This article describes the process faculty used to implement National Council of State Boards of Nursing (NCSBN) Next Generation NCLEX-RN (NGN) test item writing at an urban southeast U.S. ADN program. Attendance at several NGN workshops included learning the clinical reasoning and test question composition process and incorporating NGN test items for use in the formative evaluation process which determines student proficiency in content in the ADN program. These methods integrated by faculty should help the nursing student attain the knowledge, skills, abilities, and reflection to improve critical thinking and ensure competent clinical judgment at the entry level in their careers as registered nurses. Additionally, incorporating NGN using the Clinical Judgment Measurement Model (CJMM) will preclude the potential failure by new graduates to recognize patient complications coupled with the inability to act to rescue patients. The goal for nursing programs implementing NGN is for new graduates delivering competent nursing care, intervening early, and reducing the incidence of patient harm.