Writing is now a tested skill on the Next Generation NCLEX and it matters more than most nursing students realize. The NGN evaluates your ability to interpret clinical documentation, recognize patterns in charting and demonstrate clinical judgment through written case scenarios. If you’re wondering whether your documentation skills will affect your NCLEX score, the answer is absolutely. 

What has changed is, the NGN moved away from simple multiple-choice questions and introduced case studies that require you to analyze nursing notes, prioritize interventions based on documented patient data and even complete charting exercises. Your ability to read, interpret, and respond to clinical documentation is now directly tied to your exam performance.

And honestly? That makes sense because in real nursing practice, documentation is patient care.

Why Documentation Actually Matters (Beyond “Because We Said So”)

Every note you write becomes part of the permanent medical record. It guides treatment decisions, protects patients and shields you legally when things go sideways.

According to the American Nurses Association, poor documentation is one of the leading contributors to medical errors and malpractice claims. Not because nurses don’t care because they’re rushed, overwhelmed or never learned to chart effectively in the first place.

Here’s what good documentation does:

• Ensures patient safety. Clear notes prevent the day shift from repeating what night shift already tried. They stop a provider from ordering a medication the patient’s allergic to. They catch trends before a patient crashes.
• Supports clinical reasoning. Writing forces you to organize your thoughts. You can’t chart “patient deteriorating” without identifying what changed and why it matters. That process recognizing, analyzing, acting is clinical judgment in action.
• Provides legal protection. “If it wasn’t documented, it wasn’t done” isn’t just a nursing school cliché. It’s courtroom reality. Your notes are evidence. Sometimes the only evidence.
• Facilitates reimbursement. Insurance companies and Medicare pay based on documented care. Miss key details and your hospital loses money. Lose enough money and units close. It’s how healthcare economics work.

But here’s the deeper truth: documentation is clinical thinking made visible. When you write a nursing note, you’re proving you can assess, analyze and respond appropriately. The NGN is betting your documentation skills predict your nursing competence.

They’re probably right.

How the Next Generation NCLEX Changed Everything

The NGN launched fully in April 2023. It represents the biggest NCLEX overhaul in decades, designed by the National Council of State Boards of Nursing (NCSBN) to better reflect real-world nursing practice.

That includes the messy, high-stakes reality of clinical documentation.

New Question Formats That Test How You Think and Write

The NGN ditched pure multiple-choice questions in favor of case studies and scenario-based items. You’ll need to:

• Interpret and analyze client data from charts, lab results and nursing notes
• Prioritize interventions based on written clinical information
• Recognize trends in documentation over time (like vital signs slowly tanking)
• Generate hypotheses about what’s happening based on documented evidence

The Clinical Judgment Measurement Model: Where Writing Meets Thinking

At the heart of the NGN sits the Clinical Judgment Measurement Model (CJMM), a framework developed by NCSBN that mirrors the nursing process. It includes six cognitive functions:

1. Recognize cues (What’s important here?)
2. Analyze cues (What does this mean?)
3. Prioritize hypotheses (What’s most likely happening?)
4. Generate solutions (What should I do?)
5. Take actions (What will I do first?)
6. Evaluate outcomes (Did it work?)

Documentation touches every single step.

When you chart a patient’s condition, you’re recognizing and analyzing cues. When you write a nursing diagnosis or care plan, you’re prioritizing hypotheses and generating solutions. When you document interventions and patient responses, you’re taking action and evaluating outcomes.

Poor writing = poor clinical judgment. If you can’t clearly articulate what you observed, why it matters, and what you did about it, you’ll struggle both in practice and on the NGN.

Real-World Example: How Documentation Reveals Your Clinical Thinking

You’re caring for a post-op patient. You notice; increasing restlessness, slight tachycardia (HR 102, up from 88), decreased urine output (20 mL over 2 hours) and patient reports feeling “dizzy.”

A weak documentation approach looks like this:

“Patient seems uncomfortable. Vital signs monitored. Will continue to observe.”

This tells us almost nothing. What does “uncomfortable” mean? Which vital signs? Observe for what, exactly?

Compare that to a strong, clinically sound note:

“Patient increasingly restless, reports dizziness. HR elevated from 88 to 102 bpm over past hour. Urine output decreased to 20 mL in 2 hours (expected >30 mL/hr post-op). Possible early hypovolemia. MD notified. IV rate increased per order. Will reassess vitals and UOP q15min.”

The second example demonstrates critical thinking in writing. You’ve recognized cues (restlessness, tachycardia, decreased UOP), analyzed them (possible hypovolemia), taken action (notified MD, increased IV rate), and set a plan for evaluation (reassess in 15 minutes).

This is exactly what the NGN is testing.

This is exactly what keeps patients alive.

Why Nursing Students Struggle with Documentation (And What to Do About It)

Most nursing students don’t get enough hands-on documentation practice. You might observe preceptors charting or complete a few care plans but writing clear, concise, legally sound nursing notes under pressure is a skill that takes repetition.

Schools focus on med-surg knowledge and skills competencies. Documentation gets treated like something you’ll “pick up” during clinicals. Except you don’t. Not really.

Common Documentation Mistakes

• Too vague. “Patient doing better” tells me nothing. Better how? Based on what assessment data?
• Too wordy. Long, rambling narratives that bury the important stuff. If I have to read three paragraphs to find out your patient’s blood pressure dropped, you’ve lost me.
• Missing clinical reasoning. Just listing tasks without explaining why. “Administered morphine 2mg IV” is incomplete without “for patient-reported pain 7/10, left hip.”
• Inconsistent terminology. Using casual language instead of proper medical terms. “Patient peed” vs. “Patient voided 250 mL clear yellow urine.”
• Skipping the “so what?” Failing to connect observations to nursing actions. You noted the patient’s respiratory rate is 28. Now what? What did you do about it?

How to Improve Your Documentation Skills Before the NGN

1. Practice with real case studies. Use NGN-style practice questions that require you to interpret documentation. Resources like NCSBN’s official NGN practice exams  and UWorld are excellent for this. You need exposure to how the exam presents clinical information and what it expects you to do with it.
2. Learn SBAR and DAR formats. These frameworks train you to think systematically and write concisely.

• SBAR (Situation, Background, Assessment, Recommendation): Great for handoffs and communicating with providers
• DAR (Data, Action, Response): Efficient for focused charting

Once you internalize these structures, they become automatic. You won’t waste time figuring out how to organize your thoughts.

3. Review actual nursing notes during clinicals. Ask your preceptor if you can review recent documentation. Notice how experienced nurses phrase things, what they prioritize, and how they justify interventions. Pay attention to what gets charted and what doesn’t.
4. Write out your clinical reasoning. After each patient encounter, practice writing a one-paragraph note that includes:

• What you observed (assessment data)
• What you think is happening (nursing diagnosis or hypothesis)
• What you did (interventions)
• What happened next (evaluation)

This mirrors both the CJMM and real-world charting. Do this enough times and it stops feeling artificial. It becomes how you think.

5. Study medical terminology and abbreviations. You can’t document effectively if you’re unsure whether to write “dyspnea” or “difficulty breathing,” or if you mix up “q.d.” and “q.i.d.” And yes, some abbreviations are on the Joint Commission’s “Do Not Use” list—know them. Using a banned abbreviation in your documentation can be a patient safety issue and a legal liability.
6. Get comfortable with EHR systems. Many schools use simulation EHRs like EPIC or Cerner in labs. Spend extra time familiarizing yourself with where to chart assessments, medications, I&Os, and nursing notes. The more comfortable you are navigating these systems, the faster and more accurate your documentation becomes.

Speed matters. On a busy shift, you don’t have 10 minutes to hunt for the right charting field.

How Testavia Helps You Master NGN Documentation

At Testavia, we built our NGN prep around one truth: documentation isn’t just a checkbox. It’s a clinical skill that deserves focused, deliberate practice.

Our practice questions mirror the exact thinking processes you’ll use on exam day; interpreting patient data, prioritizing nursing actions and applying clinical judgment through realistic case scenarios.

We train you to think, analyze and document like a nurse.

The Bottom Line: Writing Is Nursing

You can’t separate writing from nursing competence. The ability to clearly document patient care is inseparable from the ability to provide safe, effective care.

If you can articulate what you see, why it matters and what you’re doing about it, on paper and in practice, you’re already thinking like the nurse you’re becoming.

So yes, work on your pharmacology. Master your pathophysiology. Know your lab values cold.

But don’t sleep on your writing skills.

Practice documenting every chance you get. Learn to write with clarity, precision, and purpose. Because when you’re standing in front of the computer at 2 a.m. on your first night shift, or sitting in that testing center staring at an NGN case study, your ability to think critically and communicate clearly in writing won’t just help you pass.

It’ll help you become the kind of nurse your patients deserve.Ready to sharpen your clinical judgment and documentation skills? Explore Testavia’s NGN practice tools and start preparing the smart way.

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