Getting Prepared for the Next Generation NCLEX® (NGN): Frequently Asked Questions

Getting Prepared for the Next Generation NCLEX® (NGN): Frequently Asked Questions

In this question and answer session, NGN experts Donna Ignatavicius and Linda Silvestri from Elsevier provide answers to common questions that educators often have about the Next Generation NCLEX.

How will the NGN change the way we teach and learn for both teachers and students, and what can teachers do to adapt their teaching to these changes?

It’s important that our teaching methods encourage “thinking like a nurse” to develop clinical judgment. Purely lecture-based classes need to change. Students should participate actively in class, whether it’s in-person or online. Many nursing programs are using interactive strategies. Consider using a “scrambled classroom” approach, mixing short lectures with activities like case studies and clinical judgment exercises followed by discussions.

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For clinical judgment exercises, choose case studies with NGN-style questions. Start with single cases testing specific cognitive skills like recognizing and analyzing cues. As the course progresses, include unfolding case studies assessing all six cognitive skills.

Why is focusing on clinical judgment important for the NGN, and how will this change affect nursing and future nurses?

Good clinical judgment in nursing isn’t new, but it’s critical. Nurses often struggle with clinical reasoning and judgment. Research shows only a small percentage of new nursing graduates are competent in these skills. Employers are dissatisfied with their clinical judgment. The NCLEX-RN® and NCLEX-PN® currently don’t assess clinical judgment. This needs to change to ensure patient safety. The NCSBN developed the Clinical Judgment Measurement Model (NCJMM) to address this. They focus on cognitive skills needed for clinical judgments. It’s important for nurse educators to prepare nurses who can think and make judgments.

What should educators consider when adapting their curriculum for NGN concepts?

Understand the NCJMM and its cognitive skills in Layer 3. Collaborate among faculty to plan NGN integration. Use case studies as teaching tools and assess for retrieval learning. Single-case studies with NGN questions are great for early courses. As students advance, include more complex case studies.

Are post-exam reviews led by faculty and missed-item analysis assessments valuable?

Yes, they are. Reviews help students identify strengths and weaknesses. They promote retrieval learning. They’re a chance for faculty to use the “scrambled classroom” approach. For instance, if a question is problematic, you can discuss it briefly and ask what the implications would be if each wrong option was chosen.

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Is there a template for creating NGN items?

Guidelines exist for creating NGN items. Templates will be updated based on NCSBN updates. Faculty webinars on NGN item writing are planned.

How will NGN concepts be integrated into the test plan? Should faculty incorporate current NCLEX categories and future NCJMM labels?

The Client Needs framework remains, updated every three years by NCSBN. NCJMM will be integrated into the plan. NGN items will be linked to client needs categories and subcategories. Continue using current item types alongside NGN items.

Should previous course exams coordinate with initial assessments for new courses?

Yes, it fosters retrieval learning. Use questions from prior finals to create pre-course assessments. Make them count towards course grades.

Will schools solely prepare students for NGN items? Is there a curriculum adaptation process?

Nursing programs are responsible for NGN preparation. Use known resources to integrate NGN concepts. Foster clinical judgment skills across the curriculum. Utilize Elsevier’s NGN preparation resources.


Barnett, P. E. (2014). Let’s scramble, not flip, the classroom. Inside Higher Education. Retrieved from

Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.

Dickison, P., Haerling, K.A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing Clinical Judgment Model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72-78.

Gonzalez, L. (2018). Teaching clinical reasoning piece-by piece: A clinical reasoning concept-based learning method. Journal of Nursing Education, 57(12), 727-735.

Herrman, J.W., & Johnson, A.N. (2009). From beta-blockers to boot camp: Preparing students for the NCLEX-RN. Nursing Education Perspectives, 30(6), 384-388.

Kavanaugh, J.M. & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses’ clinical reasoning. Nursing Education Perspectives, 38(2), 57-62.

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