The US Nursing License Exam Has Changed: How to Prepare for the New Version of the NCLEX-RN Test

The Nurse Licensure Exam (NCLEX-RN) is the final and most important step for those who want to work as a nurse in America. Starting April 1, 2023, in order to obtain a nursing license in the United States, you need to pass a new test - the NCLEX-RN of the new generation (Next Generation NCLEX or simply NGN).

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The US National Board of Nursing (NCSBN) reviews the NCLEX every three years to determine how well it evaluates nurses' knowledge and relevance to modern medicine. If the test is deemed ineffective, it is changed. That is exactly what happened this year. Nurses in today's hospitals must make difficult decisions when providing patient care. These decisions require an understanding of the entire clinical picture, rather than individual aspects, without which it is impossible to provide safe and effective patient care. And the primary purpose of the NCLEX-RN test is to test how capable a future nurse is of ensuring patient safety. Therefore, the new test format places even more emphasis on the practical knowledge and abilities of future nurses in clinical assessment.

We analyzed these changes in more detail together with school specialists. Concord rusam, which has been preparing immigrants for the U.S. Nurse License Test for 20 years.

What remains the same

Next Generation NCLEX-RN very different from the previous version of the exam (traditional NCLEX-RN). However, much of the testing process remained the same.

1. Computer adaptive testing

The exam continues to use Computer Adaptive Testing (CAT). This means that your answer to each question determines the difficulty of the next question the system will offer you.

A correct answer makes the next question harder, and an incorrect answer makes it easier. The goal is to reach and maintain a certain level of test difficulty. So the computer algorithm will be able to accurately assess your level of knowledge.

2. Types of questions

The NGN uses the same question types as the old NCLEX format. These include:

Multiple choice. The most common form of questions in the NCLEX test isRN. They offer several answers from which you must choose the correct one. They are textual and graphic (pictures and graphs are used as answer options).

Several correct answers. Such questions are considered most complex. You have to choose from the given options. ALL right answers (there may be one, two or more), and this is the main difficulty of the issue.

"Hot spot". These are graphic questions. You need to select a specific area of ​​the graphic element (pictures, diagrams, tables, etc.) that will be the answer to the question.

Fill in the pass. There are no options for these questions, you yourself must enter the answer in a special field. Often these are questions about the calculation of the dose of the drug, etc.

Dragging. This question format is typically used to have the examinee arrange the answers in the correct order, such as describing the steps of a particular procedure in sequence.

Audio or video questions. The subject is asked to listen to a sound (heart murmur, abnormal breathing, wheezing) or watch a short video, and then answer a question about its content.

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What changed

Here are a few salient features that differentiate NGN from the traditional NCLEX-RN:

1. More difficult questions

The NCSBN believes that nurses often care for seriously ill clients, and the old licensing test did not take this into account, and they sometimes lacked knowledge. Therefore, issues at NGN have been made more complex, with increased attention to the care of the seriously ill.

2. New question types

One of the major changes you'll find in the next generation NCLEX is the use of clinical scenarios that help assess test takers' critical thinking abilities. A scenario that could actually happen to a patient assesses the test taker's ability to cope with a specific nursing situation. The subject is provided with information about the patient: his diagnosis, results of examinations and tests, a list of medications he is taking. Based on this information, the prospective nurse is asked questions that are designed to determine how she will react or handle a certain situation. This test requires critical thinking and a high level of nursing knowledge, and evaluates whether a person can provide not only quality, but also safe patient care. The test will have approximately three case studies of 6 questions each - that is, 18 items in addition to the other question types.

Photo: Concord Rusam

Other types of questions that have appeared in NGN:

Drop down list of responses. It's a cross between multiple choice and filling in the blanks. These questions are a drop-down list of possible answers to complete the sentence.

Advanced drag and drop - This type of question is similar to traditional drag and drop, except that there are more answer options than spaces, i.e. subjects will have to decide for themselves whether they should use only some or possibly all of the options available.

Matrix/grid. Here the subject needs to fill in the table. For example, he is given a patient's medical history and a list of eight procedures. He must arrange them in the columns of the table, dividing them into “necessary procedures”, “contraindicated” and those that are “not related to this case”.

Trend - this type of questions tests knowledge of the processes of diagnosing and assessing the patient's condition (Clinical Judgment Measurement Model).

Extended Hotspot (Enhanced Hot Spot) - The test taker must identify words or phrases from a sample medical record that answer the question. Unlike a typical “hot spot,” there may be more than one correct answer.

3. Number of assessed questions

Each candidate will receive a minimum of 85 and a maximum of 150 questions in the exam. 15 of these are prelims and are not scored, so you can expect between 70 and 135 questions that are actually scored on the next generation NCLEX-RN exam.

The number of questions varies because the NCLEX-RN uses Computerized Adaptive Testing (CAT), which offers questions of varying difficulty levels based on previous answers. You will receive questions until the computer determines with 95% confidence that you have passed the exam, that is, it finally understands what level of knowledge you have. The maximum length of the NCLEX-RN test is 5 hours.

4. New scoring system

Now for the good news: the new generation NCLEX has changed the scoring model. In the regular NCLEX, questions were only marked as "pass" (1 point) or "fail" (0 points). In the new test, you can get credit for partially correct answers (in questions with multiple correct answers), and then this credit will increase the total score you received.

Photo: Twitter / Concord Rusam (@concord_rusam)

How to Prepare for the New Next Generation NCLEX Nurse License Test

Concord Rusam keeps track of updates to the Nurse License Tests and adapts its NCLEX-RN exam preparation course respectively.

NCLEX-RN's course Concord rusam includes 160 hours of lessons (online or in the classroom) in the form of lively and interesting lectures. Students are offered methodological handouts (it is sent to the post office in advance, even before the course starts) with the main provisions of the lectures, diagrams and visual tables. This is done to facilitate the assimilation of a large amount of information.

Students have constant access to a computer room with a bank of questions on the NCLEX-RN test. Training takes place in English, but all terms are explained in Russian, if necessary, so that students can master the vocabulary necessary to work as a nurse in the United States. The school has bilingual teachers who will always come to the rescue if you have any questions or misunderstanding of complex material due to the language barrier.

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School Concord rusam helps his students to properly complete the documents for the board of nurses. This speeds up your approval to take the NCLEX-RN exam.

Note NCLEX-RN course suitable for those who already have a nursing education in their home country and have a strong desire to work in the profession in the United States.

Do not worry too much about the changes that have appeared in NCLEX-RN new generation. If you study hard, use lecture material from Concord Rusam to study the theory and practice questions regularly, you will definitely succeed. How it turned out for many thousands of former Concord Rusam students, and now successful American nurses.

And if you still have questions about the exam, join the group NCLEX with Greg in Telegram. There you can also practice your knowledge with NCLEX quizzes.

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