By Paige Twenter

On April 1, the National Council Licensure Examination for registered nurses will include more competencies in care management and basic care and comfort, while most of the exam structure, scoring and content distribution is unchanged.

New competencies include providing unbiased care and dignity throughout a patient’s lifespan.

Every three years, the National Council of State Boards of Nursing reviews and makes tweaks to the NCLEX, which has one version for registered nurses and another for practical nurses. In 2025, nearly 330,000 candidates took the NCLEX-RN and nearly 70,000 took the NCLEX-PN, according to the NCSBN.

The planned changes to the test are less significant than the last overhaul in April 2023, when the NCSBN launched “Next Generation NCLEX” to better measure clinical judgment and decision-making. After the redesign, the NCLEX-RN pass rate among first-time, U.S.-educated individuals increased, from 79.9% in 2022 to 88.6% in 2023.

The NCLEX-RN test plan is reviewed based on recent practice analysis of RNs and expert opinions to ensure the exam matches current practices.

There were no substantial changes to a majority of the test and its scoring. Here are four notable changes in the 2026 NCLEX-RN framework:

1. In the “beliefs” section of the 2026 NCLEX-RN test framework, “health equity” was added to the foundational principles guiding RN practice. The framework also revises end-of-life language, expanding the 2023 phrase “dignity in dying” to “dignity throughout the lifespan including at the end of life” in 2026.

2. There were few substantive changes to categories or subcategories. However, in the 2026 “management of care” subcategory, there is an explicit, required competency for nurses to “support unbiased treatment and equal access to care” regardless of culture, ethnicity, sexual orientation and gender identity or expression.

3. In the “basic care and comfort” subcategory under “physiological integrity,” the 2026 NCLEX-RN blueprint adds a new activity statement requiring nurses to maintain client dignity and privacy during care — language not included in the 2023 framework.

No significant changes were made to the “pharmacological and parenteral therapies” or “reduction of risk potential” subcategories.

4. In the “physiological adaptation” subcategory, the 2026 test plan includes one new activity statement requiring nurses to monitor and maintain internal monitoring devices, such as intracranial pressure monitors and intrauterine pressure catheters.