Educational restructuring created by the Covid-19 pandemic is rapidly intersecting with the evolution of the Next Generation NCLEX (NGN). This juxtaposition has required faculty to reconsider and reorganize the delivery of activities that build clinical decision-making in pre-licensure nursing students. It’s time to consider how we plan to address these vigorous changes to meet our needs in the here and now and to prepare for an undoubtedly dynamic future in nursing education. With an ever-changing learning environment, how can faculty develop high-quality clinical judgment simulations and activities, that meet NGN outcomes and objectives, and transition these online at the drop of a hat when needed?
Now more than ever, incoming nursing students need quality learning experiences that facilitate the transition from novice nursing students into reliable clinical decision maker from the outset of their training. These students also need support in managing their cognitive load, navigating multiple electronic platforms, and attaining high-quality learning outcomes and objectives in the event in-person simulation and skills experiences are moved online. Faculty have the unique challenge of fostering students that are well-versed in NGN innovative item types while reacting and adapting to dynamic changes and restrictions created by the pandemic. Additionally, faculty have an ethical obligation to ensure quality experiences for students whether they complete an activity in-person or virtually. If a student, or students, must miss a critical in-person simulation experience, is assigning them an alternative exercise on the same content sufficient? Or can that student participation in the simulation “virtually” if the simulation is recreated? Constructing clinical judgment activities that facilitate achievement of NGN competency across courses within a program, and that can easily transition from in-person delivery to an online format, is paramount in not only surviving but thriving in this “new-norm”. Leaning on the NCSBN Clinical Judgment Measurement Model (NCJMM) as a foundation for creation and implementation is one way to accomplish this.
The NCJMM aims to facilitate nursing education methods that appropriately foster and measure students’ abilities to make appropriate clinical judgments to prepare them for the increasing challenges newly licensed nurses face. Layers three and four can be implemented in the form of an actionable model and used as a tool to develop clinical decision making. Specifically, Layer four can provide a pathway for pushing past the basic introduction of the NGN Case Study by introducing a variety of conditioning factors, both individual and environmental, that create realistic client scenarios.
Developing clinical judgment simulations and activities
So what are the main points faculty must address to ensure that they develop clinical judgment simulations and activities in a high-quality fashion? How do faculty ensure reproducibility but allow for malleability in the event they must be moved online? How can faculty reduce cognitive load among students transitioning within this semi-hybrid environment to meet learning objectives and achieve quality outcomes? How can programs address this across courses and across the program as a whole? The following three points discuss solutions to these challenges:
1. Introduce the NCSBN Clinical Judgment Measurement Model (NCJMM) early in the program.
Begin to expose students to the model and NGN item types early on at the foundational level. Incorporate NGN Case Study item types from the outset of the program and align these critical skills and simulation experiences into NCJMM action model experiences. This allows for smooth transition of foundational principles across first semester courses, and into higher-level decision-making courses like med-surg etc.