Understanding the Next Generation NCLEX (NGN): A Guide for Nurses

The National Council of State Boards of Nursing (NCSBN) assesses the NCLEX every three years to ensure it accurately measures new graduates' readiness to work in a hospital setting. In a recent assessment, the NCSBN discovered that nurses routinely care for critically ill patients and are responsible for making complex decisions. This finding, supported by the 2017 RN Nursing Knowledge Survey, led to significant changes in the exam.

In April 2023, the NCSBN introduced the Next Generation NCLEX (NGN) initiative, marking the most substantial update to the NCLEX in recent years. The NGN emphasizes clinical judgment and decision-making skills, aiming to better reflect the complexities of modern nursing practice and ensure newly licensed nurses are well-prepared for safe and effective patient care.

These changes, now fully implemented, have transformed how the exam evaluates the critical thinking and decision-making skills of nursing candidates. To help candidates navigate this new format, this guide will outline the key changes in the NGN and offer practical advice for exam preparation.

Key Changes in the NGN

1. Clinical Judgment Emphasis

   • The NGN uses the NCSBN Clinical Judgment Measurement Model (NCJMM) to evaluate clinical judgment, recognizing it as essential to nearly all nursing tasks. This model is based on extensive research and analysis.

2. New Question Types

   • Extended Multiple Response: Similar to traditional select-all-that-apply questions but with more options.
   • Extended Drag and Drop: Requires candidates to sequence or categorize information.
   • Matrix/Grid: Involves selecting answers from a table format.
   • Highlight Text: Candidates highlight specific text or data within a given context.
   • Bowtie and Trend: These formats ask candidates to identify key information and trends from clinical scenarios.

   • More Challenging Content

     • Real-world scenarios with multiple variables, requiring nuanced decision-making.
     • Higher-order thinking skills (analysis, synthesis, evaluation) are prioritized over factual recall.
     • Scenario-based questions simulate actual patient care situations, testing knowledge application under pressure.

3. Unfolding Case Studies

   • These simulate real-life clinical scenarios where candidates must analyze and respond to evolving patient situations, demonstrating their ability to make sound clinical judgments over time.

4. Partial Credit Scoring

   • Unlike the previous all-or-nothing scoring system, the NGN allows for partial credit. This means candidates can receive partial points for partially correct answers, providing a more nuanced assessment of their knowledge and decision-making abilities.

   • Scored and Unscored Questions:

     The NGN includes both scored and unscored questions, also known as pretest items. Unscored questions are used to gather data for future exams and do not count towards the candidate’s final score. These pretest items are crucial for the ongoing development and validation of the exam, ensuring its fairness and accuracy. Candidates will not know which questions are unscored, maintaining the integrity of the assessment.

     Minimum and Maximum Questions:

     Candidates must answer a minimum of 85 questions, with up to 150 questions possible if the adaptive testing algorithm requires more data to make a reliable pass/fail decision. This structure ensures a thorough assessment of each candidate’s abilities, as the algorithm adjusts the difficulty of questions based on the candidate's performance. By tailoring the number of questions to the individual, the NGN aims to provide a precise measure of competency and readiness for real-world nursing practice.

How to Prepare for the NGN

To succeed in the NGN, focus on developing your clinical judgment and decision-making skills. Familiarize yourself with the new question formats through the following methods:

1. Practice Exams

   • Utilize practice tests that mimic the NGN format to become comfortable with the new question styles and scoring methods.

2. Case Studies

   • Work through clinical case studies to practice making decisions based on patient information and evolving scenarios.

3. Simulation Labs

   • Participate in simulation-based training to apply clinical judgment in a controlled, hands-on environment.

Resources for NGN Preparation

For more detailed information, refer to resources like the NCSBN and ATI Testing. These organizations along with Med-Challenger's Nurse Certification & NCLEX Exam Review provide comprehensive materials to help you prepare for the updated exam.

As you prepare for the Next Generation NCLEX, focus on honing your clinical judgment and decision-making skills, and familiarize yourself with the new question formats. Comprehensive preparation and a deep understanding of the updated test pattern will be crucial for success in this more rigorous and dynamic examination.