NCSBN Clinical Judgment Measurement Model

The NCSBN Clinical Judgment Measurement Model (NCJMM) was developed by NCSBN researchers as a framework for the valid measurement of clinical judgment and decision making within the context of a standardized, high-stakes examination. While clinical judgment and decision-making have been important elements in most prelicensure education programs for many years, significant research and development were required to isolate and measure these traits with psychometric rigor. 

To create the NCJMM, NCSBN researchers drew upon the prevailing literature in nursing, nurse pedagogy, cognitive psychology, psychological assessment, and decision science related to decision making and nursing clinical judgment. In addition, multiple investigations were conducted involving over 100 nursing experts and analysis of data from more than 200,000 NCLEX candidates. The result of this work was an evidence-based framework for developing, classifying, and scoring test items that was not only technologically attainable, but feasible within the current computerized adaptive testing paradigm of the NCLEX.

The diagram below illustrates the "layers" of the NCJMM starting from the broadest layer 0 defining the context of the clinical situation to the most specific contextual layer 4.  Layer 3 outlines the cognitive aspects of clinical decision making that are directly measurable and are the basis for the development of Next Generation NCLEX test items and case studies for the NCLEX exam. Layer 4 provides examples of contextual elements that were identified in the Nursing Clinical Decision-Making: A Literature Review. More detailed information about the NCJMM and the item development process can be found in various research publications including the  Journal of Applied Testing Technology, 2019 Special Issue on Assessment in Medical Education.

Underlying the NCJMM is a nursing process. However, there are varied models across educational and clinical settings, and the NCJMM was not constructed to replace any of these. No matter what model is used to teach or learn the nursing process, or whatever pedagogical framework is used to contextualize this learning, good instruction and guidance using any nursing process model will provide a solid foundation for the Next Generation NCLEX exam measuring clinical judgement. The NCJMM provides NCSBN (and potentially other users), for the first time, a method for measuring and deriving valid inferences around the nursing clinical judgment and decision-making ability of prospective entry-level nurses.

While the NCJMM neither defines nor redefines clinical judgment, it allows NCSBN (and potentially other users) for the first time a method for measuring and deriving valid inferences around the nursing clinical judgment and decision-making ability of prospective entry-level nurses.