The Next Generation NCLEX (NGN) exam rolls out in April 2023 and is being met with trepidation by nursing students across the U.S. But their international counterparts may face even more challenges. To understand how NGN may impact your future as a nurse in the U.S., you need to know what to expect.

How Is the 2023 NCLEX Exam Different?

Although both the new and old NCLEX exams allow you five hours, the NGN will have more scored questions, up from 60-130 to 70-135. And while prior to 2023, the NCLEX exam had multiple choice, fill in the blank, view chart or exhibit, ordered response, and graphic items, NGN adds five additional question types:

  • Extended Multiple Response
  • Extended Drag and Drop
  • Cloze (drop down)
  • Enhanced Hot Spot
  • Matrix (grid)

Although it’s generally acknowledged that the new test is more difficult, it covers a range of important issues and should better prepare you to work as a nurse in the complex U.S. healthcare setting.  

Included in the NGN content are:

  • Case scenario questions: where you need to answer multiple questions on a single patient case example 
  • Drop-down answers: that combine multiple choice and fill in the blank
  • Extended drag-and-drop: that provides more answers than spaces where some answers need to be excluded
  • Extended select-all-that-apply: provides you with up to eight answers to choose from
  • Highlight text questions: where you must highlight text from a passage representing action critical responses for a particular case.
  • Matrix/grid: that will provide you with more than select or don’t select options


What is the Goal of the New Generation NCLEX?

The real difference in NGN is what it attempts to achieve. Because nurses are more often caring for patients who are critically ill,  the exam is formulated to simulate real-life nursing scenarios better and assess whether candidates are ready to perform the tasks of the job. The exam tests you on critical thinking, clinical fluency, judgment, and decision-making. The overall goal of the new exam is to ensure that only practice-ready nurses pass the exam. The NGN assesses your ability to think more critically so you can make better patient care decisions.

How Will the Next Generation NCLEX Affect International Nurses?

Even before NGN, the NCLEX pass rate for international nurses taking the exam for the first time was only 47%, compared to an 82% pass rate for U.S.-educated nurses. But the new exam may present additional challenges. There are four main concerns for international nurses:

  1. Language Barrier for International Nurses
    The highest NCLEX pass rates occur among candidates who state that English is their primary language. Pass rates for those who do not claim English are 10-15% lower than native speakers. Even if you consider yourself fluent in English, there may be a gap between how well you communicate verbally and how well you understand the written word. Reading comprehension is especially critical where case study questions require you to imagine what-if scenarios and use your critical thinking to make clinical decisions. 
  2. International Nursing Education and Curriculum
    While the new NCLEX exam is closely aligned with a U.S. nursing curriculum, it may not reflect how you were taught in your own country. Educational programs for nursing can vary widely. For example, in the UK, nurses receive either a nursing diploma or a degree. In Ireland, New Zealand, and Spain, there are single programs to become a nurse. And countries in the Middle East that have a shortage of nursing faculty, actually send nurses abroad for training. Whatever may hold true in your own country, in the U.S., there are three pathways to becoming a registered nurse: a two-year associate degree, a three-year diploma, and a bachelor’s degree program. And while U.S. nursing students may have an upper hand, even in the U.S., the nursing school curriculum is likely to change to help students prepare for the NGN. 
  3. NGN Technology and International Nurses
    If your country of origin doesn’t have wide range internet and easy access to computers, you may find the technology of the exam to be a small hurdle. Administered by Pearson VUE, the NGN must be taken online at a Pearson VUE testing center. Computer proficiency will help you perform the tasks of the exam more easily. For example, knowing how to drag and drop, pull from a dropdown menu, or highlight text are important—but easy—skills to acquire and perform during the exam. Particularly because international nurses often cite technology as a barrier to their preparedness for U.S. nursing practice, being familiar with technology before, during, and after your NGN exam is crucial. 
  4. Adapting to U.S. Customs and Traditions
    Another reason you may find the Next Generation NCLEX exam to be a difficult test of your skills is because your cultural references may be different. There are nuances to patient care in any environment, but if your nursing background is starkly different from how medicine is practiced in the U.S., you may miss clues within test questions. In some countries, there are distinct gender roles between male and female nurses. In parts of India, for example, male nursing students cannot provide obstetric care. The kinds of questions that make the NGN a better test for nurse readiness—case studies and real-world scenarios—can serve as a stumbling block if you don’t come from the same world as the test’s origin.

Despite the challenges the NGN may present, the rewards of being a nurse in the U.S. cannot be overstated. At Global Nurse Partners, we connect nurses from across the globe to healthcare facilities in the U.S. And we’re with you every step of the way, including helping you to prepare and pass the Next Generation NCLEX. Request a consultation today.