A Conceptual Model Framework Linking NGN NCLEX Readiness, Nursing Student Persistence, Licensure Success and Workforce Retention

The future of the nursing profession has become one of uncertainties. Both the hospital workforce and institutional leaders are now in the same boat, asking many of the same questions about retention and readiness to practice in the field of nursing. Leaders have been reevaluating strategies and interventions focused on training and maintaining the most trusted and ethical profession in the world. Since the COVID-19 pandemic, one thing has become abundantly clear: there is, in fact, a shortage in nursing. I have seen a growing narrative online that argues whether there is truly a shortage or whether the profession is facing a retention problem alone. After a literature review and a deep dive as a practicing nursing academic leader with more than 10 years of experience in higher education, I believe both are true. There is a nursing shortage and a nursing retention problem (Mohamed & Al-Hmaimat, 2024; Pressley & Garside, 2023).

This article proposes that the NGN-CJMM conceptual model integrates and promotes clinical judgment development and that by focusing on cues, priorities, and case development, nurses learn confidence, belonging, and persistence of skill. What we have seen since the pandemic especially highlights an entire shift in the paradigm of readiness. The National Council of State Boards of Nursing recognized this shift, and the post-pandemic launch of the Next Generation NCLEX was born from the need to better measure clinical judgment and decision-making abilities among new graduates (Dickison et al., 2019; Nielsen et al., 2023).

Many schools across the country have seen a lower ability for nursing graduates to pass the NCLEX, and concerns regarding practice readiness have become increasingly common. A program must teach clinical judgment and provide opportunities for students to gain confidence and belonging that eventually develop into safe, practice-ready skills at the bedside. Emerging literature demonstrates that CJMM-based classroom activities, simulation experiences, and debriefing structures improve engagement, critical thinking, and confidence among nursing students (Sullivan et al., 2024; Regier & Kessler, 2024; Sessions, 2025).

In order to retain nurses, the research also suggests that while the CJMM has been gradually integrated into nursing education, hospitals could benefit from adopting similar frameworks within nurse residency and transition-to-practice programs (Mohamed & Al-Hmaimat, 2024; Ingalsbe et al., 2024). The goal is for prioritization, cue recognition, and confidence in applying critical thinking to become part of the ongoing training and experience of new nurses.

The feedback loop is a positive one. By creating a safe place to continue gaining support in clinical decision-making through case studies, simulation, mentorship, and guided debriefing, new nurses become increasingly confident and supported in their practice environments, reducing the risk of turnover and attrition (Ingalsbe et al., 2024; Weller-Newton et al., 2022). Nursing leaders cannot say they are surprised. The possibility of a nursing shortage was described more than 25 years ago. The profession understood that with the retirement of the Baby Boomer workforce and evolving regulatory and workforce demands, the need for additional nurses would be substantial.

The development of the NCJMM was not only the beginning of a potentially excellent tool for advancing training and readiness in nursing, but rather a framework that should be expanded and applied throughout both higher education programs and healthcare institutions hiring new nurses (Dickison et al., 2019).

The hypothesis of this conceptual model is that higher levels of CJMM integration will be positively associated with nursing student program completion, NGN NCLEX success, and new graduate nurse retention. Clinical judgment competency serves as a mediating variable between curriculum design and retention outcomes. NGN NCLEX readiness predicts first-time pass success, workforce readiness predicts first-year workforce retention, and ultimately academic-practice alignment improves both licensure success and workforce retention outcomes (Dickison et al., 2019; Nielsen et al., 2023; Mohamed & Al-Hmaimat, 2024).

Our mission should be to create a collaborative platform that aligns curriculum across RN and BSN pathways with clinical skills validation and opportunities for case discussion and debriefing integrated into every clinical experience. Opportunities to practice case prioritization and NGN thinking should not only be leveled according to student placement, but also aligned with course objectives.

For example, a senior-level medical-surgical student should be placed on a high-acuity medical-surgical or step-down unit, and course objectives aligned with the AACN Essentials should correspond directly to weekly lecture content and clinical objectives (Jackson, 2024; Mueller-Burke et al., 2024). Faculty in the classroom should incorporate andragogical strategies that apply lecture content to realistic case studies reflective of the patient-care experiences students will encounter during clinical rotations. Research evaluating clinical judgment instruction consistently identifies case studies and simulation as effective approaches for developing clinical judgment and readiness for practice (Nielsen et al., 2023; Sullivan et al., 2024).

Most clinical rotations include a debriefing or post-conference session where classroom concepts are connected to real-world nursing practice. This process highlights gaps between classroom learning, simulation, clinical experiences, and actual bedside practice. Students are not successful and practice-ready solely because of faculty instruction; mentorship and coaching are equally important. The nurses working on clinical units often do not realize how significant their role is in the life cycle of a new nurse.

Nurses within healthcare organizations have spent years operating in survival mode, particularly following the pandemic, while navigating burnout, staffing shortages, and cultural shifts. This reality further reinforces the importance of nurse residency programs. Literature examining transition-to-practice programs consistently identifies mentorship, social support, structured onboarding, and confidence building as contributors to new graduate nurse retention (Mohamed & Al-Hmaimat, 2024; Hallaran et al., 2022; Weller-Newton et al., 2022).

Nursing school strategies that improve retention may also have significant value when translated into healthcare organizations. Strategies that both schools of nursing and healthcare systems can benefit from include mentorship programs, peer support groups, early risk identification models, transition-to-practice pathways, simulation experiences, remediation plans, and competency-development tracks (Mitchell et al., 2021; Baharum et al., 2023; Weller-Newton et al., 2022).

In efforts to realign curriculum, program leaders began reevaluating the use of high-stakes testing. High-stakes testing is generally defined as an assessment used as a benchmark for competency and projected NCLEX success, where progression or graduation may be contingent upon achieving a predetermined score. However, many accrediting and regulatory bodies have shifted away from supporting high-stakes progression policies and instead encourage more comprehensive readiness assessment models.

At the same time the NGN NCLEX was launched and schools were adapting to the clinical judgment framework, programs experienced declining benchmark scores and increasing attrition associated with testing requirements and changing performance expectations. In response, many state regulatory bodies lowered minimum NCLEX pass-rate expectations from 85% to approximately 80% to support the continued entry of nursing graduates into the workforce pipeline.

As graduate nurses enter practice, they face additional gaps that must be bridged through continuing development opportunities. These nurses require ongoing exposure to CJMM-based learning experiences, clinical coaching, simulation, reflection, and support systems that reinforce the same clinical judgment framework introduced during nursing school. The continuity of clinical judgment development from student nurse to professional nurse may ultimately represent one of the strongest opportunities available to improve readiness, belonging, persistence, and workforce retention across the nursing profession (Ingalsbe et al., 2024; Mohamed & Al-Hmaimat, 2024; Pressley & Garside, 2023).

References

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