Eight Simple Steps to Writing an NGN Case Study

by Christi Doherty, DNP, MSN, RNC-OB, CNE, CHSE, CDP, Director, Nursing Research | October 19, 2021

The National Council of State Boards of Nursing (NCSBN) is launching the Next Generation NCLEX-RN® examination in April 2023. The new question types will include case study information. The case study is designed to provide data for the student to utilize in applying the clinical judgment measurement model. The model identifies six cognitive processes a nursing graduate must master. These include recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. Nursing students must practice mastering the cognitive processes in question format before taking the high stakes NCLEX® examination. The Kaplan experts have many resources available to assist educators in helping their nursing students to be successful. Let me provide you with easy steps to transform your lived nursing experience into a case study for new graduates.

Step One: Ask, what is the goal of the case study? 

What is the goal of the case study? Do you want to teach a specific concept, a disease process, or appropriate interventions for a clinical situation? Remember, all case studies should be leveled to the new graduate. Try hard not to include lessons learned from years of clinical nursing practice. We need nursing students to provide safe, quality care equal to the entry-level nurse competencies.

Step Two: Tell a clinical story.

Don’t worry about the specific questions you intend to develop. Think about a patient you may have cared for while performing bedside nursing. We all have those patients that have impacted our lives and our nursing careers. Use that story to bring the case alive for the student. Put the student at the bedside.

Step Three: Consider the process of recognizing cues.

Once you have a story, consider the first cognitive process of recognizing cues. What are the most pertinent clinical findings, objective and subjective, necessary for the nurse to identify? These findings can include vital signs, clinical signs the healthcare provider can observe, symptoms the patient describes, or observations by family members. This information forms the basis for the selection of findings that need follow-up by the nurse.

Step Four: Consider the process of analyzing critical information.

Once the nurse identifies the pertinent cues, they need to interpret the information. For example, does the presence of fever indicate a disease process? Is the shortness of breath a pulmonary issue or a cardiac problem? The nurse will apply the clinical manifestations to what is known about the patient, thus analyzing the cues.

Step Five: Prioritize hypotheses.

The next step is to prioritize hypotheses. What is the problem or problems the patient is experiencing? Which one is most important for the nurse to address first? For example, the patient has shortness of breath and foot pain from stubbing their toe on the curb leading to the Emergency Department. A simple example but one which requires the nurse to make a decision.

Step Six: Generate Solutions.

Now what? Generate solutions. What actions can the nurse do to assist this patient? Does the patient need oxygen, medications, diagnostic tests, or immediate intervention by a physician? In this question, the nurse will select from essential interventions needed, actions that can wait until later, or actions that will cause more harm to the patient and need to be avoided. Consider the story; what were the choices you had when you were caring for this patient in real life?

Step Seven: Take action! 

Take action! Assessments are done, decisions are made, now is the time to intervene for the patient’s benefit. The questions you develop for this step can include selecting appropriate actions, identifying how to perform specific interventions, or even the need for additional assessment.

Step Eight: Ask yourself, did it work?

The final phase is to ask, did it work? Is the patient better or worse? How do you know? What clinical findings support that decision? The cognitive process encompassing evaluating outcomes—the last but often the most crucial step in the case study process.

You did it! You have designed a case study! Maybe you don’t have the technology available in your testing system to deliver the questions in the manner that NCLEX® questions will be delivered in 2023, but that is okay for now. Giving students a head start on thinking through the case study is valuable for their clinical judgment development and success in the future. Keep posted for updates. Kaplan is here to help!


National Council of State Boards of Nursing (NCSBN). (2020). Next generation NCLEX news: The NGN case study. https://www.ncsbn.org/NGN_Spring20_Eng_02.pdf.

NCLEX® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names are the property of the respective trademark holders, none of whom endorse or are affiliated with Kaplan.

Dr. Doherty is a skilled nursing researcher with published works on clinical judgment, communication, pharmacology, medical-surgical nursing, research design, and statistics. She was a professor of nursing at both the prelicensure and doctorate level. An experienced clinical nurse at the bedside for over 20 years and more recently a virtual simulation content designer, Dr. Doherty uses her vast experience to enhance nursing education at Kaplan.

See more posts by Christi Doherty, DNP, MSN, RNC-OB, CNE, CHSE, CDP, Director, Nursing Research