What Nurses Should Know about the Next Generation NCLEX

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A new and improved National Council Licensure Examination (NCLEX) is coming soon, called the Next Generation NCLEX, Next Gen NCLEX or NGN. The National Council of State Boards of Nursing (NCSBN) has been working towards the Next Gen NCLEX since late August 2019, which becomes effective on April 1, 2023. Although the exam wasn’t completely overhauled, nor is it radically different, it contains significant changes prospective nurses should know to help better prepare them to pass the NCLEX and pursue state licensure.

Why Did the NCLEX Change?

The NCSBN determined that 46% of all tasks entry-level nurses performed had direct links to clinical judgment, but research indicated that novice nurses had inferior clinical judgment abilities. To help ensure new nurses have the skills they need to avoid nursing errors, the organization created the NGN. The new exam seeks to measure the test-taker’s critical thinking and decision-making abilities, which combined is known as clinical judgment.

What’s Changed on the Next Generation NCLEX?

The NGN includes several new items that seek to simulate what occurs in a nurse’s typical workday, utilizing case studies seen in the real world. The most significant change is a switch to the NCSBN Clinical Judgment Measurement Model which places a stronger emphasis on clinical judgment.

The NCSBN applied the new model to both the NCLEX-RN for registered nurses and the NCLEX-PN for practical and vocational nurses, creating a next-generation exam for nurse graduates in either field. However, the NGN for PNs won’t include prioritization or hypothesis as these aren’t reflected in their scope of practice.

Understanding the New NCLEX Scoring Model

The new scoring model extends the current scoring model to give credit for partial understanding. This type of scoring is known as a polytomous scoring model. In the previous NCLEX, questions received a score of either correct or incorrect. Test takers had to correctly answer every part of a multi-part question to receive credit.

The NGN’s polytomous scoring model gives partial credit when a candidate correctly answers some parts of a multi-part question. Previously, if the candidate answered any part of a multi-part question wrong, the entire question was counted as incorrect. Under the new model, they receive points for each part they get right instead of zero points because they missed one thing. Based on the question, the NGN utilizes three polytomous scoring models, including:

• 0/1 Scoring
• +/- Scoring
• Rationale Scoring

The raw score received in the new scoring model is then converted into scores on the NCLEX scale. The total scored items on the current NCLEX range between 60 and 130, while the NGN’s range is 70 to 135. Candidates still receive a pass or fail result and not a numbered score. The new scoring model allows for better differentiation between candidates’ overall skills, abilities and knowledge.

NCLEX Test Question Types

The Next Gen NCLEX includes current NCLEX-style items and new question types, with some question types just extended versions of questions found on the previous exam. Today’s NCLEX consists of a minimum of 75 questions and a maximum of 145, while the Next Gen NCLEX has a minimum of 85 and a maximum of 150. NGN question types include:

• Extended Multiple Response: Multiple response items are similar to the current NCLEX but have been extended in that candidates may choose one or more answer options. Extended multiple response questions have more options available and utilize partial credit scoring. The NGN includes three extended multiple response question types:
  • SATA (Select All That Apply)
  • Select N Item Type (N equals a pre-set number of selections required)
  • Multiple Response Grouping (2 to 5 groupings with 2 to 4 options, like several SATA questions in a table format)

• Extended Drag and Drop: Drag and drop items are like current NCLEX ordered response questions that allow candidates to drag response options from a list into the appropriate answer spaces. However, in the extended version, the candidate may not have as many answer spaces as response options, meaning they have leftover responses. The NGN has two types of extended drag and drop question types:
  • Cloze (minimum of 4 and maximum of 10 items on a provided list must be dragged and dropped to one or more response targets)
  • Rationale (contains 1 sentence with 1 cause and 1 effect or 1 sentence with 1 cause and 2 effects, and appropriate responses must be dragged and dropped from the list provided)

• Drop-Down: These question types have candidates select one option from a drop-down list of words or phrases within sentences, tables and charts. Each question may include more than one drop-down list. The NGN has three types of drop-down question types:
  • Cloze (1 or more drop-down options to complete a paragraph, with 3 to 5 options per drop-down per sentence and 1 to 5 drop-down lists per paragraph)
  • Rationale (contains 1 sentence with 1 cause and 1 effect or 1 sentence with 1 cause and 2 effects, and appropriate responses must be selected from the drop-down list provided)
  • Table (same as Drop-Down Rationale question types only in table format)

• Enhanced Hot Spot/Highlighting: Requires candidates to highlight pre-defined words or phrases by clicking on them to select their answer. Enhanced hot spot items may present part of a client’s medical record and have candidates select the correct words or phrases to answer the question or may present a scenario and client data, and candidates highlight words or phrases in the scenario to answer the question. The NGN has two types of enhanced hot spot question types:
  • Text (requires selection of parts of the text to determine the critical action, with a maximum of 10 options)
  • Table (same as Text question type in table format)

• Matrix/Grid: Requires selecting one or more answer options for each row and/or column to measure multiple aspects of the clinical scenario. These question types provide a scenario and client information, and candidates must make judgments about the findings by checking the appropriate boxes in the matrix. The NGN has two matrix question types:
  • Multiple Choice (contains 4 to 10 rows, with 2 to 3 options/columns, and each row must have 1 response option selected before continuing to the next row)
  • Multiple Response (contains 2 to 10 columns with 4 to 7 rows, and each column must have 1 response option selected before continuing to the next column)

• Standalone Items: These question types are new to the NGN and require candidates to use the information received in Case Studies to answer the question. They include 6-question sets, progressing from recognizing and analyzing findings to making clinical judgments to providing appropriate care and evaluating the client’s response. The NGN has two standalone items:
  • Bowtie (addresses all 6 of the NCSBN Clinical Judgment Measurement Model in one question, requiring candidates to drag and drop items from a series of targets to move forward)
  • Trend (addresses multiple steps of the NCSBN Clinical Judgment Measurement Model by having candidates review information over time and can utilize any type of question response)

What Stayed the Same?

The NCSBN considers the Next Gen NCLEX an extension of the current NCLEX because it’s not extensively different from the previous version. The new test design simply places more emphasis on the need for entry-level nurses to have a strong foundation of clinical judgment through sound critical thinking and decision-making to ensure patient safety. Thus, several things haven’t changed.

Time Allowed and Delivery Method

Candidates still have five hours to finish the NGN, just like the current NCLEX. The NGN also still utilizes variable-length computerized adaptive testing. Computer adaptive tests adjust the difficulty level based on the test taker’s responses, providing a better assessment of their overall knowledge and skills. However, items within a Case Study in the NGN are static, not adaptive.

Testing Accommodations

Like the current NCLEX, candidates applying to take the NGN can still request testing accommodations. They must follow the same process used on the former licensure exam. Candidates should contact their nursing regulatory body to receive more information on testing accommodations.

NCLEX Passing Standards

The Board evaluates passing standards for the NCLEX every three years to protect the public by ensuring minimal competence of entry-level nurses. On December 6, 2022, the NCSBN Board of Directors voted to uphold the current passing standards of the NCLEX-RN and NCLEX-PN for the Next Gen NCLEX. 

The current passing standards reflect the amount of nursing ability required at this time to practice competently at the entry level and include:

• 0.00 Logits for the NCLEX-RN
• -0.18 Logits for the NCLEX-PN

Both passing standards remain in effect until March 31, 2026, when the Board analyzes them again to determine whether they’re still relevant. The NCSBN coordinates its passing standard analysis to coincide with the test plan evaluation, which also occurs every three years.

If you began nursing school in the Fall of 2021 or later, you must pass the NGN, not the previous version of the NCLEX. Ensure you’re better prepared for the new, improved exam by browsing the NCSBN’s Next Gen NCLEX resources and Next Gen Tips and Tricks from the Organization for Associate Degree Nursing. Use our NCLEX Tips to help you pass whether it’s your first or fifth attempt.

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