HJNO May/Jun 2023

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAY / JUN 2023 49 Karen C. Lyon, PhD, MBA, APRN-CNS, NEA Chief Executive Officer Louisiana State Board of Nursing THE National Council of State Boards of Nursing (NCSBN) has worked with juris- dictions throughout the United States and its territories to develop psychometrically sound and legally defensible examinations consistent with the current practice of both Registered Nurses (RNs) and Licensed Practical/Vocational Nurses (LPN/LVNs). Since April 1994, more than 6 million can- didates have taken the exam offered in the computer adaptive testing (CAT) format. CAT is a method that uses computer tech- nology and modern psychometric theory to increase the efficiency of the testing process. NCSBN has identified the follow- ing benefits of CAT: • Reduces the number of “easy” items that high-ability candidates re- ceive; “easy” items tell little about a high-performing candidate’s ability. • Reduces the number of “difficult” items low-ability candidates receive; candidates tend to guess on items that are too difficult, which can skew results. • Reduces item exposure and subse- quent security risks. • Improves precision of measurement of the NCLEX candidate’s ability re- lated to nursing. • Provides a valid and reliable mea- surement of nursing competence. 1 NGN commenced April 1, 2023. Al- though April Fools’ Day might not have been the most auspicious date to launch the new format, the test will improve our ability to measure our candidates’ clinical judgment and decision-making abilities. The development of the innovative ques- tion types began back in 2013-2014 with the NCSBN Strategic PracticeAnalysis. The analysis began with a simple question: Are we measuring the right information? The analysis demonstrated that nurses were being asked to make increasingly more complex decisions when caring for pa- tients. With patients being older and sicker with multiple co-morbid conditions and with the evolution of new medicines, tech- nologies, and procedures, academicians, regulators, and practice partners realized that we needed more rigor and quality in our competency evaluation of candidates. The NGN reflects a valid measurement of clinical judgment more precisely than the previous versions of the examination. It is based on the evidence within the nursing literature, nurse pedagogy, psychological assessment, and decision science. 2 One of the most remarkable constructs of the NGN is that it accommodates all the varied models across practice and aca- demia by which nursing process can be taught. The NGN doesn’t replace any mod- el. It reinforces the idea that any model can be used to teach the nursing process. The NGN’s clinical judgment model simply affords a valid methodology for evaluat- ing those clinical judgments and critical thinking required of the 21st-century pro- fessional nurse. More than 100 expert clinicians and 200,000 NCLEX candidates piloted the question types added to the NGN. The re- sult of this work was a clinical examination outlining the cognitive aspects of clini- cal decision-making that are measurable. These results became the basis of the case studies in the new test items of the NGN. The process begins with the nurse recog- nizing cues including abnormal versus normal, signs and symptoms, and clinical history. The nurse is then expected to an- alyze cues, including connecting patho- physiology to clinical presentation, and use those observations to determine client needs. This leads to developing and prior- itizing hypotheses, generating solutions, and taking action. The end of the process is evaluating outcomes and reassessing the patients’ continued needs. 3 Clinical judgment is the fundamental underpinning of everything professional nurses do. We have always tested it, but the NGN allows us to evaluate how nurses use clinical judgment in real time. We have built a better model based on evidence to evaluate the clinical outcomes for pa- tients receiving care based on those clini- cal judgments. The case scenarios and test items look like real life. They will validate the knowledge, skills, and abilities nursing students receive in their education pro- grams. The first candidates tested April 1, 2023. We are confident that the results will demonstrate the excellence of Louisiana nursing programs producing competent, confident nursing professionals ready to transition to real-world practice on their first day as licensed nurses. n REFERENCES 1 National Council of State Boards of Nursing. “Next Generation NCLEX.” Accessed April 2023. https://www.nclex.com/next-generation-nclex. page 2 National Council of State Boards of Nurs- ing. “Clinical Judgment Measurement Model: A Framework to Measure Clinical Judgment & Decision Making.” Accessed April 2023. https:// www.nclex.com/clinical-judgment-measure- ment-model.page 3 Betts, J.; Muntean, W.; Kim, D.; et al. “Building a Method for Writing Clinical Judgment Items for Entry-Level Nursing Exams.” Journal of Applied Testing Technology 20, S2 (2019): 21-36. https:// www.ncsbn.org/publications/building-a-meth- od-for-writing-clinical-judgment-items-for-en- try-Level-nursing-exams