Next Generation NCLEX: Your Questions Answered

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Hi, this is Ellis with Level Up RN, and this is my longer explainer video for the Next Generation NCLEX or the NGN. So I'm going to start this video much like my last one, so I'm sorry if you already watched that one. Not that sorry. This is all really important information.

So the NGN, the Next Generation NCLEX, what is it? It is the same thing that it used to be, but it has new item types on it. So there are new items that are being added to the NCLEX that allows for the assessment of clinical judgment. So the NCLEX, or the National Council Licensing Exam or Licensure Exam, has the two tracks. There's the RN and the PN, the registered nurse and the practical nurse, and those exams are overseen by the governing body of the National Council of State Boards for Nursing, or the NCSBN. So the NCSBN develops what's called a test plan, and then the NCLEX is constructed using the test plan so that it can hopefully accurately determine whether or not a prospective nurse will make a safe and competent nurse. And to do that, to develop these test plans, the NCSBN performs what's called a practice analysis. So every three years, they do a bunch of research, and they spend a bunch of time and money, and they talk to people in organizations and facilities, and they do research, and they read literature, and they talk to managers and nurses and study outcomes, and they do all of this stuff. And they decide what skills do nurses, RN and PNs, what skills do nurses need to practice safely and competently? And they determined that, overwhelmingly, new nurses are struggling with clinical decision-making.

Now, clinical judgment is a very ambiguous word. It's a very hard-to-define word or term, excuse me. I want to define it as being a nurse because sometimes nursing, right, is hard to define because it just envelops all these different pieces, and it feels intangible. But what it boils down to is the ability to gather data, assess data, know what data to assess and gather, organize and analyze that data, act on that - right?- implement things, provide interventions, evaluate those interventions, right? It's all of that, is clinical judgment. And the NCSBN realized, through their literature review and their research, that entry-level nurses or new nurses were making errors, and a lot of those errors were due to a lack of clinical decision-making, a lack of clinical judgment, a lack of critical thinking, and they decided that the best route would be to change the test plan and develop it in a way that we are able to hopefully assess for that clinical judgment skill so that those prospective nurses demonstrate that they have it before they're allowed to practice as nurses.

And furthermore, employers, managers, facilities, whoever, they were reporting that this was one of the skills that they felt was lacking in entry-level nurses or new-to-nursing nurses. Of the top five skills that the NCSBN - and I'm going to read, excuse me - reported that are needed for nurses, clinical judgment is on that list. Critical thinking is on that list. Problem solving is on that list. And you'll notice problem solving and critical thinking are both skills that are crucial to clinical judgment. The two other top five included professional communication and active listening.

And so what the NCSBN did with all this information is they developed what's called the clinical judgment model, the NCSBN clinical judgment model, and they used that to develop a framework, and that is the qualifying factors that we're assessing for in nurses. And for the RN, those factors are - sorry, I haven't memorized this yet, probably should - recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. Now, if you're in nursing school, then you probably noticed when I listed those that that sounds a lot like the nursing process. Because it basically is the nursing process. This is the way that we are assessing how you're able to implement the nursing process, right? You are using the nursing process, and then we are deciding-- and by we, I mean the test. I'm being the test right now, right? That you're able to recognize cues, you're able to analyze cues, you're able to prioritize hypotheses, right? That's what this model is for. And that's what the framework was for, and that is what the test plan is, and the test plan is how the NCLEX is written, and the NGN is just the new name for it because it's the new version of it. Right? So this applies to PNs as well, although their priorities were focused more on recognizing cues, analyzing cues and taking action. So still falling under the clinical judgment model, still obviously being updated to the NGN. And that is happening April 1st, 2023. So if you're taking your test anywhere near or after that time, then you will be exposed to the NGN.

So what does that mean, right? What's the difference? Well, the difference is the item types and the scoring. But the item types. So let's start there. And before I get into the new item types, I just want to say that I think the most common misconception I've heard-- and honestly, I had this misconception as well. When I heard about the new test, I was like, "Oh my gosh, we have all these new item types. I'm going to have to change all my exams." I'm nursing faculty if everyone doesn't know that. I teach in a BSN program. And so I was like, "How am I going to change all my exams for these new item types?" But I don't have to. Because the NGN is approximately going to be 25% new item types. So about 75% of the exam is still going to be what it's always been. It's going to be those multiple choice and select all that apply and all that kind of stuff, right? But only 25% is going to be this new fancy, scary-- they're not scary, I promise. This new type of item that is really honing in on that clinical judgment. So that's the big difference, right?

So I'm going to make my head a little smaller so that you guys can see better that these are the new question types. So I have some examples on some following slides. And again, I'm sorry, I did have to write notes to myself because this is new to me too, right? This is new to educators, and we're learning how to implement this into our curriculum and how to change our curricula and to help prepare you. And that's what I'm trying to do here. So I'm learning too. So there is going to be extended multiple-response items, and that's similar to what it has been previously. Multiple-response items is-- that's just a fancy way to say select all that applies. So there will be newer versions of that where maybe it will be Select N, meaning select the first three things you're going to do, or select the top five actions the nurse should make, whatever.

The Drop-down Cloze is an option. Cloze is a fancy way to say fill in the blank. Like you're closing the sentence or the phrase, I think, is what it's supposed to mean. So Drop-down literally meaning that you'll have a dropdown box that has options in it. So that could be a dropdown box that has words or phrases. That can be to complete a sentence, to complete a table, to complete a patient's chart. So there will be dropdown options. There will be Drag-and-drop Cloze. So the same concept, meaning there will be a sentence or a table or a chart, or they'll ask you to put things in an order, and you'll be able to drag and drop from one side of the screen to another, one part of the screen to another. And to note with that, they may have named the top five things you need to do next, but they might give you seven options to choose from, right? And what they're trying to do there is trying to challenge you because if there's five options and there's five slots, you can kind of figure it out usually, right? Because you know they all have to be used. And if you know the first three, then you can-- it's 50/50 on those last two, right? But if I give you seven options and five slots, they're not all used. So you have to really do a lot more analysis on which ones apply and what order should they be in.

Bow-Tie question type is kind of a new guy, only in the way it's formatted. So what Bow-Tie means is there's two entries here that lead to one outcome that have two entries on the other end. So it's fat on the outside, and it kind of goes in on the inside so that it makes like the shape of a bowtie. So let's say it could be two problems my client is facing, patient is facing. So two problems my patient is facing, the diagnosis related to that, and two outcomes I might expect, or two interventions I'm going to do, or two interventions, the outcome, and two evaluations. So that's what a Bow-Tie means.

Enhanced Hotspot is usually going to be related to highlighting. So you're going to get text or a chart or a table or a grid or whatever, and you're going to be asked to highlight certain content in that item. And then a matrix or a grid, it's a lot like multiple choice, and I have a demonstration of that that I'll show you.

So scoring is also changing. Prior to this version of the NCLEX, it was All or Nothing - right? - which is what I think a lot of us are used to. It's what a lot of nursing programs do. There's no partial credit. There's no extra credit. There's no rounding, right? So the traditional grading, meaning if you get an item correct, you get a point. If you get it wrong, you get no point. That's just how it is. But now some items are going to be partially scored so that you can get partial credit for them. And that is going to apply immediately, as soon as the exam begins. And while I'm on the topic of scoring, I want to point out that nursing faculty do not know what you need to pass the NCLEX. So that's called a passing standard, right? There's a threshold at which you pass. And I don't know what that is, right? The NCSBN doesn't share that. They have what they call subject-matter experts that decide on the passing standard, and it is a top secret, and we don't know what it is, right? So, for example, if I have a test that has 100 items on it, and you have to get a 75 to pass that test, then we know that you need 75 answers to be correct to meet the passing standard, right, to meet that threshold. The NCLEX, that information is not shared with us. We don't know, right? So it's not that your professors are being coy with you. Or if you're looking for this on the internet, it's not there. It's not there. We don't know what that is.

So I just wanted to include some of the NCSBN examples of the new item types. Again, the extended multiple response is very similar to a select-all-that-apply item, but you'll notice that they're going to give you a lot more information on these. So you can see there's multiple tabs that you can look, health history, nurses' notes, vital signs, lab results, and you can use any or all or however much of that information you need to make the decisions in this item. So like this, for example, is a select-all-that-apply item. Here is an example of the drag and drop. So again, I've got a lot of information that I can review, and then I can drag the assessment findings that require immediate follow-up over to the other side. And like I said, sometimes it's going to give me 10 assessment findings but only give me 4 slots that I can drag them into. Close, and this is the example of the dropdown version. So again, this is just like a fill in the blank. It's just giving me options for it. So, for this example, it's, "The nurse should first address the client's blank, followed by the client's blank." So I use that information on the left side of my screen to make the decision on what we should address first. So, as I think you've hopefully noticed, a lot of these are about prioritizing. What should I do first? What should I assess first? Who should I see first? Those kinds of things.

This is the highlighting option. So, in this case, "What does the nurse need to do to prepare for the client? Click to highlight statements in the transfer report that require action by the nurse prior to the client's arrival." So what do I need to do to prepare for this client? What information do I need to already be acting on before my patient even gets there?

And then matrix or grid. So these are kind of like extended versions of select all that apply, and they can be in this type where I can only pick one bubble per row, right? So this example has potential orders that I might think will happen according to this client's information and then whether or not I think that order is anticipated, not essential, or contraindicated. I can only pick one of those three. But in some items like this, I could pick any or all of those three. Instead of circles, they'll be checkboxes, and I could pick more than one depending on the item style.

So when it comes to scoring, again, the 0/1 Scoring means you get 1 or 0. You get 0 or 1. If you get it correct, you get a point. If you get it wrong, you get no points. And again, that's going to still apply to most of the items on this NCLEX. The +/- Scoring is a little bit more confusing, but I know you're going to like it because it's partial scoring. So this is applied to those items that you can over-respond or maybe under-respond even. So if you pick an answer that's correct, you get 1 point, but if you pick an answer that's incorrect, you get -1 point. So let me scroll back to my multiple response. So say this question - and I'm making it up; I didn't read the whole question - has three correct answers. If I pick all three and that's all I pick, I get 3 points for this item. If I pick two of those answers, I get +1, +1, but then I get -1. So instead of getting 2, I only get 1 point for that question. If I pick all three correct answers but then pick a fourth one, I get +1, +1, +1, -1. So I get a 2 for that one. Now, so that can be good or bad depending on whether you pick enough or pick too many. The good news though is that if I go wild on this question and I pick all of them, then I get those 3 points for the first three, but then I'll get -1, -1, -1, -1, right? And eventually, I'll end up in the negatives. But the good news is that the minimum score you can get for those items is a 0, so I can't go into the negatives. So once I get -1, -1, -1 on my example, I would just get zero points for that question.

The rationale ones are a little bit confusing. So the first style is fine, the dyad. So there's two blanks. So on my example here, I have, "Do X because of X," and if I get both of those correct, I get 1 point. If I get one of those wrong, I get no points. Obviously, if I get them both wrong, I get no points, right? It's where the triad comes in that gets a little more confusing to me. If I get all three correct-- "So X might occur due to Y and Z." So if I get all three of those correct, I get 2 points, and sometimes if I get two of them correct, I'll get 1 point, and then, of course, if I get one or none correct, I get no points. But the partial scoring with those ones seem to be that if I get the initial response incorrect, or if I get the clinical reasoning response, the decision-making response incorrect, then I get the problem incorrect, so I get 0 points. But if I get the clinical reasoning part, the decision-making part correct and one of the other parts correct, then I can get partial credit. I can get 1 point for that. So I think that's just a little bit confusing, but I hope that made sense.

So, ultimately, you got this. We got this. We all got this. Talk to your faculty. Practice your questions. Do your practice stuff. Work hard. And I know you can do this, right? Don't be afraid of these new item types. They're not there to trick you or confuse you or overwhelm you. They are there to make sure that we have safe and competent nurses entering practice, and that should be all of our goals. So if you have any questions, please let me know. If I don't know the answer, I'll figure it out. I'm obviously really passionate and excited about this. I want all my students to be successful and pass their NCLEX, and I want you to as well. So let me know if you have any questions, and good luck.