First Advisor

Dunemn, Kathleen

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Date Created



Clinical judgment is considered a core competency of nursing care as 46% of nursing tasks performed by new graduate nurses require the use of clinical judgment (National Council of State Boards of Nursing [NCSBN], 2018). With 23% of new nurses not demonstrating entry-level competency, patient safety is at risk (Kavanagh & Szweda, 2017). These deficits are driving changes to national licensure board examinations to focus on the level of clinical judgment new graduates demonstrate (NCSBN, 2018). The purposes of this non-experimental exploratory study were (a) to explore the validity and reliability of the Modified Lasater Clinical Judgment Rubric (MLCJR) developed for this study and (b) to objectively explore and measure clinical judgment within the cognitive domain using the MLCJR. This non-experimental exploratory study was guided by the NCSBN’s (2018) clinical judgment measurement model. Prior to data collection, adaptation of the original Lasater clinical judgment (Lasater, 2007a) rubric for use in the classroom environment occurred with approval of the original author. The original Lasater (2007a) clinical judgment rubric was chosen for adaptation as significant previous research demonstrated the validity and reliability of the tool and it reflected Tanner’s (2006) theory of clinical judgment. A convenience sample of 11 junior-level nursing students from one baccalaureate nursing program at a small university in the Midwest responded to NextGen style questions within the unfolding complex case study developed for use with the MLCJR. The MLCJR was then utilized by nurse educators to evaluate the validity and interrater reliability of the instrument. The MLCJR was found to be a valid and reliable, objective instrument for evaluation of clinical judgment when used to evaluate student responses to the unfolding complex case study. This study is positioned to be among the first to utilize the NCSBN’s (2018) clinical judgment measurement model (CJMM) to guide evaluation of clinical judgment in the classroom setting. This is significant as the NCSBN’s CJMM is the foundation of the newest version of the NCLEX-RN being deployed in 2023. This study presented beginning research supporting operationalizing of the NCSBN’s CJMM for nurse educators in the classroom. The work presented here featuring development of the MLCJR to evaluate student clinical judgment has the potential to make a meaningful and effective contribution to nursing education.


412 pages

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