Evaluating the effectiveness of clinical judgment–aligned standardized assessments in registered nurse education programs

Background: Clinical judgment (CJ) has been formally emphasized through the National Council of State Boards of Nursing's Clinical Judgment Measurement Model and the implementation of the Next Generation NCLEX under the 2023 Test Plan. Although standardized assessments for prelicensure nursing programs are widely used to predict NCLEX readiness, limited research has compared their predictive relationships before and after the integration of CJ frameworks. Purpose: To evaluate the predictive value of standardized prelicensure assessments aligned with the 2023 NCLEX-RN Test Plan (including CJ components; post-CJ period) compared with earlier versions of the same assessments without explicit CJ measurement (2019 NCLEX-RN Test Plan; pre-CJ period). Methods: A comparative design was used to analyze standardized assessments from two periods aligned with the 2019 and 2023 NCLEX-RN Test Plans. Correlational and regression analyses were conducted to evaluate relationships between in-program assessment scores and end-of-program performance. Results: Significant positive relationships were observed between in-program content assessments and end-of-program performance under both test plans. Students who achieved proficiency across a greater number of in-program assessments showed higher end-of-program scores and higher predicted probabilities of NCLEX-RN success. Assessments aligned with the 2023 NCLEX-RN Test Plan demonstrated stronger and more consistent predictive relationships, accounting for a greater proportion of variance in end-of-program outcomes. Conclusion: Findings suggest that incorporating CJ components into standardized assessments improves prediction of NCLEX readiness and facilitates earlier identification of students at risk. These results highlight the educational value of strengthening students’ CJ skills and the assessment value of more accurately measuring NCLEX readiness through CJ-inclusive frameworks in contemporary nursing education.

Duke Scholars

Author Beth Cusatis Phillips School of Nursing