The Next Generation NCLEX: What Changed in April 2023 and What It Means for Test-Takers

By NurseGPT Editorial Team · April 24, 2026 · 8 min read

The Next Generation NCLEX: What Changed in April 2023 and What It Means for Test-Takers

On April 1, 2023, NCSBN launched the most significant NCLEX redesign in decades. Here is what is different about the exam, item by item.

After nearly a decade of development, the National Council of State Boards of Nursing launched the Next Generation NCLEX (NGN) on April 1, 2023. The new exam replaced the previous NCLEX-RN and NCLEX-PN formats on the same date. Every candidate who took the exam after that date took the NGN.

The NGN is not cosmetic. It is built on a new scoring model, introduces item formats that did not exist on the old exam, and measures a different target construct. This article walks through what actually changed.

Why NCSBN Redesigned the Exam

NCSBN's own research program identified a gap between what the NCLEX measured and what new-graduate nurses were being asked to do in practice. Employer surveys and the NCSBN RN Practice Analysis found that new graduates were weakest at clinical judgment, the process of recognizing cues, analyzing information, prioritizing, generating solutions, taking action, and evaluating outcomes. The previous NCLEX measured knowledge and discrete skills; it did not measure the integrated judgment process.

NCSBN's response was the NCSBN Clinical Judgment Measurement Model (NCJMM), a six-step framework built on prior cognitive-science work. The NGN's new item types are designed to measure each step.

Source: NCSBN Research, "The NCSBN Clinical Judgment Model," published in the Journal of Nursing Regulation.

The New Item Types

The NGN retained the traditional multiple-choice format but added several new item types:

  • Extended multiple response — select all that apply, with partial credit scoring
  • Extended drag-and-drop — place multiple items into sequenced drop zones
  • Cloze (drop-down) — complete a sentence by selecting words from drop-down menus
  • Enhanced hot spot (highlight) — highlight words or phrases in a passage
  • Matrix / grid — evaluate multiple items against multiple criteria
  • Bowtie — integrate recognition, analysis, and action into a single item
  • Trend — analyze data presented over multiple time points

Case Studies and Stand-Alone Items

The NGN delivers items in two formats:

  • Case studies present a single patient scenario and ask six related questions that reflect the full clinical judgment cycle. Each RN exam contains three case studies.
  • Stand-alone items test individual steps of clinical judgment without the case-study wrapper.

Partial Credit Scoring

This is one of the most significant scoring changes. On the old NCLEX, a "select all that apply" item was right or wrong. If you missed one, you got zero. On the NGN, several item types award partial credit using one of three models: 0/1 scoring (legacy), +/- scoring (credit for correct selections, penalty for incorrect), or rationale scoring (full credit, partial credit, or no credit based on the combination of answers).

Passing Standard

The NCSBN Board of Directors approved a new passing standard for the NCLEX-RN in April 2023, set at -0.18 logits. This is the threshold the computerized adaptive test uses to make the pass/fail decision. The standard is reviewed every three years.

Source: NCSBN, NCLEX-RN Test Plan and passing standard announcements.

Exam Length and Time

  • NCLEX-RN: minimum 85 questions, maximum 150 questions, up to 5 hours
  • NCLEX-PN: minimum 85 questions, maximum 150 questions, up to 5 hours

Both exams are computerized adaptive tests. The exam ends when the candidate's ability estimate is determined with enough confidence, when the maximum item count is reached, or when time expires.

Pass Rates Under the New Exam

NCSBN publishes quarterly and annual pass rate reports at ncsbn.org. For U.S.-educated first-time NCLEX-RN candidates, annual pass rates have historically ranged in the mid-to-high 80 percent band. The first-time pass rate for U.S.-educated candidates in the first full year of the NGN was broadly consistent with that range. For the current published figure, check the most recent "NCLEX Examination Statistics" report on the NCSBN site. It is the definitive source and is updated each quarter.

How Study Prep Has Changed

Every major NCLEX review publisher rebuilt their materials for the NGN. Programs to look for in your study materials:

  • NGN-style case studies, not just multiple-choice banks
  • Exposure to every new item type, including bowtie and trend
  • Application-level items rather than recall questions
  • Practice in recognizing cues and analyzing information, not just memorizing facts

If you are using a review book published before 2022, it is pre-NGN and does not reflect the current exam.

Who Still Takes the Old Exam

Nobody. As of April 1, 2023, all NCLEX-RN and NCLEX-PN candidates take the NGN. There is no grandfathering.

Where to Read the Source

  • NCSBN Next Generation NCLEX program: nextgen.ncsbn.org
  • NCLEX-RN Test Plan: ncsbn.org/testplans.page
  • NCLEX Examination Statistics: ncsbn.org/exams.page
  • NCSBN Clinical Judgment Measurement Model: ncsbn.org/clinical-judgment-measurement-model.page

Bottom Line

The April 2023 NCLEX redesign added new item types, introduced case studies, enabled partial credit scoring, and reoriented the exam around clinical judgment rather than discrete knowledge. Candidates preparing today should be using materials built for the NGN, practice the new item types explicitly, and rely on NCSBN's own publications for the authoritative, current picture of the exam.