What Educators Need to Know Now About Next Generation NCLEX

  • 06 June, 2022

Calling all nursing educators!!! We've been hearing about "the change" for years and now it's actually happening! The release of the Next Generation NCLEX (or NGN) is now less than a year away. The NCSBN plans to begin using the new testing format in April 2023. All students who are currently in a nursing program will be seeing the new format for their tests. So, let's do what we do best - prepare the next generation of nurses!

What Educators Need to Know Now About Next Generation NCLEX

1. Why is the NCLEX changing?

The planning for NGN first started in 2009 when the NCSBN began a thorough review on the preparedness of new nurses to make clinically-sound judgements on their own. The discovery was pretty harsh - we were delivering nurses into the clinical setting with book smarts but not "street smarts" so to speak. The exact statistics were that 50% of entry-level nurses had some sort of an error in clinical practice; 65% of the errors these entry-level nurses were making were directly related to poor clinical judgement and decision-making. And employers were having to provide more on-the-job education to help the new nurses in their decision-making because only 20% of employers felt satisfied that new graduates could make competent decisions.

Since problem-solving, critical thinking, and clinical judgement are the top skills required of new nurses, something needed to change to ensure our new graduates had those skills. There are a lot of people out there who can memorize the facts needed to pass an exam in nursing school, but not everyone can think through a problem critically to devise a safe clinical plan. So, the NCSBN is turning to the Clinical Judgement Model (CJM) as the basis to measure whether new nursing graduates are minimally competent in their clinical judgement. The nursing process is woven into the NGN, so your students still need to ADPIE, but the CJM is the method used to measure competency. You can see below how the nursing process aligns with CJM. The NCSBN (and all experienced nurses working with new grads) wants graduating students to be able to look at any situation and recognize what information is important, what it could mean, what they should do about the situation, and what the result of those actions is.

2. How can I prepare my students?

The best way we can prepare students to pass the NCLEX and be prepared to enter the clinical setting as new nurses is to build their critical thinking skills. Our students need to graduate and enter the nursing field thinking like a nurse! We need to help them improve their ability to distinguish between normal and abnormal assessment data and recognize distracting information that they shouldn't focus on. Our students need to take all the book knowledge they have gained and apply it in any situation. If we are merely teaching students to memorize information from the textbook but they cannot apply it in the clinical setting or at the client's bedside, then we are not adequately preparing them to enter the workspace or to pass the NGN.

Students learn these skills by doing and repeating. Simulation labs are a great place to work on those application skills, but it's not possible to be in the simulation lab every day. So, the next best option is using case studies. Let the student begin to picture themselves in the case study and think through what they would do. That would help the student think in the same way they need to at the bedside and thus prepare them to think that way when they are sitting at the computer taking the NGN exam!

We also need to be making sure our students understand the "why" behind answers, whether on a case study or an exam. Simply knowing that the correct answer was "hold medication and notify physician" is not enough. WHY are they holding and notifying instead of giving the medication? Learning why will help the student be able to apply the knowledge better when it is needed. Knowing the why helps build their critical thinking and reasoning skills. And those are the skills nurses need to have sound clinical judgement.

Learning to prioritize client needs and actions is a key skill for entry-level nurses and is a key skill for taking the NLCEX. Students can expect to see questions asking them to drag and drop the clients into the order they would prioritize their care. Help them understand why they need to see the client who is 3 hours post-op with a suddenly saturated surgical dressing before the client screaming with pain rated 10/10. They need to be able to prioritize the day-to-day nursing actions as well. Will they first see the client who needs a daily dressing change or draw a CBC on the client who needs to confirm their H&H is stable before discharge?

The entire nursing education system feels the pressure to redo the question format of classroom exams and NCLEX study materials. Every publishing company and test-prep program is writing case studies and new NGN format questions right now (trust me - I've been writing for several!), so there will be resources for you to introduce the format to your students. The best thing you can do as a classroom and clinical instructor is focus on the way students think, and the rest will fall into place. If they can think through a case study, then it doesn't matter whether they have seen the question format - they will know the answer!

3. When is the NCLEX changing and what will it look like?

The NCSBN plans to introduce the NGN in April 2023, so all students who are currently enrolled in a nursing program will experience NGN. NCLEX test takers have been experiencing NGN format questions as part of the research section of the exam for a while now, but in April 2023, the entire exam will shift to that format. The new format questions have been fairly well received by test-takers - many students who have received the research questions say they actually prefer them to traditional questions!

The time allotted to each test-taker is not changing. Students will still have 6 hours to complete the exam. The exams will include the unfolding case studies covering each step of the CJM - so 6 items for each case study. The rest of the exam will cover traditional style questions similar to what is seen now on the NCLEX. If the computer-adaptive technology (CAT) determines there is more information needed to determine competency, a test-taker may see several of the alternative "stand-alone" item types, such as bowtie or trend questions which test all 6 steps of the CJM in 1 item.

I'm sure as we move into the 2022-2023 school year and the NGN is finalized in preparation for the April 2023 rollout, we will begin to get inundated with information. But until then, don't panic! Lots of work is being done behind the scenes through every company who does anything to prepare students to pass the NCLEX to help everyone be prepared! And don't forget, you can participate in the future development of NCLEX items as a volunteer! The NCSBN has an application to volunteer as an item writer or item reviewer, or you can volunteer be on a panel of judges https://www.ncsbn.org/exam-volunteer-opportunities.htm. This is a great opportunity to hone your question writing skills, contribute to the nursing profession, and gain continuing education credit!

NGN resources. NCSBN. (n.d.). Retrieved March 31, 2022, from https://www.ncsbn.org/ngn-resources.htm

About the Author: Lana Wilkins, MSN, BSN, RN

Lana Wilkins is a Registered Nurse with over 16 years of professional nursing. She is a nursing educator, consultant, Subject Matter Expert, and writer with a passion for helping students and new nurses. She holds a B.S. in Nursing from the University of Oklahoma and a M.S. in Nursing Education from Western Governors University. Outside of the world of nursing she can be found managing the chaos of 2 kids, a husband, and a cat, being crafty, or spending time with friends.

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