Time always feels like it’s in short supply in nursing education. You’re juggling countless responsibilities—preparing students for the NCLEX, ensuring they’re ready for real-world practice, and ensuring essential skills get mastered. Amidst all this, skills labs often end up as purely task-oriented environments: learn this skill, practice it, and check it off. But there’s an exciting opportunity we might be missing—using skills labs to foster clinical judgment and deeper learning.
Why This Matters
If you’re like most nurse educators, you’re probably still left wondering how your students will fare on the Next Generation NCLEX (NGN). The new exam format tests clinical judgment in a way we haven’t seen before. Add that to the usual challenges—too little time to teach everything, plus the need to tie classroom content to clinical practice—and it’s easy to see why many educators feel overwhelmed.
The Silo Problem
Think about how nursing education is typically structured:
- Class: Learn about diseases and processes.
- Clinical: Spend part of a day caring for one patient.
- Skills Lab: Practice a clinical procedure step-by-step.
While each setting has value, they often operate in silos. So, how do we break down these barriers and bring it all together?
5 Strategies for a More Balanced Approach
1. Introduce Skills Within a Patient Scenario
Whenever you teach a skill, tie it to a realistic patient case. Instead of just showing how to start an IV, present a scenario about a patient who needs fluid replacement due to dehydration. By adding a storyline, students think critically about their actions and why they matter.
2. Require Patient-Centered Practice
Avoid “practice for practice’s sake.” Every time students work on a skill, make it about caring for a patient with a particular need. If they’re learning how to give a subcutaneous injection, assign them a patient who has diabetes and needs insulin. This way, they’ll consider vital signs, blood sugar readings, and potential side effects—boosting their critical thinking.
3. Map Every Step to Clinical Judgment
The Clinical Judgment Measurement Model (CJMM) has six cognitive skills: Recognize cues, Analyze cues, Prioritize hypotheses, Generate solutions, Take action, and Evaluate outcomes. Incorporate these into your teaching by asking students which skill they use at each step. This will make clinical judgment feel like an active part of skills lab sessions, not something reserved for lectures or clinical rotations.
4. Include Environmental and Individual Factors
Real-life nursing doesn’t happen in a vacuum. Consider the patient’s room setup, time pressure, available resources, and the nurse’s experience level. Maybe the patient is anxious, or the environment is noisy. Encourage students to adapt their approach and decision-making based on these factors. This way, they learn to handle the curveballs they’ll inevitably face in real practice.
5. Build in “Time Outs”
Slowing down can feel counterintuitive in a jam-packed curriculum, but it’s worth it. After each step of a procedure, pause and discuss:
- Why did we do that step?
- What outcome do we expect?
- What if things don’t go as planned?
- How would we adjust?
Encouraging students to verbalize their thought process helps them connect the dots between doing a skill and thinking it through.
An Example: Medication Administration
Let’s take a common scenario: administering meds to a patient with heart failure, like 75-year-old Albert Davis. Maybe he’s on multiple oral medications and also needs a STAT IV diuretic. For fundamental students, you might focus on basic assessments like blood pressure and heart rate. More advanced students could perform thorough lung, heart, and edema assessments. Either way, students aren’t just checking boxes—they’re figuring out why these checks matter for this patient.
Don’t Forget the Big Picture
To truly prepare students for NGN—and safe practice—you need to keep connecting what they learn in class, clinical, and skills lab. Reference those six cognitive skills any chance you get. Talk about environmental and individual factors. Slow things down with purposeful timeouts. Yes, it might feel like extra work, but the payoff is huge: students who can think independently, adapt in real-time, and deliver top-notch patient care.
Bottom line? Skills labs don’t have to be just for skills anymore. You’ll help students make meaningful connections throughout their nursing education by weaving in clinical judgment strategies. This ensures they’re better prepared for NGN and the challenges they’ll face in their first six months on the job—and beyond.
