A webinar featuring Patrick Luna from the University of Colorado
Patrick Luna, Senior Instructor of Clinical Teaching at the University of Colorado, explains how he uses video assessment to prepare nursing students for the Next Generation NCLEX (NGN).
Hillary Gamblin: Hello, thank you for joining today’s workshop on Preparing for the Next Generation NCLEX. My name is Hillary Gamblin. I’m your host, MC, whatever you’d like to call me. I’m an employee at GoReact, a video-based assessment software company that is sponsoring this workshop. And today I’ll be interviewing Patrick Luna. Patrick, do you want to introduce yourself?
Patrick Luna: Hi, my name is Patrick Luna. I am a senior instructor of clinical teaching at the University of Colorado. I instruct students in our undergraduate program with an emphasis on foundational first year nursing students.
Hillary Gamblin: Fantastic. Thank you, Patrick. We’re so excited to chat with you today. Now, for those of you who are new to our nursing education workshops. Let me outline how we structure these virtual events real quickly. So for the first 30 minutes or so, I will discuss with Patrick his insights that he’s gathered over the last year, preparing the University of Colorado students for the NGN. After interviewing Patrick, we’ll spend about 10 to 15 minutes doing a live Q and A. If you’d like to submit a question for the Q and A, there is a tab just below the video feed. And if you see a question that someone asks you’re like, “Yeah, I want that answer, too.” You can use the upvote feature. And then don’t forget to use the chat feature, which is on the right side of the video feed. And this is where a lot of attendees will discuss ideas, exchange personal information so they can connect after the workshop. A lot happens in this little chat feature. So don’t miss out.
Okay, now that we’ve covered all the technical details, I just want to emphasize that the goal of today’s workshop is to discuss the upcoming NGN and to give you some ideas to help you prepare your students for these changes. So with that goal in mind, let’s start. Now, Patrick, the NGN is going to be released in 2024 that’s a few years away. So, why did you begin researching and preparing for the NGN over a year ago?
Patrick Luna: So I was introduced to the NGN and the prospect that they were changing the NCLEX like probably like many of you. I was invited to a seminar with, by colleagues that say, “Hey, the NCLEX is changing.” And so that’s a pretty big deal since I taught an undergraduate nursing education. So, I went, I listened to Phil Dickinson speak and listened to the whole presentation. If any of y’all went to that, it’s a few hours long. And I just watched the entire crowds just jaws drop. I mean, with the graphs and the tables and how they came up with these models. I mean, I could literally hear the people who were going to retire right after the presentation. So as a newer faculty member, it got me real excited. I could see why this change was needed. I’ve always heard and became confronted with the academic practice gap.
I never heard it quantified like that before in anything that I’ve ever seen. So as an educator, we were aware of the gap, but the path forward was being paid for us to, we just needed to start walking down. And so after the meeting, I walked up to Phil, he mentioned during the presentation, he was a paramedic, an old street paramedic. And so am I. It’s my background. And not many paramedics go into psychometrics. And so talked about his career a little bit. He told me the NGN was going to turn on like a switch. His job was to go out and tell people and instruct educators just about the change. So, I’ve kept in contact with him. We email every once in a while and this is going to be quite a challenge to our educational status quo, but he believes in it. And so do I.
Hillary Gamblin: Now, we may be covering items that our audience already knows, but I just want to set the foundation to contextualize our discussion around the NGN by asking two questions. First, why did the NCSBN make these changes? Why are they making the changes? And what changes are they specifically making to the test itself?
Patrick Luna: So I mentioned the academic practice gap earlier. So the NCSBN, they do a review of practice every three years. It evaluates new nurse competency. And it’s based on of course, our ever evolving state of healthcare. So a trend over the past few analysis has been that clients in healthcare settings are getting significantly sicker and nurses are being asked to make many more complex clinical judgments and decisions in this environment and they directly impact client outcomes. So they started a literature review at the NCSBN and looking at the factors affecting decision-making of novice nurses directly. So, that revealed that they weren’t being adequately prepared to make decisions. And so it also revealed that 50% of novice nurses were involved in practice errors. 65% were due to poor decision, clinical decision-making. And 20% of our agencies that hire our new grad nurses, they weren’t satisfied with the decision-making abilities of their new grad nurses.
So they went on, did a practice analysis to rebuild that clinical judgment is a required nurse skills. So this is after they figured out or just kind of did a survey of what nurses actually do. And clinical judgment is essential to practicing safely as a novice nurse. So, to properly evaluate clinical judgment, the NCSBN created a clinical judgment model, and it outlines the process of making a clinical judgment. And they’re actually going to be adapting the NCLEX licensure examination to adhere to this model. The goal is to properly measure clinical judgment. This has resulted in five different question types that are being studied for inclusion. The question types are designed to evaluate clinical judgment using this model. But the emphasis is on fidelity in creating an environment where the students have to make a decision similar to the decisions and the environment that they’ll have when they go into practice. So, they will recharge. They’re going to have more hours. They might have set of provider orders. So, they’re going to be asked to recognize important information that can be utilized to make a sound judgment.
Hillary Gamblin: Fantastic. It sounds like the NCLEX changes are logical and necessary, but the devil is in the details. And as we were preparing for this workshop, you mentioned that you were confused by some of the articles released by the NCSBN. To help our audience way through that information that’s been released, what should nursing educators be focusing on when it comes to the NGN?
Patrick Luna: So they have a lot of information and they’re doing a lot of promotion of this, we need to know about this, so we know how to adapt ourselves. But when I see the clinical judgment model, I think of all the people in the country who are recently shown a curve and told that we needed to flatten it. It needs explanation. And in a way it’s a little bit open to interpretation as well. So, the first thing to understand about it is that it’s an evaluation model. It was designed to provide a template for the NCSBN to write test questions. It’s not meant to replace our existing teaching methods. This is stated explicitly by the NCSBN. So we don’t need to go and burn all our textbooks up. The nursing process is still alive and well, I teach it every day.
In fact, there’s a, what’s called an active model that has the nursing process written at the bottom of the clinical judgment model. I couldn’t find it on their site, but I screenshotted it and I show it to everybody. Just to let them know that, that is still the process and how the model can conform to our current teaching methods. So, just going through the model a little bit, the first two layers of the process of arriving at a clinical judgment, in a very broad sense, it paints it with a very, very broad brush. Basically, your client needs something. You come up with a goal based on that need, you make an action, and then you evaluate. So it’s actually kind of incorporates clinical judgment, but very, very broadly. So, tier three, is where the educator should focus on. And in fact, tier three and four are the foundation of what can become an active model and an active educational model.
So this is where the educator should focus. This is the process that will be evaluated. So any of you that teach simulation, you’ll recognize a lot of these terms. It starts with recognizing and analyzing cues. Can students pick out information that is important? Can they link that information to the client’s issues or the client’s clinical picture? And then can they formulate a goal and prioritize that goal? The wording used in the model is hypothesis. I find that word difficult to teach. It’s a very scientific process, but goal is something that I feel like I can work with a lot easier and translate a lot better. So, still prioritize what you want to see in your client, and then take the actions.
What’s usually forgotten is the evaluation step. And so that’s something that’s going to be placed into the model so that it can remain cyclical, a lot like the nursing process. So this tier is where we can interject our teaching methods very, very directly. We can look at these direct, these steps within this layer three, and kind of progress our students in that way and write test questions based on that. So in that way, we’re increasing the fidelity. We are directly helping our students in training them to not only succeed at this test, but to see them succeed in practice. And that’s the way that we’re closing the academic practice gap.
Hillary Gamblin: Perfect. Thank you. Now, our audience knows to focus on tier three and four, right?
Patrick Luna: Three and four are great. Yeah.
Hillary Gamblin: Three and four. But there’s still the question of how to effectively make the shift. What has your program done at an administrative level that has really helped faculty understand and prepare for the NGN?
Patrick Luna: So, those of us in attendance at that, at Phil’s talk presentation, we huddle about a month later. There were clinical representatives. There was of course faculty in this group and one of our academic deans. And we started brainstorming just about what we heard and how it possibly we’ll have a downstream effect on how we teach. So 2024 didn’t seem like far away, even a couple of years ago when we started that. So we formed a group that we met twice a month. This culminated in providing just kind of incremental education at undergraduate faculty meetings. And we created a canvas shell actually, that’s our, you know that canvas is our LMS. And it had next generation NCLEX information in it. So we would update that. We’re still updating that. We bought on board our instructional design and IT departments. Because what we realized is we are going to need some technology just to increase that fidelity and make it as realistic as possible to create those environments for our students.
And so we have our first workshop actually in November. And what we’ve asked our faculty to do is bring existing learning activities, case study, simulation scenarios, bring some writing prompts, and we’re going to work together in a workshop to reformat some of those to adhere to this model so that we’re adequately teaching this clinical judgment model. So we have discovered is that, what we discovered is when we go through these processes, we don’t have to change a whole lot. It’s just kind of tweaking some of our existing activities so that they are more realistic.
Hillary Gamblin: That sounds like there were probably sighs of relief after all that.
Patrick Luna: Definitely. Definitely.
Hillary Gamblin: Now, as you said, you’ve been recently leading workshop with your colleagues at the University of Colorado to adapt course curricula for the NCLEX changes. What are three pieces of actionable advice that you would give to nursing educators that are starting to adopt or adapt their courses to the NGN?
Patrick Luna: So, Probably the first thing, and this is what I hear a lot from our faculty is don’t think you have to change everything. That’s the first thing. Of course, that kind of mindset is going to lead to fatigue. It’s going to lead to burnout. This is just a new method of evaluating students’ clinical judgment. This isn’t a rebuke of the way that that anybody’s been teaching. So, and that’s echoed in the NCSBN material. Again, we’re not burning our textbooks. This is an evaluation tool. So, number two, look at ways that you can bring more realism to your teaching in your evaluation. Think about what your students will see in practice. So prepare them explicitly for the realities of making a clinical decision. What they see, how are they going to discern information?
So, start slow. Don’t confuse the students with a lot of potential cues right away. They need to be taught what’s important information first. Number three is scaffold their learning. This can’t be done in a silo, especially when they’re going to be tested basically on a finished product, as a new grad nurse, that’s sitting for licensure. So scaffolding is of course, curriculum dependent. Early in the student’s program, we can focus on how to discern information. That’s that recognizing cues. This fits really well into like a health assessment course early in an undergraduate program.
We want to build on this by teaching how to formulate a goal, based on that knowledge. As they learn interventions, they should also learn prioritization. That’s really important. And remind them always to evaluate, so emphasize the cyclical process. So once they’re familiar with this concept and we’ve given them some basic structure, we can start to challenge them because the NCLEX is going to challenge them. As they get closer to graduation, they’re going to be expected to be able to do a lot of this. So set standards really because the NCLEX it’s still, even after this change, it’s still going to be pass fail.
Hillary Gamblin: Okay. You also mentioned when we were bringing in your instructional designers, because you realized that you needed more technology to make the fidelity really work. And as you were working to prepare your students, you found a useful tool, GoReact. And so I have two questions for you. Can you explain to our audience what GoReact is? And then how have you used GoReact to improve nursing student psychomotor skills?
Patrick Luna: Definitely. So skills acquisition development, it’s built into the clinical judgment model as students are learning to generate solutions and take actions. So this is when the students will recall their stability based knowledge and recognize the task complexity surrounding their nursing intervention, like time involved. So, that’s all specifically built into the model. So when we were looking for something, especially, for teaching a course like health assessment, that’s very skills heavy, so I researched a bunch of different tools. And I couldn’t find one that matched the GoReact functionality. It’s a tool designed specifically for skills acquisition. So, GoReact, it provides a platform for faculty to provide direct feedback to student actions. So, using this platform, I’ve been able to witness student performance in the online teaching environment. So it’s been great for me. So I watched this student perform a cranial nerve examination while he was in his own living room. I provided a focus feedback to improve. This wouldn’t have been possible without GoReact. You take a look at it.
Cage: All right. And then I’m going to ask you to stand up and just try to stay still and make sure you don’t sway at all. All right. You can go ahead and sit down. So testing proprioception and balance through the cerebellar function, noticing that we have well-balanced, minimal swaying. We have accurate appropriate reception and all your movements are smooth. Is there anything else I can do for you? All right. I’m going to note everything in the EHR. Perform hand hygiene and we’re good.
Patrick Luna: Cage, you did a great job. That was an excellent neuro focused exam. Taking all of that information, knowing the assessments well enough to where you can smoothly transition between them. That is going to be imperative during your HACP. So, really good work. And I could tell that you practiced. It was an excellent exam. One of the better ones that I’ve seen. That was a really, really good assessment.
Hillary Gamblin: Okay. Another tier focus with the NGN is helping students practice clinical judgment. As we’ve been talking about, that’s been the whole thing, right? Can you share how you’ve been using GoReact to improve students’ clinical judgment?
Patrick Luna: So, this is where I think a tool like go react is really beneficial. So, due to that unique feedback mechanism that y’all just saw, I can have students interact with media in a very meaningful way. So that feedback mechanism is not just for faculty. I can have students interact with each other. I can have them specifically interact with the video. So I recorded three students engaging in simulated scenarios in our SIM lab. And I uploaded the video to GoReact. I pre-briefed before the scenario, I set up the scenarios with the entire class as if we were all about to engage in the scenario. So the students watch the simulation and we’re able to provide specific responses to moments in the simulation. They recognize when a client was possibly confused based on an orientation assessment. And then we could discuss and debriefing what possible actions would be.
So I was able to engage in a simulation in an online setting using real time feedback as if we were all in the same room together. This was not a written scenario. It wasn’t a formulated case study. This was a simulation of an actual patient encounter that the students engaged in from home. So the possibilities with a learning tool like this are endless. And I’m already brainstorming other ways to use this tool to make even more realistic encounters. So I’ll let you guys take a look at the SIM scenarios.
Alex: Hi, my name’s Alex. This is Jessica. We’re going to be your nurses for the day.
Jessica: How are you doing today, Mr. Russo?
Mr. Russo: Oh, I’m here with you guys.
Jessica: All right. Can you tell me your name and your date of birth?
Mr. Russo: My name is Salvatore Russo.
Jessica: All right.
Mr. Russo: And my date of birth, let me get that. It’s January 11th. Yeah, I lose track of the days sometimes. Okay.
Jessica: All right. Thank you. All right. It looks like it matches. Are you comfortable? I know you’re here with some issues-
Mr. Russo: Yeah.
Jessica: We’re wondering if feel comfortable right now?
Mr. Russo: Yeah. That’s on point right now. Okay, perfect. Well, before we begin, we’re going to run through some universal competencies, make sure we had everything we need and that your room is pretty much clear, okay?
Mr. Russo: Okay. Y’all go ahead. Y’all do what you got to do.
Alex: All right. So I’m looking around the room. I see we have an oxygen with…
Hillary Gamblin: Fantastic. I’m curious because it sounds like you’re really taking advantage of GoReact. So are there any other interesting ways you’ve been using the software to better prepare your students for the workforce? I’m curious.
Patrick Luna: Oh yes, definitely. So the multi-camera setting, that’s my favorite feature in GoReact. With that enabled, I can create an interactive environment for students to discuss and record an assignment. So, it’s a meeting room as well as a medium for them to complete an assignment. For example, I have my didactic students record an SBAR in groups of like five or six. They discuss a case scenario, collaborate on an SBAR and then record it. And they do that all within GoReact. This is so much more meaningful than writing in a discussion post. I also can record video feedback directly into the assignment, so they get to see me, too. Here’s an example of that assignment.
Speaker 7: Mrs. Jones was started on Levaquin for her possible pneumonia. She’s never had Levaquin before and does not recognize the medication name, but seemed to tolerate the first dose well. Mrs. Jones is cooperative, but anxious to be treated in the hospital away from her husband, whom she cares for and is anxious to be discharged. What do you think about discontinuing Levaquin and monitoring for any change in symptoms or status? If the symptoms continue, we can consider a stress induced rash. And if they subside, we can evaluate Mrs. Jones needs a different antibiotic.
Patrick Luna: Purple G, thank you so much for your presentation. It was clear. It was concise. You all did a great job of just combining all that information and presenting it very clearly. So excellent work on presenting and organizing your SBAR.
Hillary Gamblin: I love the multi-camera, too. Thank you for sharing these videos with us. Just to let everybody know that we did get permission from all the students to share this. They knew that we’d be using it for educational purposes. But, so thank you for taking the time to give us those three examples. I think that’s really illustrative of how you can use GoReact to increase the fidelity and clinical decision-making skills. Patrick, my final question I want to ask is, just do you have any last words of advice or wisdom for our audience as they’re about to jump into the NGN?
Patrick Luna: So gather a team, take it slow. Everyone that I work with on implementing these changes, we’re all invested longterm in our students’ success. So, we all want to see them succeed. So our focus is to pairing faculty, but our goal is to better prepare our students. So, for some, this is an ideological reorienting of how we prepare our students for licensure. We got really comfortable with the way the NCLEX has been delivered, and we know how to prepare students for that. But the environment that they are, that we are preparing our students for has changed. I mean, it’s changed dramatically in the last, what? Six months. So, and it changes every day. So as educators, we must evolve our methods as well. So look at this as an opportunity to improve how well we prepare our students for practice. And that’s what we should be focused on. Better prepared new grad nurses are going to make better clinical decisions and improve our client outcomes. That directly reflects on us as educators. So, we know that their success is also our success.
Hillary Gamblin: Thank you for answering all of my question. You’ve provided some wonderful context and actionable strategies to help administrators and faculty really start approaching and preparing for the next generation NCLEX. I want to take the next 10, 15 minutes, maybe even more because we have the time to answer any questions of those that are attending. There are people behind the scenes that have been monitoring your questions and they have been sending them to me. The first one is, can you give a sample of scaffolding?
Patrick Luna: Sure. So, like I said, when I was asked this question earlier, it’s curriculum dependent. This can be part of a larger conversation. And like I mentioned earlier as well, I work with very foundational nursing students as they first come into the program. So for my didactic course, we’re actually building in aspects of our, of the clinical judgment model into our course design. So in our learning activities, what we want to do is really concentrate on their ability to recognize cues and discern information. Like I was saying, I don’t want to confuse them with a lot of different information at once. That’s what’s going to be what’s on the NCLEX. But when they’re first learning what important information is, I really want them to understand that, what a cue is, how to recognize it. And then we start building them toward making a clinical decision.
And that’s what has to happen in later courses. In a foundational nursing course, when they’re just learning interventions and they’re trying to piece that all together, we can be very deliberate in adhering to the model and just how we train them to do that. But as well as later on, when they’re seniors, before they take the NCLEX, we need to start challenging them based on the model with test questions, with scenarios, with case studies, and we need to directly try or attempt to evaluate.
And this is where a lot of our innovation as educators will come in, is where can we evaluate them based on these different steps and then where do we want them to be by the time that they graduate? Because if you look at the examples of the questions that are on the NCSBN on website, I mean, they have to be able to do that. And that’s a lot of information. What the NCSBN calls it is a sterile test question. It is a test question that has no context. So they get a very clear psychometric number based on that. But that the reason behind this change is they want to introduce that context in that fidelity.
Hillary Gamblin: Fantastic. We have another question here. And it says when it comes to coaching and measuring critical judgment and nursing for a nursing student, how have you been able to use a tool like GoReact to help with that?
Patrick Luna: Okay. So as far as coaching, my background is clinical education. I began in nursing education as a simulation instructor. So what I’m seeing is kind of the convergence of the ideals that we’ve done in simulation to build clinical judgment, being incorporated into classrooms as well. So this is a very deliberate merging of worlds. So, our opinion and my simulation team and my simulation director, we’re being called upon more to utilize our knowledge within our, the didactic environment.
So, and a tool like GoReact is excellent at that. The simulation video that I showed earlier, where we can actually, and that has direct implications for our current online teaching situation is, how can I do this within this environment to still have that feeling of being in a clinical scenario? And there’s tons of research about observing a simulation and how that affects the actual learning that observers have. And it’s very positive in that regard. So skills acquisition, simulation. And what you’ll notice about the three examples that I gave, they’re from three different areas. They’re from simulation, they’re from skills lab and they’re from didactic. So there is opportunities across nursing education to use a tool like this to increase the fidelity of our teaching.
Hillary Gamblin: The third question that we have is what suggestions do you have to improve fundamental labs?
Patrick Luna: Fundamental labs. So, anybody who’s in that world and I wait in it every day. It’s a major question that we get from our nursing students. Is they want to concentrate on skills. They feel like that is what’s going to make them a nurse. And so doing that, I mean, I’ve only begun to scratch the surface of what I’m going to do with this particular piece of software. I used to sit in my nursing skills lab for two weeks and watch everybody do a head to toe exam. And it’s the same thing over and over and over again. Because of this online environment that we were in now, I had everybody recorded into GoReact and I watched it, I could break it apart and do it in a couple of days.
Patrick Luna: So improving skills is built into this program as far, that’s what it’s designed for. I mean, I’ve implemented it in another ways, but you can use this to give direct feedback. Even when we go back to campus, I want to utilize this tool. Not only for faculty time to save on that and our workload, but it’s excellent. We hear so much about the current students and how they want to, an education environment, that’s more conducive to their time. And I mean, they can go in and film this stuff in the lab whenever they want. So, and I can give them direct feedback and formative feedback as they’re going along. So I just liked the interface of the tool. And I’m spreading it to different faculty all over the college, just to let them know that this is something that they could use.
Hillary Gamblin: The kind of spreading we liked during the pandemic.
Patrick Luna: Yeah. Yeah. Maybe, I should think of a different term.
Hillary Gamblin: And then the final question is when is the NGN being deployed spring 2023? What is it? Do we know?
Patrick Luna: So they haven’t come up with a hard-and-fast rule or a time. So, it was initially slated for 2023. And because of COVID, there was an announcement that they pushed it back to at least 2024. But what I’m finding is that, just the fact that they have this model deployed and it’s directly related to how our students are going to perform once they start practicing, I mean, I’m starting to incorporate this now. If it’s going to help them when they go to practice, and I was a clinical instructor, and still am, and knowing what their struggles are in that environment and translating their knowledge there. This is something that we can start right away. Just to, piece by piece and see how it’s going to change our teaching methods.
Hillary Gamblin: So 2024, it sounds like, but might as well just get started.
Patrick Luna: Yeah. Might as well get started. And when they come… And Phil told me, and that was a question I raised my hand during the question and answer session. And I said, “Hey, what’s the advanced warning?” And he basically told me you’re getting it now. Like he goes, “When this happens, it’s going to be one test. It’s one group we’ll get the old test. One group is going to get the new one”. So this is something that we need to start thinking about right now.
Hillary Gamblin: Well, Patrick, thank you so much for sharing your expertise and all of your knowledge about the NGN. You did this workshop voluntarily. So we appreciate you taking your personal time to help share strategies with your fellow nursing educators. And because the NGN, as we said, is coming soon. Not to Game of Thrones, Winter is Coming. NGN is coming. I know this webinar will be particularly useful for people. So, we’re actually going to make a recording of this workshop available as soon as possible. And we will send an email with the link to the recording along with a captioned version. So please watch for that in your inbox, but that is it for today. Thank you to those who have participated. Thank you for those that are working behind the scenes. And of course, thank you to our guest of honor, Patrick Luna.
Patrick Luna: Bye.
Hillary Gamblin: And that’s it. So we’ll see you next time.