Educator Blog

What You Need to Know About the Next Generation NCLEX®

Oct 17, 2018, 11:43 AM
<4-min. read> The National Council of the State Boards of Nursing (NCSBN) is taking an analytical look at the NCLEX. The goal? To determine what changes are needed to assess student nurses’ clinical judgment. The NCSBN is referring to this project as the Next Generation NCLEX.
Worried about this potential change? Don’t be. In an interview with ATI, Philip Dickison, PhD, RN, NCSBN Chief Officer of Examinations, said, “I’ve heard stories that we’re going to implement this in 2019. I can tell you, no, that’s not true.” What is true? We’ve got the details from Dr. Dickison and NCSBN.Sheryl Sommer interviews Phil Dickison, NCSBN, at the ATI National Nurse Educator Summit in April 2018 about Next Generation NCLEX.

Specifically, NCSBN’s expert team of psychometricians and researchers are following eight evidence-based steps:

1) DEVELOP A CLINICAL JUDGMENT MODELNCSBN created The Clinical Judgment Model.

NCSBN developed a model consisting of five interacting layers that illustrate the complex process of clinical judgment, including the context in which decisions are made.


Measuring clinical judgment requires more unique item types than simple multiple response questions with different scoring methodologies, including penalties for answers indicating a lack of clinical judgment.


Students, nurses, and educators have reviewed item prototypes to ensure they represent real-life clinical judgment scenarios.


NCSBN added a “Special Research Section” with new item types for select students to voluntarily answer after completion of the current NCLEX. Their responses don’t impact scores but do provide valuable insight on question fidelity.


Psychometricians have received thousands of results from the NCLEX “Special Research Section.” Ongoing analysis will help determine which item types accurately measure clinical judgment and nursing competence.


In 2019, NCSBN expects to have enough info to determine whether to continue moving forward with the project and begin to explore — and build — the complex technology needed to support the new item types.

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Multiple evaluations will be necessary to compare test questions. NCSBN will scrutinize every item type for those providing the highest accuracy.


An operational phase of testing and building item types will likely take three to four years. The soonest, then, you’ll likely see a new version of NCLEX-RN is 2022-2023.

What Does Next Generation NCLEX Mean for You and Your Students?Faculty member talking with student.

NCSBN’s initiative is both exciting and anxiety-inducing. A new NCLEX means better evaluation of graduates’ readiness for the challenges of real-life nursing practice — and more difficult, in-depth questions that put pass rates at risk.

So, what can you do today to prepare for this potential new future? Look for products that help students sharpen clinical judgment and develop this critical skill. ATI offers a variety of tools to support these crucial objectives:


The new item types likely to appear on the Next Generation NCLEX will be unlike any that nursing students have previously encountered. ATI’s new NCLEX Experience will help acclimate students to these new item types, which will be aimed at measuring, quantifying, and testing their clinical judgment skills.

The NCLEX Experience will comprise an engaging tutorial and mini quiz to provide familiarity and build confidence in successfully answering the new item types on the actual NCLEX.

NURSE'S TOUCH, THE COMMUNICATOR 2.0Developing effective communication skills goes hand-in-hand with developing sound clinical judgment.

Developing effective communication skills goes hand-in-hand with developing sound clinical judgment. One research study1 reported that, “Collaborative dialogue between students, educators, and clinical mentors as role models during nurse-patient interaction is a powerful learning tool in facilitating clinical judgment.”

ATI’s new product Nurse's Touch, The Communicator 2.0, uses simulation to help students develop these essential skills. Students interact with virtual humans in repeated engagements, so they can learn and practice communication techniques for those key conversations they will experience as nurses.


ATI’s Real Life Clinical Reasoning Scenarios addresses vital issues.

Nurses who lack clinical reasoning skills make poorer nursing judgments: They have difficulty differentiating between acute problems and those needing immediate attention. These nurses often fail to detect impending patient deterioration. In addition, they often make inappropriate judgments, such as misidentifying a situation or using faulty logic. ATI’s Real Life Clinical Reasoning Scenarios is specifically aimed at addressing these vital issues.

The product’s computer-based simulations are designed to develop clinical reasoning, while its live-action videos create “emotional fidelity,” engaging students’ mental and emotional abilities. Its “Rational Mode” option provides immediate feedback to students after they make a decision. Students gain exposure to key clinical situations; learn from their errors and the consequences to improve future interactions; and advance their knowledge. Students are able to repeat scenarios until they achieve mastery.

To learn more about these new products, contact your account representative or a member of the ATI team.

New Item TypesStudent uses computer at desk.

The Next Generation NCLEX test will use a complex mix of item types that require nursing students to demonstrate their clinical judgment skills.

Item types being tested include:

  • CLOZE (may be referred to as Drop-Down)
  • Extended Drag-and-Drop (may be referred to as Drag-and-Drop)
  • Dynamic Exhibit
  • Matrix (may be referred to as Extended Multiple Response)
  • Highlight
  • Multiple Selection.

Provide feedback about the Next Generation NCLEX to the National Council of the State Boards of Nursing (NCSBN) at:

  • Mail: 111 East Wacker Drive, Suite 2900, Chicago, IL 60601-4277
  • Phone: 312.525.3600
  • International phone: 011 1 312 525 3600
  • Fax: 312.279.1032
  • Email: [email protected]

 Anna C. van Graan, Martha J.S. Williams, Magdalena P. Koen
Professional Nurses’ Understanding of Clinical Judgment: A Contextual Inquiry
Health SA Gesondheid, Volume 21, December 2016, PP. 280-293

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