Everything You Need to Know About the Next Generation NCLEX®

The Next Generation NCLEX® is almost upon us.

Starting April 1, 2023, students in the United States, Canada and Australia will take a revised version of the classic nursing exam that introduces new item types, case studies and scoring methods.

Though nursing students and educators have been buzzing about the changes for a while, the time has finally come to begin classroom preparation for the new test design of the NCLEX®.

Here’s what you need to know about the new-and-improved Next Generation NCLEX®.

Why is the NCLEX® changing?

Every three years, the National Council of State Boards of Nursing performs a detailed practice analysis to help ensure that the NCLEX® testing plan accurately measures safe practice in nursing. The regular job analyses allow the NCSBN to keep the NCLEX® current amid the ever-changing healthcare landscape.

Through research and several years of practice analyses, NCSBN found that new nurses are caring for more critically ill patients, resulting in the need to make increasingly complex clinical judgment decisions in their day-to-day work.

And with the increase in complex decision-making comes an increase in nursing care errors. A commonly cited study in the Journal of Nursing Management found that poor clinical decision-making caused 65% of nursing errors. Of those nursing errors, 50% involved novice nurses.

To create safer nurses and increase test validity, NCSBN began crafting NCLEX® item types to better test critical-thinking skills and clinical judgment. Between July 2017 and December 2022, candidates had the option to try out some of the items in progress through a special research section at the end of the exam.

From this data, NCSBN developed and launched the 2023 Next Generation NCLEX®.

How does the Next Generation NCLEX® measure clinical judgment?

The NCLEX® has always tested clinical judgment, but now it will extend the focus of the assessment and measurement of clinical judgment as a vital aspect of entry-level nursing practice.

Defined by NCSBN as “the observed outcome of critical thinking and decision making,” clinical judgment is the foundation of safe, successful nursing care at any level. The clinical judgment process is how a nurse responds effectively to client needs in all areas of practice.

Testing and nursing experts collaborated to operationalize the clinical judgment process, creating a step-by-step framework called the Clinical Judgment Measurement Model.

Layer 3 of the Clinical Judgment Measurement Model walks students through six steps needed to make an appropriate clinical decision:

1. Recognize Cues
2. Analyze Cues
3. Prioritize Hypotheses
4. Generate Solutions
5. Take actions
6. Evaluate outcomes

These steps tend to become second nature with time, but they are particularly helpful in developing clinical judgment in a nursing student or recent graduate.

On the Next Generation NCLEX®, students will face three unfolding case studies that follow this clinical judgment testing model. Each case study will include six questions, allowing students to demonstrate their knowledge of all six clinical-judgment steps.

What’s new on the Next Generation NCLEX®?

In addition to current item types, the Next Generation NCLEX® also introduces five new item types designed to measure nursing clinical judgment more effectively.

1. Extended Multiple Response

Similar to current item types, Extended Multiple Response allows students to select more than one answer at a time. Unlike current multiple response items, Extended Multiple Response has more possible responses (up to 10) to choose from and will allow students to receive partial credit. This item type may appear as “Select All That Apply,” “Grouping” or “Select ‘N.’”

2. Extended Drag and Drop

Extended Drag and Drop items ask students to choose the correct response options and place them in the appropriate answer spaces. The main difference between the NCLEX®-ordered response items and the new exam is that now Extended Drag and Drop items may have more responses than answer spaces, forcing nurses to practice prioritizing information and allocating resources.

3. Cloze (Drop-Down)

Students may find Cloze items in tables and charts, where they can fill in the blank by choosing an answer from a drop-down list of words and phrases. There may be more than one drop-down list within a single Cloze item. When encountering a Cloze item about a client, a student may not only have to fill in the blanks about what drugs or medications to withhold but also why they would withhold that medication.

4. Enhanced Hot Spot

Enhanced Hot Spot items ask students to select the answer by highlighting pre-defined text. For example, students may read a portion of a nurse’s note, lab values or a client's medical history, then highlight the relevant words or phrases to answer the item. Instead of rote memorization, Enhanced Hot Spot items allow students to show their clinical judgment when faced with an abundance of information.

5. Matrix/Grid

For a Matrix item, students select one or more answer options for each row and/or column in a table, allowing the measurement of several aspects of the clinical scenario within a single item. A Matrix item may be multiple response or multiple choice.

How will Next Generation NCLEX® items be scored?

The current version of the NCLEX® uses dichotomous scoring models, meaning students’ answers to items are either “all correct” or “all incorrect.”

However, the Next Generation NCLEX® uses polytomous scoring models, allowing students to receive partial credit for partial knowledge or understanding.

Three new scoring models will go into effect with the new exam:

1. The 0/1 Method

With the 0/1 Method, students receive one point for every correct answer and zero points for every incorrect answer. Matrix Multiple Choice, Multiple Response ‘Select N’ and Cloze are a few items that use this scoring method.

2. +/- Scoring

In the +/- Scoring Method, students earn one point for giving a correct response and lose one point for giving an incorrect response. This model measures whether students can differentiate the correct answers from the distractors, making it helpful for scoring Multiple Response Select All That Apply and Matrix Multiple Response items.

3. Rationale Scoring

The Rationale Scoring Method gives students one point when both responses in a pair are correct and zero points if they select any incorrect options. The NCSBN will use this scoring model for items that assess paired information, such as cause-and-effect relationships.

How should students and educators prepare for the Next Generation NCLEX®?

The exam changes may seem intimidating, but little about your preparation needs to change. Review courses designed to enhance clinical judgment skills should adapt well to the Next Generation NCLEX®.

Begin by revisiting the must-know core content and incorporate clinical judgment exercises into your review of each topic. Pay particular attention to the “why” and how it relates to causes, signs and symptoms.

Because the new item types build off of the guidelines for current items, learning NCLEX®-specific testing strategies continues to be essential to your success on the new exam.

Then, practice the current and new item types with a comprehensive question bank. When you’re ready, evaluate your preparedness for the exam with a series of readiness exams.

When the new exam comes, you’ll be ready for success and safe nursing practice!

With Hurst Review, you’ll pass the Next Generation NCLEX® the first time — guaranteed. Learn why 400,000+ students have trusted Hurst Review with their nursing careers. Start your seven-day free trial today.

January 27

Hurst Review Staff