With less than two years before the upcoming Next Generation NCLEX (NGN), it is a priority for nurse educators to work with their students to develop clinical judgment—critical not only for passing the NGN, but for safe nursing practice.
Did you know that almost half of all tasks that a nurse does involve making clinical decisions? Yet fewer than ¼ of graduate nurses who have passed the NCLEX are competent in clinical judgment.
The current NCLEX isn’t fully capturing if a graduate nurse possesses clinical judgment. This is the primary reason that the upcoming Next Gen NCLEX will emphasize case-based scenarios to evaluate clinical decision making.
The essence of the NCSBN Clinical Judgment Measurement Model is Chris Tanner’s model of clinical judgment: Thinking like a Nurse: A Research-Based Model of Clinical Judgment and the four reasoning steps of:
- Noticing
- Interpreting
- Responding
- Reflecting
As a nurse in practice and nurse educator, I recognized the value of Tanner’s framework to clinical judgment. As a result, KeithRN Clinical Reasoning Case Studies have been integrating Tanner’s Model of Clinical Judgment using open-ended questions when I wrote my first case studies in 2012.
A bit of my background for context…
Before starting KeithRN, I was a nurse at the bedside for 36 years, primarily in acute care, most recently in the ICU/ED/RRT/circ in a large metro hospital in Minneapolis.
Twenty-five years into my practice, I realized I loved to teach and mentor new nurses. Then I thought, what about teaching nursing students? I taught clinical as an adjunct for one semester and loved it!
Soon I was completing my master’s degree, while continuing to care for patients. I pursued my passion.
During my 2nd year of teaching full time in 2011, I experienced firsthand the academic-practice gap which is the disconnect between how nursing is taught and practiced. This included lengthy care plans that required precisely worded 3-part NANDA diagnostic statements, and lengthy powerpoints inherited from prior faculty.
Paradigm Shifts
I read Pat Benner’s Educating Nurses: A Call for Radical Transformation, and EVERYTHING changed for me.
I began implementing much-needed change in the classroom, even though some students resisted. I persevered, didn’t look back, and eventually students came around and understood the need for change.
To make a long story short, I met Linda Caputi at our state conference, shared a sample of my case studies, and was invited to present at Elsevier Faculty Development Conference in Las Vegas. KeithRN was born in 2012 so I could share my case studies and tools with other nurse educators at this conference.
I focused on developing tools that represented best-practices and made them practical for teaching. My case study scenarios were derived from clinical practice, unfolding like a nurse experiences, step by step.
Fast forward a few years and in 2018, I began my PhD studies and focused my dissertation on the use of unfolding case studies to develop clinical thinking, clinical reasoning, and development of clinical judgment. After completing my PhD in 2020, the NGN had become a hot topic and I recognized the confusion that many educators had about what clinical judgment is and how to best develop it.
Critical Thinking + Clinical Reasoning = Clinical Judgment
I began developing the Faculty Guide to Develop Clinical Judgment earlier this year using what I learned from my dissertation to help faculty best prepare their students for practice and the Next Gen NCLEX.
And I realized, until clinical judgment is defined concisely and correctly, you don’t have clarity on the target you are shooting for with your students. The following thinking skills that are similar but distinct first need to be defined:
- Critical Thinking requires the nurse to think clearly, precisely, and accurately and act on what they know and UNDERSTAND and are able to apply to the bedside…not memorize to pass the test.
- Clinical Reasoning is the thinking in action that takes place at the BEDSIDE while providing patient care and is dependent on the ability of the nurse to apply knowledge, and reason as a situation changes over time.
- Clinical Judgment is the nurse’s conclusion that recognizes then correctly interprets relevant clinical data to determine the best response for the patient. Tanner’s Clinical Judgment Model and the NCSBN agree that Clinical judgment is an OUTCOME dependent on the nurse’s critical thinking and clinical reasoning skills. It cannot be taught directly.
Therefore, the Equation for Clinical Practice is CT+CR=correct CJ.
To develop Clinical Judgment, emphasize UNDERSTANDING of essential content such as pathophysiology. Do your students really understand the information you are teaching them?
Students aren’t graduating practice-ready possessing clinical judgment because they don’t have a deep understanding of essential content they are taught. Strengthen critical and clinical thinking by teaching content in context to the bedside and what is most critical to patient care for a first year generalist nurse.
Then PRACTICE clinical reasoning by making learning active by applying content taught to the bedside such as an unfolding case study. There is no better strategy than a realistic case study to use knowledge and apply to practice.
Get a FREE Download: How Case Studies Develop Clinical Judgment
To be empowered to confidently develop clinical judgment in your students, I just published a new resource for nurse educators: Faculty Guide to Develop Clinical Judgment. Get a free download excerpted from this guide at keithrn.com.
In Closing
Though the NGN is a cause of stress and uncertainty, it is an OPPORTUNITY for nursing education. Why? Because it is compelling faculty to change the way nursing is taught using case studies to evaluate if students can reason through realistic scenarios.
Since KeithRN case studies use realistic scenarios that emphasize application of knowledge and integrate clinical reasoning you can confidently implement needed change in your content by using them to better prepare your students for both practice and licensure including NGN!
To go more in depth on this topic, watch this video:
Keith Rischer – Ph.D., RN, CCRN, CEN
As a nurse with over 35 years of experience who remained in practice as an educator, I’ve witnessed the gap between how nursing is taught and how it is practiced, and I decided to do something about it! Read more…
The Ultimate Solution to Develop Clinical Judgment Skills
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