NCLEX-RN® Test Plan Update
To the Editor:
I want to take this opportunity to provide your readers with an update on the NCLEXRN* Test Plan that is cited in my article "NCLEX-RN: From Job Analysis Study to Examination," co-authored by Nancy L. Chornick, PhD, RN, from the October 1997 issue of the Journal of Nursing Education (Vol. 36, No. 8, pp. 378382). As noted in the article, job analysis studies are conducted every 3 years and, if needed, test plans are revised.
The National Council conducted a job analysis study for newly licensed RNs in 1996, and the information from that study was used to evaluate the NCLEX-RN Test Plan. Based on the 1996 Job Analysis Study of Newly-Licensed Entry- Level Registered Nurses (Yocom, 1997) and expert judgment, the NCLEX-RN Test Plan was revised. A new NCLEX-RN Test Plan was adopted in August 1997 by the National Council's policy-making body- the Delegate Assembly. The new NCLEX-RN Test Plan, as weil as a new passing standard set by the National Council's Board of Directors, will be implemented in April 1998.
While "client needs" is retained as the major content dimension of the NCLEXRN Test Plan, "phases of the nursing process" will be integrated throughout all areas of the test plan. Test questions will continue to be written to cover content from all phases of the nursing process, and the NCLEX-RN item pools will contain items from all phases of the nursing process. However, the nursing process will not be used by the item selection algorithm which controls the assembly of each candidate's examination. In addition, the smaller, more specific client needs sub-category weights will be used to assemble each candidate's examination to provide more control over the content administered to candidates, more information about the content in each examination, and more detailed feedback to failure candidates.
More information about the NCLEXRN Test Plan and passing standard can be obtained by accessing the National Council's website at http://www.ncsbn.org and reading Issues (Vol. 17, No 4; Vol. 18, No. 3; Vol 18, No. 4). Copies of the test plan are available by filling out the publications order form, which can also be found on the National Council's website, and sending a check or money order with your order form to: National Council of State Boards of Nursing, Department 773953, Chicago, IL 60678-3953.
Anne Wendt, PhD, RN
NCLEX9 Content Manager
Yocom, C. (19971, 1996 Job analysis study of newly licensed entry-level registered nurses. Chicago: National Council of State Boards of Nursing, Inc.
The Importance of Critical Thinking
To the Editor:
I am writing in response to your December 1997 Guest Editorial, "Critical Thinking- Say What?" by Karen H. Morin, DSN, RN (Vol. 36, No. 10, pp. 450-451).
Dr. Morin poses many questions in her Editorial regarding critical thinking. Her basic premise seems to be that no one really knows what critical thinking is. She is suspicious that faculty may not think critically themselves, yet propose to teach critical thinking skills. She says that we teach nurses how to care for people and can try to accomplish this goal by "embracing the concept of critical thinking." Does this emphasis on critical thinking detract from teaching people how to care for other people? Is critical thinking measurable?
Many authors have different definitions of critical thinking (Abegglen & Conger, 1997; Duff & Chew, 1995; Stark, 1995; Widener University, 1996; Wilkinson, 1993a, 1993b). This is true with any word or combination of words that exist. This is why researchers use operational definitions. But in our hearts, we all know what critical thinking is.
What wonderful questions she poses! I would like to answer them for her. An individual who is able to respond to problems by using the nursing process effectively is a critical thinker. That person gathers and sorts out data. From that data, problems are identified, goals are set, and appropriate, effective interventions are implemented in a timely manner. That person evaluates the situation and makes rational decisions about what to do next accordingly. The individual who attempts to simply dredge up a "test response" from their memory cannot act in the best interest of a patient- no matter what definitions we dream up and no matter whether we call it thinking critically, critical thinking, or inductive reasoning (Toliver, 1989). That is the bottom line.
It is questioning, thinking about things, and using logic. And, perhaps the most important aspect, it is being creative. The individual who depends on memory alone, who is unable to be creative in the process of caring for patients is not a critical thinker. Is it important to be a critical thinker? Absolutely! There are not enough memorized situations in the world to depend on memory alone. Machines do not always act the same, and certainly not human beings with all of their complexities.
Thus, how can an emphasis on critical thinking detract from that which we do? And, indeed, teaching students how to be criticai thinkers will help produce a better product! I will tell you that if I am ever a patient, I do not necessarily want the nurse with the GPA of 4.0! I want the nurse who can think through the whys and the wherefores of my specific problems and concerns and knows how to deal most appropriately with them. If that nurse has a 4.0 GPA, so much the better. However, there have been many students in my clinical groups who have had GPAs of 2.9 or 3.0 who 1 would prefer to care for me before the one who has a 4.0 but cannot think critically. I bet every educator has known such students.
Now, regarding the question of whether or not educators can think critically. There are some who do and some who don't. Again, we all know each kind. The faculty who cannot or will not try new things, who criticize those who are creative in their teaching and evaluation methods are not critical thinkers. They are rigid. They test only by way of multiple choice questions. They dredge questions out of the fine print in the back of the handout or book. They spend lots of time figuring out how net to help students learn, especially to think critically. They want students to regurgitate the answers they told them somewhere along the way. So, of course they cannot teach critical thinking. They demand that students memorize and regurgitate. Even worse, they are then angry because the students do not think. They complain that faculty who have taught those students before must not be doing a good job. They are great at confusing the students so much that the students are unable to do eithermemorize or think.
Abegglen and Conger (1997) present a course wherein the faculty incorporated critical thinking. They seem to have measured it quite well. It seems to have been a positive experience. To me, that faculty demonstrated a lot of creativity in developing, applying, and evaluating the course and its outcomes.
Yes, Dr. Morin, there is critical thinking. It is important. It is measurable. Faculty need to be more willing to think critically to teach students to be critical thinkers. The typical undergraduate student comes to us with apparently very little experience in thinking at all. Therefore, it behooves us to start teaching that skill very early in the program. Apparently, elementary educators have dropped the ball big time in this aspect. We are obliged to pick up that ball and run with it as fast and as far as we can.
Abegglen, J., & Conger, CO. (1997). Critical thinking in nursing; Classroom tactics that work. Journal of Nursing Education, 36, 452-458.
Duff, J., & Chew, P. U995). The importance of critical thinking. Paper presented at a faculty meeting, Widener University, Cheater, PA.
Stark, J. ( 1995). Critical thinking: Taking the road less traveled. Nursing 95, 2S(Il), 52-56.
Toliver, J.C. (1989). Inductive reasoning: Critical thinking skills for clinical competence. Clinical Nurse Specialist, 2(4), 174-179.
Widener University School of Nursing. (1996). Criteria for Capstone experience essay for critical thinking. Unpublished essay.
Wilkinson, J. (1993a, Spring). Promoting critical thinking. Issues in Action: The Newsletter for Nurse Educators from Addison Wesley, 1, 2-6.
Wilkinson, J. (1993b, March 27). Promoting critical thinking: Strategies for nursing instructors. (Nursing Workshop Handout). Philadelphia: Addison-Wesley Nursing and Community College of Philadelphia.
Doris I. Young, EdD, RNC
Widener University School of Nursing
I thank Dr. Young for her comments and for presenting a different perspective about what I still consider an illusive concept. I am pleased to have the opportunity to respond to several points she makes.
The first point Dr. Young makes is that "in our hearts we all know what critical thinking is." I must disagree with her because if this is truly the case, we would not have the plethora of definitions that abound. I believe her statement reflects a basic assumption (that we all know what it is) about critical thinking. This is an assumption that I am not ready to adopt. Furthermore, I think this basic assumption interferes with our ability to arrive at an acceptable definition. For example, Bandman and Bandman (1995) define critical thinking as "the rational examination of ideas, inferences, assumptions, principles, arguments, conclusions, issues, statements, beliefs, and actions" (p. 7). Paul (1992) defines critical thinking as "self-improvement (in thinking) through standards (that assess thinking)" (p. 7). I believe critical thinking involves assuming responsibility for one's actions. This responsibility entails considering (thinking about) all aspects of an issue, problem, or patient caxe situation. I also believe that I need to learn and be open to all options before I make a decision end act on that decision. Such accountable makes thinking critically an active, ongoing process. Do these definitions have anything in common? I think they do because they seem to be speaking about thinking, or how one thinks, and how one can think to the best of one's ability. This ability should be learned early in life, a point alluded to by Dr. Young. I question why this has not occurrred and wonder if this apparent void is reflective of a general lack of accountability.
Dr. Young believes that following the nursing process reflects critical thinking. I disagree. Critical thinking is more than following a problem-solving method. Bandman and Bandman (1995) also consider critical thinking as more than the nursing process. In fact, I assert that, although the nursing process has served us well on many occasions, its use has fostered a lock-step approach to nursing that discourages thinking critically. I believe the nursing process format makes thinking out-of-the-box (what I consider creative thinking) more difficult. Thus, I support Dr. Young's comment that being creative is "perhaps the most important aspect" of critical thinking.
However, I am challenged to understand, and challenge Dr. Young as well to help me understand, how we foster student creativity as well as our own. Furthermore, the issue of creativity raises more questions for me that are not addressed by Dr. Young. How does one learn to be creative? Is it by considering all possible options? How do students learn about the possible options? Can students learn all the possible options while they are students? Is that what nurse educators really mean when they talk about critical thinking? If students learn to critically think by having faculty pose questione, and challenge them to travel the road less traveled, will faculty be able to rise to the challenge? What does that mean in terme of student success? Do students who are creative make sound decisions relative to patient care? How do I assess this?
Available data regarding measurement of critical thinking do not permit to support Dr. Young's belief that critical thinking is measurable. Perhaps it is because the methods we have used to measure the concept need refining, or perhaps it is because the definition needs retooling. Nonetheless, as several issues of the Journal of Nursing Education demonstrate, critical thinking remains a "hot issue" in nursing. I look forward to reading what faculty have implemented in regard to fostering critical thinking and trying their strategies. However, I remain skeptical about this particular issue, perhaps because the relationship between fostering critical thinking, teaching, and learning has not been explicated well enough for me.
Karen H. Morin, DSN, RN
Widener University School of Nursing
Bandman, E.L., & Bandman, B. (1995). Critical thinking in nursing. Norwalk, CT: Appleton & Lange.
Paul, R. (1992). Criticai thinking. What every person needs to survive in a rapidly changing world. (Rev. 2nd ed.). Santa Rosa, CA: The Foundation for Critical Thinking.