Degree Name
Nursing Practice, DNP
Publication Date
8-3-2026
First Advisor
Lisa Drake
Second Advisor
Veronica Arredondo
Abstract
Evidence identifies clinical judgment deficits among newly licensed nurses, supporting the integration of the National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (NCJMM) and Next Generation NCLEX (NGN) strategies. Inconsistent NGN implementation and Assessment Technologies Institute (ATI) Comprehensive Predictor performance established the local problem. This quality improvement project evaluated the impact of implementing NCJMM-aligned NGN instructional strategies, including unfolding case studies and bow-tie questions, on students’ first-attempt achievement of the ATI Comprehensive Predictor benchmark and faculty outcomes. The primary aim was to increase the percentage of students achieving the ATI Comprehensive Predictor benchmark of 76.2% on the first attempt. Faculty-related aims evaluated perceptions of clinical judgment instruction, use of NCJMM-aligned NGN instructional strategies, and confidence in developing NGN assessment items. Donabedian's model provided the theoretical framework, Kotter's 8-Step Change Model guided change, and the Plan-Do-Study-Act cycle directed implementation. Using a quantitative, nonexperimental design, seven faculty members completed a 10-week mentoring and curriculum development intervention with preintervention and postintervention surveys. Aggregate ATI outcomes for 22 students in 2026 were compared descriptively with historical cohorts. The first attempt pass rate was 54.5% in 2026, compared with 67.9% in 2024 and 77.8% in 2025; therefore, the primary aim was not achieved. Paired-samples t tests demonstrated significant increases in faculty use of NGN unfolding case studies, use of NGN bow-tie questions, and confidence in developing NGN assessment items (all p < .001). Interpretation was limited by the small faculty sample, non-equivalent student cohorts, and one-semester implementation period. The project strengthened faculty competencies and developed sustainable curriculum resources to support continued NCJMM implementation. Longitudinal evaluation is recommended to determine the effect on ATI Comprehensive Predictor outcomes.
Rights Management
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Recommended Citation
Morgan, April, "Improving Exam Scores: Alternative Next Generation Questions in Curriculum" (2026). Doctor of Nursing Practice Projects. 371.
https://arch.astate.edu/dnp-projects/371
