New NCLEX Exam to Replace Nursing Process With An Untested Clinical Judgment Model

BrentRN, PhD · Jun 26, 2019

This topic may seem arcane to the average nursing student but it is important to learn about. I recommend nursing students talk with their nursing faculty about this issue when they return to school.

The National Council is changing the exam and changing the foundation the questions are built on without research to support those changes.

Rosalinda Alfaro-LeFevre · Jun 26, 2019

I agree..,talk it over with ur teachers. I never thought about my rights when I was a student. Many students today are more savvied: Stand up and question this plan to change the license exam to a reasoning model that’s NOT USED in clinical practice.

Some of us are working to change this. Join our NCSBN Clinical Judgmet Model Discussion Group on Facebook to learn more. ?

Home Health Columnist / Guide · Jun 26, 2019

The NCSBN has info on Next Generation NCLEX Project.

Exam under development for implementation in 2023 with testing of questions started in 2017 NCLEX special section.

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The 2013-2014 NCSBN Strategic Practice Analysis highlighted the increasingly complex decisions newly licensed nurses make during the course of patient care. NCSBN is conducting research to determine whether clinical judgment and decision making in nursing practice can be reliably assessed through the use of innovative item types. This objective is the Next Generation NCLEX project, or NGN. ...
...Beginning in July, 2017, NCSBN is presenting a Special Research Section as part of the NCLEX-RN administration. By participating in the Special Research Section, candidates are making valuable contributions to the future development of NCSBN examinations as well as to the enhancement of the nursing profession.
The Special Research Section is given to select candidates taking the NCLEX-RN and takes approximately 30 minutes to complete. This section is administered following the regular exam and does not count as part of the NCLEX score....

Under Next Gen FAQ section for Educators:

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NCSBN is researching several item types, including: extended multiple response items, extended drag and drop items, drop-down (CLOZE) items, enhanced hot-spot items, dynamic exhibit items, and constructed response items.
Expert nurses and psychometricians at NCSBN and Pearson VUE created the new item types based on the steps of the clinical judgement model. The content was validated with approved nursing references and by NCSBN subject matter expert reviewers.
Focus group studies, usability studies, and cognitive labs studies have been completed or are planned for future portions of this research project. The data from the special research section is another step to collect important empirical evidence to validate new item types.

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How can educators start to prepare students?
Educators can begin incorporating the clinical judgment model into their curriculum immediately. The model can be used in a variety of nursing education settings, such as simulation labs, clinical rotation post-conference, and standard written exams. The task model template provided in the Spring 2019 NGN newsletter can be a useful tool to start developing clinical judgment assessments for students.

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Will the entire NCLEX format change in 2023 or will it be partial changes?
NCSBN is still in the research and development phase of item development. Following this phase, NCSBN will begin to determine test design, which may include either partial or complete changes to the NCLEX format. More information will be provided at that time.

Home Health Columnist / Guide · Jun 26, 2019

NGN Spring 2019 Newsletter has full info on NCSBN Clinical judgement model:

https://www.ncsbn.org/NGN_Spring19_Eng_04_Final.pdf

BrentRN, PhD · Jun 26, 2019

The issue here is that the NCSBN has conflated two issues. The first is their ongoing efforts to improve the NCLEX-RN exam's ability to identify a safe, beginning nurse. Licensure was first done with paper and pencil tests on five areas of practice that was offered twice a year. In the 1990s, Computer Adaptive Testing was implemented to allow year round testing and to achieve reliable testing results with a minimum of questions. Since that time the NCBSN has been trying to go to a richer testing experience. They have been talking about using case studies and more intelligent computer analysis of answers but have not gotten far. A few years ago they launched their NGN initiative. It is attempt to have the candidate progress through a case by demonstrating mastery of the parts of the nursing process. The new question types being tested are mostly extensions of the current alternative question types that have already been in use.

The trouble has come from the second effort of the NCSBN to declare a clinical judgment model as "driving nursing practice". There are several problems with this approach.

1. First and foremost: The NCLEX-RN should be REFLECTING nursing practice not DRIVING it. The NCSBN needs to examine what and how nurses think, and only then create exam questions to test that ability.

2. The CJM was created through a quick literature review and synthesis of existing models without first testing the validity of the model. The model may be perfectly fine, but that is not how a model with such far-reaching effects should be put into effect. Any proposed model needs to be looking beyond the few sources they cite, collecting qualitative data from practicing nurses and faculty, and then proposing a model. The model would then need testing of its validity.

3. The CJM seemingly has ignored literature on the simultaneous use of analytic and intuitive thinking. The NCSBN has just created another linear thinking model with different labels and no validity testing.

4. The NCSBN continuously conflates NGN testing with the CJM. They seem to be using a circular logic that the CJM guides the NGN which validates the CJM and NGN (my head is spinning writing that).

The NCSBN is well funded and secretive. They have taken a paternalistic "we know best" attitude so far to any criticism of this process. There are good reasons for test security but they need to be more forthcoming with the process of test creation.

Major changes to the NCLEX-RN will mean changes in nursing schools to nursing curricula, pedagogy, and evaluation. These will all cost money and time. It is clear that many people and organizations are ready to cash in on this change as it rushes toward implementation. It is time to slow down this push to change the basic view of how nursing judgment works and proceed in a more scientific manner.

Rosalinda Alfaro-LeFevre · Jun 27, 2019

Excellent summary!

kbrn2002, ADN, RN · Jun 28, 2019

On 6/26/2019 at 5:17 PM, NRSKarenRN said:
The 2013-2014 NCSBN Strategic Practice Analysis highlighted the increasingly complex decisions newly licensed nurses make during the course of patient care. NCSBN is conducting research to determine whether clinical judgment and decision making in nursing practice can be reliably assessed through the use of innovative item types. This objective is the Next Generation NCLEX project, or NGN. ...
...Beginning in July, 2017, NCSBN is presenting a Special Research Section as part of the NCLEX-RN administration. By participating in the Special Research Section, candidates are making valuable contributions to the future development of NCSBN examinations as well as to the enhancement of the nursing profession.
The Special Research Section is given to select candidates taking the NCLEX-RN and takes approximately 30 minutes to complete. This section is administered following the regular exam and does not count as part of the NCLEX score....

Thank you for clarifying the particulars of this. I was about to do the same and saw you already responded. I am a panel member for the NCSBN and have participated in sessions regarding this new format. While I can't go into any particulars due to confidentially agreements I will say the test questions we have worked on are not such a departure that it is an entirely new concept in testing. The NCSBN website links provided by NRSKarenRN are the place to go for official information.

As mentioned this is still in the testing phase. The students that are presented with a section of questions using the new format will receive them after they have already completed the actual test. These new questions are not scored. They are there to compile data collected from actual test takers that will be extensively studied before any changes to the scored test are implemented.

I don't think it breaks any of my confidentiality agreements to say this is not new for the NCSBN. Part of the exam writing process involves inserting non-scored questions in the NCLEX exam before they are included as part of the official test bank as well as evaluating questions that are already in the test bank to ensure they remain relevant to current practice.

**NICU Guy, BSN, RN** · Jun 28, 2019

On 6/26/2019 at 7:36 PM, BrentRN said:
The CJM was created through a quick literature review and synthesis of existing models without first testing the validity of the model. The model may be perfectly fine, but that is not how a model with such far-reaching effects should be put into effect.

That is why they have been using the Special Research Section at the end the current NCLEX since July 2017. That will give them almost 6 yrs of data to see if those questions can effectively determine a competent nurse.

BrentRN, PhD · Jun 29, 2019

5 hours ago, NICU Guy said:
That is why they have been using the Special Research Section at the end the current NCLEX since July 2017. That will give them almost 6 yrs of data to see if those questions can effectively determine a competent nurse.

The problem is that the tested questions are simultaneously assuming the CJM is valid and that the questions validated the CJM. That is circular logic.

Imagine this analogy:
Suppose I have a theory that homeopathic medicines are using "quantum level force" that cures headaches. I then give my headache patients the medicine and find that about half the time the headache goes away within a few hours. Did I just prove "quantum level force" cures headaches? Of course not. Without a mechanism for how the force relates to headaches just showing good results does not confirm the force exists.

This is just why the NCSBN cannot say their research is validating the CJM. The other problem is that the secrecy of the NCSBN keeps anyone from seeing their data, or even discussing their methods. We are just supposed to believe them but that is not how science works.

BrentRN, PhD · Jun 29, 2019

9 hours ago, kbrn2002 said:
As mentioned this is still in the testing phase. The students that are presented with a section of questions using the new format will receive them after they have already completed the actual test. These new questions are not scored. They are there to compile data collected from actual test takers that will be extensively studied before any changes to the scored test are implemented.

I think it is a good thing to try and improve the exam. The tested NGN questions are not problem. The problem comes from creating the questions before validating the CJM. The council claims the model was validated via an expert review but that is an inadequate method for a model that has far reaching effects on nursing education and practice.

pmabraham, BSN, RN · Jul 1, 2019

Why go from evidence-based practice to non-sense that doesn't happen clinically in the field?