Are we preparing nurses for entry into practice? 1. Over the last decade, there has been widespread recognition that students must be prepared for this increasingly complex environment. However, everyone involved in preparing students for practice or helping them transition into various practice settings has wondered if novice nurses were really ready to practice effectively in today’s healthcare environment. Beginning in 2009, the National Council of State Boards of Nursing (NCSBN) initiated an extensive research process to determine better methods to assess the clinical judgment competency of the novice nurse taking the NCLEX exam (https://www.ncsbn.org/sites/ncsbn/exams/next-generation-nclex/ngn-resources.page). The process included an extensive literature review regarding clinical judgment, culminating in a white paper of the findings (https://www.ncsbn.org/public-files/Nursing_Clinical_Decision_Making_A_Literature_Review.pdf). The results of this review included: § 50% of entry-level nurses were involved in practice errors (Smith & Crawford, 2002). § 65% of entry-level nurse errors were related to poor clinical decisions (Brennan et al., 2004). § Only 20% of employers were satisfied with the decision-making abilities of entry-level nurses (Saintsing, et al., 2011). The Next Generation NCLEX® 2. The NCSBN began the Next Generation NCLEX® (NGN) project to find methods to better assess the abilities of new graduates. Central to this project was the development of a new Clinical Judgment Measurement Model (CJMM) designed to clarify steps in the clinical judgment process which should be tested before new RNs can practice. The project also introduced new test items that would more adequately measure clinical judgment competency. The CJMM model defined clinical judgment as a combination of critical thinking and problem solving. The model highlights the steps of the clinical judgment process that can be evaluated. These steps, similar to those in the
nursing process, are: 1. Recognize cues. 2. Analyze cues. 3. Prioritize hypotheses. 4. Generate solutions. 5. Take action. 6. Evaluate outcomes.
The NCSBN website provides detailed information about this work with which all nurse educators should become familiar as the NCLEX-RN and PN exams are changing to address these issues beginning in April 2023 (https://ncsbn. org/clinical-judgment-measurement-model). With the changes in the NCLEX examinations as background, the question becomes what can nurse educators do to adapt to this change?
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