What Is the Next Generation NCLEX (NGN)? A Complete Guide

The Next Generation NCLEX (NGN) launched in April 2023 and represents the most significant overhaul of the nursing licensure exam in decades. Rather than testing isolated facts, the NGN evaluates your ability to think through patient situations the way a real nurse must. Understanding the exam’s structure and clinical judgment framework is essential before you sit for the test.

Why the NCLEX Changed to the Next Generation Format

The National Council of State Boards of Nursing (NCSBN) conducted extensive research and found that new nurses were entering practice without the clinical judgment skills needed to keep patients safe. The old exam could measure knowledge recall, but struggled to assess higher-order thinking such as recognizing a deteriorating patient or prioritizing care for multiple clients at once.

To close this gap, the NCSBN developed a new testing model grounded in real-world nursing decision-making. The result is an exam that presents detailed patient scenarios and asks you to reason through them rather than simply recall a fact.

The NCSBN Clinical Judgment Measurement Model (NCJMM)

The heart of the NGN is the NCSBN Clinical Judgment Measurement Model. It describes six cognitive skills that nurses use every time they care for a patient:

• Recognize Cues — identify relevant information from the patient scenario
• Analyze Cues — determine what the information means clinically
• Prioritize Hypotheses — rank possible explanations by urgency and likelihood
• Generate Solutions — identify evidence-based interventions
• Take Action — implement the highest-priority solution
• Evaluate Outcomes — determine whether the intervention worked

Each NGN item type is designed to measure one or more of these skills within a realistic patient case.

New NGN Item Types You Will Encounter

The NGN introduces several new question formats alongside traditional multiple-choice items. You should be comfortable with all of them before test day:

• Extended Multiple Response (EMR) — select all correct options; similar to SATA but scored differently
• Extended Drag-and-Drop — drag items into categories or sequences
• Cloze (Drop-Down) — fill in blanks within a sentence by choosing from drop-down menus
• Enhanced Hot Spot (Highlighting) — highlight words or phrases in a passage that answer the question
• Matrix/Grid — mark yes or no, or select responses for multiple rows and columns
• Bow-Tie — connect causes, actions, and expected outcomes in a structured diagram

Many of these appear as case studies: a six-item set built around one detailed patient scenario, testing multiple clinical judgment skills in sequence.

How the NGN Is Scored

The NGN uses Next Generation Scoring, which allows partial credit on some polytomous items. For example, an Extended Multiple Response item may award full credit for a fully correct response and partial credit for a mostly correct response. This is different from traditional SATA, which is all-or-nothing.

Standalone NGN items and case-study items are weighted differently in your overall result. Your final pass or fail determination is still based on whether your demonstrated ability exceeds the passing standard, but the scoring engine is more nuanced than the old exam.

How to Prepare for the Next Generation NCLEX

Preparing for the NGN requires a different mindset than cramming facts. Focus on the following strategies:

• Practice reading patient scenarios carefully and identifying relevant versus irrelevant information
• Work through each of the six NCJMM cognitive skills systematically for every practice case
• Use NGN-style question banks that include case studies, bow-tie items, and matrix grids
• Review rationales closely — understanding why an answer is correct builds the reasoning skill the exam tests
• Simulate test conditions by timing yourself and avoiding interruptions during practice sessions

Consistent practice with authentic NGN item types is the single best predictor of readiness. The more comfortable you are with the new formats, the less cognitive load the interface creates on exam day, freeing mental energy for the clinical reasoning itself.