According to the National Council of State Boards of Nursing [NCSBN] (2022), “the Next Generation NCLEX (NGN) exam asks better questions to help nurses think critically when providing care and make the right decisions” (para. 1). NCLEX NGN licensure exams begin May 2023. In 2021, the American Association of Colleges of Nursing (AACN) transitioned from essential core competencies for professional nursing education to new competency-based education domains that impact future curriculum enhancements in clinical judgment, critical thinking, and decision-making testing (AACN, 2021). Preparing diploma, associate, and baccalaureate degree students for the new NGN examination is vital to schools relying on first-time pass rates to maintain accreditation and success in meeting the new essential core competencies for professional nursing.

The study faculty developed a 60-item, 90-minute pretest-post-test exam of previously seen questions from exams taken by the students in first- and second-level classes. The selection of questions was obtained from five courses: Introduction to Professional Nursing (n=7), Nursing Assessment & Health Promotion (n=12), Pathophysiology (n=8), Pharmacology (n=17), and Foundations of Nursing Practice (n=16). The questions chosen were based on: Item Difficulty (p-value): the percentage of exam-takers getting the question correct; Discrimination Index: the difference in item performance between top and bottom performing students; and Point Biserial: whether getting the question correct correlated positively or negatively with performing well on previous exams as a whole (ExamSoft Worldwide, 2022). A total of 800 questions were reviewed. The sample questions selected had lower percentages of correct answers and vast differences in item performance between top and bottom performing students and the item difficulty p-value index (Appendix A).

After administering a pretest to 56 nursing students, scores from five Med-Surg 1 exams between August 31, 2021, to December 1, 2021, were analyzed to determine if reinforcing learned nursing concepts and using a new strategy, “run the six,” over a three-month timeframe, would positively affect posttest scores. Run the six is a strategy intervention focused on organized thinking rather than intuitive guessing to improve testing scores, decrease anxiety, and increase testing-taking confidence. The tool adapted from Harding's (2022) definitions of Maslow's Hierarchy of Needs, Nursing Process, Review of Systems (pathophysiological signs and symptoms), Vital Signs and Lab Value normal values, and Nurse Responsibility is the primary intervention for the study (Appendix B).