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Getting Ready for the Next Generation NCLEX
BY LOUIS PILLA
If you’re a student who will take the NCLEX after April 1, 2023, or an educator preparing students for the test, you’ll be faced with an exam that is very similar to, but in some ways very different from, today’s NCLEX.
The Next Generation NCLEX (NGN) will include a significant emphasis on clinical judgment and changes in item types and scoring. In this article, we’ll take a look at some of the major changes.
Focus on Clinical Judgment
With the advent of the NGN, “we’re introducing the
biggest change to the exam since going to computers,” says Jason Schwartz, MS, director of outreach at the National Council of State Boards of Nursing (NCSBN). When the new test plans come out for the RN and PN exam in April 2023, “we’re putting a direct focus on clinical judgment as a new construct on the exam that we’re very interested in measuring based on its importance to safe and effective care.”
To measure clinical judgment, the NCSBN had to go beyond the multiple-choice items the exam contained and include new item types and case studies. “The case study is a brand new element coming to the exam,” says Schwartz, who has worked on the NCLEX and other NCSBN exams since 2010. “That is what we found was the most effective way to measure clinical judgment. These case studies will look very different from today’s NCLEX.”
Each case study will present a real-world nursing scenario followed by six questions. “Our Clinical Judgment Measurement Model essentially breaks clinical judgment down into a sequence of six testable components, each of which becomes a focus of an item in the case study,” according to Schwartz.
Every test taker, says Schwartz, will see three case studies that count toward the score. A graduate might see more than three case studies, but any additional case studies are simply part of the normal data collection that goes on for the NCLEX and do not count toward the pass-fail result.
New Item Types
Besides the case studies, test takers will see several new item types on the NGN, including two specifically designed to measure clinical judgment. They are a trend item and a “bow-tie” item.
For the trend item, a question will provide information about a situation that changes over time. For instance, notes Schwartz, the question might provide information about vital signs at noon, 2 pm, and 4 pm, and ask a question related to the different measurements. The bow-tie item involves a drag-and-drop technology, where the test taker moves things from one place to another. The response area where items are dragged and dropped looks like a bow tie.
Not Radically Different
Although the NGN will feature significant changes, Schwartz cautions against thinking that the NGN is a radically different test from today’s NCLEX. In the NGN, “the overwhelming majority of questions that graduates see will be identical to what they would see today on the test,” he says.
Schwartz uses the analogy of a pizza. “If today’s NCLEX is a cheese pizza, the NGN will be a pepperoni pizza,” he says. “It’s today’s test with some toppings or extras.”
The NCLEX typically changes incrementally every three years, based on a practice analysis, notes Schwartz. That practice analysis is a scientific study designed to tell NCSBN exactly what entry-level nurses are doing at the RN and PN levels. According to Schwartz, the practice analysis measures not only what the nurses are doing but also the frequency and criticality of those tasks.
What’s more, the exam normally changes based on changes in practice, such as phasing out questions about procedures or practices that are no longer performed.
One Passing Standard
The NGN will have one passing standard for both the traditional and the clinical judgment items in the exam. “What we were able to find in our studies is that we could keep a single threshold for the exam,” Schwartz says. “In other words, your work on the clinical judgment and everything else blend into a single ability estimate, and we can maintain a passing standard or pass-fail cut-off. If your ability estimate is at or above that cut-off, you pass; if it’s below, you don’t pass.”
Still Five Hours
Like today’s NCLEX, the NGN’s maximum exam time is five hours. However, today’s NCLEX is 75 to 145 items, and the next generation NCLEX will be 85 to 150 items. Those extra questions, notes Schwartz, allow for the measurement of clinical judgment. “Keep in mind that the length of today’s NCLEX,
as a computerized adaptive test, can vary, depending on who takes the exam,” notes Schwartz.
“Ultimately, when we’re looking at the time limit, what we’re looking at is will the overwhelming majority of candidates have time to finish? Therefore, five hours remain sufficient even though ‘maximum length’ testing candidates will now receive five additional items,” says Schwartz.
Partial Scoring
For the first time, notes Schwartz, test takers will earn partial credit for getting some, but not all, parts of a question correct. “At the item level, partial credit is a major change to the scoring,” Schwartz says.
For instance, imagine a “select all that apply” question that asks about the signs and symptoms of COVID, and three out of the five responses in the query are correct. In the past, a test taker had to get all three responses right to get credit for the question. Otherwise, they would get zero credit. Now, if they answer two of the three, the test taker will get partial credit for that question.
As nursing classes start this fall, students and educators need to keep these changes to the NGN in mind.
Louis Pilla is a seasoned publishing expert with over 20 years of experience providing content and digital products to healthcare audiences.
