As the field of nursing evolves, the standards for nursing competence and readiness must also adapt. The National Council Licensure Examination (NCLEX) is changing to reflect this progression, making clinical judgment a critical element for new graduate nurses. But what is clinical judgment, and how can one develop this skill in the context of NCLEX? This comprehensive guide will enlighten you.

What is Clinical Judgment?

In nursing practice, clinical judgment refers to the thought process that allows healthcare professionals to arrive at a conclusion based on objective and subjective information about a patient. It involves collecting and analyzing data, problem-solving, decision-making, and critical thinking. Ultimately, good clinical judgment leads to effective and safe patient care.

The Importance of Clinical Judgment for the Next Generation NCLEX (NGN)

The NCLEX has long been a test of nursing knowledge and abilities. However, with the advent of the Next Generation NCLEX, the focus has shifted more toward assessing a candidate’s clinical judgment skills. Being a nurse means working in a high-stakes, fast-paced environment where quick, informed decisions can make the difference between life and death. Therefore, developing strong clinical judgment skills is integral not just to pass the NCLEX, but to excel in your nursing career.

NCSBN Clinical Judgment Measurement Model

The National Council of State Boards of Nursing (NCSBN) has defined a Clinical Judgment Measurement Model for the NGN. This model helps measure and draw valid inferences about your clinical judgment and decision-making abilities. It consists of six interconnected steps: recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

Developing Clinical Judgment for NCLEX

Navigating the six steps of the NCSBN Clinical Judgment Measurement Model might seem daunting at first, but with consistent practice, you can build strong clinical judgment skills. From learning to recognize relevant cues to analyzing them and generating solutions, this guide provides actionable strategies to help you master these steps.

Let’s break down these steps:

Recognize Cues

Recognizing cues is the initial and one of the most critical steps in the clinical judgment process. This stage involves collecting relevant information about the patient from various sources such as the patient’s medical history, physical symptoms, diagnostic test results, and the patient’s own account of their illness.

Cues can be both obvious and subtle. They could be physical signs like a patient’s elevated temperature, changes in heart rate or blood pressure, skin color, or breathing patterns. They can also be changes in a patient’s behavior or mental state, such as increased anxiety, confusion, or decreased responsiveness.

Effective cue recognition requires thorough patient assessment, attentive listening, and sharp observational skills. It means taking note of both objective data (measurable, factual information such as lab results, vital signs) and subjective data (information given by the patient, such as pain level or feelings of discomfort).

As a nursing professional, it’s important to differentiate between relevant and irrelevant cues. Asking yourself the following questions can help:

  1. What information is immediately relevant to the patient’s current condition?
  2. What could potentially impact the patient’s health outcomes?
  3. Are there any cues that are of immediate concern?

Recognizing cues accurately and swiftly is crucial as it sets the foundation for the next steps in the clinical judgment process – analyzing cues and prioritizing hypotheses. This skill, while intuitive to some degree, can be developed and improved with practice and experience. To enhance your ability to recognize cues, engage with varied clinical scenarios, participate in simulations, and learn from experienced nurses.

Analyze Cues

After recognizing the relevant cues, the next step in the clinical judgment process is to analyze them. This involves interpreting the collected data and looking for patterns or inconsistencies. You’re essentially making sense of the cues in relation to the client’s overall health condition. This step often requires a deep understanding of pathophysiology, pharmacology, and the norms of vital signs, among other things.

  1. How do these cues link to the client’s clinical presentation?
  2. Are the cues indicating a common medical condition?
  3. Do the cues contradict each other, and if so, why?
  4. What additional information is required to clarify the relevance or significance of a cue?

During this stage, it is important to ask yourself:

To analyze cues effectively, you’ll need to apply critical thinking and your nursing knowledge. Always be mindful of potential biases in your analysis, and validate your assumptions through evidence and consultation.

Prioritize Hypotheses

Once you’ve recognized and analyzed the cues, you will have a set of possible explanations or hypotheses for the client’s condition. The next step, prioritizing these hypotheses, involves evaluating and ranking them based on their urgency, risk, and potential impact on the client’s health.

Some questions to consider at this stage include:

  1. Which potential explanations align with the severity and urgency of the client’s condition?
  2. Which hypotheses pose the greatest risk to the client’s health if not addressed promptly?
  3. Which hypotheses are most and least likely based on the collected cues?

Prioritizing hypotheses requires you to make informed judgments on the likely accuracy and urgency of each potential explanation. It requires an understanding of disease progression, risk factors, and the potential impact of leaving conditions untreated.

Generate Solutions

After prioritizing your hypotheses, you should generate potential nursing interventions to address the client’s needs. This step involves determining the desired outcomes and creating a plan of care that will help achieve them.

Key questions to consider during this phase are:

  1. What are the desired outcomes for the client’s health and well-being?
  2. What nursing interventions can be implemented to achieve these outcomes?
  3. What are the potential risks of each intervention, and how can they be mitigated?

The process of generating solutions involves critical thinking, creativity, and a thorough understanding of nursing interventions and their potential outcomes. Remember to consider the client’s preferences and values when planning the care, as patient-centered care is fundamental to successful nursing practice.

Take Action

After you’ve generated potential solutions, it’s time to put your plan into action. Taking action involves implementing the chosen nursing interventions. This is where you put your practical nursing skills to use in caring for the client.

The focus in this stage is on executing your plan of care effectively and safely. Questions you might ask yourself during this stage include:

  1. How should I perform the chosen interventions?
  2. What resources or assistance do I need to execute these interventions?
  3. How can I communicate effectively with the client, their family, and other healthcare professionals involved in their care?
  4. How can I adapt if conditions change during the implementation of the interventions?

The process of taking action can be complex, requiring flexibility, technical skills, and adaptability to respond to changing conditions. Remember to always document your actions and observations accurately and thoroughly.

Evaluate Outcomes

Once you’ve taken action, the next step is to evaluate the outcomes. This involves assessing the client’s response to the nursing interventions and comparing the actual results with the expected results.

The goal of this stage is to determine if the plan of care was effective, and if not, to understand why. Questions to guide this process might include:

  1. Did the client’s health status improve, deteriorate, or remain unchanged following the interventions?
  2. Were the actual outcomes consistent with the expected outcomes?
  3. If the outcomes were not as expected, what factors might have contributed to this?
  4. What changes, if any, should be made to the plan of care based on these results?

Evaluating outcomes requires careful observation, documentation, and analysis. It is an ongoing process that informs your future actions and helps you refine your clinical judgment over time. This cycle of evaluation and adjustment is crucial for continuous improvement in the quality of care.

Tips for Building Clinical Judgment for NGN

Beyond mastering the steps of the Clinical Judgment Measurement Model, other strategies can bolster your clinical judgment skills. Regularly analyzing case studies and solving practice questions in the NGN format can help acclimate you to the exam’s demands. Regular practice tests can assess your development, refine your intuition and knowledge, and making you feel more confident in your decision-making abilities.


Developing strong clinical judgment skills will not only prepare you for the NCLEX but will also support you in providing the best possible patient care throughout your nursing career. By understanding what clinical judgment is and practicing the strategies mentioned in this guide, you can excel in your NCLEX and beyond.

Remember that developing clinical judgment is a journey that takes time, practice, and experience. So, start early, stay consistent, and continually refine your skills.

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