1. Alfaro-LeFevre, Rosalinda MSN, ANEF, RN
  2. Boyer, Susan DNP, RN-BC

Article Content

Dealing with a scarcity of skilled nurses is keenly on chief nurse executives' (CNEs') radar, making development of Next-Generation Nurses (NGN) key. Studies show that the percentage of NGNs meeting practice entry expectations has dropped from 35% to 23% since 2010.1 We need to examine what we are doing right and where we may be going wrong to help NGNs gain the knowledge and skills needed to succeed.


Knowing that clinical judgment is gained on the job, NGNs often choose jobs based on the level of support they expect to receive. With the right programs in place, CNEs can help NGNs grow into loyal, productive clinicians. Best practices for NGN development include the following:


* formal transition programs that use simulation to promote safety and allow immediate feedback, corrections, and reflective learning;


* residency programs focusing on accountability, professionalism, clearly defined knowledge base, teamwork, evidence-based practice, and individualized clinical coaching2;


* clinically competent preceptors who promote novice learning, critical thinking, and reflective practice; and


* competency systems that cluster skills representing how patients present, rather than isolated tasks and procedures.



Where Are We Going Wrong?

One example of where we may be going wrong is a change that is happening in nursing education. What started as a good idea has turned into a controversy. After an NCSBN practice analysis showed that NGNs lacked clinical judgement, the NCSBN decided to change NCLEX to testing clinical judgment skills.3,4 Where could a good idea like this go wrong? It began with a decision to create a new clinical judgment model (CJM) that would be used as an alternative to nursing process to guide the new exam (NCLEX [NGN]).3,4 (


Without surveying other professional nursing bodies, the NCSBN assumed that there were issues with the nursing process. They established an interdisciplinary team and used qualitative methods to create a new CJM (Supplemental Digital Content 1, In webinars and publications, the NCSBN encouraged faculty to integrate the CJM into curricula and tests.4 These communications and the process put the NCSBN in the position of driving nursing practice, rather than reflecting it.


Some educators embraced the new model and began marketing programs and materials to teach how to apply it. These educators and the NCSBN sent articulate, persuasive communications on using the new CJM. This information, coming from trusted resources, influenced many to believe that this is great for nursing. Yet, others (eg, Benner,5 Alfaro-LeFevre,6 and Boyer7) who examined the NGN project reported major issues. They noted that the NCSBN assumed the role of theory development rather than using established, evidence-based theories and pointed out that the new CJM is flawed, likely to inhibit clinical judgment.5-7


Undergraduate faculty will be required to teach the new CJM. Hospital leaders and educators will have to decide what to do when NGNs arrive having been schooled in a complex model that they, themselves, have never used. The NCSBN states, "If the evidence during any individual step (of the NGN project) indicates that potential innovations will not support the rigor and quality of the NCLEX, the project will be reexamined at all levels."3 Education leaders have detailed problems with the NGN project to the NCSBN. Yet, no communication related to reexamining the CJM or research process has been reported. Change is likely to happen only if leaders, educators, and students send their concerns to the NCSBN in formal communications. The 2023 NGN launch will affect current freshmen nurses.


Where Do We Go From Here? When changing accepted practices and standards, identify key stakeholders early in project development, and keep them involved as the projects proceed. Develop new standards through sound research processes. Standards must be based on clear, compelling evidence. The NCSBN has an important job to protect the public and support nursing practice and licensure. If needs are identified, including the development of clinical judgment, employers and educators must work together across professional organizations to develop solutions.




1. Kavanagh JM, Szweda C. A crisis in competency: the strategic and ethical imperative to assessing new graduate nurses' clinical reasoning. Nurs Educ Perspect. 2017;38(2):57-62. [Context Link]


2. Boyer S, Mann-Salinas E, Valdez-Delgado K. Clinical transition framework: integrating coaching plans, sampling, and accountability in clinical practice development. J Nurses Prof Dev. 2018;34(2):84-91. [Context Link]


3. National Council of State Boards of Nursing (NCSBN) Next Generation NCLEX project. Accessed July 25, 2019. [Context Link]


4. Dickison P, Haerling K, Lasater K. Integrating the National Council of State Bards of Nursing Clinical Judgment Model into nursing education frameworks. J Nurs Educ. 2019;58(2):72-77. [Context Link]


5. Benner P. Commentary on Susan Boyer's article, is theory development the right role for the NCSBN? June 25, 2019. Accessed July 25, 2019. [Context Link]


6. Alfaro-LeFevre R. Position paper: the national council of state boards of nursing must pause the Next Generation NCLEX(R) project and re-examine Phase One (Develop Clinical Judgment Model). 2019. Accessed July 25, 2019. [Context Link]


7. Boyer S. Is theory development the right role for the NCSBN? June 27, 2019. Accessed July 25, 2019. [Context Link]