Page Link ngngreenbanner

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 as the current version of the exam.
  • Most items on the minimum-length exam will be standard NCLEX items.
  • The scoring scale will not change.
  • The Next Generation NCLEX 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 Next Generation NCLEX'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 Next Gen NCLEX 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, 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 a set amount of case studies on the Next Generation NCLEX.
  • The test will use partial-credit scoring.
  • Students may also receive single, standalone, clinical judgment item types.

Case studies

Case studies on the Next Generation NCLEX will provide a good tactic for measuring clinical judgment as each question builds on the next. Case study items will reflect the kind of real-world decisions nurses must make in healthcare settings.

Partial-credit scoring

The NCSBN's Dr. Dickison said some new item types on the Next Generation NCLEX 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.

STANDALONE items

Candidates who continue beyond the the minimum-length exam may receive as much as 10% 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 5 for use with case studies and 2 for use with standalone items.

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 cognitive functions (recognize cues, analyze cue, prioritize hypotheses, generate solutions, take actions, evaluate outcomes).

WHAT ARE STANDALONE ITEM TYPES?

  • Bowtie: Incorporates all 6 cognitive functions in one item. 
  • Trend: May use any NGN Item type; includes data that trends over time.

AN INTRODUCTION TO THE CASE STUDY

Case studies are real-world nursing scenarios that focus on the 6 clinical judgment phases of Layer 3 of the Clinical Judgment Measurement Model.

TIP: To simplify these phases 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: 

Describes the scenario and includes a rendition of a client-care record with tabs for nursing notes, lab notes, healthcare orders, etc.

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:

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.

Case study items may target all the clinical judgment phases in Layer 3 of the Clinical Judgment Measurement Model or only a portion of the phases. For example, the first item may target the “Recognize cues” phase, followed by an item that focuses on “Analyze cues,” followed by an item that is related to recognizing new cues.

Note: Case study items are static and are not computer-adaptive. Only knowledge items on the test will be computer-adaptive.

AN INTRODUCTION TO STANDALONE ITEMS

Standalone items are individual questions that are not part of a case study but have a similar format. 

Each standalone item represents a clinical situation presented either as:

  • A moment in time
  • A review of information over time.

Standalone items target one or more of the clinical judgment phases in Layer 3 of the CJMM.

These questions provide additional data about a candidate’s clinical judgment ability when they are close to the cut score.

Note: Standalone items can pop up anywhere on the exam; they aren’t attached to case studies.



THE DIFFERENT FORMATS OF CASE STUDY ITEM TYPES


THE MATRIX ITEM TYPE: MULTIPLE-CHOICE & MULTIPLE RESPONSE

A matrix item type (also referred to as a grid) is a form of multiple choice and multiple-response. It is presented in a table format with multiple lines of answers. 

These items provide a scenario with associated client data. The candidate then must make judgments about the findings and respond by checking the appropriate boxes in the supporting matrix.

In some grid items, the candidate will be told how many boxes to check; in others, they must decide on their own.

A clue as to how many answers the candidate can or should choose? Look at whether the grid contains circles or boxes.

  • Circles mean the candidate can choose only 1 option in each line of the grid.
  • Boxes mean the candidate can choose multiple options.)

THE HIGHLIGHT ITEM TYPE: TEXT & TABLE

(The formal name for this item type is enhanced-function activation point. It is also referred to as enhanced hot spot.)

On this item type, the test-taker is instructed to “click to highlight” the appropriate answers to the question.

This item type can be presented in a table format or in text format where the test-taker highlights a sentence that helps answer 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 DRAG-AND-DROP ITEM TYPE: CLOZE & RATIONALE

    Other names for this item type:

    • enhanced drag-and-drop
    • extended drag-and-drop
    • advanced drag-and-drop. 

    This item type is similar to the ordered-response item on the current NCLEX. However, in the NGN version, not all responses are necessary to answer the question.

    Some items may offer more response options than answer spaces.

    This item type asks the candidate to complete a scenario using drag-and-drop functionality. For example, the candidate may be presented with a list of assessment findings in one table and a list of findings that require immediate follow-up in a second table. The candidate must choose which of the findings require immediate follow-up and drag the text from the first table to the second table.


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

    You'll also see this referred to as an extended multiple-response.

    This item type sets up a question that asks the candidate to select:

    • All that apply
    • "N" (a set number)
    • A grouping.

    Up to 10 answer options may be presented. Partial credit is allowed for correct answers. A narrative passage may introduce the item.

    NOTE: Scoring of these questions will be different than on standard multiple-choice items because candidates could choose a mix of correct and incorrect answers. If that happens, they will be penalized for choosing an incorrect answer.


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

    Drop-down item types ask the candidate to selection options from a drop-down list to answer a question. The variations can be a form of cloze, rationale, and table formats.

    These items can vary in length and complexity. A single sentence may offer 2 drop-down segments for which the candidate must choose answers. Or the item could be presented as a full paragraph with multiple drop-down segments. The drop-down list of options can be used as words or phrases within a sentence or within tables or charts. 

    Together, each drop-down answer must match and make sense with the other chosen answers.




    DIFFERENCES IN SCORING THE NEXT GENERATION NCLEX

    HOW NEW ITEM TYPES WILL BE SCORED

    With traditional NCLEX items, answers are either right or wrong. Points earned for a correct answer are either either 1 or 0. This is referred to as dichotomous scoring.

    For Next Gen NCLEX-style items, in which the student is trying to choose among multiple responses, the scoring will be more complex. 

    On these new item items, a candidate’s response may be correct, partially correct, or incorrect, which allows the student to receive full credit, partial credit, or no credit. This is referred to as polytomous scoring

    Partial credit scoring can be assigned in 3 different ways:

    • +/- scoring: Candidates receive a point for correct responses and lose a point for incorrect responses. With this scoring, a candidate can over- or underrespond in a “select all that apply” example. 
    • 0/1 scoring: Candidates receive a point for correct responses but do not lose points for incorrect responses.
    • All or nothing: Candidates receive “all or nothing” credit for linked units within an item.

    NOTE: Partial credit does not mean that a candidate gets credit for a wrong answer. The individual only gets partial credit for choosing a correct answer. 


    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

    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

    Published in 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.

    Read More

    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.

    Read More

    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.

    Read More

    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.

    Read More

    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.

    Read More

    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