WHAT WON'T CHANGE FROM THE CURRENT NCLEX
- 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
- 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.
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.
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 Clinical Judgment Measurement Model.
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
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.
Includes the questions 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.
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.
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 action), and the parameters to monitor once interventions have been implemented (evaluate outcomes).
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.”
NOTE: Candidates who answer more than the minimum number of items will be presented with additional questions of which about 6-7 will be NGN stand-alone items.
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.
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.
THE DRAG-AND-DROP ITEM TYPE: CLOZE & RATIONALE
On drag-and-drop item types, the candidate will drag word choices (options) from the word choice box to the targets in the question.
- 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.
- 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.
THE MULTIPLE-RESPONSE ITEM TYPE: SELECT ALL THAT APPLY, SELECT "N," & GROUPING
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 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.
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.
THE DROP-DOWN ITEM TYPE: CLOZE, RATIONALE, & TABLE
- 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.
- 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.
- 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.
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.
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.
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