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September 2019 Update: NCSBN's Next Generation NCLEX

Sep 17, 2019, 13:03 PM
<9-min. read> Dr. Sheryl Sommer, ATI Chief Nursing Officer and Vice President, delivers the latest news about the Next Generation NCLEX. This presentation is based on personal conversations she's had with Dr. Phil Dickison, NCSBN’s Chief Officer, Operations & Examinations, as well as sessions she's attended at recent NCSBN conferences.

Following is a transcription of the video presented by Dr. Sheryl Sommer:

I am pleased to provide an update on the Next Generation NCLEX project. The information was obtained through direct dialogue with Dr. Phil Dickison, as well as from updates at the recent NCLEX conference. NCSBN continues to report that the Next Generation NCLEX's anticipated launch will not be before 2023. They are anticipating that that will be the earliest that any kind of change in the NCLEX will occur.

The reason for focusing on clinical judgment has been under a lot of discussion by NCSBN. And, just as a little bit of a reminder: The results from the 2012 Functional Job Analysis for RNs, as well as the 2015 Strategic Job Analysis for RNs, identified three top activities that were very important in what nurses do. And those included clinical judgment, professional communication, and active listening.

The clinical judgment model is not going to replace the nursing process. There are a lot of similarities between that model and the nursing process, and NCSBN says there is no need for you to change if you're currently using the nursing process in your program as you teach your students.

The Special Research Section has yielded a number of findings, and a couple of them I want to share with you now. Clinical judgment items have been found to be a little more challenging than knowledge items. However, the difference between performance on the two is not really large.

The candidate performance -- also, when you look at areas related to the steps of that clinical judgment model, are very interesting to consider. Student performance from highest to lowest is cue recognition being highest, followed by outcome evaluation, and then judging options, and clinical action at the lowest end.

So what you can do with this particular information is think about it as you focus on activities for your students and learning how to perform clinical judgment. Place more emphasis, perhaps, on some of those areas that students are experiencing more difficulty.

The Next Generation NCLEX item types have been announced by NCSBN. They are currently looking at including five item types. They include the multiple selection, highlight, cloze -- another name for that is drop down -- drag-and-drop, and a matrix item.

The multiple selection item is one that is being used by NCSBN. The candidate is asked to read the question and respond to this scenario. So, as they read, it would say they use the following scenario and client data to answer the question. "The nurse is assessing a 78-year-old female client who is experiencing diarrhea. Information in the box includes data from the client regarding vital signs, physical examination, medications, their activity, diagnostic results. There could be other information, as well, in other scenarios. The question says, "Which of the following actions should the nurse take. Select all that apply." The candidate would then read through all of the options and select each of them that they believe applies to that particular scenario.

Highlight is another type of item. In this item, the candidate's instructed to use the following scenario and client data to answer the question. "The nurse is preparing to administer a dose of medication to a client. The nurse has not administered this med before, and so they're using a drug reference to review the information." The left table shows client information, and the table on the right shows drug reference information. The question to the candidate says, "Which client and drug reference information supports your decision to withhold that medication. Click in both tables to highlight the text that supports your decision." So they would read information related to the client and also the drug reference and click on information that would respond to the question that they're being asked.

Cloze is another item type that NCSBN is using. In this item type, the candidate is to read the case study and then refer to it to answer the question. In this example, the question states a nurse is preparing to administer medications to a client who is two hours post-up following a total knee replacement. The nurse has the following data. You look at that table again with all of that client data. The question to the right states, "Which three medications require clarification prior to administration? Complete the following sentences by choosing from the drop-down lists. Do not use the same medication selection more than once." So they would go to the first place down below that question that says, "The nurse should not administer the ..." Click the down arrow next to select and choose the medication, and then they would indicate the rationale for why they should not administer that particular med. They would do that three times as is instructed in this particular question.

Drag-and-drop is another item type. In this particular item, "A nurse is preparing to make room assignments for the 8 clients below. What room assignments result in a safe assignment for each client? Drag each client below to an appropriate room and bed. A maximum of two clients can occupy each room. Some clients might require a private room based on their diagnosis or condition." The list of clients is below. And to the right is a diagram showing the rooms and beds, as well as the location of the nurse's station.

Matrix is another item type being tested by NCSBN. In this particular item, the candidate would read, "Use the following scenario and client data to answer the question. A nurse is caring for a newborn who has hypoglycemia. Below are assessment findings on admission." There is information regarding the medical history, vital signs, physical exam, diagnostic tests. In this particular example, off to the right, then, the candidate would read, "The nurse is assessing the newborn 30 minutes later. How should the nurse interpret the findings?" For each finding, click to specify whether the finding is unrelated to the diagnosis, an indication that the client's condition is improving, or an indication that the client's condition is worsening." The table down below is where they respond to each of the items in relationship to whether the particular item or finding is related to the diagnosis or not.

Item scoring is another thing that NCSBN is considering. They realize that with new item types, there is a need to look at how items are scored. The first type of scoring is called dichotomous. This is the method that's currently being used in a typical multiple-choice question. The answers are either correct or incorrect, and credit is only given for a correct answer.

Subset scoring is another method that NCSBN has explored. In this type of method, correct answers are given credit; incorrect answers receive no credit.

Off to the left is an example that I'd like to walk through with you to help you understand how subset scoring might work if you had a multiple-selection item with correct responses A, B, D, and E.

A candidate who might have selected B, D, and A would receive 3 points. If a candidate selected A, D, and E, they would receive 0 points, because in that response set, there is an incorrect response. If they selected B and D, they received 2 points. And if they responded with a letter e, they would receive 1 point credit. Plus-minus scoring is another method that NCSBN is looking at. In this particular method, the correct answers are given credit, and any incorrect answers cause credit to be subtracted from the total points that a candidate receives for an item. Again, looking at that multiple-selection item example, with correct responses of B, D, and E, if a candidate responded with B, D, and E, they would receive 3 points: 3 for the correct responses, and they would have no points deducted, because they did not select any incorrect responses.

If they selected B and D, they would receive 2 points. However, if they selected A, D, and E, they would receive 1 point: 2 points for the correct responses, and they would lose a point for the incorrect response they selected.

And, finally, if they were to select A, B, D, and E, they would receive 2 points: 3 for the correct options they selected, and they would lose 1 point for the incorrect option that they selected.

NCSBN has identified that the amount of time required for candidates to respond to Next Generation NCLEX items is approximately one minute. So they aren't taking a lot more time on these item types than they do on the traditional NCLEX item types.

You may be asking yourself how can I prepare my students for the Next Generation NCLEX? We have a couple of recommendations for you. First of all, incorporate clinical judgment in the classroom, lab, simulation, and clinical. Incorporate clinical judgment in as many experiences and activities as you can so that students get a lot of exposure and opportunities to practice it. Second, you might want to go to the NCSBN website and volunteer for item writing.

We also suggest that you explore ATI solutions. We have a number of solutions that are really designed to strengthen students' clinical judgment skills. If you use them, it will help you as you're preparing activities and instructing your students. It will help them as they're trying to gain that information and skill in making clinical judgments.

So what's ahead with NCSBN? A couple of things. First of all the, NCLEX-PN candidates are going to be included in some future research around the Next Generation NCLEX at this time. However, NCSBN has not announced a date as to when that would begin.

Secondly, NCSBN is synchronizing efforts with ATI and others to really help prepare students for the new NCLEX. There is a meeting coming up very soon that ATI has been invited to participate in where NCSBN will be providing additional information to vendors so that we can do a better job preparing products and assessments in the future to prepare students for the Next Generation NCLEX.

There are a couple of resources I'd like to highlight for you. You may want to go to site to be able to get a lot more information about the Next Generation NCLEX. They have an FAQ section, for example, that you may enjoy browsing through just to get information.

You can also go to It's another place you might want to go. Choose the category Next Generation NCLEX. This is where we are constantly loading new information on the blog to keep you updated on the Next Generation NCLEX.

It's been great sharing this new information with you, and I look forward to continuing to share information as NCSBN makes it available to us. Thank you, and have a great day.