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CHANGES & ITEM TYPES

WHAT WON'T CHANGE FROM THE CURRENT NCLEX

BASIC FACTORS

  • The Next Generation NCLEX will continue to measure the same critical content areas.
  • Most items on the entire exam will be standard NCLEX items.
  • The scoring scale will not change.
  • The exam will remain computer-adaptive.

We asked the NCSBN's Dr. Phil Dickison, the chief architect of the Next Generation NCLEX, to provide more detail on the factors above:

Content areas covered

The reason for changing the NCLEX was to measure clinical judgment, but the exam’s focus won't change in terms of the overall content it covers.

“Just because we’re measuring clinical judgment doesn’t mean all the other stuff that we’ve been measuring is not important; it’s still important,” Dr. Dickison explained.

Majority of item types

Dr. Dickison cleared up a misconception for many that the revised exam will focus exclusively on new NGN-style item types.

“The majority of items on a minimum-length exam will still be the standard NCLEX item types,” he said.

Same scoring scale

"We’ve kept that scale stable for 20 years,” Dr. Dickison said. Going forward from the Next Generation NCLEX, he noted, the exam will continue to offer longitudinal comparisons of nurse ability; scores will be comparable from 4 years ago to a year after the NGN launches.

WHAT WILL CHANGE FROM THE CURRENT NCLEX

BASIC FACTORS

  • Each candidate will see new item types.
  • Students will be presented with case-study items and stand-alone items.
  • Some items on the test will use partial-credit (dichotomous and polytomous).

Next Generation NCLEX items

The Next Gen NCLEX will then measure clinical judgment in two different ways:

1) Case study items that reflect real-world clinical situations and the decisions nurses make to address clients' needs and anticipated outcomes.

2) Stand-alone items that are not part of a case study.

Case study items

Case study items require candidates to respond to items representing each function of clinical judgment in order: recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes.

Partial-credit scoring

The NCSBN's Dr. Dickison said some new item types on the NGN won’t be scored as simply right or wrong. Instead, candidates will receive full, partial, or no credit for an answer based on the selected response.

Stand-alone items

Two stand-alone item types will be offered: the bow-tie and the trend. Candidates who continue beyond the minimum-length exam may receive as many as 6-7 of these item types on the rest of their exam.


NEW ITEM TYPES ON THE NEXT GEN NCLEX

THE MOST SIGNIFICANT CHANGE TO THE TEST WILL BE UNIQUE NEW ITEM TYPES.

The NCSBN researched a variety of item types to determine which best measure clinical judgment. The organization settled on 12 for use with case studies and two for the use of stand-alone items. (A standard multiple-choice item can also be used in a case study.)

WHAT ARE THE NEW ITEM TYPES?

  • Matrix multiple-choice
  • Matrix multiple-response
  • Multiple-response: Select all that apply
  • Multiple-response: Select N
  • Multiple-response: Grouping
  • Drag-and-drop: Cloze
  • Drag-and-drop: Rationale
  • Drop-down: Cloze
  • Drop-down: Rationale
  • Drop-down: Table
  • Highlight: Text
  • Highlight: Table

WHAT IS A CASE STUDY ITEM TYPE?

  • May use a variety of NGN item types
  • Consists of 6 items
  • Includes 1 item for each of the 6 functions of clinical judgment (recognize cues, analyze cue, prioritize hypotheses, generate solutions, take actions, evaluate outcomes) in Layer 3 of the NCJMM.

WHAT ARE STANDALONE ITEM TYPES?

They are broken into two types:

  • Bowtie: Incorporates all 6 functions of clinical judgment in one item. 
  • Trend: May use any one of the NGN Item types; includes data that trend over time; targets one or more of the six Layer 3 clinical judgment functions.

AN INTRODUCTION TO THE CASE STUDY

Case studies are real-world nursing scenarios that focus on the 6 clinical judgment functions of Layer 3 of the NCSBN Clinical Judgment Measurement Model (NCJMM).

TIP: To simplify these functions for students, define them using the questions in parentheses:

  • Recognize cues. (What matters most?)
  • Analyze cues. (What does it mean?)
  • Prioritize hypotheses. (Where do I start?)
  • Generate solutions. (What can I do?)
  • Take action. (What will I do?)
  • Evaluate outcomes. (Did it help?)

THE FORMAT OF CASE STUDIES

Left side: 

Look at the example below. The left side describes the scenario and includes a rendition of a client-care record with tabs for nursing notes, laboratory results, provider orders, vital signs, and history and physical.

Tabs are offered throughout the case study and may include additional information as the case progresses — just like in real life, where a client’s condition changes or more information becomes available.

Right side:

In the example below, you'll see that the right side includes a question to be answered. These questions will be in the form of new item types specially designed to assess clinical judgment.

Once the candidate answers an item, the screen will update and present a new item on the right.

The client information on the left side may remain the same, or new information may be added. (See example below with red arrow.)

Items within a case study are static and are not computer-adaptive. But the NCSBN has indicated that there will be an estimate at the end of each case study.

Intro to case study graphic 1v2

Intro to case study graphic 2 v2
AN INTRODUCTION TO STANDALONE ITEMS

Standalone items are individual questions that are not part of a case study but have a similar format. They are introduced after the minimum number of items.

Stand-alone items target one or more of the clinical judgment functions in Layer 3 of the NCJMM.

Stand-alone items will consist of two item types:

A BOW-TIE ITEM

Bow-tie items address all six steps of the NCJMM in one item. The candidate reads a scenario to recognize whether findings are normal or abnormal (recognize cues), understands the possible complications or medical conditions the client may be experiencing (analyze cues), and identifies possible solutions to address the client’s needs and issues (generate solutions). The candidate then answers the question to determine the most likely cause of the client’s issues (prioritize hypotheses), the appropriate actions to take (take actions), and the parameters to monitor once interventions have been implemented (evaluate outcomes).

TREND ITEM

Trend items are individual items in a scenario in which the candidate reviews information in the medical record that trends over time (from minutes to hours, days, or more). Trend items address one to all of Layer 3 of the NCJMM. Trend items can feature any item response type. Possible tabs include “Nurses’ notes,” “History and physical,” “Laboratory results,” “Vital signs,” “Admission notes,” “Intake and output,” “Progress notes,” “Medications,” “Diagnostic results,” and “Flow sheet.”

Sample of a bow-tie stand-alone item

The nurse is reviewing the client’s assessment data to prepare the client’s plan of care.

> Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address the condition, and two parameters the nurse should monitor to assess the client’s progress.

Sample of Bow-Tie


THE DIFFERENT FORMATS OF CASE STUDY & TREND ITEM TYPES


THE MATRIX ITEM TYPE: MULTIPLE-CHOICE & MULTIPLE RESPONSE

A matrix item type is presented in a table-like format.

A matrix multiple-choice item will have 4-10 rows and 2-3 columns. Each row must have only 1 answer.

A matrix multiple-response will have 4-7 rows and 2-10 columns. Each column must have at least one response. A row can have 0 to all answers.

A clue as to how many answers candidates can or should choose? Look at whether the grid contains circles or boxes. Circles (also known as radio buttons) only allow candidates to choose one option.

 

Matrix examples


THE HIGHLIGHT ITEM TYPE: TEXT & TABLE

On this item type, candidates are instructed to “click to highlight” the appropriate answers to the question.

This item type can be presented in a table format or in a chart tab where the candidate clicks to highlight a token that answers the question. Candidates read a portion of a client medical record (e.g., a nursing note, medical history, lab values, medication record) and then select the words or phrases that answer the question.

The answer can also be part of a sentence. The answer options will be shown when the candidate hovers over a section that is tokenized. The student will then click to choose it as an answer.

Highlight example


    THE DRAG-AND-DROP ITEM TYPE: RATIONALE & CLOZE

    On drag-and-drop item types, the candidate will drag word choices (options) from the word choice box to the targets in the question.

    DRAG-AND-DROP RATIONALE

    • Presents information in a single sentence
    • The sentence contains two targets (dyad) or three targets (triad)
    • Answers are selected from corresponding word boxes and dragged to appropriate targets
    • This item type will have two word-choice boxes with five options each.

    DRAG-AND-DROP CLOZE

    • Presents information in sentence format
    • Contains one to five answer spaces, or targets, that represent a missing word or short phrase
    • Answers are dragged from word-choice box to targets
    • The word-choice box contains 4-10 word choices
    • The word-choice box always includes more word choices than available targets.

    Drag and drop example


    THE MULTIPLE-RESPONSE ITEM TYPE: SELECT ALL THAT APPLY, GROUPING, & SELECT "N"

     

    MULTIPLE-RESPONSE SELECT ALL THAT APPLY

    In this item type, there are 5-10 options. Select 1 to all options to answer the item.

    MULTIPLE-RESPONSE GROUPING

    Presents information in a sentence format with 2-5 small groups of options. Each group contains 2-4 options with 1-4 correct answers. Select 1 to all options in each group to answer the item. The number of correct answers in each group might not be the same.

    MULTIPLE-RESPONSE SELECT “N”

    Presents information in a sentence format with a list of 5-10 options. The number of correct answers is indicated in the stem of the item. Candidates select the appropriate number of options to answer the item.

    MR examples


    THE DROP-DOWN ITEM TYPE: CLOZE, RATIONALE, & TABLE

    DROP-DOWN CLOZE

    • Presents information in sentence format.
    • Contains 2-5 drop downs that represent missing information in the form of a word or short phrase; each drop down has 3-5 options, and the candidate selects an option from each drop down to complete the sentence.

    DROP-DOWN RATIONALE

    • Presents information as a single sentence containing two drop downs (dyad) or three drop downs (triad) that represent missing information in the form of a word or short phrase. The candidate selects the option from each drop down to complete the sentence.

    DROP-DOWN TABLE

    • Presents information in a table containing at least one column and three rows.
    • Each row has one drop down that the candidate must answer.
    • The candidate selects an option from each drop down

    Drop down examples


    DIFFERENCES IN SCORING THE NEXT GENERATION NCLEX

    HOW NEW ITEM TYPES WILL BE SCORED

    With traditional NCLEX items, answers are either right or wrong. Responses may receive zero or one point. This is referred to as dichotomous scoring.

    For NGN-style items, the NCSBN decided to add 2 different scoring methods to allow for partial credit.

    All of the new items will be correct or incorrect. Some will have partial scoring to give a candidate partial credit. This is referred to as polytomous scoring.

    Partial credit scoring can be assigned in different ways:

    • +/- scoring: Candidates earn 1 point for each correct response and lose 1 point for each incorrect response. Scores are summed together to get the item total score. If the summed value is negative, the final score will be truncated to 0.
    • 0/1 scoring: Candidates earn 1 point for each correct response and points are not deleted for incorrect responses. Points are summed together to get the item total score.
    • Dyad/triad: In a dyad, candidates earn one point when both responses in a paired set are answered correctly. In a triad, candidates get one point if they get the cause and one effect correct. The candidate gets two points if they get all correct.
    NOTE: Standard items (Fill-in-the-blank numeric, Multiple choice, Multiple-response select all that apply, Hot spot, and Ordered response) continue to be worth 1 point. (The multiple-choice item can be text or a graphic. In 2023, Multiple-response items will receive partial scoring.)

    WHAT'S THE LATEST FROM THE NCSBN ABOUT CHANGES?

    The National Council of State Boards of Nursing (NCSBN) strives to continually improve the NCLEX to protect the safety of the public. To help you stay abreast of the latest information released by the NCSBN regarding changes to the exam, we've gathered links to the organization's updates, along with ATI's helpful resources, so you can find all the need-to-know information about the Next Generation NCLEX is one convenient site.

    If you prefer to visit the NCSBN's website directly, look for the "Next Generation NCLEX Project" in the far-left column. Or search for "NGN" in the search box in the top-right corner of the organization's home page.

    THE CLINICAL JUDGMENT MEASUREMENT MODEL: A FRAMEWORK FOR THE NEXT GEN NCLEX

    NCSBN'S NEXT GENERATION NCLEX NEWS: NGN FOR LICENSED PRACTICAL/VOCATIONAL NURSES

    Publication  NCSBN (Fall 2020)

    This issue of "Next Generation NCLEX News" from Fall 2020 focuses on information related to expanding the organization’s research for the NGN to include licensed practical/vocational nurses (LPN/VNs). Beginning in October 2020, NCLEX-PN candidates will be able to participate in the NGN Special Research Section (SRS).

    Read More

    NEXT GENERATION NCLEX NEWS: LAYER 4 OF THE NCJMM

    PUBLICATION: NCSBN (Summer 2020)

    This issue of "Next Generation NCLEX News" follows up on the Spring 2020 issue, which illustrated Layer 4 of the NCSBN Clinical Judgment Measurement Model (NCJMM). This issue takes a similar approach in focusing on Layer 4, which are the conditioning factors that influence the nurse's ability to think critically and make a clinical decision.

    Read More

    NCSBN'S CLINICAL JUDGMENT MEASUREMENT MODEL

    VIDEO: JACKLYN CURRIER, OPERATIONS MANAGER, EXAMINATIONS, NCSBN

    Measuring clinical judgment has been one of the major undertakings of the Next Generation NCLEX project. The latest NGN Talk looks at the different parts of the Clinical Judgment Measurement Model -- and what NCSBN is doing to measuring them.

    Read More

    THE CLINICAL JUDGMENT MEASUREMENT MODEL AND ACTION MODEL

    VIDEO: JENN KEATING, OPERATIONS COORDINATOR I, EXAMINATIONS, NCSBN

    To close the gap between what is measured on the NCLEX and what is taught in nursing programs, NCSBN created an action model that incorporates specific concepts of the Clinical Judgment Measurement Model. This NGN Talk looks at the how the action model helps measure the individual steps of clinical judgment while creating realistic and complex clinical scenarios.

    Read More

    INTEGRATING THE NCSBN CLINICAL JUDGMENT MODEL INTO NURSING EDUCATIONAL FRAMEWORKS

    JOURNAL OF NURSING EDUCATION ARTICLE: PHILIP DICKISON, PHD, RN, CHIEF OFFICER, OPERATIONS AND EXAMINATIONS, NCSBN; KATIE A. HAERLING, PHD, RN; AND KATHIE LASATER, EDD, RN, ANEF, FAAN

    Sound nursing clinical judgment is at the core of competent and safe client care. New graduate nurses face increasing challenges that underscore the importance of investigating how nurse educators teach and measure nursing students' abilities to make clinical judgments. This article presents NCSBN’s Clinical Judgment Model and discusses its use.

    Read More

    NEXT GENERATION NCLEX NEWS: CLINICAL JUDGMENT MEASUREMENT MODEL

    PUBLICATION: NCSBN

    This issue describes how NCSBN research identified a list of contextual factors that play a role in the quality of nursing clinical judgment. These factors may be divided into conditions that are internal (education, experience, knowledge, communication, consequences/risk, emotions/perceptions, professional orientation) or external (task complexity, time pressures, distractions, interruptions, professional autonomy) to the nurse.

    Read More

    TEST ITEMS & ITEM WRITING RE: THE NEXT GENERATION NCLEX

    NCSBN'S NEXT GENERATION NCLEX NEWS: STAND-ALONE ITEMS

    PUBLICATION: NCSBN

    This issue of "Next Generation NCLEX News" from Spring 2021 focuses on the unique new item types being called stand-alone items. These will appear along with case studies to assess candidates' clinical judgment skills.

    Read More

    THE NGN CASE STUDY

    PUBLICATION: NCSBN

    This issue of “Next Generation NCLEX News” from Spring 2020 describes case studies, which NCSBN expects to be a hallmark of the NGN exam. Many educators will recognize them as similar to “unfolding cases.”

    Read More

    LIGHTS, CAMERA AND ACTION!

    Article: "In Focus" publication (Winter 2020, pp. 14-17, and Spring 2020, p. 11)

    NCSBN explains its partnership with the CBS Community Partnership Program to educate the public about the NGN project.

    Read More

    THE RIGHT DECISIONS COME FROM THE RIGHT QUESTIONS

    PROMOTIONAL VIDEO: NCSBN EXAMINATIONS

    This video introduced in 2019 helps the general public, as well as those in the nursing profession, understand how nursing requires improved measurement of clinical judgment skills to meet today’s client needs.

    Read More

    THE NEXT GENERATION NCLEX ASKING THE RIGHT QUESTIONS

    PROMOTIONAL VIDEO: NCSBN EXAMINATIONS

    This video created in 2019 is designed to help those in the nursing profession understand how the NGN exam is about asking better questions to help nurses think critically when providing care to a client.

    Read More

    APPROVED NEXT GEN NCLEX ITEM TYPES

    PUBLICATION: NCSBN

    This issue of “Next Generation NCLEX News” from Fall 2019 describes the background and process of developing new item types, including examples of the 5 now approved: extended multiple response, extended drag and drop, cloze (drop down), enhanced hot spot (highlighting), and matrix/grid.

    Read More

    BUILDING A METHOD FOR WRITING CLINICAL JUDGMENT ITEMS FOR ENTRY-LEVEL NURSING EXAMS

    "JOURNAL OF APPLIED TESTING TECHNOLOGY," 2019 SPECIAL ISSUE ON ASSESSMENT IN MEDICAL EDUCATION: JOE BETTS, PHD, NCSP; WILLIAM MUNTEAN, PHD; DOYOUNG KIM, PHD; NATALIE JORION, PHD; AND PHILIP DICKISON, PHD, RN, NCSBN

    Clinical judgment has become an increasingly important aspect of modern health service professionals. To ensure public safety, licensure exams must go beyond assessing only knowledge and skills when evaluating entry-level professions to evaluating clinical judgment. This importance necessitates licensure and certification examinations in these professions to evaluate the extent to which this domain can be measured. This study provides background on a large-scale licensure examination’s process for measuring clinical judgment in entry-level nursing. The item writing and review process is described in detail.

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    TEST VALIDITY

    VIDEO: HONG QIAN, PHD, LEAD PSYCHOMETRICIAN, OPERATIONS & MAINTENANCE, EXAMINATIONS, NCSBN

    This “NGN Talk” from 2019 describes how test validity is the degree to which evidence and theory support the interpretations of test scores. It’s the most important criteria when determining exam quality and a continuous process that helps gather evidence and data that determine sound scoring methods. This talk looks at what’s being done to ensure the validity of the Next Generation NCLEX.

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    ITEM DEVELOPMENT

    VIDEO: BETTY SANDERS, MBA, PMP, CAE, TEST DEVELOPMENT MANAGER, EXAMINATIONS, NCSBN

    This “NGN Talk” from 2019 talks about item development and workshop processes — key aspects of the Next Gen NCLEX project. Hear about the collaborative effort used to imagine, develop, review, and study items to ensure that the NGN effectively measures critical thinking and decision-making.

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    USABILITY STUDIES

    VIDEO: DANIEL HYDZIK, TEST DEVELOPMENT ASSOCIATE, EXAMINATIONS, NCSBN

    This “NGN Talk” from 2019 discusses usability studies, which are conducted to understand the extent to which a specific group can adequately use a product to achieve defined goals. Conducting usability studies improves an end-user experience by addressing certain things during the design process, including learnability.

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    A LOOK AT THE STRATEGIC PRACTICE ANALYSIS & SPECIAL RESEARCH SECTION

    VIDEO: RYAN NOVAK, COORDINATOR, EXAMINATIONS, NCSBN

    This “NGN Talk” from 2019 looks at the Strategic Practice Analysis that helped validate the knowledge, skills, and abilities required of entry-level RNs, as well as the Special Research Section that has been added to some NCLEX-RN candidate’s exams.

    Read More

    NEXT GENERATIN NCLEX ITEM DEVELOPMENT

    PUBLICATION: NCSBN

    This issue of “Next Generation NCLEX News” from summer 2018 provides information on item-prototype development.

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    AN INTRODUCTION TO THE NEXT GENERATION NCLEX

    NEXT GEN NCLEX (NGN) FORUM

    VIDEO: PHIL DICKISON, PHD, RN, CHIEF

    OFFICER, OPERATIONS & EXAMINATIONS, NCSBN

    This March 2021 presentation provides the latest information of the Next Generation NCLEX.

     

     

     

    NEXT GEN NCLEX: AN OVERVIEW

    VIDEO: PHIL DICKISON, PHD, RN, CHIEF

    OFFICER, OPERATIONS & EXAMINATIONS, NCSBN

    This 2018 presentation provides information about various pieces of the Next Generation NCLEX project as it was first being developed.

     

    Read More

    THE BASICS ON NEXT GENERATION NCLEX (NGN) PROJECT

    WEBINAR: NCSBN EXAMINATIONS

    This early webinar from 2018 provides an overview of NGN and covers the Clinical Judgment Model, item-prototype development, and frequently asked questions about the project.

    Read More

    THE BASICS ON NEXT GENERATION (NGN) PROJECT

    POWERPOINT: ALYSON BRENTON, MSN, RN,

    CNL, RN TEST DEVELOPMENT ASSOCIATE

    The Powerpoint that is the basis of the early webinar (above) from 2018 acts as a helpful resource about NGN, the early Clinical Judgment Model, item-prototype development, and frequently asked questions.

    Read More

    NCSBN'S NEXT GENERATION NCLEX ENDEAVORS TO GO BEYOND THE LEADING EDGE

    ARTICLE: "LEADER TO LEADER" BIANNUAL PUBLICATION (SPRING 2018, PP. 15-17)

    Paramount in NCSBN’s approach to potential evolutionary transformation to its exam was the foundational tenet that any changes must be evidence-based.

    Read More

    MEASURING THE RIGHT THINGS

    ARTICLE: "IN FOCUS" MAGAZINE (WINTER 2018)

    This article describes how NCSBN's NGN endeavors to go beyond the leading edge.

    Read More

    CAN CLINICAL JUDGMENT AND DECISION MAKING IN NURSING PRACTICE BE RELIABLY ASSESSED?

    ARTICLE: "LEADER TO LEADER" BIANNUAL PUBLICATION (FALL 2018, PP.13-14)

    This early article from Fall 2018 provided some initial answers to questions educators were asking about NGN.

    Read More

    PEOPLE ALSO ASK ...

    DOES NCLEX GIVE PARTIAL CREDIT FOR SELECT ALL THAT APPLY 2023?

    When candidates are asked a multiple-response select-all-that-apply question on the Next Generation NCLEX, which launches April 1, 2023, they will be able to earn partial credit for the correct answers they choose. 1 point will be deducted for wrong answers, however, though a candidate's score for a single SATA item will not drop below 0.

    WHAT ARE NEXT GENERATION NCLEX QUESTIONS?

    The Next Gen NCLEX item types will be presented as case studies and as standalone items. Both are designed to assess clinical judgment. Within these formats will be 12 item-type formats used within case studies and 2 within standalone items. There are 2 matrix-style formats, 3 multiple-response style, 2 drag-and-drop, 3 drop-down, and 2 highlight.