Next Generation NCLEX Update from Dr. Sheryl Sommer [VIDEO + INFOGRAPHIC]
Dr. Dickison reaffirmed that the new test will not launch before 2023 and emphasized the organization’s commitment to regularly communicating updates on the project, including research outcomes and implications for students, educators, regulators, and healthcare organizations. NCSBN expects to formally announce the launch of NGN soon.
This short video from Dr. Sommer includes 6 key points to help you quickly learn about this timely development.
Discover what's accurate — and what's not — in her quick update with info directly from the National Council of State Boards of Nursing (NCSBN).
Host: Welcome to the update on NCSBN's Next Generation NCLEX project. ATI is pleased to share this latest information with you on this important topic. It is my pleasure to introduce Dr. Sheryl Sommer, vice president and chief nursing officer at ATI. Dr. Sommer is an experienced, visionary leader in nursing education. She has been a reviewer for several nursing journals and author of numerous publications. Her passion for the nursing education is evident in her work, guiding development of products to promote the development of clinical judgment, helping faculty develop skills in areas such as clinical judgment, curriculum development, and student evaluation. Please join Dr. Sommer as she shares information about the Next Generation NCLEX.
Dr. Sommer: Hello, everyone and thank you for joining me. I'm very excited to share with you some updates about the Next Generation NCLEX. The National Council of State Boards of Nursing has been working on research around the Next Generation NCLEX study that they've been doing. They are ready to share some information and are wanting to get the word out. So the purpose of this particular webinar is to update you on some of the work they're doing and the direction they're planning to go.
I have basically six key points that I'm going to be sharing with you on this webinar. The first one is that NCSBN has decided that they will launch a new version of the NCLEX. The purpose of this new NCLEX is to better evaluate the clinical judgment ability of all of the candidates to take the licensure exam.
As many of you may be aware, there is -- there's a lot of literature, and it is focusing a lot on clinical judgment, as well as how it impacts client care and the performance of nurses. Many nursing curricula, Muntean identified, do already incorporate critical thinking and clinical judgment. We know that nearly 1 out 2 novice nurses are involved in a nursing care error. We also realize that those medical errors cost about 250,000 deaths a year. That makes it the third-leading cause of death in the country, only following heart disease and cancer. And we also know that only one-fifth of employers are satisfied with new nurses' decision-making ability. With all of these things said, there is room for improvement.
Clinical judgment is linked to 46% of the tasks performed by entry-level nurses. NCSBN identified this through one of the practice analyses that they did. And this research really does support the need for being able to measure that ability.
Clinical judgment is important, because it's a necessary skill. As we've identified for novice nurses, as well as experienced nurses, it can help those novice nurses improve client care and avoid errors. The need for its assessment in entry-level nurses has been clearly proven by the literature, as well as the work by NCSBN. And its assessment is a crucial part of NCLEX's goal to establish a minimum competency of new grads as they enter practice. Currently, clinical judgment is being indirectly tested by integration across various activity statements. However, the Next Generation NCLEX allows the NCSBN to measure it much more directly.
The third point is that NCSBN is promoting the following operational definition of clinical judgment. It's defined as the observed outcome of critical thinking and decision-making. It's an iterative process, and it uses nursing knowledge, so that that nurse can observe and assess the presenting situation, identify a prioritized client concern, and also generate the best possible evidence-based solution to deliver safe client care.
A fourth point is that NCSBN has in-depth findings on the new Next Generation NCLEX-style item types. From July of 2017 through December of 2018, there were 884 Next Gen items in 95 forms that they deployed in formal Item Writing Data Collection. There were 357,113 candidates who took the NCLEX-RN exams, and they had 85% of those candidates participate in this research. The Next Generation NCLEX participants spent about a minute on each of the NCLEX Next Gen items. So that's a really important feature that I know many people have been wondering about and thinking, "How long will it take students to get through some of these new item types?"
The fifth point is that the new item types will be: extended drag and drop, cloze, matrix, and the enhanced hotspot. Don't get confused if you hear different labels for some of these item types, because, as NCSBN has been evolving, they kind of tweak the name of the item type. So, the best thing to do is to really look at some of the examples that we'll provide for you and that you may see from them -- from the NCLEX themselves.
Let's look at some of those item types now.
The first one, an extended drag and drop, is merely an item where the candidate needs to click on sections on the left side of the screen and move it to the right. In this particular example, a nurse is preparing to make room assignments for eight clients. "What room assignments result will give you the safe assignment for each client?" So they're asking you to drag each client below to the appropriate room and bed over on the right. A maximum of two clients can occupy each room. Some clients might require a private room based upon their diagnosis or their condition. You could take a look at this item and see a variety of different types of clients. For example, client 1 is a client who has prostate cancer and a sealed radiation implant. Client 2 is someone who has diabetes mellitus type 2 and the mumps. So, as you go through, you can see some of them have communicable diseases. Others have infections that are much more contained. Others have chronic illnesses, like Client 8, who has COPD. So, this is the example of the extended drag-and-drop item.
The cloze item is something like this. In this particular item, they ask that you read the following case study and then refer to it to answer the question. "A nurse is preparing to administer medications to a client who is two hours post-op following a total knee replacement. The nurse has the following data." So you have all kinds of data on the left -- things like diagnosis, vital signs, allergies, medical history, lab tests, diet, scheduled procedures -- there can be different types of data on the left with these cloze items. On the right, it says, "Which three medications require clarification prior to administration? Complete the following sentences by choosing from the dropdown lists, and do not use the same medication selection more than once."
So this is an example of the cloze item type.
Matrix is another item type that is actually being tested. In this item type, it asks the candidate to use the following scenario and client data to answer the question: "A nurse is caring for a newborn who has hypoglycemia. Below are assessment findings on admission." Again, you'll find all kinds of assessment information on the left-hand side. On the right, then, it says, "The nurse is assessing the newborn 30 minutes later. How should the nurse interpret the findings? For each finding, click to specify whether the finding is unrelated to the diagnosis, an indication that the client's condition is improving, or an indication that the client's condition is worsening." So you would look, first of all, at the capillary blood glucose, 30 milligrams per deciliter, and identify if it's unrelated, if the condition is improving or worsening, and you would do that for all of those pieces.
Enhanced hotspot is another item type that's being used. In this item, they're asking that you highlight specific sections. So, it says, "Use the following scenario and client data to answer the question. The nurse is preparing to administer medication to a client, and the nurse has not administered this med before and is using a drug reference to review the information about the medication." So, the left-hand side is the client information; the right-hand side is a drug reference page. And what they want you to do is look at the question at the bottom of the screen, which says, "Which client and drug reference information supports your decision to withhold this medication? Click in both of the tables to highlight the text that supports your decision."
So, that is the example of an enhanced hot spot and what happens with that type of an item.
The sixth point is that the new NCLEX will not launch before 2023.
At this point in time, NCSBN is continuing their research, and they're analyzing their data. Once they get closer to late spring, perhaps, of next year, they anticipate having additional information to be able to share more exactly when they plan to launch the Next Gen NCLEX.
What Next Gen NCLEX means for educators and students. I think that's something that every school is asking. And here are some of the things that we are suggesting. First of all, we know that the NCSBN initiative is both exciting and anxiety-inducing at the very same time. So it's important that we take advantage of this new situation, but that we do what we need to do to actually prepare these students. A new NCLEX means better evaluation of each graduate's readiness for the challenges of real life nursing practice. At the same time, it does mean more challenging NCLEX items. So, as educators, what we're recommending is that you really need to adopt strategies to help students develop clinical judgment skills.
Implications for nursing programs are very important, as well. And you need to make clinical judgment a critical component of the curriculum. That's probably the first step. Make sure that they're incorporated in student learning outcomes. Incorporate clinical judgment in any way that you can and also into the course objectives. As far as student assignments, make sure that you provide multiple opportunities to develop clinical judgment skills. In other words, incorporate clinical judgment and that the necessity of students to use those skills in a lot of the assignments that you have, whether they are assignments that students prepare prior to class, or they might be a case study done in the classroom. Depending on whatever it is you do, make sure that you're incorporating clinical judgment.
When it comes to curriculum evaluation, it's important to review student acquisition of the clinical judgment skills. That's important, because as you look at the course at the end of a semester, let's say you need to see how well did your students do in comparison to the objectives that you had for them. How did they do on assignments? How did they do on it -- on your tests? So that's something to incorporate into your curriculum evaluation, looking at not only individual courses -- then pulling all courses together -- and looking at how are students doing, perhaps, on level one? How are they doing at the end of your program? And then, finally, teaching resources and tools. It's important to incorporate learning activities that require clinical judgment, and that can be done in many many ways. You know that ATI has a number of different products that are very strong in helping develop clinical judgment skills in your students -- things like Real Life. So it's important to think about that. Use the resources and tools that you have and keep clinical judgment as your focus as you're going about creating those activities and assignments for students.
ATI is continually working to support faculty and students, especially in this area of clinical judgment. We will be producing more webinars and providing you with more information to help you feel more comfortable in how to incorporate clinical judgment in your assignments and the various activities that your students are doing. If you have questions, please reach out to us and we will continue to keep you updated as additional information is obtained from NCSBN. Thank you for watching and have a great day.