Key Takeaways
- NGN was launched in April 2023 to better assess clinical judgment skills
- Six new item types include Extended Multiple Response, Matrix/Grid, Cloze, Hot Spot, Bowtie, and Trend items
- Partial credit scoring allows candidates to earn points for partially correct answers
- Case studies present six sequential questions following the NCJMM framework
- NGN items simulate real-world clinical decision-making using EHR-style interfaces
Next Generation NCLEX (NGN)
The Next Generation NCLEX (NGN) represents a fundamental shift in how nursing competency is assessed. Launched in April 2023, NGN moves beyond testing "what you know" to testing "how you think."
Why NGN Was Developed
NCSBN's research revealed a critical gap: while nursing graduates possessed adequate content knowledge, they often lacked the clinical judgment skills needed to navigate complex, high-acuity patient situations safely. NGN was designed to address this gap.
NGN Item Types
The exam includes six new item types that mimic electronic health records (EHR) and clinical documentation systems:
Extended Multiple Response
An expansion of "Select All That Apply" with up to 10 options. Tests your ability to distinguish relevant from irrelevant clinical cues.
Matrix / Grid
A grid format where you select options across rows and columns. Used for comparing multiple diseases, drug classes, or patient assignments simultaneously.
Cloze (Drop-Down)
Select words or phrases from dropdown menus embedded in sentences, charts, or nurse's notes. Simulates clinical documentation.
Enhanced Hot Spot
Click on specific areas of images (anatomical diagrams, ECG strips, chest X-rays). Tests visual recognition of pathology.
Bowtie
A complex standalone item where you identify:
- A condition (center)
- Two actions to take
- Two parameters to monitor
Tests synthesis of assessment, diagnosis, planning, and evaluation in one visual structure.
Trend Items
Presents data (vital signs, labs) across multiple time points. Tests your ability to recognize deterioration or improvement over time.
Partial Credit Scoring
NGN items use polytomous scoring (partial credit), a departure from traditional all-or-nothing scoring.
| Scoring Type | Example |
|---|---|
| Traditional (Dichotomous) | All correct = 1 point, Any wrong = 0 points |
| NGN (Polytomous) | 4/5 correct options = partial credit |
This acknowledges that clinical decision-making is rarely binary—you may correctly identify a condition but select suboptimal interventions.
Case Studies
NGN Case Studies present six sequential questions that follow the NCSBN Clinical Judgment Measurement Model. Each case study walks you through:
- Recognizing cues from patient data
- Analyzing what those cues mean
- Prioritizing which hypothesis is most concerning
- Generating solutions
- Taking action
- Evaluating outcomes
What is the key difference between traditional NCLEX scoring and NGN scoring?