NCLEX Updates and Whats Changing

All About The New Next Gen NCLEX

In late-August 2019, the National Council of State Boards of Nursing (NCSBN) announced that the NCLEX will be undergoing format changes and test updates. The Next Generation NCLEX—as it’s being called—will be released in 2023. Here’s what you need to know.

[ FREE RESOURCES: Next Gen NCLEX® (NGN) for Nursing Educators ]

New NCLEX Date: When does Next Gen NCLEX Start?

The Next Gen NCLEX will begin on April 1, 2023, as confirmed by the NCSBN. Nursing students that began nursing school in or after Fall 2021 will be tested with this new version of the NCLEX.

New NCLEX: Conceptual Changes


According to the NCSBN, clinical judgment is linked to 46% of all tasks performed by entry-level nurses, but, recent research has identified a lack of clinical judgment ability amongst novice nurses. Medical errors are the third leading cause of death in the United States, and only one-fifth of employers are satisfied with new nurses’ decision-making ability. In a 2011 report, Saintsing et al. reported that nearly 50% of novice nurses are involved in a nursing care error. 

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In an effort to remedy these trends, the Next Gen NCLEX will seek to measure clinical judgment ability. As the NCSBN is researching and developing the next version of the exam, it is operationally defining “clinical judgment” as “the observed outcome of critical thinking and decision-making…an iterative process that uses nursing knowledge to:

  1. Observe and assess presenting situations
  2. Identify a prioritized client concern
  3. Generate the best possible evidence-based solutions to deliver safe client care”

Next Gen NCLEX Format Changes: New Item Types


For NCLEX administrations between July 2017 and December 2018, candidates were given the option to complete a special research section that evaluated clinical judgment ability. 85% of test-takers opted to take it, and NCSBN used data from these candidates to validate the need for a revision to the exam and to test the validity of new item types.

The following new item types have been finalized for the Next Gen NCLEX:

Extended Drag-and-Drop Items

Extended drag-and-drop items ask candidates to pair items from two columns. For example, you may be presented with a list of clients and a description of their symptoms. Then, you will have to pair room assignments with client scenarios.

Cloze (Drop down) Items

Cloze (drop down) items present candidates with a narrative case study and then ask for as many as six responses regarding the proper course of care.

Matrix Grid Items

Matrix items provide a scenario and client data and then require candidates to make judgments about the findings, checking appropriate boxes in a supporting matrix.

Enhanced Hot Spot

Enhanced hot spot items also present a scenario and client data. Candidates are asked to highlight specific sections in the scenario to answer questions.

The new items on the Next Gen NCLEX seek to simulate the work nurses do on a day-to-day basis, testing candidates in their critical thinking, judgment, and decision-making skills. Though clinical knowledge is not explicitly tested in any of these question types, a clinical fluency is assumed and imperative for success. When the NCSBN tested these new item types in 2017-2018, candidates took about 1 minute to complete each item.

Next Generation NCLEX: What’s Next?

The NCSBN is still continuing their research and analyzing data. Of particular focus is an investigation into the technology needed to support new question types. The cloze question types, for example, have more than one question within one item, and some other question types may not have just a single right answer. The NCLEX scoring structure is likely to change, too, because current scoring methods cannot adequately score the new question items. The NCSBN is working on cementing the technology to smoothly administer and score these types of items.

Though specific research for a Next Gen NCLEX-PN has not started, the NCSBN did indicate that it intends to release a new version of the NCLEX-RN and NCLEX-PN at the same time. The earliest the new exams would be administered is 2023. It’s possible that additional special research sections may appear on either the NCLEX-RN or on the NCLEX-PN in administrations until then, although the NCSBN has not formally announced any plans. If a special research section is included in your test administration, you’ll likely be notified ahead of time and be given the choice to opt-in. 

For now, the NCLEX is not changing, so if you are planning on taking the NCLEX before 2023, you can free up some brain space and not worry about what the Next Gen version will look like. Continue to prep for the current version of the exam, and work to become an expert in its structure and content.

Check out our Next Generation NCLEX hub for nurse educators.

KEEP STUDYING: What’s Tested on the NCLEX-RN? ]