SPRING 2022

Next Generation
NCLEX NEWS
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Next Generation NCLEX®:

Overview of the 2021 RN Practice Analysis
The Next Generation NCLEX® (NGN) News is a quarterly publication that provides the latest
information on the research being done to assess upcoming changes to the NCLEX Examinations.
In this issue, you will find information related to the 2021 RN Practice Analysis findings.

Background
NCSBN conducts the periodic performance of the NCLEX® Practice Analysis (i.e., job analysis) studies to
assist in evaluating the validity of the test plan that guides content distribution of the licensure examinations.
Because the health care industry is rapidly changing, practice analysis studies are traditionally conducted
by NCSBN on a three-year cycle. In 2021, this comprehensive survey includes questions regarding the
frequency and importance of entry-level nursing activities as well as the relevancy of using clinical judgment
in performing the activities.

Clinical Judgment in Entry-level Nursing Care

Entry-level nurses are making increasingly complex decisions during patient care. These decisions often
require the use of clinical judgment to support patient safety. Clinical judgment is defined as the observed
outcome of critical thinking and decision making. This iterative process uses nursing knowledge to observe
and assess presenting situations, identify a prioritized client concern and generate the best possible
evidence-based solutions to deliver safe client care.
As clinical judgment is important in the delivery
of safe and effective nursing care at the entry
level, NCSBN has added clinical judgment
to the NCLEX Practice Analyses and the
subsequent NCLEX Test Plans.
 Survey Development
A panel was assembled and comprised of 13 nurses who worked with, educated and/or supervised the
practice of registered nurses (RNs) within their first 12 months of practice or were themselves newly licensed
RNs. Panel members represented geographic NCSBN areas of the U.S. territories/jurisdictions using the
NCLEX for licensure decisions, major nursing specialties and varied practice settings. The panel developed
the list of 146 nursing activity statements. The list was then developed into a survey and sent via email to
entry-level RNs, of which 4,758 completed the survey.

Responder Demographic Snapshot

On average, entry-level nurses responding to the survey were female, 31 years of age, employed in hospitals
located in urban or metropolitan areas on critical care or medical surgical units, caring for patients aged 18
to 64 and 65 to 85 with acute and stabilized chronic conditions.

Brief Overview of Survey Findings

A brief overview of the RN Practice Analysis reflected a couple of the highest and lowest activity statements
related to frequency performed, importance and clinical judgment relevancy (see Table 1–Table 3).
Responders were asked to rate the frequency of performance of all activities that were applicable to their
work setting on a six-point scale: ”0 times” to ”5 times or more.” Responders were asked to rate the
importance of performing each nursing activity using a five-point scale: ”1” (not important) to ”5” (critically
important). Responders were asked to rate the relevance of performing each nursing activity with regard to
clinical judgment using a four-point scale: ”1” (not relevant) to ”4” (essential) and the option ”DK” as ”Do
not know.”

TABLE 1. Two Highest and Lowest Activity Statements by Average Frequency

Average Total Group Frequency
(Total Group)

Activity Std.
ACTIVITY N Avg.
Number Err.
HIGHEST FREQUENCY RATING

Apply principles of infection prevention (e.g., hand hygiene, aseptic

25 technique, isolation, sterile technique, universal/standard enhanced 416 4.92 0.02
barrier precautions)

32 Properly identify client when providing care 512 4.83 0.03

LOWEST FREQUENT RATING

137 Implement and monitor phototherapy 400 0.40 0.06

56 Provide care and education to an antepartum client or a client in labor 521 0.36 0.05

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TABLE 2. Two Highest and Lowest Activity Statements by Average Importance
Average Total Group Importance
(Total Group)

Activity Std.
ACTIVITY N Avg.
Number Err.
HIGHEST IMPORTANCE RATING

Apply principles of infection prevention (e.g., hand hygiene, aseptic

25 technique, isolation, sterile technique, universal/standard enhanced 177 4.88 0.03
barrier precautions)

Review pertinent data prior to medication administration

93 186 4.85 0.03
(e.g., contraindications, lab results, allergies, potential interactions)

LOWEST IMPORTANCE RATING

Recognize complementary therapies and identify potential benefits and

87 177 3.20 0.08
contraindications (e.g., aromatherapy, acupressure, supplements)

137 Implement and monitor phototherapy 142 2.94 0.12

TABLE 3. Two Highest and Lowest Activity Statements by Average

Clinical Judgment
Average Total Group Clinical Judgment
(Total Group)
Activity Std.
ACTIVITY N Avg.
Number Err.
HIGHEST CLINICAL JUDGMENT RELEVANCY

145 Recognize signs and symptoms of client complications and intervene 167 3.93 0.02

88 Evaluate appropriateness and accuracy of medication order for client 147 3.91 0.03

LOWEST CLINICAL JUDGMENT RELEVANCY

75 Perform post-mortem care 169 2.54 0.07

137 Implement and monitor phototherapy 118 2.52 0.11

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Noteworthy was the type of orientation most entry-level nurses received as well as the client population.
Entry-level nurses were more likely to receive orientation with an assigned preceptor and the percentage
of newly licensed nurses attending a formal internship or transition to practice program has increased
(see Table 4).

TABLE 4. Type and Length of Orientation 2021 2017

% Avg. Weeks % Avg. Weeks

Classroom and/or skills lab plus supervised

6.8 7.7 9.7 8.4
work with clients

Work with an assigned preceptor(s) or mentor(s) with or

59.9 9.5 61.6 9.8
without additional classroom or skills lab work

A formal internship with or without additional classroom

25.7 12.4 21.8 13.9
or skills lab work

Moreover, entry-level nurses were more likely to care for clients who are 18-64 and 65-85 years of age with
a slight increase in the care of clients over 85 years of age (see Figure 1). Additionally, entry-level nurses were
more likely to care for a client with an acute condition with slight increases since the last practice analysis
in the care of clients with unstable chronic conditions, those with behavioral or emotional conditions, along
with clients at end of life (see Figure 2). These combined factors reinforced the need for measuring clinical
judgment in entry-level licensure assessment to support the delivery of safe and effective care.

FIGURE 1. Client Ages

34.4%
Adult (over age 85)
31.9%

49.1%
Adult (ages 65 – 85)
54.7%

48.3%
Adult (ages 18 – 64)
54.7%

11.5%
Pediatric* (ages 0 –17)
33.5%

0% 20% 40% 60% 80% 100%

2021 2017

*In 2017, Pediatric included separate categories: newborns (less than 1 month), infant/toddler (1 month–2 years),
preschool (3–5 years), school age (6 –12 years), and adolescent (13–17 years). In 2021, Pediatric had one category:
ages 1–17. Responders could select all that apply.

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FIGURE 2. Client Health Conditions

 FIGURE 2. Client Health Conditions

3.7%
Other
5.2%

31.2%
Clients with behavioral/emotional conditions
27.2%

25.2%
Clients at end of life
18.9%

Clients with acute conditions, including 44.8%

clients with medical, surgical, obstetrical
or critical conditions 59.9%

35.5%
Clients with unstabilized chronic conditions
34.0%

37.8%
Clients with stabilized chronic conditions
38.2%

21.5%
Well clients, possibly with minor illnesses
18.8%

0% 20% 40% 60% 80% 100%

2021 2017

Summary
Overall, the findings in the 2021 RN Practice Analysis reflect the continued congruency of entry-level nursing
practice in the U.S. and Canada and support the use of the NCLEX for licensure/registration decisions in
both countries. The 2021 RN Practice Analysis: Linking the NCLEX-RN Examination to Practice (U.S. and
Canada) is now available.

Next Generation NCLEX® News is published by National Council of State Boards of Nursing (NCSBN)
For more information regarding the NGN project, visit Next Generation NCLEX Resources on the NCSBN website.

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