What You Need to Know About the Next Generation NCLEX (NGN)

There’s been a lot of buzz about the Next Gen NCLEX (NGN), especially among nursing students and educators. This nursing board exam update is “an exciting enhancement to an already rigorous exam.” And now, it’s just a few months away. 

This nurse’s guide to the Next Gen NCLEX explains the changes, what to expect, and where students can find additional resources. 

What Is NextGen NCLEX?

After nursing school, the next step to becoming a nurse is passing the National Council Licensure Examination (NCLEX). This exam validates the skills of graduate nurses. A passing score proves to the state boards that an individual has the entry-level knowledge and skills to practice safely and effectively in a clinical setting. 

The test changes periodically. The National Council of State Boards of Nursing (NCSBN) updates the test plans every three years to keep up with practice changes. However, the next update will be a significant overhaul of the current board exam. 

The NGN is the latest version of the NCLEX exam coming this spring. It will be administered the same way as previous exams but includes new question types and scoring models. 

The Next Gen text is designed to ask better questions and help nurses think critically to make the right decisions when providing care.

>> Related: What is the NCLEX?

When Will Next Gen NCLEX Start?

The new NCLEX format goes into effect on April 1, 2023. As a result, students starting their nursing programs during or after Fall 2021 will take the Next Gen version for licensure. 

Both the NCLEX-RN for prospective registered nurses and the NCLEX-PN for prospective licensed and vocational nurses are changing.

Why is the NCLEX Changing?

NCLEX is changing to meet the growing demands of the healthcare system. Technologies are developing rapidly. Patients are experiencing more chronic and complex illnesses. The nurse’s job is more challenging today than ever, thanks to increasing regulations, litigation, and electronic EMRs. As the industry changes and patient needs evolve, nurses are increasingly tasked with making complex decisions. 

The NCSBN’s 2013-2014 Strategic Practice Analysis determined that better measurement of critical judgment was essential. Recent data supports the need to assess the critical judgment of graduate nurses better.  

• Medical errors now rank as the third leading cause of death in the US

• 65% of entry-level nurse errors were related to poor clinical decision-making

• 50% of entry-level nurses were involved in practice errors

• Only 20% of employers are satisfied with new nurses’ decision-making abilities

• Clinical judgment is required in up to 46% of all tasks performed by entry-level nurses

The NCSBN defines clinical judgment as “the observed outcome of critical thinking and decision-making” It’s an iterative process that uses nursing knowledge to:

1. Observe and assess cues

2. Identify and prioritize concerns

3. Generate the best possible evidence-based solutions for safe care delivery

According to NCSBN, “NGN is about protecting the public and achieving the best outcomes for clients, nurses and institutions.”

How is the NCLEX Changing?

Based on the 2013-2014 analysis, the national council developed new innovative question types to evaluate graduate nurses better. 

Those questions were tested as a “special research section” following NCLEX tests administered between July 2017 and December 2018. NCLEX-RN and NCLEX-PN exam candidates were given the option to complete the section evaluating clinical judgment ability. The majority of test-takers (85%) opted to take it. NCSBN used the results to prove the need for an exam revision and test the new item types.

The NGN test items attempt to simulate the work that nurses do daily. They evaluate the test taker’s critical thinking, judgment, and decision-making. Next Gen questions use case studies and patient scenarios that nurses will see in the real-life clinical setting.

Next Gen NCLEX Test Items

Based on their analyses, the NCSBN approved new item types to measure nursing judgment on the NGN. 

Extended multiple-response

The extended multiple-response items allow candidates to choose more than one answer. It is similar to the traditional NCLEX multiple response; however, there are more answer options. 

Extended drag-and-drop 

Extended drag-and-drop items ask candidates to move or place responses into answer spaces. This type is similar to the current NCLEX ordered response question format, except that they may not use all the answer choices. Certain items may offer more options than answer spaces.

Cloze (drop-down)  

Cloze (drop-down) items ask candidates to select an option from a drop-down list. On the NGN, there may be more than one drop-down list in the cloze question. For instance, candidates may read a passage and have to choose the right words or phrases within tables, charts, or sentence passages.

Learn how to answer NCLEX drop-down questions in our comprehensive guide.

Enhanced hot spot (highlighting)

Enhanced hot spot items let candidates choose their answers by highlighting certain words or phrases. For example, they may read a nursing note, medical history, or medication record and then be asked to highlight areas or lines that answer the test question. 

Learn how to answer NCLEX highlight questions in our comprehensive guide.

Matrix grid 

Matrix grid items allow candidates to select multiple answers on a chart. Each row or column may require a response. This question type may give a scenario with client data and then require test-takers to judge the findings by checking appropriate boxes in a supporting table. It is useful for measuring multiple aspects of a question in one test item.

Stand-alone: Bow-tie, and Trend items

In addition to these new formats, candidates will also see “stand-alone” items that ask a single question.

•  Bow-tie is one type of “stand-alone” question that candidates must drag and drop answers into a bow-tie shaped figure. 

Source NCSBN

• Trend items are another “stand-alone” type question where candidates are given information to review over time and choose the correct intervention.

Unfolding Case Studies

The NGN will also contain “Unfolding Case Studies.” In these questions, candidates receive information from a medical record, followed by question sets leading them to recognize and analyze findings, make clinical judgments for appropriate care, and evaluate patient response.

The new questions are scored based on the revised NGN scoring model. The previous NCLEX scored items as either ‘all correct’ or ‘all incorrect’ — a dichotomous model. In contrast, the Next Gen scoring model uses three different methods and gives partial credit for some items with multiple points — a polytomous model. 

Where to Find More Information on NGN 

The best resource for students to learn more about the Next Gen exam is the NCSBN site. With the implementation of NGN, they’ve also released updated NCLEX-RN and NCLEX-PN Test Plans, which outline the test content and include practice questions. 

Another resource is NCLEX.com, where you’ll find a sample pack of Next Gen NCLEX-RN and NCLEX-PN case studies and examples.