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Next Generation NCLEX (NGN) - Everything You Need to Know

Hello, everyone. Welcome to the Connetics USA AMN weekly show for this Friday, we know we're having nurses join us from all over the world so please type in the comments where you're joining us from our onwards and upwards show is built to help no versus navigate all kinds of different parts of the experience from NCLEX, which we're going to talk about today to visa screen to cultural assess adjustment in the US. And we're very excited to be today, having a couple of guests join us who are going to share their expertise around next gen and our NCLEX. And so like I said, Please jump on the comments and share with us where you're joining from. And we will also be looking in the comments to see whether you have questions for our expert panel that can maybe help us all better understand what you need to have in place to be ready to pass the next gen NCLEX. So next gen NCLEX is going to go live on April 1, which is right around the corner. And what we're hearing is, you know, some people are excited, sometimes they're very anxious, we have lots of nurses who are very close to actually going to take this exam. And so sometimes knowledge is power, understanding what you're going to be up against. And what you're facing helps you to kind of take a deep breath and go, Okay, I got this. But in addition to that, Connetics has some additional resources. Besides just this web show, we have some previously taped web shows and other resources on our website and our YouTube channel, which will help you to look at the information for next gen NCLEX that we can share with you, as well as some other resources that are out there to make sure that you kind of have a very holistic understanding of what's changing, there are some things that are staying the same. So thank goodness, you're going to see some similar things to how the NCLEX has always functioned. And in just a few moments, we will start to share some of that information with you. So I see that Raj Kumar is joining from India, really neat to see that you're half a world away from where I am in Tennessee in the United States. And yet, we're still going to be able to share this time together, and the information about the upcoming changes to the NCLEX. So if you are preparing for the NCLEX you may have already been working and studying and now you're facing the next gen NCLEX or you have friends or family who are also studying. And so you can get some information here to help yourself feel a little more secure and also maybe even encourage others that you work with or are you know preparing and certainly redirect them to join us either today or watch it in the future. Some more that are joining us. Good morning, Paul. Good morning, Emile. Good morning. Or good evening, Emil. And Jay. I know you guys are in the Philippines. So Texas. You're in Texas. Okay, so we've got Texas and Paul, you're in Houston as well. Okay, so two Texans. And Emile, you're in the Philippines.

Yes. I'm currently in the Philippines Miss Holly. But I'm basically assigned in Germany.

Oh, okay. Interesting. I've never been there. That's on my bucket list, too. I have been to the Philippines. Really awesome experience traveling there. So I'm just going to share with you we've got a few more nurses who have shared where they're where they're joining us from. So Arlene from Jamaica Yamane from the Philippines may from Cebu Suleiman from Sierra Leone, and Danielle from Boston. So we've got quite a mix in there already. You know, I think that a lot of people are grabbing up every bit of information that they can about these changes. And like I mentioned early on, they're kind of scared, because it's a big change to some. But we also have people who are out there kind of reassuring nurses and saying it's going to be okay, you can prepare for this, you can navigate these changes and don't let it make you think that you're not going to be able to be successful on this exam. So I'm going to actually let you introduce yourselves a little bit more. And I'll start with Paul and then j and then Emil, and just kind of share a little bit about your backgrounds and we already know where you're from at the moment, but we look forward to learning a little bit more about each of you.

All right. Good morning, everyone. This is Dr. Nurse Paul from Houston Texas. I'm the CEO of Aspire RN we offer NCLEX programs. We are in partnership with Connetics USA providing these courses. I'm an ER nurse here in the States. I'm also a family nurse practitioner certified with advanced practice registered nurse designation and a Doctor of Nursing Practice degree. I've been teaching NCLEX for 16 years. And I guess that's it. I do my classes for next gen NCLEX as well together with Connetics USA in my personal social media pages at Doctor Nurse Paul, but you can call me, Paul.

Thank you, Paul. Jay?

Yeah, good morning, everyone. And yeah, here in Texas, it's morning and in the Philippines, it's a good evening, and anywhere else in the world. I'm happy to be here in the first place. Of course, helping you guys nurses, wants to come here in the US primarily, together with Connetics and other partners like aspire and other, you know, English review centers. And I'm basically from ibis and one of the lead educators. I'm actually the lead educator. I'm one of the cofounders of bypass. I've been here for since 2016. But I started working here 2018. And until now, I'm still working here. It's just near to Houston though. It's about two hours from here, here in Beaumont. So I work in a certain hospital here as a regular charge nurse. I don't handle patients, but more most of the times like problem solving or something? Well, well, yeah, on a on an acute hospital. And I've been also teaching iPads for since 2017. And we got to NCLEX. Well, I've been a nurse for 20 years already. I'm like, often on as an educator and as a bedside nurse at this moment. I'm doing the same, I mean, concurrently, like, you know, doing the education at the same time, you know, doing the bedside as a charge nurse. Anyway, so it's like 5050. But well, yeah, that's my experience.

Thank you, Jay. And Emil.

Hello, good evening. Good evening from the Philippines. I'm Emil Gomez. I am basically a resident success coach, and also a NCLEX, educator under iPass online review and Academy. I'm currently based in the Philippines. I'm currently here in the Philippines. I've been here for a week already for my vacation. But I've been living in Germany because I worked there as a Cardiothoracic Intensive Care Unit nurse in one of the academic medical center in Hamburg, Germany. So prior to moving to Germany, I was part of the Joint Commission international Hospital in, in the Philippines, which is St. Luke's which is I work as a clinical nurse educator for many years and also in the risk unit manager. So prior to that, I was part of the university teaching, level four and level three, and also a national reviewer for radiologic technology. So it is indeed my pleasure to be here joining you Miss Holly together with Sergej, and also doctor nurse ball for this very momentous event for Connetics and all the aspiring nurses.

Thank you so much, gentlemen, I appreciate that. So I actually will take a moment and just tell you a little bit of my background. I am a US educated and experienced nurse as well. And I've been a nurse for 22 years, I've practiced in both acute care hospital and in post acute care more as a leader than as a bedside but certainly was an interesting experience. I have been an NCLEX instructor myself. And that was my current role is to be the Connetics clinical nurse educator. So under the Connetics umbrella, we partner with many great organizations like the ones that you belong to, to provide great training programs for the NCLEX. And there are some other clinical programs that we have along the way, but we're going to specifically focus on NCLEX today. So one of the things that I think a lot of people are curious about is, if they haven't really studied yet, just enough to feel like they understand the basics of what next gen is compared with something else. So I just want to have a roundtable discussion for a moment about what each of you might be able to share. And maybe we kind of do one point at a time from each of you. So Emil will kind of go in reverse this time and we all can you share one thing that's different or new with next gen. Okay.

So, basically, this is actually a transition between the normal NCLEX and this what we call the next generation NCLEX. So, so basically the NCLEX or the next generation, ng n measures the clinical judgment to focus on the following. So we are basically here dealing with measuring the three point system And we measure here patient interaction, the patient needs and expected outcomes. We got only already with memorization of factual information, but in the ng n, we basically deal with actual patient condition. So with regards to technology advancement and some of the current healthcare situation or climate nurses then to like, receive, like a more complex cases in the real world. So basically, the ng n focus on measurement or measuring the ability of the nurses in terms of how are they going to effectively and safely render patient care, because we might think that NGN is really bad. But for me, or for the entire nursing, it's actually a good transition, where in we can readily say, or 100% Say that nurses, upon passing, the US RN, will be able to equip not just factual information, but primarily things that they can actually provide for them to effectively render an excellent patient care. So as we all know, this transition with the NGN, or the next generation NCLEX, stems from the idea of there have been like an actual result from the research of 65% of the errors in the United States are coming from, from the newbie listener, he says, So specifically, the person came from the listener says, basically, so this is actually the answer. This is actually the answer for this for this gap. So the ng n really focus on impacting not only nurses, but also like, as clinical educators, supervisors, and also stakeholders. So it's really, really important for us, let's say for, for example, for IPass, being a online platform, preparing students for this examination, to be able to equip our students with how are they going to effectively manage answering this this question, so, so we might like, like, think that NCSBN, for example, it's like an evil organization? No, we are not an evil organization. But rather, they help nurses, they actually help nurses, they are really professional organization, which focus on uplifting the standards and quality of patient care. This is something that I myself wasn't, I'm already US RN, before this big transition with the NCLEX. So I can say that this is a really good step towards achieving a, a safety. Because as we all know, in United States, they are really focusing on the safety of the clients and the environments. So measuring the ability of the nurses in terms of their? Or how are they going to effectively ensure safe quality nursing is paramount to this transition. So I think, for me, that is the overview of the NGN.

Okay, now it's very comprehensive. Emil, thank you so much for sharing. I think the core of what I'm hearing you say is, one of the main changes is to evaluate that nurses clinical judgment skills. And if we were previously just reliant on memorization of key concepts and facts, you know, some of us probably got some great notes from somewhere, that we have to now take that and apply it. And realistically, that's what you have to do even as a beginner nurse when you're here in the United States. So orientations, just FYI, orientations here are not built to actually teach you that transition to using clinical judgment, which is part of the reason why the NCLEX needs to assess that. Because if we're saying, this is what an entry nurse needs to be able to do and have this skill set, the test that is used to assess for that skill has to actually do that. And so this change has come about because the expectation has been there for a long time. But the test didn't really capture the nurses ability to do that. Correct. All right, Jay, it's your turn. So give us just one thing that you know, is going to be different with the next gen and NCLEX stuff compared with the previous NCLEX process.

Yeah, I think it's being said by Emil. But what I can say is like, you know, the format is a lot different. It's a lot way different, but it's more of like, you know, utilizing your clinical judgment as Bill says, if you go back to the history, if you think about it, this program has been like overdue for a long time. Yeah. Everybody's anticipating changes since the past probably like, probably about almost The 10 years already, I was expecting to change it by to 2016 by didn't change. And then here comes the pandemic, it wasn't changed and 2022 it wasn't changed again. And here comes the ng n. So it's, it was based on, I think it was 2014, with switches like, you know, a game changing. Like they made a study like NCSBN, that really, you know, talking about clinical judgment among nurses. So for me, I'm really excited about this program, not only about the short term, you know, effects or outcome, but at the same time, you know, the long term outcome of this, like, it's really going to, you know, make a change in the health care not only in nursing, but at the same time in the overall health care delivery here in the US.

And I'm Paul, thoughts, something that's different.

Yeah, so I've been talking about this in my social media. In the last six months, I've been doing free classes with Connetics USA, online shows, and in my own shows, every Saturday, there will be plenty of changes. They've, Emil and Jay, I've covered a lot so far. But basically, we're moving from measuring students comprehension and knowledge and analysis of basic concepts to the clinical judgment model, which is a six point model, checking all the nurses ability from recognizing cues to evaluating outcomes, there will be case studies and trends. So basically, when you take your ng n or next banquets, you're looking at sort of a nursing chart, or EMR or electronic medical record, where you flip through tabs and read a case, very important that you have an in depth knowledge of the contents or the nursing concepts, because without this, it will be a little difficult or challenging to answer next, and quiz questions. And I've done a lot of shows plenty of shows, nurses have good comprehension of contents. But when put in a case study scenario, they still get this, you know, certain questions, like challenging for them, it becomes challenging for them. Because we're not only talking about case studies and trends, we're also talking about changes in test items, like highlighting texts from a paragraph highlighting text from a table, there will be table questions talking about select all the fly, there will be bowtie questions that we've not seen in any other exam types of any healthcare exams, and I took my Nurse Practitioner exam about two years ago, these types of questions are not even there considering that we have an advanced level of, you know, certification. So this is something new to say if it was going to be helpful for foreign grads, which is our market or not, it's going to be you know, we're only going to be able to prove this after the data comes in this year, I'm thinking there might be an effect or impact our foreign grads, just because the educational preparation is different. Like James said, this had been an ongoing research for the last 10 years. This study was started in 2012. It was published in 2015. They were trying to get this implemented back in 2019. But pandemic happen, so we said okay, we're gonna move it to another update, which is right now 2023. But the difference between foreign grads and US nurses, our foreign graduate nurses are not really prepared with a competency set by the clinical judgment model. On the other hand, the US nurses, you know, when I, when I did my clinical educator, I'm sorry, my certification and nurse educator year and it taught in my classes. I was instructed by my preceptor last year to do case studies versus full lectures, which is what we do in other classes, right. So they've been using case studies for years, they've already started adapting that format for years before the Nexus and clicks happen. So whenever I'm on my social media, and they get American Nurses joining me versus foreign grads, American nurses would always say, this is so easy. This is very easy versus foreign grad would say, this is very challenging or confusing, or how do I answer this, so there's a disconnect. But that's my theory. To prove it, we have to wait for the data to come in this year. But as an educator like me, I cannot wait for that to happen, I have to do something for my student, which involves me changing my ability to teach or my strategy to teach to cover the competencies set by the NCSBN for the next generation NCLEX.

Thank you, Paul. And if you're interested, there's a link that will post about next gen NCLEX straight from the NCSBN that talks about that project and the development of the current model that is going to be used on the next gen question styles. So we've also got some other countries that we have watchers from today. So every Rose is joining us from Saudi Arabia Murtala from Nigeria. Patrice from Bermuda at Fiamma from Nigeria, Mark from UAE, Abu Dhabi light from Pennsylvania, it looks like Eva from UK. Gentlemen, kale from Germany, another person from Germany. Maril. Byron, it looks like you're saying you're in Marlin, Colorado, maybe a costa from Japan, Eva from KSA. So all over the world everybody's watching. And, you know, I think the other thing that we know is that there are question styles. Paul, you alluded to this as well, there are question styles that are going to be different, we've got the case study format. But within that, we also have some computer style styles of the way the questions and the responses need to be done. And I'm going to direct the nurses to actually go to some of our other discussions about that to kind of gain more understanding about the details, because we do have some videos that talk about those question types and what they look like and things like that. What I actually would like to address next with you guys, is what are some of the facts and myths. So I'm sure each of you has heard a myth or an untrue statement from a nurse or a student that you're working with, I would like for you to share one of those with us now. And I'm going to reverse the order a little bit again. So Jay, I'll let you go first. For this one, if there's something that you're like, Okay, I see this all the time on social media, it's not true. Or my student says, so give us one of those that you've heard and what is the correct information?

Oh, I guess most of the time, they will tell that, you know, the ng n is, is difficult or something, they would always say that. But for me, NCLEX has been challenging. But you know, my answer, for me, of course, you know, the majority of the changes are like the format of the way they delivered the questions, but as to me, regardless of the questions that they are going to give, as long as you know and understand the concept, you will be okay. So like, for example, like, you know, you cannot just say that, you know, you know, or you know about ischemia or something, but you have to understand ischemia, so you have to, like, you know, go level up or something like one step at a time, one step higher, we cannot just simply like know, about ischemia, you have to, you have to understand what's really going on with ischemia. So what makes it difficult is the is the impression, right, because this is a change, you know, this is another transaction. And for sure, when they change it, it's going to be difficult. And when I see the NCSBN, they didn't mention about the difficulty level. They didn't mention about the difficulty level, it's the same difficulty. It's just the format is different. All right.

Yeah. Got it. Paul, I'll let you go next on this one. So what's a myth that you've heard? And you're like, No, that's probably not the best way to state it or it's not true.

Yeah. So, okay, I got, I got the one that Jay said, as well. And I do a lot of social media posts about next gen NCLEX, and TikTok, and Instagram and Facebook. Another one that I usually commonly get, particularly for the American Nurses, American graduate, or American students is, it's going to be the same or it's going to be easy. Okay, so be being you're saying an exam is easy or difficult is what I say, a subjective statement, which means as an educator, I believed in personalized approach. That's my theory of education the way I teach, which means each student would receive exams differently, right? It's an it's actually advantageous for us to take computer adaptive because it adapts to your level. But the problem with the next one NCLEX is the introduction of case studies, or the different test format. For American graduate nurses. This might be easy because like I said, the case study format, have already been introduced to the American education system, after the 2015 report from NCSBN was released. And for sure, they said we are gonna do the case study format, we're just gonna have to coat it and do some technical research about it, but it's gonna happen. So educators adapted that note to say, like, for example, add students from Sri Lanka. I was teaching my students last night from about the other week, Thailand, and I've introduced a certain case study, right? So say, for example, I was teaching myocardial infarction, they know what myocardial infarction is, but within the case study or the clinical judgment model, there's now a step where we do analyzing cues and prioritizing cues which is basically in nurse practitioner or medicine school is differential that diagnosis were represented with a clinical scenario with all of the signs and symptoms and diagnostic studies. Now we're gonna have to pick what's our priority diagnosis over the other? Is this myocardial infarction? Is this a triple A? Is this a thoracic aortic aneurysm? Are we talking about pneumonia here, because we're also talking about chest pain. So these things might be very challenging and confusing for our foreign grads, I'm definitely worried about the foreign grads because or the international educated nurses, because, you know, that's, that's our passion, why we're doing this shows, and that's our market. And we've seen that in 2022, during the pandemic, pandemic graduates, as we call them here in the United States, the American us performance for first time NCLEX went down to 83% in a very linear way. The foreign graduates are internationally educated nurses also went down from 46 and 2021 to 43% in 2022. Now, will that increase or decrease further after the next reason introduction and April one will be very interesting. And we'll see the data as it trickles monthly, or quarterly until the end of the year. So to say it's easy, it's the same is actually very subjective. And this is what I said in my show before, if you are a high performing student, the next gen NCLEX will be much very much easier for you. But if you're in the moderate the low performing student, it might cause you to fail the exam more. So which means you have to prepare longer or prepare using the next is adequate skills. Next NCLEX strategies. Next Gen NCLEX question backs.

Makes sense. All right. And Emil, um, would you have any other myths that you'd like to add to that? I'm sure you'd probably agree with what our first two points were. So anything else?

Yes, definitely. I read Sergi in Dr. Paul, but for me, I can share my fair share of concern with this myth. So basically, a lot of nurses I heard they're expressing their concerns about the ng n. So they believe that clinical differences would impact the ability of these nurses to pass the examinations. So what do we mean by that, with this clinical differences, we mean, clinical differences, let's say, for example, here in the Philippines, so we have a different level of practices in the Philippines. Nurses here always work under the supervision, strict supervision of the doctors, so which means the practice of them, these nurses for what we call autonomy, or their ability to think critically rely, they always rely on the physician's order. But it's quite different from the practice in the United States. Because I believe, even if I know I wasn't able to work momentarily in United States, but I believe during my practice, here in the Joint Commission, international nurses in the United States would like trained to be more aggressive, in a way, a more aggressive in a way that they will think, with a combined knowledge, clinical judgment and critical skills, they are expected to, to like, anticipate the outcomes anticipate to effectively communicate with the doctors, so epic, this clinical difference mind for other nurses most of the nurses might hinder the ability of international nurses to pass the NCLEX. But with this, I do not believe solely believe with this idea why? Because having this appropriate training, which, for example, the idea that this opportunity that we can share information with, with other nurses like what we're doing right now with Connetics, what we're doing in in IPass, and Dr. Paul in there is asked by training. So using this appropriate training, it's actually bridged the gap. So if the nurses will be able to understand the dynamics of the ng n per se, the transition this great transition, what are they really wanted to measure? What are the changes the format's, I believe, no matter what clinical difference may have, may it be you you're coming from a sharper example in India and the Philippines, you are Filipino, taking NCLEX in United States, I think for me, it's no longer a clinical difference, but rather having this appropriate training is something that that that is very important for you to ace the ng n. So I think that's the clinical differences. Yeah,

I'm really glad you brought that out. Because while I don't currently teach and NCLEX myself, I remember back in the day with the current test plan and outline, that I was always stressing with the nurse to You know that these are entry level us nurses. So you don't want to let your day to day experience color, how you evaluate your questions, your answer options, everything, you are really learning the by the book, you're applying the by the book. And if you combine that knowledge with understanding the nurses role, which can be trained, you don't have to be actually practicing it, it can be trained, don't make the assumption, I think that an answer option isn't correct, because where you're working, the doctor does it, the NCLEX isn't built to trick you like that. And that's not going to change as we move forward, per se. Now, we so as long as we understand the scope of the nurse, we understand that there are certain things that nursing interventions allow for under that scope, then when the NCLEX is asking you, or giving you answers about you know, bringing the doctor into that environment, you should have enough knowledge of the condition, the nurses role, and everything else to be able to still appropriately answer that question. So that's not actually a change, they should be doing that now, where you might get into trouble, at least in my opinion, is if you start to think about what you did yesterday with that patient that had an MI, whether it's you or the doctor or anybody else, because that might lead your thought process to be about a daily practice experience. And if you start to add in components that aren't in these questions, and the details that they give you, that's where you might get in trouble. You guys have anything to add to that?

Yeah, it's really focused on clinical experience. And what I was telling my students in the past two, three weeks that I was teaching is, and you know, I have students from Nigeria, from Ghana, from Argentina, from Brazil, everybody brings different things on the table. And you know, the difference with our international educated nurses, most of my students are experienced nurses in their own right, so I would have civic nurses like Camille, I would have telemetry charge nurses, I would have nurses that have been in the industry for longer than I am, right. But here's the thing, whenever I start my class, I say, I'm here to teach you the American way of doing things, because that's what the NCLEX is testing. So we would have discussions about, oh, this is what we do in our area. But this is what we're gonna do based on our protocol. And then you also have that layer where nurses and the North Americans are more autonomous compared to our nurses in South America is to Africa to Europe and Asia, because we do more stuff here. Like I was telling them, I'm an ER nurse, and most case studies, er, er scenario, right. So I kind of feel like, Oh, this is my thing, because this is like my bread and butter when I was doing nursing right when I was at the bedside. But like in the ER, we have a lot of autonomy. There are hospitals that we don't even need to call the physician to initiate the Mi protocols or sepsis protocols we have, because we have one click nurse driven sepsis protocol where we activate that and we can start a whole lot of things even before the physician is at the bedside. Starting IV bolus is putting large IV gauges or bringing them to the lab or collecting our own labs and running our own lactic acids in the bedside with an ice stat. So these are things that students are not familiar about when I tell them okay, did you know that I can check the troponin in two minutes at the bedside to determine am I after I did my EKG into triage? Right? And they're like, Oh, I didn't know that was possible. That is possible. That's why the American arts protocol is to check a troponin within 60 minutes. 60 minutes is generous. In the other parts of the world, it's not true. So now when you bring in that layer, in a case study format, or a trans format for the next one, NCLEX, it becomes all the more confusing, because they're not only answering a different style of item format, but they're also bringing in what should be an entry level nurses knowledge from the American system to the exam. This is the reason why many foreign grads were failing the NCLEX in the past, because the practices were so different. The clinical exposures were so different. Now bring them all together with the next one. NCLEX. This might pose a little challenge to nurses, but like you said, this is not something to be scared about. This is something trainable, because we're only you know, using those content knowledge and comprehension to a higher level of Bloom's taxonomy to where we, we analyze them, and we use them to evaluate the outcomes whether it's good or bad. So for me, it was actually more enjoyable to do a case study class versus a full lecture class. I can do a class for 48 hours but let me tell you this I enjoy it more when I do case studies because when I present the case, and then we start answering it, I can insert little things about things that they should know on the comprehension and knowledge level. But mainly, of course, is going to check your application analysis evaluation level, which are level three, four fives in Bloom's Taxonomy. But for me, it's more enjoyable. I don't know if my students enjoy it, but I guess I hope they're starting to enjoy it. And I do classes a lot in my social media for free as well. They can check it out. But that's what I wanted to add about that. But yes, tradable.

So, um, thank you guys. I am going to look at some of the questions that we've got coming up in the chat. So Murtala says, What's the expectations in the mode of questions to be seen in the next gen. I think he's asked, he says at Jay. So Jay, when we think about these questions, when you say mode Murtala, I'm not sure. I'm fully understanding, you might want to give us a little more context, I can tell you that there are there are some things that are staying the same. So we're still going to see all those questions styles have multiple choice, select all that apply. The things that already existed aren't going away, they're just adding some additional formats. And like I said, there's a whole nether video that we have on the Connetics College website that will go through a lot more detail on the question styles and things like that. But just like quick and easy guys. So what will reverse the order again? So Emil, what is one question style that they will see with the case study and then the new next generation that they wouldn't have seen before? Just one?

Okay, I think there will be integrating this, we have these so called standalone questions. And one of these particular standalone questions is what we call bow tie. So unlike with the transition between the questions in the case studies, where in the case study aims to, to measure the sixth level of clinical judgment model, in order that you will start at the recognizing cues all the way to evaluating your outcomes. Another example of standalone questions is what we call the bowtie. So this particular bow tie ins to measure simultaneously the six clinical judgment model for dinners, so meaning to say, you will be presented with a particular key study. So the aim of this examination of this type of exam is to measure your learner's ability to think for the expected outcomes to measure to identify the outcomes, to anticipate the possible interventions and also the possible conditions that the patient is having or experiencing based on the clinical scenario. So the nurse has to or the examinee has to like evaluate this medical study, in order for him or her to, to complete this bowtie questions. So for example, the condition is specific is placed on the center. So the measures to recognize the cues is being positioned at the lab and the measure to expected measure the expected outcomes and our position on the right. So these are some of the possible test formats that the nurse might be getting in the NCLEX. Aside from they have these three case studies that they will be okay.

All right, and Jay another different question type that we're gonna see nurses face here, apart from the

both, I guess, absolutely both is one type of Indian question apart from the standalone traditional questions. And of course, the case studies definitely will have three case studies in one setting. And they said you're gonna have if you're going to have four case studies, absolutely look for the maximum of five case studies. Absolutely only three case that that's what they said. Only three case studies will be like scored. And the remaining will be unscored. Because that's their going to measure you know your ability because it's still a computer adaptive exam. Anyway, so all in all, I guess like NDN unscored is 15. And for current and classic, it's also 15. Another thing going back to your question, we have the matrix is kind of interesting as well, because you're gonna click and click and click to what specific for example, symptoms that you can see in a patient how Being appendicitis or a patient having MI, or Crohn's or ulcerative colitis or something. But it's kind of interesting, because that's what we see here as what Paul said earlier, this is what we see here in the US. And it's kind of really, you know, really, it really amazes me, because this one is really a good project, by the way, the NCSBN. Because like I said, what we see here, this is the time we're in us, as an international educator, we can, at least, you know, the gaps are there, but at least we can fix those gaps. So we can deliver it to the international nurses, if you can also see the figures were a lot lower than the figures that we can see here in the US that if you are a US graduate nurse, so what we're trying to deliver is to at least bring it up, so we can fix the gaps. So anyway, so those are just a few things. Those are just one type of question the matrix question apart from that standalone bowtie questions. And if you think about it, it really, it's really consistent with, with the six measurement model, the recognizing queues, and analyzing queues, prioritizing hypothesis, generate solutions, taking actions and evaluate outcomes, if you think about it, as well. It's like a breakdown of the nursing process. It's like a breakdown of nursing process. And if you think about also of your case studies, those are six questions. And those are really consistent with the measurement model that they gave, like, you know, the recognizing use up to evaluating outcomes, it's really consistent there. So one thing for sure, if you're going to take this ng n, you have to memorize those things like you know, the six measurement model. So what is really what is recognizing cues and what is being a nurse to analyze skills, and evaluating outcomes, you know, as part of your nursing process, you have to learn those things, you have to understand those things.

So we're not getting away from memorization. And we're getting away from understanding the models. We are just applying that at such a more, I would say almost autonomous level. And we're truly using all of that training. You know, I hear a lot of, you know, I was educated in this country. But I use new US nursing textbooks, I'm seeing the same textbooks that a nurse who's studying in the US to become a nurse is getting so the material and the foundation that you have still have to be very strong to be able to take it to the next level. There is one point I wanted to bring out when it comes to the level of difficulty you mentioned, there's there everybody's gonna get at least three of these, they may get more. Some of those will be unscored. Here's the other thing. They built all different levels of case studies. So it's not I see this. And it's a more difficult question, or it's a less difficult Paul mentioned earlier. These are subjective opinions. So for me, I've worked in med surg, I've seen a lot of different stuff. And so if you give me a, you know, that type of med surg patient, I'm like, I can handle this, you give me OB case study, haven't helped me, I'm gonna have a challenge there. So I have to make sure as well that I even if my current comfort zone, especially if I'm out in practice, is a certain setting or type of patient, I still have to be prepared for those case study style questions to be potentially harder for me for a lot of different reasons. But the way that test assumes that they are easier harder, is not going to be the same as maybe the way you as an individual evaluate the level of difficulty of the question you're facing. That was true with the current way that NCLEX is being conducted where you go, that was such an easy question. That was such a hard question. We do know, if we feel like the test was easy. If you're a high performing student, maybe you were, maybe it was easier for you, maybe you really kind of knocked it out of the park. But we've also had people say, I thought the test was easy. And sometimes that's a red flag for me. I'm like, Oh, you might have underestimated those questions a little bit. And, and now you've you think you you're okay, and then you get your result. And you're like, what happened? That could still happen in the future where you're looking at questions, and you're going, Oh, this doesn't seem as bad. I don't know why I was so freaked out. You are going to take an approach of don't try and judge how difficult or hard the question is, have a very methodical approach to that question for what's in front of you. Make sure you're not rushing it or missing details, because it seems easy. That may actually trip you more than a lack of preparation. So that's where I want to caution you guys be really careful with that opinion of what's easy or difficult or whatever. Hey, I did post a couple more links in the chat. One of them is some NCSBN videos and FAQs for students. So again, we here we're focusing on nurses that have been educated in another country, besides the US are practicing outside of the US. And so we, we know that what we're going to tell you and share with you and help you work on is going to be with that lens, okay. But NCSBN is the one who's publishing all of this stuff. So if you're one, if you're like, I have questions, these are set up for students as well. So I think it's good that you look at that, I think it's also good to look at when you're preparing, using resources without using the lens of your background, and your training could trip you up. So that's why we're here. We want to sort of combine those two elements and make sure that you get a very holistic review based on your needs. So just will pause for a minute says, we do have some resources on the Connetics website that help you know how to get started, keep in mind that if you haven't, if this is like your first thought you haven't touched any of the process to apply for the NCLEX, or prepare, it's more than just study, you have to get your education evaluated, depending on which state board you're going to get your testing permission or eligibility through, you're going to have to submit your educational experience and history to have that evaluated, according to how the board wants it done, you're going to have to get that approved to say that you have a degree that's equivalent to what an entry level nurse would have, you're going to have to spend some money on background checks and on the application itself to that state board. And those processes can take a few months. So if you start studying now, but you don't do anything about your application for the NCLEX, you're going to study a lot longer. And what we want to do is make sure that around the time you've received permission to test from the state board because you fulfill those requirements, you're also very close to being ready to sit your exam. So can Paul, can I start with you again? And have you tell us when you're thinking about international nurses preparing what's one tip that you would give them that if another were thinking about next NCLEX you'll tell them something different. You're telling them now I need you to do this, to make sure that you're prepared for this type of exam. So what's one tip that you would give, and then we'll have the other share, there's,

so I'm big on runtime, which means I expect my students to be at a certain level of you know, comprehension or knowledge, which means they shouldn't be carrying a certain level of ability, you know, to understand or have already known or understood this situations, cases, disorders, diseases, medications, and so many things I'm big on content, even before next is on NCLEX. I emphasize the students memorization is not the key to pass the NCLEX, it has always not been the key to pass the NCLEX. And it's still not going to work for the next NCLEX. So I always say content is king. And preparation is the key to the NCLEX right up to the next year NCLEX. So very important that you're really at this point, master your nursing contents. If you are an experienced nurse and have been in the bedside for 10 to 20 years, it is high time for you to open those books again, or attend lecture classes, review courses that will target your ability and adapt to your ability. So there are so many changes to the medical practice or even here in the States. We're trying to keep up every year we have to be certified educated, we have to take all these modules every year and get competency checked. And that's only in the clinical practice. That's not including changes to the way education should be delivered. Like Jason earlier diseases are getting complex. So very important that you have mastery of content, very important that you have in depth knowledge. The clinical judgment model will test you on many different content assessments such as when you're talking about recognizing cues, you should have the ability and I discussed this in my last the doctor nurse ball show secrets of lectures and NCLEX last Saturday in my own page. With the recognizing cues alone you have to have the ability to determine a normal versus abnormal findings. What does plus to false mean Right? Is that a normal finding or an abnormal finding? And the next step of the clinical judgment model is analyzing cues. You should To have the ability to, you know, you're sure to have the mastery of pathophysiology of diseases because at this point, you're gonna have to pick the diagnosis based off of the percent in case in front of you. So is this Mi is this abdominal aneurysm. And then on the third step prioritizing hypotheses, you should have established your ability to prioritize these problems. And we talked about prioritization, we say all of the options will be correct, but you're gonna have to choose only one. So these are different competencies that nurses must meet and every step of the clinical judgment model, you will not be able to go through this individual competencies, unless you have mastery of content, right? Like sepsis. When we talk about sepsis, you should know everything about that there was a case that I presented the other day, where it says the blood pressure of the patient was 88, over 50. And it's clearly sepsis based on the situation. And the nurses answer was to prioritize vasopressors or to start nor epi going off the guideline, you start with your IV bolus with 30 milligram per kilogram first for as much as three liters. But that's something that we probably don't do in the international arena compared to the North America. So content is important. And when I say content, it's not content with what you only learned in school, it's the American education guidelines, or evidence based medicine. That's the content that I'm talking about.

So you also unfortunately, you can't go and drag out your old textbooks, I could neither, even though they're, you know, like this thick. If you had them printed, you can't just pull those out, we've had a lot of things change in, you know, sometimes year over year you how you how you understand the disease, or what the recommended or evidence based interventions are, it changes and the things that we learned that, you know, we thought really probably didn't hadn't changed, when you look at even within the US a hospital that is pushing evidence based practice, and maybe has more nursing councils around that and things like that, sometimes you look at that one, and you look at maybe a small rural hospital, the things that they do and how they do it may differ a little bit. So we are still talking textbook. It's not like I learned this research happened yesterday, and I've got to go apply it on NCLEX. No, it's not that bad. But it is saying, Don't rely just on your historical experience and knowledge of a disease, you're going to have to refresh it because there are things that have advanced since we finished our nursing education us textbooks are not. And so knowing that or the NCLEX would have been an expectation today. And it's going to be an expectation after April 1. So no change there. It's just that I think it to Paul's point, it becomes that much more important for you not to be lacking in that and I can memorize a lot of things and people amazing techniques for that and mnemonics, but make sure that you, you do understand what you're memorizing, I can regurgitate facts, but not understand what I'm telling you. So it's it is very much deeper than that. Jay, what is one thing that you would tell an nurse preparing for next gen and NCLEX now that they're going to have to face that

traditional NCLEX or the NG and NCLEX it's a little bit a little bit about everything, you have to prepare everything like holistically, you have to be mentally, psychologically, spiritually, physically financially prepared to be able to ace this exam. But remember, primarily, this is a nursing knowledge exam. So you have to have a master of content. And like I said earlier, you cannot just stay on your ground like just what we used to do in our country, like you know, the nursing licensure exam, it's a lot different from the nursing licensure exam in the Philippines, you have to like, you know, go one, step two, step three step higher. Because there's, you know, too much expectation from being a nurse here in the US, you have to keep up with the standards. And like I said, mastery of the content and the question is, how are you going to master the content? Repetition. So that's one thing that I'm going to tell you know, our students that you have to really like, repeat, repeat and repeat. So you can master not only the you know, you have to master or at least the concept you have to understand the concept. So you'll be able to like you know, for example, like prioritize your hypothesis basing from what you analyze, you know, basing from what you form, you know, and your hypothesis in the beginning. So mastery, the same time repetition, and added with spirituality, of course, you have to be guided as well.

Right. And Emil, what would one tip for preparation be that you would recommend for next gen testers.

It's actually a holiday strategy. And Dr. Paul already determine the most important parameters in order for you to prepare yourself for this very challenging examination. I think one thing I can share you based on how I train my students, is to inculcate them the idea that you need to strive to understand the reasoning behind the facts, and also concept you are learning rather than memorizing them. And with regards to this central to idea of understanding the reasoning behind is also the ability, when you take this level in, of what we call prioritization, you just have to also prioritize your weak areas. This is something that I really wanted to share with my students, because of the nature of the NCLEX, which is NCLEX NGN, and it's all about a computer adaptive, you already have the knowledge, you already have the skills, you already enrich your understanding on how to attack this NGN, you already know the dynamics of this examination, the entire concept because you read a lot of resources, but you haven't been able to focus on your weak areas. And you do not go away, you only focus on the things that you think are very important, but you forget to focus or prioritize your weak areas and because of the computer adapts with your ability, and you will not be able to check whether you are like what you have said Holly A while ago, you are a med surg nurse. And you will be given a concept of about OB, oh, no, but about when the time comes that you will lag in my case, I am a master in cardiovascular, thoracic nurse, nursing. So I will be like, presented with the questions with OB just like you and also mental health, which I think I am very weak with these areas, you really have to focus. So it's not really focusing on one particular topic, but rather, like one of Sergej have said, holistically you need because of diversity of all the topics in nursing. It's really something that you cannot, you cannot it's not an overnight study, but rather it entails a dynamic approach. So you really have to go back with your previous knowledge combined with your clinical experience, training, preparation, to be able for you to get yourself into a higher level. Because this ng n is not anymore. The thing of the past, rather than this transition, it's really challenging, not only for, for me, for nurses in the US, but rather whole as a whole as a whole team. So not only nurses from Asia, nurses in other continents, but rather this whole nurses in the entire continent should be need to be ready for this transition.

Um, I'll add my two cents for what it's worth. I think historically, I've always advised nurses that when they're getting to the point, they've got a content a foundation that sort of looks like a meal said across the board, don't ignore your weak areas. Because if they come along, you have to have some core knowledge and ability to cope with that. This test is not built to test whether you're an expert in any particular area, but whether you have the foundational knowledge and skills for all of those entry level. Areas, if you will. So when we looked historically at nurses, knowledge and memorization, sometimes what they think they're going to memorize is the right answer. And so I think when we look at the current question styles today, there's a temptation to do that. We want to steer away from that and find out why did our answer. Why was our answer potentially the wrong one? And why was this answer the right one, when you get from Content Review, you've got your solid content, you now start to look at your question analysis. I think you have to take it even a step further with the next gen NCLEX practice questions to say, What could I have missed within these case studies? Are there details that I bypassed or that I didn't give enough understanding to or do I not truly understand how all the pieces and the patho comes together to evaluate what the likely clinical diagnosis in is because then from that point on, you are now making decisions based on correctly identifying what is happening with the patient. And that helps you formulate what you need to do is Nursing how, which things are priority and whatnot? So we will take a look, I know there's a couple of questions here. And I know we're running out of time. So, Paul, I do see some nurses asking about like your blog information and things like that. So if you go in on the private chat and drop it in, then our team members can put it in the public chat, and they'll have that information available to them. So check it out. And this name, Jay, and Emil, if you want to put your iPass information into the private chat, we'll also share that information. I'm getting a dog background noise, I have three myself that are behaving but if y'all can mute that might help us remove some of that background noise, please. So let me see if there's any other questions here. Is there any agency that can be recommended to a Nigerian nurse who is yet to start any process. So it there are a lot of agencies and companies out there that can help you and advise you and guide you in the NCLEX, whether it's just a study portion, or if you're actually looking to start the whole process, if you're interested in applying to Connetics and learning what they have available, you can go onto our website, apply And we will, will look at your application if we don't think that you'll fit or your qualifying for one of the programs that we have, we may have some alternate suggestions for you as well as where to go to get some help and continue your journey. So ultimately, there are so many different resources out there for nurses depending on what's important to them as they begin this process. And we hope that some of the information that we've shared today, both from the companies that we work with, and the NCSBN will help drive you towards NCLEX, readiness and NCLEX success and ultimately, the ability to immigrate here and begin your US nursing career. And on that note, I'm gonna just also plug that next week on Tuesday, our international nursing agency, will be doing the love for a talk show. And we will be sharing about some of our NCLEX heroes. We're also going to talk a little bit about how to manage test anxiety, especially since we know some of you are still anxious about the next gen and NCLEX. We're going to talk about how to manage that. And some other key points and have some of our nurses who've been successful share their experience and their wisdom, because it's always nice to hear from somebody who's recently taken this exam, and some of the things that they may be found helpful. So we look forward to seeing hopefully many of you on our Tuesday, look for a talk show session. We'll be posting that on our social media. So you'll be able to join us for that session. Dr. Paul Jay. Emil, thank you so much for joining us today and sharing your expertise. And we look forward to some future shows can't wait to see what's going to happen in April. So I'm sure we'll be having some follow up shows to talk about what the data starts to show us. And we all have students that are going to test in April. So from that, unfortunately, it is one of the ways that we'll learn the true impact of all of this, and then be able to share that with people around the world who are still in the process of preparing. Thank you again, everybody. Hope the rest of your day goes well be safe, and we'll see you again soon. Bye bye.