NurseTim Clinical Judgment Exam Testing Policies & Best Practices

Nurse Tim's clinical judgment exams offer comprehensive testing solutions, improving student clinical judgment assessment.

### NurseThink® Clinical Judgment Exams: Effective Testing Policies
* 📌 **NurseThink's** clinical judgment exams are based on the NCSBN model, focusing on bedside client care and using Bloom's taxonomy's analyzing and applying levels to measure students' **clinical judgment**.
* 💻  Partnership with ExamSoft streamlines test creation, blueprinting, and data analysis for faculty.
* 📚  Two exam packages are offered: core and comprehensive, with the latter including 14 specialty exam categories, 42 individual exams, 1400+ build-your-own items, and 3 readiness exams, totaling over 4000 test items.
* 📝 Each category has four exams: two proctored benchmark exams, one open-check practice exam, and one 100-question build-your-own exam; med-surg exams have 75 questions, while build-your-own and readiness exams have 100.
* 🗓️ Exam placement should allow for remediation and occur after students receive sufficient course content; some schools integrate exams into subsequent courses.  "You want to make sure that you've given the exam in enough time that students are able to remediate".
* 🔄 Open-check exams are unproctored practice tests to familiarize students with the question style and difficulty before benchmark exams.  They are designed to be "a little bit harder than what students are used to".
* ⚖️ Benchmark exams (two provided) can be used sequentially with remediation or independently; remediation should involve active learning, not just rereading materials.
* 💯 Scoring policies can adapt existing models from other testing platforms (ATI, Kaplan, etc.), typically accounting for 3-10% of the overall course grade; a sample policy is provided, showing how one school integrates remediation and retake opportunities.  "Don't stress yourself out and recreate the wheel on this".

Marcia, I believe it is Angela. Yes, I'm seeing some people come in now. Welcome, welcome, welcome.

Sherry, welcome. Okay, all right, ladies. So, um, because it's two o'clock, we're going to go ahead... well, it's

it's one o'clock Central Time, two o'clock Eastern Time where I am located, so we're going to go ahead and

get started. I am Stephanie Terry from Nurse Tim. I am a nurse educator, nursing consultant with Nurse Tim, and

for the last year and a half, I have been working with Nurse Tim, Nurse Think, on the clinical judgment exams.

So what we want to talk about today is testing policies that work for the clinical judgment exams. So I will try to answer your questions

um, if you guys want to um, put questions in the chat box, that would be great. I am trying

I'm going to, I'm going to try to go through this little slide I have and then I want

to stop and answer any questions or any concerns you guys may have as we go through this. So I'm going to

go ahead and get started. And first of all, just in case, I think you probably know a little bit about the clinical judgment

exams, you wouldn't be here, but just to go back and give you a little bit of a

background on that, the clinical judgment exams; they are exams based on the NCSBN clinical judgment measurement and action model. These exams

are totally focused on caring for the clients at the bedside. They are written at the analyzing and applying level of Bloom's

taxonomy. And basically what we're trying to do is measure students' clinical judgment, and we're trying to put questions out there

that's going to do that better than some of the questions we've done in the past. We are partnered with ExamSoft to take

away a lot of the legwork that faculty tends to go through with trying to develop test questions and develop blueprints and do data

analysis. So with these questions, that stuff has already been done for you, so you don't have to worry about writing

questions; you don't have to worry about blueprinting questions or trying to do the data analysis because that is done

for you. Oops, sorry, I went a little too fast. Okay, so with the um, clinical judgment exams, if you are

a complete customer, you're going to get the comprehensive solution. So, as you can see on the slide, you have a core

solution package and you have a comprehensive solution package. Um, the core package—everything in blue is what you

will receive with that—and then with the comprehensive, you will receive everything. Um, there are 14 specialty exam categories, and within

those categories, there are 42 individual exams for you to choose from. In addition to that, you'll get like 1400

test items to build your own exams, and also you will get three readiness exams, which are considered your comprehensive exams that

you usually give in that last semester to determine students' readiness for NCLEX and readiness for practice. So, in all, you get over like 4000

test items that you can work with and choose from in your curriculum. So, to break that down a little bit more—you would think I know

how to use a mouse right about now—so to break that down a little bit more, for each of those

categories that I just showed you, you're going to get four exams per category. So, for instance, fundamentals, you're going to get two

benchmark exams for fundamentals. So the benchmark exams are your proctored exams; they are the

ones that you're going to give students that you're going to proctor. Um, you get two of those; you get one what we call open-check exam

That is for practice, and then you're going to get one exam that's build-your-own, which is a hundred

questions that you can pull from to make your, um, final exams and things like that for your course. You can give quizzes,

final exams. We do ask that they are proctored, though, so I'll talk about that a little bit

as we move on. And then, once again, you're going to get those three readiness exams that are your comprehensive exams that

are given at the end. All of the exams are 50 questions each, except for your med-surg exams. You have

a med-surg one and a med-surg two that you can give, and they are all 75 questions each.

And then your build-your-own and readiness exams are all 100 questions each. So, besides those exams, all of your tests

are going to be 50 questions. So, suggestions and tips when it comes to policy. So I just talked about the exams

that you're going to receive, what you should receive, and what they're going to look like. So now is the question of where do I put

these exams? How do I align them to my curriculum? And so this right here is just a sample

of what aligning the exams to your curriculum or your course would look like. What I want to stress to you is this:

These are just suggestions because what happens sometimes is that in a fundamentals class you may teach your fundamentals, but you

may not give the test until you get to your first clinical course or med-surg course. So I've seen some

schools do this. So some schools will have a fundamentals course; they will actually give the fundamentals exams kind of in the latter part of the course,

after the students have gotten some of the information and then remediate; and then some people will wait and give that exam

And at the beginning of a new course, to make sure students have gotten all of the information they need to get

from the course. Some courses, such as nutrition, community pathophysiology—these sometimes don't have courses that stand alone.

So some faculty will put them in with another course; for instance, maybe you may have a fundamentals and a

pathophysiology course together, or nutrition and a med-surg course together, and you will give those standardized tests within

those courses. Um, what I want to stress to you when it comes to course placement, I mean exam placement,

is that a couple of things you want to consider: You want to make sure that you've given the exam in enough time

that students are able to remediate, because the point of this is you want students to understand where they're

still weak or have challenges, so that you and the students can work on those things and help the students get better. And

also, you want to give the exam late enough in the semester where the student has gotten

the bulk of the information they need to be successful on the test. So it's kind of a balance with that,

but you want to make sure those two things are in consideration when you're actually placing tests within your course.

Okay, so let's talk about the open-check exams a little bit. So the open-check exams

are what we call—we call them open-check; they are practice exams for you guys. Um, they are usually unproctored, um,

so basically this test can be scored if you want it to, or not scored. Um, basically, you can give this exam and say, 'Hey,

score 80 or 90 on it.' If you do that, then you are eligible to sit for the

Benchmark One: So basically, you can give this test to see if students are ready to take the Benchmark One. I do recommend that you

have enough time where students can practice these open-check exams because what I've been told and what we're

hearing from different schools and students is that these questions are a little bit harder than what students are used to,

and that's okay because we're trying to measure that clinical judgment piece, which is going to be very important

for them as nurses when they get into practice. So we want them to take this test to get a

feel of what the benchmark is going to be like. We want them to get familiar with the type of questions they're going to

see. They are, like I said, written at the analysis and application level. Um, you know, they are measuring different things, using

the NCLEX client needs and things like that. And we want students to be familiar with the type of questions they're going to

get, such as multiple choice.  It's going to be in there, but they're going to have some hot spots.

Um, they're going to have some charts, some, you know, electronic health records that they're going to have to read.

Um, they're going to have to just be familiar with being able to see those things and answer questions based off

of what it would look like if they were standing beside a patient at the bedside. And so we want them to be

able to feel comfortable doing that when you give them the benchmark exams. Okay, so the benchmark exams, like I said,

you're going to receive two of those: a Benchmark One and a Benchmark Two. So first of all, um, like I said,

you need to decide what you want to do with those two benchmarks in your policy. So two suggestions are: one, you could give

The Benchmark One exam has students remediate if they don't score what you need them to score, and then

take the Benchmark Two and, you know, come up with a grade or percentage or points based off of that,

or you can just have them do the Benchmark One and remediate and then give them a score based off of that. So with the Benchmark

Two, you have the freedom to do what you want to do and what fits best for your program with that.

Benchmark Two: we designed it for, let's say, Benchmark One became compromised; you can give Benchmark Two as a

replacement. Or let's say a student did not—was not able to take Benchmark One; they missed that day,

or they were excused for some reason and couldn't take it with the rest of the class. So you'll give them that Benchmark Two.

But that's something that, as faculty, you all just have to decide what you want to do with that Benchmark Two.

I've seen it so far being done both ways. Um, some people are giving Benchmark One, remediating, and doing the Benchmark Two.

You may be familiar with doing things like that with HESI or ATI or Kaplan or whatever.

And then some are just giving that Benchmark One, having them remediate, and um, just giving them a score based on

that. Um, and speaking of remediation, a point I want to make with remediation—and we may bring this up a little bit later, too—is

with remediation, you want to make sure that um, you are doing things that are active. So telling the student that, hey,

go back to your book and read page 853, you know, on diabetes to remediate, is not very productive for the student.

But having them do something active, like go to V-clinical or go to your case study book or do

some type of case study or something, putting them in a situation where they are the nurse taking care of a patient

is going to be the best remediation for them. Another suggestion that I have, and that's just a preference that

I like, um, is that I like all of my students to remediate, whether you scored well on the test

or not, because not all students—I have yet to see anybody get a 100 percent perfect score on a standardized test, so I feel like

there's always room for students to grow and learn and develop. So I feel strongly about making all students remediate, or at

least making it an option. And then for those who need to remediate, make it mandatory, but also

give an option for those who don't need to remediate to do it as well. So that's just kind of my preference on

the remediation part. Okay. When it comes to calculating the score, this is where you as faculty have to come together and figure out

what works best for you. What I always say here is that if you had a policy with—if you've had—if you used the ATI,

Kaplan, or one of those types of testing, um, things before, don't reinvent the wheel. You can use those same guidelines and

The NurseThink® Clinical Judgment Exams: Testing policies that work

NurseThink for Next Gen NCLEX 

Introduction and Overview of Clinical Judgment Exams

Stephanie Terry from NurseThink introduces herself and her involvement in developing clinical judgment exams.

The focus is on testing policies for the clinical judgment exams and addressing participant questions.

Exams are based on the NCSBN clinical judgment model, focusing on bedside client care and Bloom's taxonomy (analyzing and applying levels).

Partnership with ExamSoft reduces faculty workload in question development, blueprinting, and data analysis.

Describes core and comprehensive solution packages, including the number of exams and test items available.

Suggests various approaches to aligning exams with the curriculum, considering factors like clinical course timing.

Emphasizes the importance of sufficient remediation time and aligning exam timing with the completion of relevant course material.

Open-Check, Benchmark, and Readiness Exams

Open-check exams are unproctored practice exams, optionally scored, to assess readiness for Benchmark One.

Questions are designed to be more challenging than typical student assessments to measure clinical judgment.

Benchmark exams (one and two) provide flexibility in grading policies; Benchmark Two serves as a replacement or alternative.

Benchmark Two can be used if Benchmark One is compromised or a student misses it.

Remediation Strategies and Scoring Policies

Advocates for active remediation strategies, such as case studies, rather than passive review.

Suggests making remediation an option for all students, even high-achievers, to foster continuous improvement.

Recommends adapting existing scoring policies from other testing platforms (ATI, Kaplan, etc.) rather than creating new ones.

Provides a range (3%-10%) of the course grade typically allocated to these exams, noting variations based on institutional policies.

Strengths and Opportunities Report and Scoring Guidelines

Mentions a future discussion (Wednesday) on the Strengths and Opportunities report and remediation strategies.

Provides suggested score ranges (93%+, 83-92%, <82%) for interpreting exam results, using these as guidelines.

Suggests using these score ranges as a benchmark for open-check exams to determine readiness for proctored exams.

Highlights the importance of security and the partnership with ExamSoft for secure test administration.

Recommends forming a committee to manage the 1400 available questions and their integration into course assessments.

Allows for combining self-created questions with those from the NurseThink bank, but all should be proctored except for open-check practice exams.

Presents a sample scoring policy from a school illustrating how exam scores are integrated into the overall course grade.

This example uses the clinical judgment benchmarks, open-check exams, and proctored benchmark exams (one and two) with remediation based on scores.

Details the remediation requirements based on student performance, including the number of patients to work with and time constraints.

Concludes with an open forum for questions and emphasizes the availability of support for policy development.