Where can I find more information about the NCLEX and Next Generation NCLEX item types?
More information on item types can be found in the following locations:
- NCLEX Tutorial
- NCLEX Exam Preview
- Sample Pack
- Next Generation NCLEX Resources
What should a candidate expect when they see an NCLEX Highlight item?
Highlight items are presented as a sentence or several sentences forming a paragraph. The candidate must click to highlight and select text as a response to the item. Not all text included in the sentence or paragraph is enabled to be selected. In such cases, the candidate will see the ø symbol displayed when the mouse hovers over the text. This indicates the text is not a response option, and the candidate will not be able to select it. Text that is enabled to be selected is identified by a highlighted hue when the mouse hovers over the test. The candidate should review any remaining text, select their response choice(s) and click submit to move to the next item. Please visit the NCLEX Candidate Tutorial in the Prepare section at NCLEX.com for an opportunity to see and practice NCLEX item types.
When will the new exam format go in effect?
The new NCLEX exam format, which includes Next Generation NCLEX clinical judgment items, became effective April 1, 2023.
Where can I get more information on the Next Generation NCLEX (NGN)?
Please visit the Next Generation NCLEX (NGN) section for more information. The NGN Resources section also contains publications and journal articles related to NGN and clinical judgment. NCSBN has provided information about NGN at annual NCLEX Conferences as well as NCLEX regional conferences and other seminars scheduled at the request of nursing regulatory bodies.
What are NGN case study and stand-alone items?
NGN case study items are item sets composed of six items that are presented as part of an unfolding case scenario that are displayed with exhibit tabs such as Nurses’ Notes, Vital Signs, and Diagnostic Results. NGN stand-alone items are items administered independent of other items. Any type of item can be used in a stand-alone item. For more information on stand-alone items, please read the Spring 2021 issue of Next Generation News.
What are the benefits of implementing new scoring methods?
The new scoring methods allow for moving beyond the current scoring model that is based on candidates' responses being scored as 'all correct' or 'all incorrect'. The new partial credit scoring model allows for polytomous scoring methods meaning some items are no longer scored as completely correct or incorrect. Currently, Multiple Response Select all that Apply only allows for all correct or incorrect scores. The new polytomous models gives candidates points for partial understanding.
When will the new scoring methods go into effect?
The new scoring methods went into effect April 1, 2023 with the 2023 NCLEX launch.
Are traditional NCLEX Multiple Response Select all that Apply items scored with partial credits in the new 2023 NCLEX with NGN items?
Yes, the traditional NCLEX Multiple Response Select all that Apply items are scored using the +/- scoring method with the new NCLEX with NGN items that went live on April 1, 2023.
Are candidates able to test with accommodations for the new 2023 NCLEX with NGN items?
Candidates will follow the same process as the NCLEX to request testing accommodations and are encouraged to contact their nursing regulatory body for more information.
What changes in the NCLEX Test Plans were made with the launch of the Next Generation NCLEX (NGN)?
Beginning with the 2021 NCLEX-RN and NCLEX-PN Practice Analyses, NCSBN asked respondents regarding the relevancy of clinical judgment while performing entry-level nursing activities. Data gathered from the Practice Analyses inform the subsequent NCLEX-RN and NCLEX-PN Test Plans. With the launch of the Next Generation NCLEX (NGN) in April 2023, updated NCLEX-RN and NCLEX-PN Test Plans also become effective with clinical judgment represented as an NCLEX Integrated Process.
Are items in case studies dependent on the correct response to a prior item in the same set?
Each case study includes a client scenario and follows Layer 3 of the NCSBN Clinical Judgment Measurement Model (NCJMM) in sequential order focused on each step from "Recognize Cues" through "Evaluate Outcomes". Each item within a case study is independent of each other and scored accordingly. Candidates will not be able to go back to view previous responses and care is taken to avoid cuing within each case study. More information about how NGN items are scored can be found in this article.
Do items provide the candidate with normal reference ranges?
Beginning with the launch of the Next Generation NCLEX, items that contain a numeric laboratory value will include the corresponding normal reference range.
Why did NCSBN change the NCLEX?
The NCLEX measures the foundational knowledge and skills needed for safe nursing practice for entry-level nurses, regardless of academic background. Every three years NCSBN conducts a practice analysis to evaluate the knowledge, skills, and abilities needed for entry-level nurses and to evaluate the validity of the test plan that guides content distribution of the licensure examination. The practice analyses have highlighted changes in healthcare including an increase in acutely ill clients. Nurses are responsible for a significant proportion of the judgments and decisions made in healthcare and newly licensed nurses are required to make progressively more complex decisions about patients.
In 2009, NCSBN reviewed several research reports and engaged in professional discussions with nursing experts on the importance of clinical judgment in the nursing profession. This led to funding a thorough literature review on the subject and culminated in a comprehensive white paper. The report provided an overview of the current nursing theories and models of clinical decision-making, along with empirical research on factors that affect decision-making in nursing. Specifically, the report found that 50% of entry-level nurses were involved in practice errors (Smith & Crawford 2002) and a subsequent study by Brennan et al. (2004) found that 65% of entry-level nurse errors were related to poor clinical decision-making. In addition, Saintsing et al. (2011) reported that only 20% of employers were satisfied with decision-making abilities of entry-level nurses.
Between 2012 and 2014 NCSBN collaborated on two studies as part of a strategic job analysis. The fundamental conclusions from these studies provided further evidence of the importance of clinical judgment in entry-level nursing. One major finding was that clinical judgment was one of the top five required skills needed upon entry into the field. Interestingly, two other high priority skills in the top five were problem solving and critical thinking skills, which themselves are vital to clinical judgment. The other two were related to professional communication and active listening.
The RN Nursing Knowledge Survey from 2017 provided additional evidence of the importance of clinical judgment. The overall importance of clinical judgment was rated between ‘important’ and ‘critically important’ by newly licensed RNs, RN educators and RN supervisors. It was also similarly rated across the facility categories of hospital, long-term care, community-based care, and other. The overall result is consistent with previous research showing that clinical judgment is essential to the safe practice of nursing at the entry level.
A panel of subject matter experts consisting of PN Educators, PN Clinicians and Nurse regulators was convened to compare the activity statements included in the 2018 LPN/VN Practice Analysis to the elements of the NCSBN Clinical Judgment Measurement Model (NCJMM). The findings indicated that the entry-level PN was expected to provide care using the nursing process framework and make the necessary clinical judgments within their scope of practice. The NCJMM elements that were most often cited as essential to the practice of the entry-level PN were recognize cues, analyze cues and take action. The element least associated with the entry-level PN activities was prioritize hypotheses. Given these findings, the Next Generation NCLEX item types and NCJMM represent a valid and reliable measurement of PN competence and will be incorporated into the NCLEX-PN examination.
What standards does NCSBN use when developing a new test?
NCSBN has conducted multi-year studies to support the development of Next Generation NCLEX (NGN). Research studies analyzed items and documented the validity of these items to measure clinical judgment. Validity evidence included 1) the extent to which clinical judgment can be measured, 2) numerous item writing panels comprised of nurse faculty to write items aligned with the NCSBN Clinical Judgment Measurement Model (NCJMM), 3) nursing experts (nursing faculty, clinical educators, clinicians and numerous committees made up of experienced nursing experts) reviewed items to ensure the measurement and content was accurate and correctly classified document the validity of the items to measure clinical judgment, and 4) ensuring that items are statistically sound and reflect contemporary practice.
Standards used in the development of all aspects of the NGN project included:
AERA, APA and NCME Standards for Educational and Psychological Testing (2014).
International Guidelines on Computer-Based and Internet-Delivered Testing (2010).
ETS Standards for Quality and Fairness (2014).
Association of Test Publishers (ATP) and the Institute for Credentialing Excellence (ICE) (2017).
How does NCSBN define Clinical Judgment for purposes of a Next Generation NCLEX (NGN)?
To develop a valid and reliable means of measuring clinical judgment, NCSBN conducted extensive reviews of the literature in nursing, decision theory and testing. The result was the assessment framework referred to as the NCSBN Clinical Judgment Measurement Model (NCJMM).
It is important to note that the NCJMM is a framework designed for and specific to testing and should not be construed as a replacement for other evidence-based theories of nursing theory or practice. In particular, the NCJMM does not compete with the Nursing Process or specific pedagogical or andragogical models around the teaching of clinical judgment. Rather, it provides a systematic, evidence-based framework for measuring whether nurse licensure candidates demonstrate at least minimal competence with respect to clinical judgment and decision making.
For the purposes of the NCLEX, Layers 3 and 4 of the NCJMM guide item writers in the development of NGN content; Layer 3 elements provide the primary measurement focus for items and the Layer 4 elements provide context. Each of the Layer 3 and Layer 4 elements are defined in more detail in the publications on the NGN resource page.
What role did nurses play in Next Generation NCLEX (NGN) research?
Nursing professionals served as the pillars and foundation on which the NGN research, and the NCLEX, is built upon. This included hundreds of nurses participating in various research studies, thousands of nurses providing feedback after formal NGN presentations, and over 250,000 aspiring nurses taking the NGN research section. Clinicians, clinical educators and nurse faculty have played a pivotal role and were consulted at every stage of the NGN research project.
What is the composition of item writing and review panels?
The item writing and item review panels are generally a group of 6-10 nursing professionals who are representative of all the U.S. regions and Canadian provinces that use the NCLEX for licensure. Additionally, these educators and clinicians each have a distinct expertise area to ensure a broad range of nursing experience and context. You can read more about NGN item development panels in the Summer 2018 edition of the NGN Newsletter. Information about volunteer is available on the Exam Development Opportunities page.
What research was conducted to validate the new item types?
Focus group studies, usability studies and cognitive labs studies were employed in the early stages of development to ensure item types were not introducing any construct irrelevant variance into candidate responding. After validation from these multiple methods, items were developed and field tested within the Special Research Section to gather actual responses from candidates. This data provided confirmatory evidence that the item types were measuring as expected based on the empirical results
Did NCSBN work with test preparation and publishing companies to develop questions?
NCSBN provided information to test preparation and publishing companies prior to the launch of NGN on the NCLEX exam. This was after the NGN research was validated and the test design was determined.
When did the new NCLEX format go in effect?
The Next Generation NCLEX became effective April 1, 2023.
How can educators prepare students?
Educators can begin incorporating the clinical judgment measurement model into their curriculum immediately. The model can be used in a variety of nursing education settings, such as simulation labs, clinical rotation post-conference, and standard written exams. The action model template provided in the Spring 2019 Next Generation NCLEX newsletter is a useful tool to develop clinical judgment assessments for students.
Will the cost of the exam change?
No. The cost of the exam has not changed with the launch of NGN clinical judgment items on the NCLEX Exam.
What are the benefits of implementing new scoring methods?
The new scoring methods evaluate partial knowledge. Currently the Multiple Response Select all that Apply items only allow for all correct or incorrect scores. With the new polytomous models, candidates can get points for partial understanding.
How can educators prepare their students for the new scoring methods?
Educators can best prepare their students by reviewing the Summer 2021 issue of Next Generation NCLEX News on scoring methods and the 2023 Test Plans. Educators can also join our mailing list for informational updates.
Are Multiple Response Select all that Apply items be scored with partial credits in the NGN exam?
Yes, all NCLEX Multiple Response Select all that Apply items are scored using the +/- scoring method on the NGN Exam that went live on April 1, 2023.
Does NCSBN offer or recommend any tools or resources that allow educators to create their own NGN-style items and case studies?
NCSBN does not offer such tools. However, we have provided publishers and vendors with the most current and accurate information available to support their incorporation of NGN clinical judgment items into new or existing product offerings. NCSBN doesn’t endorse any product or publisher and encourages educators, institutions and candidates to research various offerings to determine which will best support their needs.
