If you spend time in nursing program faculty meetings, you’ll hear something a lot lately: “Our curriculum teaches clinical judgment.”
It’s in the syllabi. It’s in the course objectives. It’s on the program self-study for accreditation. And it’s increasingly the answer when someone asks why NCLEX pass rates dipped in 2025 — “We’re already teaching to the NGN, we’re already integrating clinical judgment, we’re already aligned with the CJMM.”
I want to be careful with how I say this next part, because most of the faculty I work with are deeply committed and working really hard. So here’s what I mean as gently as I can: “teaching clinical judgment” and “teaching content using clinical judgment language” are not the same thing. And the gap between them is a lot of what the 2025 NCLEX numbers are pointing to.
The data on the gap is pretty clear
Research has consistently shown that fewer than 10% of new graduate nurses possess safe clinical judgment skills, with 40% failing to recognize a patient’s urgent problem and 50% failing to intervene appropriately.¹ NCSBN cites this work as part of the rationale for redesigning the licensure exam. The NGN was a response to a workforce-readiness problem the field has been documenting for years.
And here’s the part worth sitting with: even among faculty working hard to integrate clinical judgment into their teaching, a 2024 qualitative study found “diverse terminology use, definitions, and inadequate knowledge” around what clinical judgment even is, reflecting confusion across the multiple definitions in the literature.²
So when a program says “we teach clinical judgment,” the honest follow-up question is: which definition? Using which framework? Assessed how? With what kind of faculty preparation? Those aren’t gotcha questions — they’re the questions that distinguish curricula that move pass rates from curricula that say the words and hope for the best.
What “teaching content” usually looks like
Picture the typical med-surg lecture on heart failure. The faculty member walks through pathophysiology, signs and symptoms, common medications, nursing interventions, patient education priorities. There are slides. There’s a case study at the end — usually a paragraph describing a patient, followed by a few NCLEX-style questions. Students answer the questions. The instructor reviews the correct answers. Class ends.
Was clinical judgment taught? Honestly, content was taught. Then a case study was used as an application of content. The actual cognitive work — recognizing which cues matter, analyzing what they’re pointing to, prioritizing hypotheses, generating solutions, taking action, evaluating outcomes — was largely done for them by the structure of the questions.
This isn’t a knock on the faculty. It’s how most of us were taught. The content is real, the case studies are real, the questions are well-written. What’s missing is the deliberate practice of the thinking itself — and that’s exactly what the NGN is measuring.
What “teaching clinical judgment” actually looks like
Same lecture. Same heart failure content. Different structure.
Instead of presenting the patient as a complete scenario with prepared questions, the faculty member presents cues first — a few pieces of information at a time — and asks students to identify which ones matter and why. “Out of everything I just told you, which three pieces of information are most relevant to what’s happening with this patient right now? Defend your choice.”
Students wrestle with it. The faculty member doesn’t immediately correct — instead, she asks them to analyze the cues they chose, then prioritize hypotheses, then generate solutions, then act, then evaluate whether the action worked. Six steps of the CJMM, each one practiced as a thinking activity, not a multiple-choice answer.
That’s the work. It’s harder than teaching content because it takes longer per case, students get uncomfortable when they’re not handed answers, and faculty have to know the framework deeply enough to coach through it in real time. But it’s the work the exam is measuring, and it’s the work the bedside is asking new graduates to do on day one.
A story from a tutoring session that’s stayed with me
A few years ago — before the NGN even existed — I was running NCLEX prep work through my company, tootRN. I’ve worked with more than 300 students through that program, and our pass rate has held above 98%. But the part of the work I love most isn’t the numbers. It’s the moment in a session when a student stops trying to guess the right answer and starts trying to think through the problem.
I worked one-on-one with a student who had already failed the NCLEX more than once. She was bright, she’d graduated from a solid program, and she’d done thousands of practice questions. Thousands. She walked in deflated, defensive, and pretty sure she was going to fail again.
I asked her to walk me through how she approached a question. She read the stem and immediately jumped to the answer choices. I stopped her. I asked her to put the answers out of her mind and tell me, in her own words, what the question was actually asking. She paused. Then she tried — and she couldn’t articulate it.
That was the whole problem. She wasn’t failing because she didn’t know the content. She was failing because nobody had ever taught her to slow down and think before she answered.
So I walked her through the three-step approach I’d been teaching tootRN students for years:
Step 1 — The Ask. Before you look at a single answer choice, clearly identify what the question is asking. Not what it’s about — what it’s asking.
Step 2 — The Problem. Use all the data the question gives you to determine what is actually going on with this patient. That’s your problem. It’s rarely stated outright; you have to construct it.
Step 3 — The Solution. Determine the expected outcomes of the problem and the expected outcomes of each answer option. The right answer is the one whose expected outcome matches what the patient actually needs.
I had her run a question through those three steps out loud. Then another. Then another. By the end of the session she said something I’ll never forget: “Nobody ever told me I was allowed to think this slowly.”
She passed her next attempt.
What I didn’t know at the time is that the framework I’d been teaching would map almost perfectly onto what NCSBN was about to build into the NGN. The Ask, the Problem, the Solution aren’t fundamentally different from recognizing cues, analyzing them, generating solutions, and evaluating outcomes. They’re the same cognitive work, taught in plain language. I didn’t invent clinical judgment — I just got to it from the student side, one tutoring session at a time.
That’s the kind of teaching the field needs more of. Not more questions. Not more content. More thinking, slowed down enough that students can learn how to do it.
What this means for faculty preparation
Most nursing faculty did not receive structured training in how to teach clinical judgment, because most of us came up in programs where it wasn’t taught this way. We learned to teach the way we were taught. That’s a structural reality, not a flaw in any individual faculty member. And it means that moving a program from “teaching content” to “teaching clinical judgment” requires faculty development, not just curriculum revision. You can rewrite every syllabus and put “CJMM” in every course outcome — if your faculty haven’t been coached on what that looks like in their teaching, very little will change in the classroom.
The programs I see making real progress are doing things like:
Running faculty workshops on the CJMM as a teaching framework, not just a testing framework. Most faculty know the six steps. Fewer know how to coach through them in real time.
Pairing didactic and clinical faculty in case study development. When the person who teaches the lecture and the person at the bedside with students design a case together, the case becomes a bridge between the two settings. That bridge is where applied judgment develops.
Building peer observation into the semester. Not for evaluation — for shared practice. Faculty learning from each other how they prompt students, where they hold silence, when they redirect. One of the lowest-cost, highest-impact moves I’ve seen programs make.
Treating remediation as cognitive coaching, not question volume. At-risk students don’t need more questions. They need someone to walk through the thinking with them — the same six-step coaching the curriculum is supposed to be doing, slowed down and personalized.
The honest framing
Clinical judgment is teachable. That’s the good news. It’s not a personality trait, it’s not innate, and it’s not something students either have or don’t. It’s a skill that can be developed deliberately when faculty know how to develop it.
But the shift from teaching content to teaching judgment is a real shift. It takes faculty time, faculty support, and a willingness to look honestly at what’s happening in the classroom versus what’s written in the course outcomes. Most programs I work with have the will to make this shift. What they often need is structured support to make it stick.
If you’re working on this in your program — or you’re a leader trying to figure out how to support faculty through it — that’s a lot of what I do. You can start a conversation here. And if you’re working on it on your own, keep going. The work matters, and the students notice when their faculty are teaching them to think, not just to pass.
References
- Kavanagh, J. M., & Sharpnack, P. A. (2021). Crisis in competency: A defining moment in nursing education. OJIN: The Online Journal of Issues in Nursing, 26(1). Cited in: Barriers and Facilitators Experienced by Undergraduate Nursing Faculty Teaching Clinical Judgment: A Qualitative Study. https://pmc.ncbi.nlm.nih.gov/articles/PMC11331454/
- Barriers and Facilitators Experienced by Undergraduate Nursing Faculty Teaching Clinical Judgment: A Qualitative Study (2024). https://pmc.ncbi.nlm.nih.gov/articles/PMC11331454/
- Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into Nursing Educational Frameworks. Journal of Nursing Education, 58(2), 72-78. https://pubmed.ncbi.nlm.nih.gov/30721306/
- Campbell, J., Miehe, J., & Tice, M. (2024). Faculty Development on the Use of a Clinical Judgment Model in the Pre-licensure Nursing Curriculum. Journal of Professional Nursing, 51, 9-15. https://pubmed.ncbi.nlm.nih.gov/38614679/
- National Council of State Boards of Nursing. Clinical Judgment Measurement Model. https://www.ncsbn.org/exams/next-generation-nclex.page