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Preparing for the Next Generation NCLEX Q&A with UWorld’s Director of Nursing

Nurse educators and students asking questions about Next Generation NCLEX.

Depending on whom you talk to, Next Generation NCLEX has been a topic of great excitement, consternation, or concern in the nursing education community in recent years. With 2023 quickly approaching, questions abound about the new testing format and questions types. We sat down with our new Director of Nursing Education, Karen Sutherland PhD, RN, and asked her to offer some insight about NGN from her unique experience and vantage point.

Question 1:

As a former Content Developer for the NCLEX exam and now Director of UWorld Nursing Education, you have a unique perspective on the development and launch of Next Generation NCLEX. What has that experience been like for you?

While working for Pearson Vue, I had an incredible opportunity to join a team of test professionals to research and develop groundbreaking theory and technology to elevate the “gold standard” of high-stakes exams, NCLEX, to the next level. Once the team defined the components of the new clinical judgment model, we created new question types to better measure clinical judgment for the Next Generation NCLEX (NGN) exam. Clinical judgment has been difficult to fully measure with traditional test questions so it was exciting to now be able to more precisely measure the components of clinical judgment and then integrate these new question types into the computer-based adaptive exam.

The rigor and detail that UWorld requires when creating each question aligns with the high standards I experienced while working on NCLEX, so this seemed like a natural next step for me. I have been fortunate to experience the highest quality in test development while working on NCLEX and now the highest quality in nursing education and test preparation at UWorld.

Question 2:

Based on your experience, what is the biggest misconception about NGN?

It appears that some nursing students and faculty are concerned that the NGN questions may be more difficult than traditional questions that already appear on the NCLEX exam. I find this interesting because nurses, as most healthcare professionals, are not taught to think and practice based on isolated facts or concepts. They are taught to recognize signs and symptoms in clusters and in context with what has already happened or what is happening now. They must be able to identify relevant versus irrelevant data to make decisions and provide patient care. Therefore, the Next Generation NCLEX questions will provide the students with a higher fidelity exam and more closely simulate the reality of clinical practice. The new exam will better reflect the realities of teaching and practice.

Question 3:

How is UWorld approaching NGN item development and are there any best practices or lessons learned that you could share?

There are many resources for best practices in test development, and our authors and content developers follow all of them when creating UWorld Nursing products. Best practices include recruiting, training, and retaining faculty nationwide to ensure that UWorld products reflect national, not regional, standards. Once questions are submitted, our internal team of nurses review each question and document that the right answer is right and the wrong answers are wrong using evidence-based references that support expansive rationales to help the learner. This same methodology was implemented during the creation of UWorld’s NGN practice questions, and the result is a growing bank of questions that closely adhere to the prototype questions shared with the community by NCSBN.

Next Generation NCLEX question development is already underway at UWorld. An additional set of assignable NGN questions, including case studies (6 questions) and stand-alone practice questions will be added to our Learning Platform for Nursing soon. Our goal is for students and educators to feel confident when preparing for the NGN launch in 2023.

Question 4:

As a former educator, do you have any words of advice for educators that are beginning to prepare or are concerned about preparing students for NextGen?

As a former nursing educator, I would recommend that faculty focus on teaching the NCSBN Clinical Judgment Measurement Model (NCJMM) to best prepare students for the NGN questions on the exam. The components of the Model can be easily incorporated in both fundamentals and advanced nursing content in the classroom and clinical settings. I also strongly encourage faculty to thoroughly explore the NCSBN website prior. While browsing the website, it is most important to thoroughly read the NCLEX-RN test plan or NCLEX-PN test plan. The Test Plan is based on data collected from RNs (or PNs) that are actively working as clinicians. They indicate which activities are relevant for current practice and then rate the importance and frequency of each activity. This data is analyzed and used to determine the passing standard and the content that will be included on each exam. When authors submit questions, each question must be linked to an activity statement in the Test Plan or it is not included on the exam. UWorld follows this model as well. All UWorld practice questions, including our new NGN questions, are linked to the current Test Plans to ensure that students are fully prepared for success on NCLEX.”


While nursing schools wait with some level of apprehension to see how the changes in the NCLEX will affect their programs, curricula, and instruction, there is general consensus that the long-awaited NGN is a necessary adjustment and will better gauge critical thinking and clinical readiness. As educators continue implementing their transition plans, and with thought leaders like Dr. Sutherland leading the way, there is no doubt that the next generation of nurses will be well-prepared for both exam and clinical success.