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.