Authored by: Kristen Ponichtera, Nursing Content Specialist, LearningMate
I recall the day I cared for my first patient after graduating from nursing school. I was working in a Medical-Surgical Intensive Care Unit and assumed care of a patient the day after she underwent major surgery. Entering into practice before the days of nurse residency programs and individual preceptors, I received a report on my patient from the off-going nurse and was expected to immediately continue her care. Y’all, I didn’t even know where the staff restroom was on the unit, let alone be able to identify all that the patient needed.
During my nursing education, I was not exposed directly to the procedure that the patient underwent and was unsure about how to comprehensively interpret the physician’s postoperative orders to employ the actions needed to provide safe and effective care. However, I did learn in school that knowing everything about each patient was not necessary but that, instead, I should rely on the most helpful item in my “toolbox” – my critical thinking ability. This invaluable skill was what prevented me from being overcome by nerves, and it is something that I continue to use in my practice today.
Nursing education is positioning itself to embrace the changes accompanying the dynamic environment created by our modern healthcare system. An example of this innovation is the BSN Essentials created by the American Association of Colleges of Nursing (AACN) and their aim of offering a more universal, evidence-based, consistent approach to measuring practice readiness for the baccalaureate-prepared nurse (American Association of Colleges of Nursing, 2021). Another approach is through the re-versioning of the National Council of Licensure Examination for Registered Nurses (NCLEX) with the goal of closing the gap between what is being tested to receive a license and what needs to be tested to ensure the safe care for patients by newly licensed Registered Nurses (National Council of State Boards of Nursing, 2018). This is what we refer to as the Next Generation NCLEX or NGN.
While those of us who are currently licensed are relieved that we don’t have to experience this change, I challenge you to take this perspective: nursing is a community, and it is our collective responsibility to facilitate the success of new nurses.
Students: First, take a breath; understand that you have been preparing for this exam throughout your entire nursing education. You know that your patient experiencing a myocardial infarction is going to have issues with their perfusion and oxygenation and that our role is to decrease the workload of the heart and get them to a reperfusion intervention as early as possible if they are eligible. You know this stuff! Now all you have to do is translate that to “paper.”
Faculty: You all have done an excellent job in using the classroom, lab, and clinical sites to develop the clinical judgment of the students. Trust that what you did was enough; it was. Continue to use the language that mirrors NGN by asking the student questions such as, “what are the clinical cues you would expect to recognize in this patient?” or, “How would you evaluate the outcomes for this patient?” Continue to support the students who are overcoming test anxiety by allowing them access to the question types they will see on the licensing exam.
Preceptors: Your role in this process is crucial as you assist in the critical context that allows the words on the textbook page to come to life for the student. Keep pushing them to answer the questions that touch on the “why behind the what” and the “what behind the why”; this is so important to their development and is predictive of their success.
Nurses: Support students and faculty that are implementing these changes by being open to ideas and dialogue. Also, show some empathy to those that are learning, as we all walked in those shoes at some point in our careers. We want to create a generation of nurses that we are comfortable calling colleagues, and this is how we start.
Publishers: Your content is the framework for this endeavor to take flight. Your continued dedication to creating quality content that addresses the elements of the clinical judgment measurement model while also respecting the students’ learning differences does not go unnoticed.
I know that my first day as a nurse is not unique; we all had that beginning. However, with the introduction of the Next Generation NCLEX, maybe those days will be numbered. Maybe we can turn that anxiety and fear into confidence and poise. Maybe what NGN really means is “never get nervous”. Let’s work together to make that happen.
American Association of Colleges of Nursing (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf
National Council of State Boards of Nursing (Winter, 2018). Measuring the right thighs: NCSBN’s next generation NCLEX endeavors to go beyond the leading edge. In Focus. Chicago.