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Industry Challenges
March 1, 2022

UbiSim Prepares Nurse Learners for the Next Generation NCLEX


Maria D'Errico
Director of Simulation & Scholarship

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The Next Generation NCLEX is coming – is your nursing program ready? The Next Generation NCLEX is a radical change from the current nursing licensure exam. With an expected rollout in Spring 2023, the new exam is all about clinical judgment. Read on to learn what clinical judgment is, why it matters, and how UbiSim's immersive VR simulations prepare nurse learners to excel on the Next Generation NCLEX.

Why Clinical Judgment Matters

Clinical judgment is an iterative process where nurses observe and assess clinical situations, prioritize client needs, and generate evidence-based solutions for safe client care. According to a recent nursing knowledge survey, clinical judgment is rated as an important skill by new graduate nurses, educators, and administrators. Despite these high ratings, evidence shows clinical judgment is lacking among new nurses. According to the National Council of State Boards of Nursing (NCSBN), nurses are involved in 50% of patient errors, with 65% of those errors caused by poor clinical judgment. A recent study of 5,000 newly graduated nurses found that only 23% demonstrated adequate clinical judgment skills.In response to the needs of healthcare stakeholders, the Next Generation NCLEX was created to evaluate the clinical judgment of new graduate nurses. The Next Generation NCLEX will replace the current exam, presenting radically new question types. Nurse educators must support their learners in developing clinical judgment in order to pass the Next Generation NCLEX and enter practice as safe and competent new nurses.

How Clinical Judgment is Measured

The NCSBN Clinical Judgment Measurement Model (CJMM) is a valid framework for measuring clinical judgment and decision-making. The CJMM features various layers that comprise the clinical judgment process.Layer 3 is the basis for Next Generation NCLEX test items and case studies. This layer outlines the six measurable, cognitive skills for appropriate clinical judgment: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, and evaluate outcomes.

The NCSBN Clinical Judgment Measurement Model. Retrieved from

How UbiSim Prepares Your Learners for the Next Generation NCLEX

All UbiSim scenarios are built upon the CJMM. During the scenario design process, our nurse educators align the needs assessment with Layer 3 of the CJMM. This ensures that learners have an opportunity to perform all steps of the clinical judgment process, from recognizing cues through evaluating outcomes. Educators can instantly use our diverse library of pre-made scenarios, or use our web-based Editor to easily customize or create their own VR scenarios focused on clinical judgment.UbiSim also provides a realistic context for learners to develop clinical judgment skills. Time constraints, risks, and consequences all affect the decision-making process, and these realistic elements are present throughout our scenarios.

Ready to explore how UbiSim prepares your nurse learners for the Next Generation NCLEX? Contact us for a free demo today!

How Learners Use Clinical Judgment in UbiSim Scenarios:

Recognize Cues

Nurses recognize cues to determine what matters most in the healthcare setting. Some cues are extremely important to managing the client, while others may not be an immediate concern. A few – of many – recognizable cues within a UbiSim scenario include:

  • An interactive EHR with the client’s health history, provider orders, medications, diagnostic images, and lab results
  • An authentic bedside monitor displaying vital signs in real time
  • A variety of realistic subjective and objective assessment findings

Learners interact with the client and care environment just as they would in a real-life clinical setting. Learners navigate the EHR, communicate with the client, peers, and family, and perform a physical assessment, all without menus or “point-and-click” interfaces. This realistic encounter challenges learners to recognize relevant cues that require immediate follow-up, such as vital sign changes and client complaints of chest pain and shortness of breath.

A nurse learner recognizes cues from the client assessment – including cyanosis and abnormal lung sounds


Analyze Cues

The next step is for learners to analyze the recognized cues and link them to the client’s clinical presentation. Learners identify if the relevant cues signify an improvement or worsening in the client’s condition. As learners analyze cues, they consider the following:

  • Does a family member’s concern indicate a worsening of the client’s condition?
  • Does the EHR information accurately reflect the client’s condition, or is there a new problem developing?
  • Which potential complications is the client most at risk for?

Learners analyze these various cues in a realistic, immersive clinical environment.

Nurse learners analyze cues from a concerned parent

Prioritize Hypotheses

A set of cues can be present in a variety of client problems. For example, chest pain and shortness of breath could indicate a myocardial infarction, pulmonary embolism, asthma exacerbation, or anxiety. When prioritizing hypotheses, UbiSim learners identify which explanations are most likely and the most serious. This prioritization guides the client plan of care.Learners prioritize in real-time. A sense of urgency is created as vital signs change, family members ask questions, physical assessment findings evolve, and lab results become available. Prioritization under these dynamic conditions prepares learners for both the Next Generation NCLEX and actual nursing practice.

Nurse learners prioritize hypotheses as they discuss the client’s condition

Generate Solutions

In UbiSim, learners are challenged to generate solutions and identify priority interventions.Some ways to generate solutions include:

  • Determine which nursing interventions and standing orders should be prioritized
  • Call the provider to discuss the client’s condition and recommend additional interventions
  • Determine which interventions would be contraindicated and thus avoided

Learners have exceptional freedom to act within UbiSim scenarios. This allows learners to generate and test a variety of solutions in a setting that is realistic and compelling while also being safe and conducive to exploration.

Nurse learners generate solutions by identifying actions that could achieve a desirable client outcome

Take Action

UbiSim challenges learners to take actions that address the highest client priorities. Some of these actions include:

  • Prioritize which medications to administer (and in what order) to appropriately address the client’s condition
  • Prioritize the order of their nursing actions, such as raising the head of the bed and administering oxygen to a client in respiratory distress before administering routine medications
  • Prioritize when to call the provider for further guidance

There are no menu-based actions in UbiSim. Learners decide how each action will be accomplished within the immersive VR scenario. This includes reading the EHR, performing physical assessments, and providing therapeutic communication in the learner’s own words, all of these closely mirroring the real-life clinical setting.

A nurse learner takes action when caring for a client in respiratory distress

Evaluate Outcomes

Learners can evaluate outcomes and determine if their actions were effective. They can reassess the client, ask about subjective findings, or review lab and imaging results. Learners compare observations against expected outcomes to determine if the client is improving or declining. They can also determine if more interventions are needed to address the client’s needs. Events happen in real-time, allowing learners to continuously evaluate the outcome of their nursing actions, just like in a real-life clinical setting.

A nurse learner evaluates outcomes when reassessing the client's vital signs

Ready to explore how UbiSim prepares your nurse learners for the Next Generation NCLEX? Contact us for a free demo today!

Developing Clinical Judgment Beyond the Scenario

Curated Debriefings

UbiSim provides a comprehensive, simulation-based experience that extends beyond the scenario itself. After learners complete a session, they receive an automated feedback report specific to their performance. This report includes evidence-based, constructive feedback that aligns with the CJMM. During the debriefing, learners answer guided reflection questions based on the PEARLS framework. Reflecting on their experience, learners imagine how these lessons can be applied beyond the scenario, and identify key takeaways to improve their practice moving forward.

Unfolding Case Studies

UbiSim scenarios feature unfolding case studies as a post-simulation activity. These cases expand upon the scenario, providing vignettes of the client’s situation at a future point in time. Unfolding case studies foster the development of clinical judgment with various Next Generation NCLEX question types, including matrix multiple response and multiple choice. The Editor empowers educators to easily customize or create their own case studies.

An unfolding case study that can be easily customized in the UbiSim Editor

The Next Generation NCLEX represents the most significant change to nursing education and licensure in over 15 years. Nurse educators and learners must meet the demands of the Next Generation NCLEX to improve our healthcare outcomes. UbiSim provides a safe and immersive environment where learners practice each measurable step of the clinical judgment process. In addition, UbiSim’s robust debriefing and case study capabilities reinforce and expand the learning that occurs within the VR scenario itself. These qualities give educators a powerful, fully-customizable platform that prepares learners to excel on the Next Generation NCLEX.

Ready to explore how UbiSim prepares your nurse learners for the Next Generation NCLEX? Contact us for a free demo today!
Interested in trying UbiSim in your healthcare institution?
Request a Demo
Maria D'Errico
Director of Simulation & Scholarship

Maria was a founding leader of the simulation design team for UbiSim, the world's first immersive VR platform for nursing. Working with partners across the globe, Maria empowered nurse leaders to successfully integrate immersive VR simulation into nursing curricula.

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