NGN Update: What you need to know now

By Susan Sportsman, PhD, RN, ANEF, FAAN

The Next Generation NCLEX (NGN) has been “top of mind” for the Nursing Education community for at least the last two years. Last month Elsevier Education offered a three-hour workshop, highlighting Dr. Phil Dickison, Chief Operating Officer of the National Council of State Board of Nursing (NCSBN), and two nurse educators, Dr. Linda Silvestri and Dr. Donna Ignatavicius. This webinar focused on the most up-to-date information about the NGN.

In his presentation, Dr. Dickison gave some important information of which we should all be aware as we continue our journey toward preparing our students for the NGN. Here are several points that I felt were particularly helpful.

The introduction of the NGN into the NCLEX-RN and NCLEX-PN testing of new graduates will DEFINITELY begin with the April 2023 cycle of testing.

At least 680,000 test takers opened the research component in the NCLEX-RN Exam and approximately 340,000 test takers took an average of 15 research items that were not counted in their score. Since January of 2020, more than 1000 questions have been tested. Finally, the NCSBN is confident that the technology works!

Three types of test questions will be a part of the NGN NCLEX:

    • Case Studies: involve a real-world nursing scenario accompanied by multiple (typically 18) test items. Case studies use up to six test items, which target multiple cognitive elements of the Clinical Judgment Measurement Model (recognize cues, analyze cues, prioritize hypotheses, generate solutions, take action, evaluate outcomes), using a scenario.
    • Standalone Items: Individual items that are not part of a case study, which may target one or more of the Clinical Judgement Measurement Model elements.
    • Multiple Choice/Multiple Response: test items that require students to apply clinical knowledge, using testing approaches currently on the NCLEX.

The Case studies and standalone items will include several new item types introduced specifically for the NGN. 

Many of these new item types are familiar to those who have been following the updates provided by the NCSBN, including highlighting, Cloze (Pull-Down Menu), Matrix/Grid, and Extended Multiple Response, Extended Drag & Drop. Examples can be found here.

Two newer item types to be used with the Case Studies and the Standalone items include the   Bow-tie item (so named because it looks like a bow tie) and the Trend item.

Like all the NGN-type items, the left side of the screen in these two types of items include clinical data. In the Bow-tie item, the left side of the screen may include one or more tabs. Possible tabs include Nurses’ Notes, History and Physical, Laboratory Results, Vital Signs, Admission Notes, Intake and Output, Progress Notes, Medications, Diagnostic Results, and Flow Sheets. Possible tabs in Trend items include Nurses’ Notes, History & Physical, Laboratory Results, Vital Signs, Admission Notes, Intake and Output, Progress notes, Medications, Diagnostic Results, and Flow Sheets.

    • Bow-tie items address all six steps of the Clinical Judgment Measurement Model (CJMM) in one item. The test-take must read the data outlined on the left side of the testing screen and then determine 1) if findings are normal or abnormal, 2) possible complications or medical conditions being experienced by the client, and 3) possible solutions to the problem. The Bow-tie question requires the test-taker to take this identification and analysis of the cues and generation of possible solutions to answer the question. This question type asks what the most likely cause of the client’s issue is (Prioritize Hypotheses), and the most appropriate action to take or the outcomes to evaluate.
    • Trend items, which are individual items, require information gathered over a period of time to answer the questions. Trend items address multiple steps of Layer 3 of the NCJMM, but do not follow the six-item sequence like case studies do.

Next Generation NCLEX NEWS ® SPRING 2021 Next Generation NCLEX®: Stand-alone Items provides clear examples of the content and format of these two types of NGN questions.

Dr. Dickison spoke about the differences in the current NCLEX and NGN version, which is outlined in the chart below.

Comparison of Current and NGN NCLEX

Differences between the current and Next Generation NCLEX exams

In subsequent blog posts we will talk more about ways to develop questions to help students learn to use clinical judgement in faculty-made tests, as well in teaching learning activities, to prepare for the NCLEX-NGN beginning in April 2023. However, I hope this overview will start your creative juices flowing as you consider engaging ways to implement the Clinical Judgment Measurement Mode in your own classrooms.

Let us hear from you about your ideas!


Dickison, P. (2021) Next Generation NCLEX: Update. Accessed April 2021.

______ (2021) Next Generation NCLEX News:  Standalone Items. Accessed April 2021.

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