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What You Need to Know About Changes to the NCLEX Exam

Miss Ai
14 Jun, 2024

What You Need to Know About Changes to the NCLEX Exam

The NCLEX exam is changing in spring 2023 to better emphasize clinical judgment. Here’s what you can expect on the new test.

Featured ImageCredit: Pekic / Getty Images

Every new nurse must pass the National Council Licensure Examination (NCLEX) to get their state license. The test determines if a nursing graduate has the skills and knowledge to practice nursing. To meet this goal, the National Council of State Boards of Nursing (NCSBN) developed and continues to update a sound and legally defensible examination.

Ongoing assessments of the NCLEX exams use research from entry-level nurses. The organization then refines the tests to keep pace with rapidly changing healthcare.

The result of these assessments has led to the Next Generation NCLEX (NGN). The NCSBN is in the final stages of research and testing. The new test questions and format will be released no earlier than 2023.

So what does this mean for nursing students? This page covers updates to the test and how nursing students can prepare for the NGN.

Next Generation NCLEX: Updates and What’s Changing

The NCSBN Next Gen NCLEX is expected to have significant changes when it’s released in 2023 or later. The new test hopes to evaluate new graduates better on their critical thinking skills for nurses and determine if they are ready to make the right decisions about patient care.

About every three years, the NCSBN assesses the NCLEX. The goal of the test is to assess new graduates’ readiness and ability to work in a hospital. Recently, NCSBN found that nurses routinely care for critically ill patients and are responsible for complex decisions. Findings from the 2017 RN Nursing Knowledge Survey confirm this.

The NCSBN then researched and tested questions. Data was gathered during the 2017-2018 NCLEX exam period. Students taking the registered nurse (RN) and practical nurse version of the test were asked if they would complete a special research section. These test questions were not used in their NCLEX score.

The aim of the new test questions is to better simulate a hospital’s work setting and set the groundwork for better patient outcomes. The focus is on evaluating nursing students’ judgment, decision-making, and critical thinking skills.

However, the test does not explicitly test clinical knowledge. Instead, students must have nursing clinical skills to succeed, so clinical knowledge must be used to get the correct answer.

During data gathering, researchers tested these new types of questions. They found that test-takers took around one minute to answer each one.

Conceptual Changes

The Next Generation NCLEX measures the clinical judgment model. It starts with assessing a client’s needs.

The nurse forms a hypothesis, refines it, and evaluates the outcomes. When the outcome is unsatisfactory, the hypothesis is re-evaluated and refined again. The nurse determines the correct action, which would result in strong clinical decision-making.

Nurses must consider several environmental and individual factors. For example, environmental factors include the local setting, observations, medical records, task complexity, and cultural competence in nursing. Individual nursing factors must also be accounted for, including a nurse’s personal skill level, prior experience, and knowledge.

The exam tests If a nurse recognizes relevant information from different sources.

1. The test questions give information and the nurse must decide what is relevant and what is irrelevant.

2. Next, the questions lead the test-taker to clinical presentations where they prioritize the information.

3. They must also determine what more is needed to establish a hypothesis.

4. The questions then lead the nurse through prioritizing hypotheses according to urgency. The test-taker must generate solutions that would result in a desirable outcome.

5. Finally, the candidate indicates the appropriate action and evaluates the outcomes. The test also asks to consider what other interventions may have been more effective.

These conceptual NCLEX changes were brought about in a pilot study in 2016, where the NCSBN discovered that clinical knowledge is essential but not enough to support clinical judgment. They define clinical judgment as “the observable outcome of decision-making and critical thinking.”

The pilot study also demonstrated that the development of clinical judgment is progressive. There was no single element that predicted ability. It was the combination of different elements that translated to better judgment.

Poor judgment may be a significant contributing factor to a 2016 Johns Hopkins Medicine study that suggested medical errors are the third leading cause of death in the U.S. Researchers analyzed death rate data over eight years.

Safety experts calculated more than 250,000 deaths each year are due to medical errors. This is higher than respiratory diseases as a cause of death. Increased clinical judgment skills can lessen these errors and increase patient safety.