Departments: Guest Editorial
As I share the new item types of the Next Generation NCLEX (NGN) with prelicensure nursing programs across the country, I hear a sense of angst and fear. Comments include “We have high pass rates, but I think that is going to change,” and “What can we do to prepare?” My response is: You can do this, but it requires giving up the old and ushering in the new. That is, the old way of teaching thinking must be reframed into a new way.
Throughout my years of teaching, the approach has been for faculty to teach thinking in their own way, typically through case studies, simulations, asking “why,” and other application exercises. These teaching strategies are useful, but they are no longer sufficient to meet the demands of the NGN or improve patient outcomes. There are 2 problems with this approach: The process of clinical judgment is not taught first, and faculty use their own approaches and terminology. Nursing faculty need to have a framework for teaching clinical judgment, which all faculty in the nursing program apply, and use the same terminology throughout the program. Research has shown that using a framework to teach thinking results in better outcomes.1
A new model for teaching clinical judgment is needed. I offer one I have developed based on a review of the nursing and education literature: the Caputi Model for Teaching Thinking in Nursing.2 Students first learn this framework to learn about clinical judgment/thinking in nursing before they are expected to apply clinical judgment. Supplemental Digital Content, Figure, http://links.lww.com/NE/A622, provides a graphic of the framework. The 3 components are as follows:
- The top layer of the framework is Benner's Novice to Expert theory.3 Students move through the novice stage in the first semester and then work on developing their thinking by moving into and through the advanced beginner stage as they become situation-based thinkers.
- The next layer of the framework is based on Tanner's Clinical Judgment model.4 Learning the 4 broad steps of clinical judgment—noticing, interpreting, responding, and evaluating—is helpful but still not enough to actually learn clinical judgment.
- The third, and most important layer, are the details of thinking. There are 19 thinking skills or competencies. These specific competencies are the missing piece in the way clinical judgment is currently taught. Knowledge and use of these competencies are needed to apply thinking to nursing situations.
The following are some final “takeaways”: (1) You should do the work of reframing your approach to teaching clinical judgment. Do not wait for a testing company or NCLEX review service to do this for you; (2) start yesterday as they say (sooner rather than later applies here); and (3) teach clinical judgment in a systematic, formalized way across the entire program. The need to have a systematic, formalized approach to teaching thinking in nursing has never been greater. All nurse educators are called to the challenge of rethinking and reframing for positive NCLEX results and to improve patient outcomes.
1. Brown Tyo M, McCurry MK. An integrative review of clinical reasoning teaching strategies and outcome evaluation in nursing education. Nurs Educ Perspect
2. Caputi L. Think Like a Nurse: A Handbook
. Rolling Meadows, IL: Windy City Publisher; 2018.
3. Benner P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice
. Upper Saddle River, NJ: Prentice-Hall; 2001.
4. Tanner C. Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ