Assessing and Correlating Nursing Clinical Decision Making to NCLEX-RN® Outcomes

Purpose: Clinical Decision Making (Nursing Clinical Judgment) is the foundation of nursing care. This form of judgment consists of 1) recognizing cues 2) generating hypotheses 3) judging hypotheses 4) taking action and 5) evaluating outcomes (Muntean 2015). Determining a student’s ability to implement Nursing Clinical Judgment (NCJ) in the clinical setting is paramount to positive patient outcomes. Deficient clinical decision-making could be caused by lack of content knowledge resulting in diminished recognition of cues and therefore decisions will be based on insufficient information. Nurses make better decisions with clinical experience therefore novice nurses will have limited experience in the clinical setting. This limited experience with identifying patient care problems leads to an increased potential for errors in decision-making (Thiele, Holloway, Murphy & Pendarvis, 1991).

Methods: The correlational research design will be conducted with a convenience sample of self-reporting, first-time NCLEX-RN^® test takers. NCLEX-RN^® pass/fail will be correlated with decision-making performance on NCLEX-RN^®-style items contained in a Qbank. This Qbank data will be analyzed to determine performance on the test item: is the student able to identify the correct topic of the test item, does the nurse need more assessment data of does the nurse need to implement an action, does Maslow's hierarchy of needs apply to the answer, are ABCs (airway, breathing, circulation) relevant, and do the outcomes make sense? The correlational study will assist with determining if the variables of decision-making are related to NCLEX-RN^® performance.

Results: The study findings will determine the students’ performance on the Qbank items. The data gathered will show if the student correctly or incorrectly answered the item. Additional data collected will show the coding of the item based on a decision-making methodology and whether the students’ performance in each category (topic of question, assessment/implementation, Maslow, ABCs, determine outcomes) correlates to their NCLEX-RN^®outcome (pass/fail).

Conclusion: Analysis and correlation of the data will provide guidance for nursing graduates and faculty during NCLEX-RN^® preparation. Poor performance and a negative outcome (NCLEX-RN^® failure) will allow students to plan for increased review and remediation of decision-making capabilities. Additional remediation tools can be provided prior to completion of NCLEX-RN^® preparation.