NGN Clinical Judgment

Next Generation NCLEX: What Every Nursing Program Needs to Know

The Next Generation NCLEX (NGN) fundamentally changed how nursing licensure is measured. Programs that align simulation and communication training to the NCSBN Clinical Judgment Measurement Model are seeing the strongest outcomes.

What Is the Next Generation NCLEX?

The Next Generation NCLEX (NGN), launched by NCSBN in April 2023, is a fundamental redesign of the nursing licensure examination. Unlike the previous NCLEX, which primarily tested content knowledge through traditional multiple-choice questions, NGN is built around measuring clinical judgment — the ability to think like a nurse, not just recall facts.

The foundation of NGN is the NCSBN Clinical Judgment Measurement Model (CJMM), a six-step cognitive framework that defines the mental processes a competent nurse uses when encountering a patient care situation. Every NGN item — regardless of format — is designed to measure one or more of these six cognitive skills.

For nursing programs, this means that traditional test prep strategies focused on content memorization are no longer sufficient. Students must be able to demonstrate clinical reasoning, not just recall it — a shift that requires fundamentally different preparation approaches, including simulation.

New NGN Item Types

Extended Multiple Response: Select-all-that-apply with partial credit scoring
Matrix Grid: Match multiple findings to multiple categories simultaneously
Cloze (Drop-Down): Fill-in-the-blank from drop-down clinical options
Enhanced Hot Spots: Identify clinically significant findings in a patient chart or image
Bow-Tie: Connect assessment findings → condition → interventions in a single item
Trend Items: Analyze changes over time across a series of patient data points

How ISBARR Maps to the NCSBN CJMM

Every ISBARR telephone simulation is, in effect, a clinical judgment exercise. The six steps of ISBARR align directly with the six cognitive skills NCSBN's CJMM — and that NGN tests.

1

Recognize Cues

Identify relevant information from the clinical environment — vitals, labs, patient statements, changes from baseline.

ISBARR connection: Situation (S) — stating what is happening now

2

Analyze Cues

Determine what the cues mean and connect them to potential clinical explanations or conditions.

ISBARR connection: Background (B) — synthesizing history and context

3

Prioritize Hypotheses

Rank potential explanations by urgency and clinical probability.

ISBARR connection: Assessment (A) — committing to a clinical judgment

4

Generate Solutions

Identify expected outcomes and possible interventions to address the prioritized hypotheses.

ISBARR connection: Recommendation (R) — advocating for a specific action

5

Take Action

Implement or communicate the selected intervention appropriately.

ISBARR connection: Read-back (R) — confirming and closing the loop

6

Evaluate Outcomes

Assess the effectiveness of actions taken and adjust the plan based on patient response.

ISBARR connection: Post-call reflection and documentation

How SimPhone Pro™ Prepares Students for NGN

SimPhone Pro™ is not an NGN test prep product. It's a clinical communication simulator. But the skills it builds — organizing clinical findings, committing to an assessment, advocating for a recommendation under pressure — are exactly the skills NGN measures.

When a student completes an ISBARR simulation with SimPhone Pro, they are practicing the Analyze Cues and Prioritize Hypotheses cognitive skills in a realistic, pressure-bearing environment. The faculty dashboard shows exactly where each student struggles — which is also where they are likely to struggle on NGN items.

AI-scored on all six ISBARR components after every simulation

Faculty-visible performance data across entire cohort

Objective evidence of clinical judgment competency for accreditation

Scalable — students can practice repeatedly without consuming faculty time

Complements existing HESI/ATI formative assessment programs