NCLEX-RN Exam Changes and Clinical Reasoning

NCLEX-RN Exam Changes

• The registered nurse licensure exam (NCLEX-RN) is changing format to a computerized adaptive test ("next gen").
• It is a computer adaptive test (CAT), meaning the questions adjust based on your answers.
• Not all test items will be the same.
• The exam will have 5 hours.
• Real-world case studies will be used.
• Implementation of the new format is set for April 2023.

Clinical Reasoning and Judgement

• Nursing faculty in Foundations aim to build critical thinking and clinical judgment skills.
• Clinical reasoning strategies are taught in classes, labs, and clinical settings.
• Students are to use the NCSBN Clinical Judgment Model in all clinical experiences.
• The model includes recognizing cues, forming hypotheses, prioritizing solutions, taking actions, and evaluating outcomes.
• Students are encouraged to review the NCSBN Next GEN future exam questions and videos at https://www.ncsbn.org/ngn-talks.htm.

Quality and Safety in Nursing Education

• The QSEN (Quality and Safety Education for Nurses) project prepares nurses with knowledge, skills, and attitudes (KSAs) to continuously improve health care quality and safety.

Patient-Centered Care

• Patient-centered care is a core QSEN competency.
• Nurses recognize and value individual patient hopes, histories, and beliefs.
• The blended competencies include cognitive, technical, interpersonal, and ethical/legal competencies to support patient health.
• Cognitive competence means independent thinkers using knowledge to guide actions; status quo or social media cannot affect or control
• Technical competence involves nursing skills and procedures.
• Interpersonal competence is critical in patient communication, care, and relationships.
• Ethical/legal competence relates to responsible and respectful care.

Health Assessment

• Cultural influences affect people's values and beliefs.
• Adequate lighting and correct tools are essential.
• Variations exist with physical characteristics (i.e. darker skin pigmentation).
• Clinical judgment is key to assessing patient populations.
• The general assessment is a guide for situational assessment.
• Health history collecting (patient data) and therapeutic communication are crucial.
• The chief complaint is a key component in health history information.
• Health history and physical assessment build the initial database.
• Reflective practice in documentation is a part of clinical assignments.
• Reflecting on actions and the knowledge used is a critical aspect for improving practice.

Focused Assessment

• Focused assessments are used for specific health issues/problems.
• Using accurate (calibrated and in working order) equipment is essential for assessment.
• Assessment includes tools such as visual acuity charts, penlights, and sharp objects.
• Assessment includes body mass index (BMI) for tracking conditions.
• Age-related variations should be considered during assessments (e.g. drier/thinner skin in older adults).

Nursing Process

• The nursing process links closely with clinical reasoning.
• Scientifically based, holistic, individualized patient care is a critical aspect of nursing procedures.
• Effective use of the nursing process, clinical reasoning, and concepts promotes safety and effective care.
• Concept mapping can enhance critical thinking skills by allowing users to identify and present concepts visually.