The clinical decisions that a nurse has to make on any given day require keen judgment and quick thinking. The latest version of the national competency exam for entry-level nurses takes into account this need for complex decision-making skills in an ever-changing healthcare environment.
Launched in April 2023, the revised National Council Licensure Examination (NCLEX) adds a greater emphasis on clinical decision-making and features a different format. The new exam, dubbed the Next Generation NCLEX (NGN), aims to address concerns about nurses’ ability to manage the increasingly prominent role they play in providing high-quality patient care.
But what is the NCLEX, how is the updated version different, and what NCLEX tips for studying should aspiring nurses keep in mind?
What Is the NCLEX?
Developed by the National Council of State Boards of Nursing (NCSBN), the NCLEX is a prerequisite for becoming a licensed nurse.
Licensed registered nurses (RNs) must hold an Associate Degree in Nursing (ADN), a Bachelor of Science in Nursing (BSN), or a nursing diploma. The NCLEX-RN is what RN candidates must pass as part of their licensing requirements after they complete an RN training program in preparation for starting their careers. Passing the exam shows they have the necessary nursing knowledge and clinical skills to work as a nurse.
Traditionally, the NCLEX has focused on the following areas:
- Protecting medical environments’ safety and efficacy
- Promoting healthcare education and maintenance
- Ensuring patients’ mental health safeguards
- Assisting with patients’ needs, such as medication administration and pain management
Every three years, the NCSBN assesses the healthcare environment and the key skills it requires of nurses. The NCSBN has determined that today’s nurses hold greater responsibility for quickly making complex decisions, especially with patients’ increasing need for acute care. The NCSBN adjusted the contents of the exam, and the new NCLEX includes those changes.
New NCLEX 2023: Changes to the Exam
In 2023, the new NCLEX, or NGN, was launched. Like its predecessor, the NGN uses computer adaptive testing (CAT), which means each answer the candidate provides determines how difficult the next question will be. But updated content on the exam aims to provide a more accurate assessment of new nurses’ clinical judgment skills.
The revised NCLEX also includes new types of questions and an adjusted scoring system.
NCLEX 2023 Content Changes
The NCSBN revised the NCLEX to add questions that measure a candidate’s clinical judgment and decision-making abilities, especially for cases in which the patient is critically ill. This content is designed to show the nursing candidate’s skills in:
- Observing and assessing symptoms
- Gauging the severity of patients’ concerns
- Suggesting evidence-based treatments
NCLEX 2023 Format Changes
The NGN features new formats for questions. Among the new NCLEX 2023 question formats are:
- Drop-down — Presents a case study and asks for up to six responses about what type of care to provide
- Enhanced hot spot — Provides scenarios and patient data in addition to images, asking the candidate to respond to questions by highlighting sections
- Extended drag-and-drop — Offers two columns of items, asking the candidate to note their relationship by placing them in pairs
- Extended multiple choice — Features three versions, including those that ask the candidate to select all that apply, choose a specific number of answers, or review a table and answer multiple questions in a select-all-that-apply format
- Matrix grid — Outlines a scenario and patient information and asks the candidate to check boxes based on their judgment of the situation
- Case studies — Builds on information provided in case studies, with the candidate providing answers to clinical judgment-related questions — using information presented in medical record format — pertaining to each step of patient care
NCLEX 2023 Scoring Changes
The updated version of the NCLEX has up to 10 additional questions on it, with a new scoring system meant to more accurately reflect the complexity of some of the exam’s items. Some items will allow for partial credit, scored using one of the following methods:
- One point is given for each correct response and no points are deducted for incorrect responses
- One point is given for each correct response and one point is deducted for each incorrect response, with the lowest score on an item being zero
- Highlighted units in an item are scored as all correct or all incorrect
New NCLEX Study Tips
Nursing students and graduates can help to ensure they’re ready for the NCLEX — and its changes — by following some key test preparation strategies. These NCLEX study tips include:
NCLEX Tip 1: Start Preparing Early
The first NCLEX tip is to avoid cramming by allowing plenty of time to prepare for the exam. Candidates should spend weeks or months carefully reviewing material they are likely to see on the test, which could require five hours to take. A few ways that aspiring nurses can ensure they’re studying thoroughly include the following:
- Study every day.
- Set goals for what to accomplish in each study session.
- Review any missed answers in practice testing.
NCLEX Tip 2: Know What to Expect
Another helpful NCLEX study tip is to learn what to expect on the exam. In addition to understanding the 2023 changes to the NCLEX, candidates can learn specifics about the exam by downloading test plans from the NCSBN.
Those preparing for the exam can review these NCSBN materials to discover what subject matter will be on the NGN. The plans also show what percentage of the test’s contents each subject will comprise. This information can help candidates focus on the subject matter that is most important, pinpointing which of the exam’s topics they need to work on the most in order to master them.
NCLEX Tip 3: Consider Real-World Scenarios
The third NCLEX study tip is to go beyond simply memorizing facts. The NGN takes the nursing exam’s long-time focus on evidence-based practice a step further. It also presents clinical scenarios that include many of the challenges a nurse might encounter in a real-world setting, such as limited time or space.
Candidates should be ready to show evidence of not only the information they have learned but also how their knowledge and judgment can apply to their decision-making when they’re working with patients.
Gain the Knowledge You Need for 2023’s New NCLEX
If you’re ready to build the knowledge and clinical skills necessary to take the new NCLEX — and begin a career as a nurse — you should explore the Denver College of Nursing’s programs.
Degree programs that can help prepare students to launch their career as an RN include the following:
These focused programs target nursing instruction, building on previously earned general education credits. For those beginning their RN careers, the programs can provide the foundation for NCLEX success. Additionally, ADN-educated nurses who wish to pursue a bachelor’s degree can enroll in the Denver College of Nursing online RN to BSN program. The college also offers an online Master of Science in Nursing (MSN) program for nurses looking to advance their leadership skills.
Discover how the Denver College of Nursing can help you achieve your professional goals as a nurse.
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