Continuing Nursing Education with Next Generation NCLEX (NGN)

Continuing Nursing Education with Next Generation NCLEX (NGN)

Preparing for Change

Change is on the horizon. The National Council of State Boards of Nursing (NCSBN®) has confirmed that the Next Generation NCLEX® (NGN) might not be rolled out until 2023 at the earliest. This is an update from the previous information shared in September 2018 in Charlotte, NC, which suggested a potential implementation in either 2022 or 2023.

A major concern for nursing educators is, “How can we prepare for NGN when we’re uncertain about what to expect?” Initially, this question can be overwhelming. However, when we concentrate on what we do know — that clinical judgment is pivotal — the path becomes clearer. It’s important to keep refining thought processes that guide students in recognizing the relevance of the situations they encounter. Embracing a model or theory offers a reliable approach to cultivating these cognitive processes.

Getting Prepared for the Next Generation NCLEX® (NGN): Frequently Asked Questions

Depending on the curriculum, you might follow various methods of “thinking like a nurse” — commonly, educators report using approaches like ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation), AAPIE (Assessment, Analysis, Planning, Implementation, Evaluation), or Tanner’s Model (Noticing, Interpreting, Responding, Reflecting).

When the NCSBN Clinical Judgment Model (CJM) aligns with the components of ADPIE, AAPIE, and Tanner, it’s evident that you might already be on the right path towards teaching and reinforcing clinical judgment. For instance, if your approach leans towards AAPIE for patient care, teaching students to conduct assessments effectively essentially involves helping them recognize cues (CJM) and enhancing their noticing skills (Tanner). When you guide them in planning and executing interventions (AAPIE), you’re essentially nurturing their ability to devise solutions and take responsive action (CJM), which aligns with the essence of responding (Tanner).

By capitalizing on your existing practices and incorporating interchangeable language from these models/theories, faculty can use language that is relevant to NGN.

Remember that the CJM was crafted to “explore new approaches to testing clinical judgment within the nursing profession as part of licensure examinations” (NCSBN, 2019b). Dickison, Haerling, & Lasater (2019) formulated a hypothetical action model to assist educators in implementing the clinical judgment model. This action model “integrates specific CJM concepts… to bridge the gap between exam measurement and what is taught in clinical nursing education” (NCSBN, 2019b).

NURS-6051 Week 9: Discussion THE INCLUSION OF NURSES IN THE SYSTEMS DEVELOPMENT LIFE CYCLE

Nursing faculty can contribute to closing this gap by “immediately integrating the CJM model into their curriculum” (NCSBN, 2019a), across didactic, laboratory, and clinical settings. The subsequent section discusses some ways to achieve this.

Preparing Students

While the Clinical Judgment Model (CJM) might appear intricate, the action model demonstrates how cognitive processes, such as recognizing cues, are applied. Using the CJM, cue recognition involves assessing elements like the environment, client observations, medical records, resources, time constraints, consequences, risks, task complexity, and cultural considerations. Analyzing cues prompts nurses to apply knowledge to assessed cues and then prioritize hypotheses to decide the most appropriate intervention.

It’s important to remember that the issue of failure to rescue still persists in nursing due to errors of omission, failure to detect evolving patient conditions, and lapses in clinical decision-making (Mushta, Rush, & Anderson, 2018). Guiding nursing students in prioritizing care and generating solutions is integral to addressing these concerns related to failure to rescue. Teaching using this model blends theoretical knowledge (e.g., underlying pathophysiology and nursing processes) with the current clinical scenario. After generating solutions, the CJM guides student nurses to take action, a phase that necessitates nursing experience and a progression of clinical judgment.

You might think that a novice or foundational level nursing student lacks the experience required for action-taking. However, within each tier of nursing education, students acquire a skill set and enhance their cognitive processes that align with their education level. They also gain life experiences that enrich the context through which they make judgments. The CJM incorporates this notion through individual factors such as knowledge, specialty, skills, candidate characteristics, prior experience, and level of experience.

Following action in the CJM, outcomes are evaluated, leading back to the assessment of cues.

Interested in learning more from Cherie Rebar and Nicole Heimgartner? Don’t miss their blog on Preparing Students for the Next Generation NCLEX.

References

Dickison, P., Haerling, K. & Lasater, K. (2019). Integrating the National Council State Boards of Nursing-Clinical Judgment Model (NCSBN-CJM) into Nursing Educational Frameworks. Journal of Nursing Education, 58(2), 72-8.

Mushta, J., Rush, K., & Anderson, E. (2018). Failure to rescue as a nurse-sensitive indicator. Nursing Forum, 53(1), 84-92.

NCSBN. (2019a). FAQs for educators. Retrieved from https://www.ncsbn.org/11447.htm

NCSBN. (2019b). Next Generation NCLEX News: The Clinical Judgment Model and action model. Retrieved from https://www.ncsbn.org/NGN_Spring19_Eng_04_Final.pdf