When this year’s nursing graduates take the Next Generation NCLEX® exam (NGN), they won’t just be tested on what they know — but on how they think. The new test is focused on evaluating the learner's ability to demonstrate the use of clinical judgment when responding to clinical questions.
Ensuring that graduating nurses have training and proficiency in clinical judgment is key to patient safety. Research by the National Council of State Boards of Nursing (NCSBN), which oversees the NCLEX exam, shows that 65% of nursing errors result from poor clinical decision-making, with 50% of novice nurses involved in those errors in nursing care.
Of course, teaching nurses clinical judgment skills is nothing new, says nurse educator Michelle Moulton, DNP, RN, CHSE, CNE, Senior Manager for the Division for Innovation in Education Excellence at the National League for Nursing (NLN). “Nursing education has always focused on developing nurses who are good thinkers and decision-makers,” she explains. “The issue now facing nursing education is the need to shift ‘how we teach’ to best prepare learners to develop their clinical judgment skills. Nursing education is challenged to be more thoughtful and strategic in preparing our learners,” which includes leveraging promising immersive technologies like virtual reality (VR) to enrich the learning experience.
Measuring clinical judgment
To better assess a nursing student’s decision-making capacity, Dr. Moulton says NCSBN’s new measurement model focuses on clinical reasoning to make sound clinical judgments, which is an abstract concept for most learners. “Clinical reasoning is all about the thinking process and how we interact and engage with the environment where thinking happens. “Engaging learners to ‘think’ on paper is challenging. The thinking happens at the bedside while doing care, with alarms going off, phone calls coming in, all while multiple patients require varying degrees of care complexity.”
Framed around patient cases, Moulton says the NGN clinical reasoning questions are much more detailed, mirroring the complexity of real-world clinical practice settings where new nurses will be challenged to make decisions. “The learner needs to sort through more clinical cues, which is why learning in VR is more robust. For instance, learners are given a list of provider's orders and they need consider each one for relevance, safety, and priority – many more decision points. Here, the learner needs to be more discerning, pulling out the most relevant pieces of information. That's thinking in action."
