F.A. Davis Struggling Students: Next Gen NCLEX® Prep

Struggling Students

HELPING THEM PREPARE FOR THE NEXT GENERATION NCLEX ®

Susan Sportsman, PhD, RN, ANEF, FAAN Managing Director Collaborative Momentum Consulting

Introduction April 1, 2023 is the first day the new version of the NCLEX® examination for registered and practical/licensed nurses will be offered. This ends a decade of research and planning by the National Council of State Boards of Nursing (NCSBN). The goal of this massive initiative was to develop a testing process that accurately assesses the new graduate nurse’s ability to care for the patients assigned to them when they assume their first position. Central to this goal is the ability to use effective clinical judgment to make decisions about care. While physiological and psychosocial knowledge continues to be important, the novice nurse must also be able to take that information and APPLY it in a variety of clinical situations. While the need for clinical judgment in nursing is not new, the Next Generation NCLEX® Clinical Judgment Measurement Model (CJMM) focuses on steps nurses should take to apply their knowledge to specific clinical scenarios. Similar to the well-known Nursing Process, the model outlines the following steps required to make

these judgments: § Recognize Cues § Analyze Cues

§ Prioritize Hypothesis § Generate Solutions § Take Actions § Evaluate Outcomes

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Preparation for the Struggling Student 1. What about those students who struggle? As nursing graduates begin to take a licensing exam that more closely represents clinical practice, we can expect that the NCLEX exam will be viewed by most test-takers as more difficult than past tests. Students who may struggle with the rigors of nursing school in general may have particular difficulty with the new version of the NCLEX. A strong remediation/support program offered throughout the course of study is important to ensure these students’ success. According to Mee and Schreiner (2016) “ Any structured process, including multiple modes of instruction, should be consistently implemented throughout the program. ” Here are some suggestions to help struggling students overcome the barriers that may prevent them from being successful in nursing. 1. Plan to offer remediation/support services for students beginning with the first term of the nursing program and continuing until students graduate. Whether the school has a “remediation specialist” responsible for all remediation/support activities, or the nursing faculty are responsible for working with their own students, or a combination of approaches, the structure of the remediation/support process should be fully considered. The following questions provide guidance for a thoughtfully designed remediation/support program. a. What are the criteria for student participation in the program? b. Which staff or faculty members are going to evaluate individual student’s performance and encourage them to participate? c. Should the remediation/support program be required or encouraged? d. Once students are referred to the program, what criteria should they achieve to no longer participate? e. How is the overall program evaluated and who is responsible? Too often remediation is an afterthought; students may or may not participate regularly; the learning activities are not clearly defined; and the outcomes of the program may not be regularly evaluated so improvements can be made. Under such unstructured circumstances, the remediation/support process is likely to fail. Careful planning is key to developing and maintaining a program that helps students become safe and effective nurses. In addition, the model identifies possible environmental and individual factors that might affect the nurse’s clinical judgment (https://ncsbn.org/clinical-judgment-measurement-model). The CJMM model is important to NCLEX test-takers and the faculty who teach them because the new, Next Generation NCLEX® (NGN) uses this model to develop the questions that are included in the examination. In short, all of the questions, regardless of their structure, will require test-takers to use these clinical judgment steps to correctly answer the NCLEX questions. The emphasis on evaluating new nursing graduates’ clinical judgment in a variety of scenarios in the licensing exam is designed to better evaluate their ability to provide safe care to patients immediately as they move into the practice environment. For this reason, all new graduates must be prepared to make decisions using this model. This heightened expectation points to changes in preparing ALL students for licensure and practice. For example, avoiding a straight lecture format, using active learning strategies to engage students in class, structuring learning activities to represent actual clinical situations, revising faculty-made testing formats to replicate questions on the Next Gen NCLEX, and giving students plenty of practice with new question formats are all necessary steps to prepare students for the new examination.

2. Students may resist participating in remediation/support activities because they do not want to appear “dumb.” Using terminology such as “Student Success Program“ to describe the program may be helpful in reducing negative stigma. Most importantly, developing an environment where students know that this program is an important resource designed to support them in becoming safe and effective nurses following graduation is a critical step in reducing student resistance. 3. When students are first admitted to the nursing program, use admission data (e.g., GPA, scores on standardized tests, etc.) to identify students who potentially may struggle and encourage them to participate in the remediation/support program. The earlier a student receives additional support, the more likely they are to be successful. 4. As students progress through the curriculum, use data regularly to determine if students need additional help. This data may include faculty tests, standardized tests, results from digital work, and general performance in class or clinical experiences. Students who struggle with some aspect of the nursing program should have the opportunity to participate in targeted remediation/support as soon as they (or their faculty) identify potential issues. Thus, a remediation/support program should be available at any point in the curriculum. Table A provides suggestions for times students are likely to need referrals, as well as possible data faculty might use in making the decision for referral.

Table A: Possible Referral Points

Time for Referral

Data used for Decision-making

At the beginning of the curriculum

Admission criteria data

Failing tests in an individual course

Grade on exams per protocol

Course GPA

Scores below benchmark

Standardized tests throughout the curriculum Predictive scores below benchmark

Exit standardized tests

Predictive scores below benchmark

Documentation of relevant laboratory, simulation, or clinical experience

Clinical error or near miss

Publishers’ Role in Supporting the Development of Clinical Judgment

Providing targeted remediation/support for students throughout the curriculum may feel daunting to faculty. Publishers provide support materials that facilitate the process. For example, F.A. Davis provides an entire suite of online materials, Davis Advantage , which can be a resource for remediation and support. Davis Advantage is built around the principles of Learn, Apply, and Assess.

In the Personalized Learning section, students take pre-assessment quizzes that correspond to the topics in their textbooks. The results of the pre-assessments give students an opportunity to assess what information they know and where their knowledge is weak. They then watch videos and complete activities that relate to the topic at hand that reinforce learning and provide practice applying their knowledge, followed by a post-test. To support self- learning, students are given feedback regarding their scores on the post-test. In the Apply and Assess sections of Davis Advantage, students are given the opportunity to use clinical judgment in a variety of clinical settings. Clinical scenarios integrating various medical conditions are presented, after which students are evaluated on the clinical judgments they must make for each scenario using test questions that conform to the new, NGN test questions. In these situations, students are given feedback on their performance (e.g., “You got 8 out of 10 questions correct.”) They are also given a personalized learning plan based upon their performance, which they can use for further study. Faculty have access to a dashboard in Davis Advantage which allows them to monitor their students’ progress in all activities at both the class and individual student levels. Faculty also can download personalized teaching suggestions to integrate into learning activities in class or lab.

Individual Student-Faculty Interaction

To fully support the struggling student, student and faculty (or remediation coordinator) should meet frequently to review the student’s progress and to provide additional instructional support. For example, the faculty may want to help students develop clinical judgment skills by working through unfolding case studies. The role of the faculty is not to give the students the answers. Instead, they should ask probing questions so that the students are encouraged to use components of the clinical judgment measurement model to analyze the case. Table B below outlines questions to guide students through the process of clinical judgment. Table B: Probing Questions related to the Clinical Judgment Measurement Model

Components of CJMM

Questions

• What cues can you identify in this scenario? • Patient? • Environmental? • Individual issues experienced by the provider?

Recognize Cues

• Are there cues that are clinically related? • What do the cues tell you about the patient’s need? (developing hypotheses) • Which cues have the highest priority in caring for this patient?

Analyze Cues

• What hypotheses for care can you identify? • What hypothesis has the highest priority for safe care? • Why?

Prioritize Hypotheses

Components of CJMM

Questions

• What viable solutions might there be to address the hypothesis(es) you have identified? • What would have the highest priority? Why?

Generate Solutions

• Identify actions you would take in the order you would perform them. • What is the rationale for your decision?

Take Actions

• What evaluation strategy(ies) would you use? • When? • Why?

Evaluate Outcomes

In another example of how individual students and faculty might work together to support the student’s progress, they may meet to review answers to test questions, particularly those the student answered incorrectly. The goal is for the student to analyze their own errors, determine exactly where they went wrong, and generate ideas for doing better the next time. Again, the role of the faculty is not to provide the student with specific answers, but to prompt the student to answer their own questions. In the box below is a checklist that faculty might use to help the student analyze their work and to develop self-reflection skills.

Diagnostic Checklist 1. Why is the correct answer correct? 2. Why did you answer the question incorrectly? 3. What content would be necessary to answer the question correctly? 4. Explain the reasons underlying the correct answer?

The NGN process and its impact on the preparation of nursing students is significant. It is up to the nursing faculty to provide sufficient remediation/support to prepare them for the exam. The faculty effort in the remediation/ support process can make a huge difference in the success of the students.

References Dickison,P., Haerling, K., Lasater, Kathie. (2019) Integrating the National Council of State Boards of Nursing Clinical Judgment Model into Nursing Educational Frameworks. Journal of Nursing Education. 58(2) Published Online: January 22, 2019. https://doi.org/10.3928/01484834-20190122-03. aCC Mee, C., Schreiner, B. (2016) Remediation in Nursing Education Today: Review of the Literature and Considerations for Future Research. Journal of Nursing Regulation . 7 (1) April, 37-45. About the author Susan Sportsman, PhD, RN, ANEF, FAAN , is a nationally recognized speaker and consultant with over 10 years of consulting experience, providing program development and other consultation services to nursing and health professions programs throughout the United States and Canada. Previously, she served as Dean of the College of Health Sciences and Human Services at Midwestern State University in Wichita Falls, Texas.

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