The upcoming Next Generation NCLEX® has nursing educators and students alike scrambling to ensure they are adequately prepared for a significantly different exam.
There is no doubt that the Next Generation NCLEX (NGN) is the buzz of the nursing community, with more questions than answers right now.
For educators, it is critical to know the how, what, when, where, and why of the Next Generation NCLEX. Let’s look at these questions based on the most current information the National Council of State Boards of Nursing (NCSBN) has made available.
Why is the NCLEX® changing?
Simply put, the purpose of the NGN is to ask questions that better measure a candidate's clinical judgment.
In 2013-2014, the NCSBN performed an analysis of the knowledge and skills required for nursing practice. This analysis (NCSBN Strategic Practice Analysis), along with accompanying research, revealed an increasing minimal level of knowledge and skill required to practice as a nurse.
As technology expands and clients experience more acute and complex illnesses, healthcare is becoming more challenging. As a result, more errors may occur due to poor clinical decision-making by nurses.
This is the impetus for the Next Gen NCLEX—to ask questions that will better measure clinical decision-making, a critical nursing skill.
The NCSBN Clinical Judgment Measurement Model (NCJMM)
The NCJMM is a framework that breaks down the steps a nurse must take to respond appropriately to client needs. Nurses must first recognize the cues that a problem exists and then follow a decision-making process to take action and evaluate the client’s response. The model builds on the nursing process and allows for a more detailed assessment of the thought processes embedded in clinical judgment and also the context surrounding these decisions.
Tier three of the NCJMM is focused on six measurable steps in the clinical decision-making process. These steps inform the six sequential items within NGN case studies and stand-alone items.
- Recognize cues
- Analyze cues
- Prioritize hypotheses
- Generate solutions
- Take actions
- Evaluate outcomes
When is the NCLEX changing?
For years, educators have been wondering, when will the Next Generation NCLEX start? The NCSBN has confirmed that the Next Generation NCLEX exam will launch on April 1, 2023. This means that students who entered nursing school in Fall 2021 will be tested with the NGN.
What is changing about the NCLEX?
The NGN is not a new or separate exam. It is an enhanced version of the current exam designed to better measure a student's clinical judgment. The result is an updated test design that includes the addition of new Next Generation NCLEX item types, changes to the length of the exam, and a new scoring methodology.
Next Gen NCLEX item types
The NCSBN has approved these new item types:
- Extended Multiple Response
- Extended Drag and Drop
- Cloze (Click or drag answer options to fill in the blank)
- Highlight Text
In addition to the current item types found on the exam, the Next Generation NCLEX will introduce unfolding case studies and stand-alone clinical judgment items. Each case study includes a clinical scenario, supporting information, and six questions that require candidates to make multiple decisions. The items are presented in sequential order so candidates progress through all six steps of the NCJMM. Any of the traditional or new Next Generation Nclex item types, except for bowtie, can be used in the case studies.
Clinical judgment stand-alone items also include a diagnosis and supporting information and use either the bowtie or any of the NGN item types. The new stand-alone item types are trend and bowtie. These are different from traditional stand-alone items because they assess the candidate’s understanding of one or more steps within the NCJMM.
We spend 40+ hours developing each Next Generation NCLEX® Case Study
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Minimum/maximum length of the exam
With the introduction of Next Gen questions, the minimum length of the exam will be 85 questions (70 scored and 15 unscored) and the maximum 150 questions (135 scored and 15 unscored). “Within the minimum-length exam, there will be 52 stand-alone questions and 3 case studies (each case has six questions for a total of 18 questions) that will be scored and contribute to the pass/fail decision” (Next Generation NCLEX News, Winter 2022). However, candidates may receive up to two more unscored case studies (total of 5) as part of the pre-test questions.
After the minimum-length exam, candidates have a 10% chance of receiving a clinical judgment stand-alone item administered alongside the traditional items until one of the stopping rules is applied and they pass or fail the exam.
Next Gen NCLEX scoring models
The Next Generation NCLEX introduces a new scoring methodology known as polytomous (partial credit) scoring. For the current exam, each item is scored as either all correct or all incorrect. For the NGN, candidates may receive partial credit for correct responses on items. The NCSBN explained the new scoring rules in-depth in the “Summer 2021 - NGN Newsletter,” but here is a simple breakdown of the new scoring models:
0/1 Scoring Rule
The answer is either correct or incorrect. Candidates get one point for answering correctly and zero points if they answer incorrectly. The best example of this is multiple choice items.
+/- Scoring Rule
Candidates earn points by selecting the correct options, but they lose points by selecting incorrect options. The score for this question is tallied by adding up the correct option points, then subtracting the incorrect option points. If candidates answer more options incorrectly than correctly, the lowest score they can receive is a zero.
Rationales Scoring Rule
The rationale scoring rule is applied to questions assessing relational or paired information. Because the question is assessing a candidate's knowledge of the concept, both answer options must be correct to earn a score of one point. If one or both of the options selected are incorrect, then the score is 0. (Example: The client is at highest risk of developing [select answer] as evidenced by the client’s [select answer].
What is not changing about the NCLEX?
Although the test design is changing, the Next Generation NCLEX will not be an unfamiliar exam. The delivery method, time allotted, and candidate performance report will not change in April 2023.
Despite the fact that there are new item types on the exam, the NCSBN anticipates that candidate response times will be similar to the current exam. Therefore, the time allowed will not change. Candidates will still have up to five hours to complete the NCLEX-RN or NCLEX-PN exam.
The Next Gen NCLEX will continue to be a variable-length computerized adaptive test (CAT). Candidates will continue to receive items targeted at their own ability levels throughout the exam. NGN case studies will be delivered according to the CAT model. A composite score will be computed from the candidate’s responses to each item within the six-question case study, and the score for the entire case study will determine which item will be delivered next to the candidate.
Candidate performance report (CPR)
Candidates will still be issued a performance report, but depending on whether they passed or not, the content will change slightly. If they did not pass, the report will also include a new section on clinical judgment performance, which will include a score for all of the clinical judgment questions. This score will also be broken down into the six steps of the NCJMM: Recognize cues, Analyze cues, Prioritize hypotheses, Generate solutions, Take actions, and Evaluate outcomes.
Evaluating Next Gen NCLEX Items
In many nursing programs, educators are tasked with writing their own items for instruction, homework, and assessment. For some, item-writing is a joy… and for others it is a task. Whether you are writing your own items or evaluating Next Gen NCLEX items for use in your program, be sure to follow the NCSBN’s best practices for item-writing and development. Ask yourself these questions:
- Does the item align with the NCLEX-RN and/or NCLEX-PN Test Plans (blueprint)?
- Does the item content reflect current, relevant, and evidence-based practice?
- Does the item avoid bias?
- Does the item discriminate between low-ability and high-ability students?
- Does the item contribute to valid and reliable tests?
If this seems labor-intensive or overwhelming, you may prefer to use a teaching and learning resource, like UWorld, that includes high-quality NGN-style items with relevant statistical data that can be used for instruction, homework, and low-stakes assessment. Our goal is to provide you with the best practice questions and answers for the exam, so you can spend time preparing students for the bedside.
How can I begin adjusting my program in advance of the Next Gen NCLEX?
As we get closer to April 1, 2023, you may be wondering how you can begin to adjust your program. An important first step is to familiarize yourself with the NCJMM as you update your curriculum and incorporate Next Generation Nclex sample item types in preparation for the upcoming exam changes.
Remember, the NCJMM is simply a framework that enables you to better measure a candidate’s clinical judgment abilities. The framework is designed to work alongside, rather than replace, the nursing process and other nursing theories/models.
Consulting NCJMM will help you determine where you can adjust existing content, integrate new practices, and align evaluation methods with clinical judgment in the style of the NGN.
Read more if you are preparing for the Next Generation NCLEX.
Getting started with the Next Gen NCLEX
Look for online teaching and learning platforms, like UWorld Nursing, that provide high-quality NGN-style practice questions, content-rich rationales, and vivid illustrations that can be assigned in a variety of ways to develop your students’ clinical judgment.
Any resource you use should be doing these four things:
- Actively produce NGN case studies and clinical judgment stand-alone items to build students’ clinical judgment and prepare them for the updated exam.
- Tag all items (NGN and traditional items) and document relevant statistical data to ensure nursing programs can easily report on student learning outcomes for accreditation purposes.
- Prepare to update all items banks to align with the 2023 NCLEX-RN and NCLEX-PN Test Plans and communicate changes to nursing programs.
- Follow the NCSBN for the latest NGN updates as per the NGN newsletter, conference presentations, and webinars.