With the introduction of a significant change to the NCLEX-RN® test plan comes the heightened anticipation of nurse educators everywhere. Even though we do not yet know the specifics of the Next Generation NCLEX (NGN) plan, we understand from NCSBN® that the focus on clinical judgment is of paramount importance. Nurse educators have already begun investigating ways to best prepare students for this new test plan that is expected to be implemented in 2023. Coupled with exploring ways to prepare students in the didactic, simulation, and clinical environments, is the desire to lay a strong foundation for how students need to approach studying for this test well in advance of the actual NCLEX-RN. In this article, we discuss best practices and proven methodologies for coaching students to take the NCLEX and highlight how current teaching techniques can reinforce students’ ability to appropriately prepare for the test.
The more things change, the more they stay the same.
French writer Jean-Baptiste Alphonse Karr once penned, “plus ça change, plus c’est la même chose.” Translated, this means that “the more things change, the more they stay the same.” Although NGN may sound new, there are key elements of this proposed test plan that are similar to what we currently know and expect of NCLEX-RN.
Nurse educators who remember testing by paper and pencil may recall “unfolding case study” questions on the test, where a scenario was presented and several subsequent queries regarding that situation were posed. At the 2018 NCLEX Conference in Charlotte, North Carolina, NCSBN provided examples of possible question types that are reminiscent of this model, in which students would read a scenario and then respond by answering several questions about relevant (key) information, irrelevant (non-important) information, and critical interventions that influence better patient outcomes.
Another possible type of question discussed by NCSBN at the 2018 NCLEX Conference is that of expanded multiple select. Currently, “select all that apply” questions may “require a candidate to select a single correct response, have more than one correct response, or require all responses to be correct regardless of the number of possible responses” (NCSBN, 2019). There are generally 5 to 7 possible answers. The NGN may have up to 12 possible answers. Consideration is being given to how these new multiple-response questions will be evaluated, with possible partial credit being given for a partial number of correct answers as long as no wrong answers were selected.
Readying for Readiness
Regardless of how or if these question types are adopted, the bottom line is that nurse educators already use multiple-select questions as a method of assessment, and unfolding case studies as a form of teaching and/or assessment. Being mindful of the possible changes to come, it is important to remember that adaptation to these proposed new forms of questioning does not appear to require radical, immediate transformation in the ways that nurse educators currently approach preparing students for NCLEX or for entry to practice.
The emphasis at this time should be placed on the development of clinical judgment skills. Students should be guided to synthesize information that is relevant or irrelevant to the situation and taught how to select important interventions that lead to better outcomes. It is just as important that students be taught to consider interventions that could be potentially harmful to the patient, and how to avoid them. This skill set will help students answer multiple-select questions with even more distractors, as well as questions associated with unfolding case studies, ultimately helping them to be more effective when providing actual patient care.
How Exactly Do I Teach That?
In the weeks and months to come, we will continue to stay tuned to NCSBN as the authorities on what to expect as NGN develops. In the interim, maintain and strengthen what you are doing by focusing on helping students recognize cues (capture assessment information), analyze the meaning of that data, and use relevant information. Prompt them to think through what interventions most meaningfully assist the patient to regain or maintain health, as well as identify actions to avoid that could potentially be harmful. These approaches build students’ confidence in their ability to meet the NCLEX examination head-on. It also helps them practice important ways of thinking that are critical in entry to practice.
NCSBN. (2019). What the Exam Looks Like. Retrieved from https://www.ncsbn.org/9010.htm.