”
Our Mission Statement
“The National Council of State Boards of Nursing provides education, service, and research through collaborative leadership to promote evidence-based regulatory excellence for
patient safety and public protection.”

5. The purpose of NCSBN is to:
Provide an organization through which the Boards of Nursing can act and counsel together,
Provide services and guidance in regulatory functions,
Promote uniformity in the regulation of nursing practice,
Provide ownership of the NCLEX-RN®, NCLEX-PN®, NNAAP® and MACE® examinations,
Serve as a not-for-profit organization that supports 59 member boards of nursing.

6. Member Boards 50 states District of Columbia
Three states with separate RN and PN boards
One state with separate RN/PN and APRN boards
Island Jurisdictions

7. Exam Users and Associate Member Boards
12 Provinces and Territories in Canada
6 other countries:
Australia
Bermuda
Ireland
Kazakhstan
New Zealand
Singapore

8. History of NCSBN
1978
NCSBN was founded as a not-for-profit organization
Roots trace back to American Nurses Association (ANA)
1982
NCLEX-RN – delivered for the first time
1985
NCLEX-PN – delivered for the first time
1994
Computerized adaptive testing (CAT) introduced as the mode of delivery for the examinations
2015
NCLEX-RN – delivered in Canada for the first time

9. Examinations Department at NCSBN®
Three teams:
Test Development/Content
Psychometrics
Operations
Examinations Department Committees
NCLEX Examination Committee (NEC)
NCLEX Item Review Subcommittee (NIRSC)

10. Research and Clinical Judgment Model

11. 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.

12. The Beginnings NEC* 2012: Is the NCLEX® measuring the right things?
2015: Strategic Practice Analysis Pilot Study
*NCLEX Examination Committee

13. Literature Review Findings
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
employers satisfied with clinical decision making skills of novice nurses
20%
novice nurses involved in nursing errors
50%
errors attributed to poor clinical decision making
65%

14. 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
2015
Strategic Job Analysis (RNs)
90 SMEs
20 Practice Settings
33 States
Tenure ranges 2 – 45 years
Top 3 Areas Identified:
Clinical Judgment
Professional Communications
Active Listening

16. 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

17. Current NCLEX® Item Bank: Clinical Judgment Domain Distribution
Cue Recognition
Hypothesis Generation
Communication
Consequences and Risk
Task Complexity
Time Pressure
Distractions and Interruption
Multiple Choice
Multiple Response
Drag and Drop
Hot Spot
Audio
Graphic
Exhibit

18. Summary Clinical judgment is a necessary skill for the novice nurse.
Client care and nurse errors can be improved by enhancing clinical judgment skills in novice nurses.
There is a clear need for a direct, extensive, and explicit assessment of this construct in entry-level nurses.
Assessing clinical judgment is a critical component of the overall goal of NCLEX ascertaining minimum competency.
Clinical judgment currently is indirectly tested in a limited manner through integration across activity statements.

19. NCSBN Clinical Judgment Model
Development of
NCSBN Clinical Judgment Model

20. Clinical Judgment Model Frameworks
Three predominant nursing theoretical frameworks for assessing clinical judgment
Intuitive-Humanistic Model (Benner)
Dual Process Reasoning Theory/Model
Information Processing Model
Nursing clinical judgment is difficult to define.

21. Nursing Process Overview
Assessment
Nursing Diagnosis
Planning
Implementation
Evaluation
Critical Thinking
Clinical Decision-Making

22. January 2015: Operational definition of nursing clinical judgment
Clinical Judgment Model Definition
January 2015:
Operational definition of nursing clinical judgment
Clinical judgment is defined as the observed outcome of critical thinking and decision-making. It is an iterative process that uses nursing knowledge to observe and access presenting situations, identify a prioritized client concern, and generate the best possible evidence-based solutions in order to deliver safe client care.

23. NCSBN Clinical Judgment Model

24. Layers 2 and 3

25. Definitions of Layer 3
Recognize Cues-Filtering information from different sources (e.g., signs, symptoms, medical history)
Analyze Cues-Organizing and linking the recognized cues from previous step to the client’s clinical presentation. Candidates should establish probable client needs, concerns, or problems
Prioritize Hypothesis-Evaluating and ranking hypotheses according to priority (urgency, likelihood, risk, difficulty, time, etc.)
Generate Solutions-Identifying expected outcomes and using hypotheses to define a set of interventions for the expected outcome
Take Action-Implementing the solution(s) that addresses the highest priorities. Important to recognize that sometimes no action is an action itself
Evaluate Outcomes-Comparing observed outcomes against expected outcomes

26. Layer 4

27. Applying CJ Model in Education
The CJ Model assesses if the student makes an appropriate nursing clinical judgment decision within a scenario by following the cognitive operations through an entire case study.
Cognitive Operations = Layer 3
Factor Conditioning = Layer 4
Expected behaviors/actions = appropriate student actions or observable outcomes

28. Task Model Layer 4 Layer 3 Cognitive Operations (NCSBN-CJM Layer 3)
Factor Conditioning (NCSBN-CJM Layer 4)
Expected Behaviors/Actions
Recognize Cues
Environmental Cues
Location: Emergency Department
Parent present
Client observation cues
Present age: 8-10 years
Present: signs/symptoms of dehydration: dry mucous membranes, cool extremities, capillary refill 3-4 seconds.
Present/imply: lethargy
Medical record cues
Present/imply: Hx. of diabetes
Present/imply: Vital signs
Time Pressure Cues
Set time pressure to vary with onset/acuity of symptoms
Recognize signs/symptoms of dehydration
Identify history of diabetes
Recognize abnormal vital signs
Hypothesize dehydration
Hypothesize diabetes
Analyze Cues
Requires knowledge of pediatric development
Requires knowledge of dehydration symptoms
Requires knowledge of diabetes symptoms
Describe relationship between level of blood sugar and dehydration
Use evidence to determine client issues
Prioritize Hypotheses
Give vital sign monitors as resources
Set time pressure to vary with vital signs
Prioritize dehydration
Address dehydration
Avoid glucose
Generate Solutions
Requires knowledge of pediatric developmentally appropriate approach
Requires knowledge of dehydration treatment and intervention
Requires knowledge of diabetes treatment and intervention
Take Actions
Experience:
Requires experience of administering isotonic fluid
Administer isotonic fluid
Evaluate Outcomes
Show client awake and talking
Imply improvement in vital signs based on actions
Reassess vital signs
Reassess lethargy
Task Model
Layer 4
Layer 3

29. Conditioning Factor(s) Prioritize Hypothesis
Cognitive Function
Conditioning Factor(s)
Expected Behaviors
Recognize Cues
Environment Cues:
Recognize abnormal vs normal
Patient Observation Cues:
Recognize signs and symptoms
Medical Record Cues:
Time Pressure Cues:
Identify history of
Analyze Cues
Requires knowledge of signs and symptoms of…
Prioritize Hypothesis
Can give vital signs as resource
Can add time pressure for context of vital signs
Requires prioritization of condition…
Address condition of…
Generate Solutions
Knowledge of conditions
Knowledge of treatment for conditions with nursing intervention
Take Actions
Experience:
Nursing Intervention…
Evaluate Outcomes
Follow-up on labs, vital signs, assessment etc- determine improvement or worsening of condition being treated
Patient Observation Cue:
Task Model Template

30. NCSBN Clinical Judgment Model Research and Task Model Publications
1. Dickison, P., Luo, X., Kim, D., Woo, A., Muntean, W., & Bergstrom, B. (2016). Assessing higher-order cognitive constructs by using an information-processing framework. Journal of Applied Testing Technology, 17(1), Retrieved from
NCSBN website:
2. Dickison, P., Haerling, K. & Lasater, K. (in press). Integrating the National Council State Boards of Nursing-Clinical Judgment Model (NCSBN-CJM) into Nursing Educational Frameworks. Manuscript submitted for publication.

31. Next Generation NCLEX (NGN) Prototypes

32. Case Study Example

37. Extended Drag and Drop

38. Extended Drag and Drop

39. Cloze

40. Matrix

41. Extended Multiple Response

42. Enhanced Hot Spot

43. New NGN Item Types: Clinical Judgment Model Domain Distribution
Cue Recognition
Hypothesis Generation
Communication
Consequences and Risk
Task Complexity
Enhanced Hot Spot
Extended Multiple Response
Extended Drag and Drop
SBAR
Cloze Items
Constructed Response
Rich Media Scenarios
Dynamic Exhibits

44. Special NGN Research Section
Current item types being piloted in the research section:
Extended Multiple Response
Extended Drag and Drop
CLOZE
Enhanced Hot Spot
Dynamic Exhibit
Constructed Response

45. NGN Information on NCSBN Website

46. NGN Resources Quarterly Newsletter
Next Generation NCLEX Project: Next Generation NCLEX FAQs: Measuring the Right Things, In Focus article:

47. Thank you!
For additional information please
For additional questions please

48. Common FAQs

49. What does the special research section look like?
Once a candidate finishes their exam, an introductory screen will indicate the beginning of the Special Research Section. This section will also continue to be numbered in accordance with the completed exam – for example, if a candidate's exam ended with question 153, the first question on the Special Research Section will be numbered 154. Despite the consecutive numbering, these new questions will have no impact on NCLEX scoring or results.
What information will be collected?
The special research section collects data for developing scoring rules, provide evidence of item characteristics and determine how much time candidates spend on each item.

50. How should students prepare for the special research section?
As the new items included in the special research section are for research purposes only, no additional preparation is necessary. The special research section is testing the new item types’ functionality, not the candidates’ ability.
Can educators see the special research section?
All questions on the NCLEX-RN and the special research section are confidential, and are not available to anyone outside of the testing environment.

51. Which candidates are selected for the special research section?
Only NCLEX-RN candidates are selected to participate in the special research section. A number of factors determine whether or not a candidate will be given the special research section (e.g., the time remaining in their NCLEX appointment).
How will the items be scored?
The special research section items will not be scored. One of the purposes of the special research section is to gather the data needed to determine scoring methods for the new item types.

52. Is there a penalty if a candidate refuses to participate?
No. The special research section is optional and will not count towards the NCLEX result.
Will more information about the special research section come out soon?
Yes. Language informing candidates about the special research section is included in the regular correspondence to NCLEX candidates, on the NCSBN and Pearson VUE websites and provided via the NCSBN social media sites.