Ready For Nursing School – Next Generation NCLEX®

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Hi, Everyone, this is The Nursing Podcast from 

Today we are talking about Getting Ready for Nursing School – specifically Next Generation NCLEX

Also knows as Next Gen, or NGN.  The NCSBN is the governing body that makes the NCLEX.  

And for some time now they have been planning on making some updates to the NCLEX.  

So what does this mean for you??  If you will likely be taking your NCLEX before April 2023 then there won’t be any changes made to your NCLEX OTHER than you might be selected for a special research section where they will be testing out new questions.  However, you can exit out of these if you choose and they do not impact your result.  

Sooo, again if you will be taking the NCLEX before April 2023 you should not be expecting any big changes to your NCLEX.  

However, if you will likely be taking it after April 2023 which is the NGN Exam launch, then lets talk about how the NCLEX is changing.  

However, before that let’s talk about why…  

A Strategic Practice Analysis was done in 2013-2014 by the NCSBN, and they found that new nurses are making more difficult decisions.  

According to the NCSBN

  • 65% of nurse errors result from poor clinical decision making
  • 50% of novice nurses are involved in those errors 

So it is difficult for a new nurse to go from reading a text, hearing a lecture, taking a test, to on the job decision making.  Those buzz words you will hear sooo many times.  Critical thinking, clinical judgment, decision making they really do matter.  

So the NCSBN is still in the research phase determining how to reliably assess this clinical decision making.  This “decision-making” that is drastically affecting new nurses and is leading to errors.  

So that is the WHY  

No let’s talk about HOW

Again, they did a Strategic Practice Analysis 

Some of the methods used 

  • First, they reviewed literature from U.S. Department of Labor
    • Work requirements, including job duties and tasks performed and tools and equipment used.  – What are new nurses doing, what tools/equipment are they using???  
    • Worker requirements, including job “KSAOs”.  (skills, abilities, knowledge)
    • Key judgments made on the job and the consequences of making an error in these judgments.
    • Health care and nursing trends are expected to affect the RN job as it is performed now and in the future.
  • Conducted structured interviews with RNs and LPN/VNs to collect additional information regarding the duties, tasks, tools and equipment, and abilities
  • Then created a preliminary list of job duties and tasks, abilities, and tools and equipment.
  • Prioritized the list of knowledge, skills and abilities for inclusion on the NCLEX-RN test specifications

The NCSBN still has the 2019 Test Plan in place and it is 50+ pages document of items covered including things like 

  • Assess client knowledge of advance directives
  • Mix medications from two vials when necessary
  • Perform diagnostic testing (e.g., electrocardiogram, oxygen saturation, glucose monitoring)

And one of the MAIN results from the Analysis was a recommendation to develop new item types for measuring the updated list of knowledge, skills and abilities

Let’s talk about WHAT.  

I would like to break this up into 4 areas, however, know that it really ALL fits together.  

  1. So there is that list of Prioritized knowledge, skills and abilities for inclusion on the NCLEX-RN test specifications
  2. However, as of RIGHT NOW – the Test plan has not been updated.  
  3. Current 2019 NCLEX-RN Test Plan  EFFECTIVE APRIL 1, 2019 THROUGH MARCH 31, 2023
  4. So the updated content is not currently available.  

However, the next 3 pieces of info ARE available  

  1. The second thing I want to talk about is the Questions.  So how are the questions changing.  According to the NCSBN The NGN exam uses case studies like you would see in the real world to reflect the kinds of critical decisions nurses have to make when they are actually on the floor.   It focuses on interactions between nurse and client, the client’s needs and expected outcomes. So your question might be using a piece of an actual nurse’s note, or other pieces of a patients chart.   So we should be seeing more realy world type questions 
  2. THIRD, NEW Question Types  
    1. Extended Multiple Response
      1. The nclex already has multiple response questions (where more than one answer is right) this is the same, just longer 
    2. Extended Drag and Drop 
      1. Similar to ordered response on the current NCLEX where you have a list of items and you order them, except currently ordered response is just prioritization, in the future you must choose which ones to prioritize so you may not use ALL the options
    3. Cloze/Drop down 
      1. So from within a sentence, there will be a missing word and drop down for you to select the correct answer.  
      2. There may be multiple of these in one question.  
      3. In reality, this is similar to a multiple-choice in that there is only one correct answer out of the options, however they are in-line with the question 
    4. Enhanced hot spot
      1. So you will have a question and to answer it you will actually Highlight sections of the actual patient chart.  
    5. Matrix/Grid 
      1. Essentially you have a table, almost like taking a survey where you give each option a rating low med or high.  Effective or ineffective, And you choose which one for each row. Or in some cases you may choose multiple for each row.  
      2. But for a question, you will fill in the entire table. 

So THOSE are the new question types being looked at.  

So new test plan, questions that are more case study, real life type scenarios, new question types.  

AND LASTLY, and most importantly so that you aren’t overwhelmed by some of the question types listed above.  


The questions will be scored differently on the Next Gen NCLEX…  

New scoring types 

The key thing you need to know is this will introduce Partial scoring.  OK this is HUGE.  It will not just be an ALL or nothing anymore.  Ok, so big news, lets go into details.  There are 3 types 

  • 0/1 Scoring – typically used for multiple-choice questions 
    • You get a point for correct answers, no points for incorrect.  
    • This would be used for 
      • Cloze/Drop down
      • Matrix/Grid
      • Mult choice 
  • +/- scoring 
    • This gives you a point for correct and takes away a point for any wrongly selected.   
    • Applies those SATA questions 
    • Applies to matrix/grid where there may be more than one answer
    • You won’t ever go into the negative here just fyi
  • Rationale scoring
    • Is for paired answers, if two answers go together.  
    • Only earn points if both are correct 
    • So for a Cloze/Dropdown
      • The client is at highest risk of developing BLANK evidenced by the client’s BLANK.  
      • You have to get these BOTH correct or NO credit.  
      • The whole point of the question is to gauge full understanding of the relationship for example a cause/effect relationship.  There is no way to give partial credit on these.  

So you might be asking, what does this mean for me?  How can I be prepared.  

Well, let me tell you what we are doing.  

  1. First, we create our content with practicing experts in their field.  They have FIRST hand knowledge of WHAT you need to know to be an OB, mental health, ED, nurse.  They just saw a patient yesterday that had xyz, and they KNOW how to care for that patient.  So even without an updated NSCBN test plan you can count our content to provide you with the MOST important information to be a great NEW nurse.  
  2. Second, we teach the WHY behind the WHAT.  This is very important for critical thinking.  In fact, it is essential.  You can’t apply what you know if you don’t understand it.   You can’t just memorize.  
  3. We are multi-modal – teaching using different methods can help the knowledge sink in more thoroughly and can help you more easily recall what you know.  

Again the whole point of these changes is to gauge your critical thinking.  And these realistic scenarios and case studies can help.  

It will be critical to understanding WHY you do what you do.  Critical thinking is the ability to take what you learn and not only apply it in real-life situations but apply it in real-life situations that may be similar but NOT exactly the same.  They also call this transference.  

Here is a way to look at it…  in a book I may read that the medication Dilantin shouldn’t be administered while a patient is being Tube Fed.  So you are supposed to hold or pause TFs before and 1 hour after Dilantin administration.  

Well in real life someone is not going to come up to you and say  Which of the following medications may be impacted by TF administration.  

  1. Digoxin
  2. Phenytoin (Dilantin)
  3. Diazepam
  4. Etc

NOOOO in real life, this will happen 

Hmm, the Dietitian ordered this rate for TF, but I noticed the patient is losing weight…  I wonder why…  


We are giving a patient Dilantin, but therapeutic levels aren’t being reached.   I wonder why?  

Well, to apply critical thinking to the first scenario.  

Well, we started Dilantin and are holding the patient’s tube feeds for 4 hours a day… maybe that is why… 

Or in the second scenario 

You may notice, ahh well TF wasn’t held, maybe that is why.  

That is critical thinking.  That is the difference between a TEST and real life, and that is what the NCLEX is trying to achieve.  

But really that is what YOU have always been trying to achieve.  So as long as that is your goal you don’t need to change anything!!! 

What will help you be the best nurse you can be.  

Phew… this was a bit longer episode than normal thanks for hanging in there with me.  

But let me leave you with this… You can do this.  I believe in you.  Now go out and be your best self today and as always Happy Nursing.  

Where are You in your nursing journey?

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