Preparing Students for the New NCLEX

Kenya Lund:

Hello and welcome to our webinar today. We are thrilled that you have joined us and hope you enjoy the presentation and walk away prepared to inspire your students and make a positive impact on their careers. My name is Kenya Lund. I’m on the GoReact team and we are hosting today’s presentation. For those of you who aren’t familiar with GoReact, we are competency-based video assessment and feedback solution used primarily across campuses in the US and UK. I’m happy to be joined today by our presenter, Patrick Luna, senior instructor of clinical teaching at the University of Colorado College of Nursing. Patrick will be joined by another GoReactor, my colleague Jessica Hurdley, who will be moderating today’s discussion.

Before I hand it over to Jessica and Patrick, I’ll run through a few points of housekeeping. Today’s event will last for about 45 minutes, that includes 30 minutes of presentation and 10 to 15 minutes for Q&A. We are recording today’s presentation, so if you need to hop off before we finish or if you want to share the recording with a colleague, we will email that recording to you. We do want today’s presentation to be as interactive as possible. So throughout the presentation please participate in the polls and prepare your questions.

To submit questions for Patrick or Jessica, please use the Q&A function. We’ll answer as many questions as possible in today’s session. You will also see a chat function. Please use the chat function to introduce yourself, tell us what school you are with, and if you have links or relevant resources to share with other attendees, please do so in the chat. And if you experience any technical difficulties, please use the chat to reach out. Without further ado, I’ll hand it over to Jessica to introduce herself and then welcome Patrick and begin today’s presentation.

Jessica Hurdley:

Thank you so much, Kenya. Like she said, my name is Jessica Hurdley and I am part of the GoReact team. I work specifically with schools in Maryland, Ohio, Pennsylvania and north, but we have someone else on our team that handles all of the other schools across the world. I thank you again for being here today and I just want to turn it over to Patrick. Patrick, is there anything you want to lead with before we start with some pre-created questions that we have to ask you?

Patrick Luna:

I guess the only thing is just welcoming everybody like you all have done and just telling y’all how excited I am to be here. I’m keeping an eye on the chat here and just seeing where everybody’s from. I love these opportunities to connect with colleagues, with people from all over the country, just hearing what you all are doing and the amazing things happening in your program. So this is really exciting. Just really happy to be here.

Jessica Hurdley:

Awesome, awesome. Well thank you for joining us and I’m sure all of the information you’re going to share today is going to be so helpful for all of those in attendance and anybody watching on the recording as well. So let’s get started with some questions. My first question is kind of a statement, but walk me through what the next generation NCLEX for new nurse licensure means to your program and any curriculum changes your program has made as a result.

Patrick Luna:

Yeah, thanks Jessica for that. I guess I need to describe my environment. And I know there’s a lot of different environments, BSN, ADN, LPN. There’s a lot of programs that these changes are going to affect. So I’m a senior instructor of clinical teaching at the University of Colorado College of Nursing. We’re here in Aurora, Colorado on the Anschutz Medical Campus, which is a huge medical campus. We have multiple hospitals and a children’s hospital and there’s a lot of research and things going on here. We have a multidisciplinary environment here. So that’s my overall environment. My college of nursing is the largest college of nursing in the state of Colorado. We’re also very historically old, I guess you could say. Been around since, I think, 1890 was when this college was created. So there’s a lot of history, a lot of really excellent resources here that I know that a lot of other programs don’t have.

So where I teach and what I do is I am a first semester nursing instructor. I integrated my clinical background and what I did clinically into my teaching immediately. So these are first semester college students. We have a couple of different programs, an accelerated program and a traditional two-year nursing program where they have two years of college before that. So that’s my environment. This impacts me very, very directly because I feel like it’s my responsibility to really start to prepare these students immediately as soon as I see them on the first day of lab during health assessment, and then teaching my didactic course in foundations. So this process of introducing the clinical judgment model, of introducing… And I’m going to talk about a process as far as how I do this and how I’ve kind of interpreted a lot of the different resources that I’m sure most of us have looked at.

So it’s going to the NCSBN website. I went to the initial in-person presentation with Phil Dickinson and connected with him and really was interested in how the test was going to change because it seemed so impactful, and at the time was very, very scary. I mean, I don’t know if any of you went to those initial meetings, but they were kind of tense. They were really tense because what we were hearing was that what we were going to attempt to do hadn’t really been done before in licensing nurses. It was on us to really prepare our students for all these changes. So with that said, we started pretty much right away here at the University of Colorado. We met up in the parking lot, actually, of those initial meetings. And if you remember, the NCSBN went on literally a nationwide tour and started collecting educators in different areas.

And we met in the parking lot and just started to brainstorm. What came out of that is a work group, and the work group started to meet regularly just to start to get this rolling as far as how we were going to prepare. This was before a lot of the resources that we have now have come out. So with those resources, we’ve been able to really pinpoint our approach with how we’re going to approach this from not only a curriculum standpoint but from a faculty ground level educator standpoint, which is where I started to look at this. So I wanted to see what I could do within my environment. So this is before this change takes place. So this is within my course, within the things that I do. How can I start to use these terms? How can I start to use some of these evaluation techniques?

So as far as what this meant from a program perspective, we had heard, and of course we’re familiar with the term clinical judgment. We knew what it was. We thought we were doing a pretty good job of creating nurses that were going to be able to practice effectively, safely, and effectively in the clinical setting. When we saw all of the research that came out and that presentation from the NCSBN that said that our agencies were seeing something different, and we realized we need to strengthen that partnership and really needed to look at what we were doing from a program standpoint.

So we knew we needed to do it. This is the type of thing that was very jarring to people because this was something that we didn’t have a choice in. This was not a poll they took of educators, nursing educators, and said, “What are we going to do to better prepare our nurses?” They can get some valuable data for that. But they went to the agencies, they went to the agencies and asked, “What do new nurses look like, and are they prepared to practice in your environment?” And there was, as we’ve all seen, some very interesting and just enlightening research for what exactly our deficits were in the education environment.

So what this means to most programs is that we can evolve along with the test to prepare students that are better prepared for practice. So that’s what we’ve taken out of it, from my program standpoint, is that we need to do a better job of preparing students for practice. That hasn’t caused too much of a… What I’m trying to say is it hasn’t been extremely difficult. What we’ve realized is that we just needed to get the word out and start to refine the way that we’re preparing our nurses, including from all aspects of our program.

So we weren’t given a choice as to what these changes were going to be or what they were going to be doing specifically. So trying to stay ahead and not be so reactionary and see what we’re doing already well. So that’s what we started with. We did things like we had a faculty retreat. We didn’t go anywhere fun. We literally just all sat in a room and started talking about, from an individual perspective, what could we do to start to implement these changes. We started to highlight faculty that were already using a lot of these techniques and a lot of this terminology just already, because this stuff basically has been out there for quite some time. This was just a push to get us to prepare for the rollout, which if everybody hasn’t heard, is this April. So we’ll know a lot more and how effective our preparation was and will be when we graduate this group in May.

I would like this to be an ongoing conversation because I actually want to check in with everybody and see how other programs are doing. The NCSBN has already done quite a bit to prepare for the change. In fact, they’ve been doing it for so long. But it’s specifically as a result of COVID as well. We saw NCLEX rates drop. So there’s a lot of changes going on there, but this is an opportunity for programs to really update their preparation of new nurses to align with clinical practice and to also align with what the changes in healthcare are, because it just didn’t make sense anymore. And the more I think about it, it didn’t for them to sit and take a multiple choice test and then be ready for practice. So I think it’s just an evolution of nursing education.

Jessica Hurdley:

Thank you for that. Being the largest nursing program in Colorado is definitely something to be proud of. That also comes with having access to some additional resources. So with that in mind, what do you think smaller programs without a lot of resources can do to prepare for the new NCLEX?

Patrick Luna:

Yes, that’s a excellent question. I’ve connected with a lot of individuals who are from smaller programs. I graduated from a smaller program and I’ve told you this Jessica, I went to Lone Star College Community College in the Houston area. My school was between a Baptist church and a grocery store. So I graduated with a group of about 18. So learned quite a bit. Excellent nursing program, still excellent program to this day. Advantages and disadvantages, one of the greatest advantages of being in a small program is I had one nursing instructor, and she never repeated herself. So when you get all these moving parts and these super large programs, I was just sitting downstairs this morning in the pharmacology class and what I realized is my students know a lot more when they come to me than they act like they do.

So I think there’s a lot of redundancy in large programs that it’s just hard to avoid because there’s so many different programs, and so many different courses and different faculty, and that can be confusing to students as well. So that’s an advantage of being a small program is less instructors, more concise information. You can be really pinpointed in how you’re approaching your students in a smaller environment as to what you are purposefully trying to do. I am envious of all of you. I teach a class with a hundred people staring at me. And so that’s a completely different issue. So whenever I’m speaking with faculty about how they’re specifically trying to prepare students or… The NCSBN has all of these amazing resources. But the first step is looking at what you’re doing currently, and I’m not the first person to say this.

I’ve been to a lot of these webinars and a lot of these retreats that the NCSBN has put on. Not so much retreats, but just their webinars that they put on. They pretty much echo the same thing, is the way that you are preparing your students does not have to change dramatically. There’s some small things and some small tweaks that you can do to start to implement this language even without the needed technology to specifically change your test questions. I still haven’t figured that out. I cannot do that in my current LMS system, make it look like what the NCLEX is showing us. We’re working on it, but it’s outside of my technological expertise. I am still trying to figure that out. So a lot of people are dealing with that as well.

Looking at what you are doing specifically, so clinical judgment and what we know about clinical judgment is very important. So this is a concept. There’s programs that are built on the Lasater model. All of us teach the nursing process. So that is the first step. And if you look at the faculty guide from the NGN, and that’s a wonderful piece of information that I encourage all of you to look at, is it has a model for how you would prepare a student from the beginning of the program and then all the way to sitting for their licensure exam. It’s pretty specific as to what we do at the beginning. Like I said, this is where I live. So I’ve looked at that very closely. The nursing process is not going away. It’s very much ingrained in how we teach clinical judgment. So if we can get that concept into school, into students early, which all of you are doing.

So it’s introducing that model for clinical decision-making. I feel like I need to define clinical judgment according to what the NGN says. Wat was just kind of enlightening about their definition is that it is an outcome. It’s an outcome based on clinical decision-making and critical thinking. So those are terms we’ve used in nursing education for a really, really long time. So clinical judgment is the result of that. So looking at something and saying that you made a sound clinical judgment is the result of clinical decision-making, critical thinking within a process. This is all iterative. So whether you’re using the nursing process, which we all do, which will prepare them for that, eventually making clinical judgments and doing that within the confines of the clinical judgment measurement model, which we’ve all seen. And so that’s the process.

So once we’ve defined that, we can look at those critical thinking processes, those clinical decision-making processes that we are all already doing. But what we might not be doing is thinking of those processes, the critical thinking and the clinical decision-making things that we’re teaching our students, as having a very specific outcome. We kind of just leave it sometimes with, “Okay, you can give a med.” You know when to give a med and that’s about it. But if you look at the larger picture, if you look at what the ultimate goal is, is to have these students be able to perform these skills and make these clinical judgements within a clinical setting, and that’s built into the clinical judgment model as well. It’s in layer four. So with everything that we know about nursing and everything that then the environment that we practice in, those things are the road to clinical judgement.

So maybe we just need to finish that equation. You take your students to a certain place using the processes that you’ve already are comfortable with, but you always have an end game. It isn’t just for them to feel good about giving a med or to even, in isolation, create a therapeutic communication, or just improve their therapeutic communication. This always applies to a clinical setting, and that’s what the NCLEX is going to do now. So three cases that are all unfolding within the NCLEX model, and there’ll be six questions per case. A lot of you have already seen this before, and already heard of this, but this came out. The test plan is out, and this is something they’ve been saying for a while. All students will have to do that, and they’ll have MARs. They’ll have histories. They’ll have patient information. If we can make our students start to really just be comfortable with using that information and doing this constantly, they’re going to rock those questions.

That’s what I’m telling my students all the time is, your knowledge is great. You have an isolated pharm class, you have an isolated patho class. You come to me with all this knowledge. When you show up for your first day of work, they’re not going to give you a patho and a pharm test. They’re going to ask you to enact the knowledge that you have. And that was the deficit that we had as nursing educators is we weren’t finishing that equation. So I think this is our opportunity. Even with a smaller program with the advantage of being in a smaller environment, there’s not so many educators. This is something that you can specifically do.

Jessica Hurdley:

Thank you so much for all of that. So for our next question, what formative assessments have you included to set your students up for success on the NGN?

Patrick Luna:

Yeah, so what we’re talking about here is how are we going to be able to assess our students’ ability to perform a clinical judgment? There’s a lot of different ways to do this. I saw in the chat somebody’s asking about GoReact specifically. That’s a tool that I use along with a lot of different tools to specifically try to create an environment where my students have to enact the knowledge that they have. Simulation is a great way of doing this. I teach in simulation. That’s where I started in nursing education. And I am a huge proponent of using an environment like that to assess your student’s ability to make clinical judgments. The de debriefing is very rich with how we can improve clinical decision-making, critical thinking, and now clinical judgment using different models within that environment, which is excellent.

So using a tool like GoReact specifically for assessment and in doing this, using the information that I gave you before within your current environment using the tools and the methods you’re already using, all of you probably engage in case studies. If not, you should because there are going to be three on the NCLEX now. So we all do that. We all use that as a method to bring reality, to bring different situations into our didactic environments because if we can discuss a case, then we all will learn from it.

So the way that I implement something like that, which is traditionally like a written assignment, or something that we have as a discussion in class as a group, we have a case or we use an unfolding case study that has a point. I want you to have some kind of understanding by the end of that case. It’s a teaching technique. The way that I’ve adapted that using a tool like GoReact is rather than write it out, especially if I want to see how they’re enacting a process like the nursing process, I’ll give them a case. We all have cases, and I’ll put it into my LMS, and then have them respond verbally and explain their plan of care through GoReact.

There’s a lot of things that I can assess a lot better than reading a hundred care plans on paper is how you communicate information is a lot more relevant to clinical practice than how you write it. That’s just the way that practice is going. You chart less, which even though there’s a lot of charting, but we’re not writing narrative notes about our patients for the most part. Especially new nurses aren’t coming out writing these long narrative notes. And I don’t know if anybody’s doing it. If you are, let me know. But in my environment I’m not preparing nurses for that. But what they will do is they’re going to communicate plans of care to multiple people throughout a given shift, their patient to the multidisciplinary care team, to their preceptor, or instructor, or whoever’s there with them. They will have to explain this.

So with moving a case study like that, and I call them video case studies, to GoReact has allowed me not only to assess what their clinical decision-making and their utilization of the nursing process is, but also their communication and how they communicate information. I find myself within GoReact, which is a excellent feedback tool, just giving them feedback on how they communicate information and how they do it clearly and effectively. I always give them a time limit. Those are things, we always learn things. Don’t leave this as a… Because they will use a lot of time. And I gave them a time limit because I want them to be concise, and there’s a lot that I can do within that environment just to make sure that I’m assessing them on things that they will use clinically.

Jessica Hurdley:

That’s awesome. Thank you for giving GoReact a little plug in there as well. We’re happy to show any examples and just wanted to contact your account executive or our GoReact team for those demos and meetings as well. So as far as the next question, we’ve heard from several nursing programs that the NCLEX pass rates have been declining, especially since the pandemic. And I believe you touched on this a little bit earlier, but from your perspective, what’s the best approach to combating this decline?

Patrick Luna:

So this was a result of the Covid pandemic and the scrambling that we all had to do to translate our programs to online. If you were in an online program already, it was a dream come true I bet. But for those of us that were in-person programs, it was a lot of sleepless nights. There was a lot of discussion. It was actually how I learned about GoReact. My director came to me and literally said, “We need a tool to assess students while they’re at home with their skills.” They pulled up. We gave them a bag. They went home and they were recording their skills at home and we were grading them through GoReact, which I was a fan ever since then. So we might not have to respond or just to change as much as we think we do. And this is why. The NCSBN meets every three years and they discuss the level for competency on the NCLEX.

So they met after Covid, and have realigned using this new format with where that passing standard is. And with the computer adaptive testing, you’re either above the line or below the line, and once you demonstrate that you’re above the line at 95% certainty, they will turn your test off. So it’s still computer adaptive. That’s not changing about the NCLEX. But the passing standard, and they haven’t told us exactly like what the new passing standard is now, but as a result of what happened during Covid, we’re pretty sure they may have readapted where that passing standard is.

So we still need to prepare. We still need to do everything we need to do as far as preparing students for these new questions and for this new concept of clinical judgment. Just to let everybody know, it’s not the entire test. There’s still multiple choice tests on the exam. There’s what are called standalone items as well. So they’ll have different formats using clinical tools. Many of you have seen those new different types of questions. But what we can do, and what I’ve been concentrating on, is exposing students to these concepts very early on, like I was saying earlier, and having that end goal and outcome of looking at a clinical judgment. And there’s a process to this. Starting early is very, very important.

So you asked me the best approach. You all know your environments. All of the educators here know, their students know. And I know the student populations, they’ve changed rapidly, especially after Covid, but we’re kind of reaching this area where we have an idea of the results, or just the impact that has had. We’ve also learned a lot about ourselves. I never would’ve heard of a tool like GoReact if it wasn’t for the pandemic. Or maybe eventually, depending on how good your marketing team is, Jessica, which they’re very excellent, but I needed something like that. And that’s why that’s found it.

So I think it’s just trying to adapt to the needs of our students and trying to communicate to them that it can be daunting. And nobody likes the NCLEX. I didn’t like taking it when I took it. It’s something you can specifically prepare for. And all that preparation’s not done at the end. All the preparation starts the moment that you decide that you want to be a nurse and that there’s a process, and that process is getting through licensure. So I think a lot of this is individual to your environment, to your student population. There’s the similarities in the fact that we’re all trying to prepare them for the NCLEX, but the differences to your environment are very, very important. I’m all about just adapting to what the needs of your students are.

Jessica Hurdley:

Thank you for that. What type of assignments, and I know that you’ve talked a little bit about a communication assignment, but what types of assignments, simulations, modules, experiences, are you personally using to prepare your students for the new format and the new types of questions on the NCLEX?

Patrick Luna:

Yes, so this is something. I have a technology team and an instructional design team. We kind of share them with some other colleges, but we have a liaison, and I’ve had multiple discussions with them about what the new test test questions are. How can we incorporate these into evaluations? So specifically, even without using any new technology as far as with my testing and evaluation, things like the video case study that I told you about along with… I’m in BSN program. So the BSN essentials were released last year, and we’ve been responding to that as well. What we figured out, we have the administration who’s looking at the essentials and our work group that was really diving into the NGN, the next generation NCLEX, and we realized a lot of our work overlapped. With competency based education being a focus on the BSN essentials, we wanted to have our students demonstrate things already and that was already something that we were working on through our work group.

So we realized a lot of that overlapped. There are some really good resources on the AACN website. They have toolkits for different concepts including clinical judgment, and there’s specific recommendations they have for different techniques. Some of them are very broad. They say use case studies, but some of them are very specific. One thing I took from this, and this is something that I’ve implemented into my foundations class, is using a tool called the Comfort Communication Model. I had heard about it when I was going through the communication toolkit for the AACN, and they have a built out nursing assignment. There’s two of them. The one that I utilize is talking through PPE. And this was a government funded research grant, or not research grant, it was a grant and they used it to improve communication during Covid.

So this is available everywhere. It’s an app which when I walk into class and I say, “Hey everybody download an app, we’re going to use this to talk about communication again,” it very much speaks to my student population. It’s something they can carry with them, even the clinical, and use some of these concepts. But that assignment, and it’s under nursing faculty resources on the Comfort Communication Model, literally just… And it’s open educational resource. So nobody’s going to sue me for using it. In fact, they really want us to use it. I copied it. I copied it into my LMS. They have a rubric. They have everything. So if anybody’s looking for an assignment that’s evidence-based, and it actually aligns to all the BSN essentials for communication. Not all of them, but it’s aligned within the resource you can see if you want to map it out.

I translated this to a GoReact assignment where I have students respond to the case. And it’s an unfolding case study. There’s three questions I believe. And I have them respond and demonstrate what they would do in that situation to communicate better with a patient. Really short, I give them a two-minute limit to implement and demonstrate one technique, and then I use the rubric within that assignment to evaluate them. So this is something that they could use in clinical practice. It’s implementing specific communication techniques, it’s learning the process of communicating, which is very, very important. And it’s using resources in the clinical environment. So it’ll help them with the NCLEX. It’ll help your program get accredited if you can tell them that, “Hey, I used this assignment that was on your toolkit.” And it’s very easy to implement. So that’s just one of the different things that I’ve done as far as just assignments. Simulation, we’ve changed a little bit, just our language, especially surrounding debriefing.

The one advantage that we can use, especially early on in programs, is the first step on layer three is recognizing cues. In the faculty resource or the model for preparing students for the NGN, the first step is teach them the nursing process, which like I said, we’re already doing. And the next one is start to put them on the process to creating a clinical judgment within that framework. So the first thing is recognizing cues. What we can do in the simulation environment is we all know we can create as much chaos in there as we wanted to. And not so much have them process it, like to the point where they have to get to an end goal, especially early on in their program. It’s like somebody’s coding in a simulation. You might not want to do that that early on, but what you can do is put different stimuli in there.

So you can give them an EHR. You can have some notes out for them to read. You can have a patient family member maybe in the room talking to them. You can have a patient who has some input and as they assess. What they’ll realize is, “Oh, there’s all this information, there’s all this stuff.” And it’s like if the first time you ever walk into a room as a nurse is in simulation, that’s a good thing because it’s a safe environment. You’re not going to hurt anybody. But what it’ll allow you to do is start to sift through that information so that when you walk into a real patient care environment you have…

In the military, they use similar techniques for, they call it stress inoculation. So it’s the same concept within healthcare, is I can get you to a point where you recognize what this stimuli is and then you can start to point yourself in a direction and identify what’s important. So I can’t speak enough about the simulation environment and how it can help with this as well. We’re looking at it from a program perspective as maybe we don’t do enough of it, and we need to do more simulation, and specifically to prepare them for the NCLEX. So those are talks that we’re having right now.

Jessica Hurdley:

Awesome, awesome. Well that is all of my questions and questions that we’ve heard from our community, but definitely want to encourage you to put additional questions in the chat or in the Q&A, even if it’s specific to your program. While we have Patrick here, we definitely want to ask him everything that’s on your mind. I do have a couple questions that have come in. But again, keep those questions coming so we can answer anything that you have on your mind. The first question, Patrick, that came in, will the next generation NCLEX also be required for the LPN licensure?

Patrick Luna:

So what I’ve seen in this test plan that came out, I didn’t see anything specifically about LPN. But on the website they talk about it a lot. I haven’t been concentrating specifically on what those communications are, and I don’t want to tell you wrong. But I have seen a lot of references to LPN and the LPN NCLEX test in the material for the next generation NCLEX. I’m reading the chat, and someone in that world, Andrew Thomas, I really appreciate it said, yes, it is required. I kind of assume that because it was in the resources along with the RN test as well. LPN NextGen, April, 2023. Thank you.

Jessica Hurdley:

Perfect. So the next couple questions kind of go together and people want to know more about, A, how you use GoReact, the uses that you have used. Is it just case studies? Are you using it in clinical, or theory classes, or both? So are you able to share a little bit more about that?

Patrick Luna:

Yes, and I’m a heavy GoReact user. I really am. I look at all of these tools as just different ways that I engage my students. And it’s not just GoReact, I use other ones as well. But specifically with GoReact, it started as a skills thing, and really, really effective just because of the feedback mechanism that you could use with it. Also, just a few things as far as I didn’t have any technical problems with it. In fact I’ve been a pretty heavy user for going on almost three years, and haven’t had a lot of technical issues. All videos get uploaded. I’ve never lost one. So it’s been really, really great from that standpoint, as well as faculty time, if this was a clunky mechanism that we had to constantly troubleshoot. But you can get in and out of a student assignment fairly quickly. I use it for a lot. I even use it for high stakes testing. I have my students record their assessment now in our lab rather than having a faculty member sit in the room with them to manage student anxiety.

They still have to show up and know it. But instead of having me there, they record it and turn it in and then I’m able to grade it on GoReact and I don’t have to sit in the lab for nine hours and watch everybody do an assessment. I’m glad I don’t have to do that anymore. But yeah, I use it for a lot of different mechanisms. I use the multi-camera assignment for an SBAR assignment just to teach communication. GoReact was initially a communication tool that was used to improve communication techniques within different environments. So that’s just using it for its original intended purpose. And so I use it for communication quite a bit.

Presentations, it’s really amazing. It has different tools and different… I can have students share a screen. I can see all the students while they present as well. So I do my final project, which is kind of writing a huge care plan and then presenting it on the GoReact interface. I even do a lot of peer feedback with it as well. So I have groups watch the videos as well and they ask questions and engage with each other through the mechanism as well.

I use a lot. Like I said, that and other tools. This is both in the lab environment specifically for skills and simulation, but also in my didactic environment. It’s really hard to give students individual feedback. It’s just difficult, especially in a program my size. So I’m able to do that and do it efficiently without having to read a hundred papers. So I like connecting with my students in that way. I leave video feedback so they can see me, and that helped during Covid because they weren’t in class with me at the time. So I just feel it’s a way to connect with them through all these different means. They can upload YouTube videos now, which is really convenient for them and how they share information. So I use it quite a bit.

Jessica Hurdley:

Awesome. And for those that aren’t familiar with GoReact, GoReact at its core is a feedback tool for your students. So them performing a skill, performing a simulation, having that recording impairing awareness with contextual feedback or input, whether that be through self-reflection or peer review or from a trusted advisor, a instructor, that at its core is really what research shows how students and adult learners progress their skills and progress them quickly. So that is really what the tool is built on. But that’s exciting to hear that you weren’t aware of GoReact and you wanted to learn about more of the NGN and what is coming. So as far as the next question, what do you do with students who say they will do practice questions daily, however, they really do nothing? Any tips to get students motivated and to actually do it?

Patrick Luna:

I kind of look at issues like that. My mom used to tell me, when you point a finger, you have four pointing back at you, and I’ve always remembered that. So whenever I have, or just hear about these issues, I tend to look in internally a little bit. I also think about my students’ experience. We give them a lot of information and they have their own stuff going on. I totally get that. I really try to support what their workload is and what I can feasibly ask them to do. Everything that I do, I try to make it beneficial for them in some way. I mean, I have an accelerated group here that’s literally they walk through the hallway like zombies. They go through nursing school in one year, and I have to be especially just very literal about how I use their time. I can’t rush them through a nursing program even though we do. But I still need to hold them to the same standard and the same preparation.

It doesn’t matter if we can get them through a program if they’re not going to pass the NCLEX because they’re not going to help our clinical partners out there who are looking at us to bring them nurses and competent nurses. So I really think about workload management and just trust as well. And I know these are just like, this is a weird answer to the… I’m not really talking about the student, I’m talking about me, and what I can do is I need to build that trust with them, because if I tell them to read an entire chapter and then they come to class and I don’t discuss the chapter at all, I just wasted their time. And they’re not going to do anything I say anymore. They’re not going to believe that what I’m asking them to do with their time is beneficial.

So I really try to translate their workload to things that are really beneficial to them. It is beneficial for them to do NCLEX practice questions. But what I figured out about that is that not everybody needs to do it. Some people are really good just inherently at answering NCLEX style questions. And I figured that out fairly quickly. They’re the ones that are really high performing on my tests and I want to know how they’re doing it.

Some of them are studying really hard, some of them, they just know how to do this. I can’t explain it neither can they. But for those that need it, and I give them that. I say, go buy an NCLEX test bank. I will give you a bunch of free questions that I have and start answering a couple every day and reading rationales. So that helps. And I’ve had a lot of success with that. But it’s more individual than it is telling everybody to do it because if I do that, some people don’t need it. So I know that that’s kind of a strange way of looking at it, but it seems to work for me and it helps me to build trust with my students.

Jessica Hurdley:

Awesome. Any recommendations on how to integrate clinical judgment in the nursing care plan?

Patrick Luna:

So they go hand in hand. Like I said, that’s a process that’s ultimate outcome is clinical judgment. So what within the confines of the nursing process, you can show them the process of how to create clinical decisions. The problem, or just what I find the limitation of the nursing process is, is that it’s really limited to one nursing diagnosis. So as opposed to the nursing, to the clinical judgment measurement model, which is taking into account the dynamics of the nursing environment and the kind of decisions we make, we might make a decision, or have an intervention that treats multiple areas of that patient’s condition. So I think that’s where we can translate it. At the beginning, we need to show them a nursing process. We need to show them how to take… Because we don’t want to overload them with a bunch of the dynamics yet.

We just want them to be able to learn the process of clinical decision-making. And then once they are exposed to that and know that, then we can start to really expand and grow and scaffold their ability to make a clinical judgment using things like simulation, using targeted case studies that really assesses their ability to navigate different components of the clinical environment, whether that’s using a MAR, or using a history and physical, or using some assessment data. That’s the process. That’s the process of getting them there.

So within the nursing care plan, I’m a huge proponent. This afternoon, I’m teaching care plans and I’m ready. And because I know I have to explain that, I have to get that across as our foundational theory, as the way that we’re going to start this journey to using the assessment techniques that they just learned in their past class. So I’m on that journey with you, but I had to really figure out where that fit. There’s a really good model within the NCSBN that has the nursing process in the middle of a circle and the clinical judgment measurement model layer three around that, and then Tanner’s model on the outside. What that illustrates is that all of these things go hand in hand. We’re all attempting to do the same thing. It’s just how we get them there.

Jessica Hurdley:

Thank you for that. Just looking at the clock, we are a little bit past time, so I definitely want to wrap everything up. We’re going to go ahead and put the link in the chat. If you are interested in a demo, we can have one of our product specialists reach out to you. It is a quick form that you just have to fill out showing with your information so we can get in touch with you as well. It seems like there’s some folks on here that weren’t familiar, so we’d be happy to share that information with you. Patrick, is there anything else that you want to leave everybody else with before we turn it over to Kenya for our closing remarks?

Patrick Luna:

Just that it was really great to be here and connect with you all and answer some questions and just talk about a topic that’s really important to all of us right now. I’d love to revisit this again right after the summer, after our May graduates take it because I think we’re going to have a lot of things to discuss and a lot of things that worked for some people and a lot of things we can learn from. Wanted to address Sarah in the chat. Gene Watson came to my class during Covid and spoke to my class via Zoom. They were at home too, and they’re alumni here from CU, along with some other legends, the first nurse practitioner ever, and some other people that have contributed to nursing. So cool to connect with them, but really, really great to be here, and I really appreciate all of your time.

Jessica Hurdley:

Thank you so much. I’ll turn it over to Kenya.

Kenya Lund:

Thank you so much, Patrick, for this excellent presentation. You’ve provided a lot of valuable information and shared a lot of key takeaways. And thank you to all of our attendees for joining us and making it an interactive presentation. Finally, we are looking for nurse educators like you who are interested in presenting at Reaction, our annual virtual conference coming up in April. Please submit your proposal by this Friday at goreact.com/submitareactionproposal, and that’s going to be dropped in the chat, that link. Hope to see you on a future GoReact webinar, and have a great rest of your week.