NCLEX and You

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April 2nd, 2012

By , BSN, RN

Right now, at the beginning of April, many nursing students across the country are headed into their final weeks of nursing school. All the late hours before clinicals and early mornings headed to class or a hospital are coming to an end in the role of student. Mortar boards will be donned, “Pomp and Circumstance” will play and in about six weeks last semester nursing students will cross the stage and receive their diplomas. And, then they face the real test.

I don’t mean moving out on your own, finding a job or starting one; I mean the test that determines whether or not you will actually be able to work as a nurse somewhere in the United States—the National Council Licensure Examination or NCLEX.

In the U.S., registered nurse (RN) and licensed practical nurse (LPN) candidates must pass the NCLEX-RN or the NCLEX-PN, which are administered by the individual state boards of nursing. Regardless of educational preparation (bachelors or associate degree, diploma program), the examination for RN or LPN is exactly the same in every state in the U.S. This provides a standardized minimum knowledge base for the client population nurses serve. What that mean is you are being tested to see if it’s safe to let you be an entry level nurse.

The requirements for licensure vary state-to-state, but most have a minimum educational requirement including graduation from a recognized nursing program; meeting the specific requirements of the state board of nursing; and passing the appropriate NCLEX. Licensure not only permits those who pass to offer special skills to the public but also provides legal guidelines for protection of the public.

The NCLEX-RN and NCLEX-PN are computer-adaptive tests (CATs). That is a testing format that is interactive with your responses to each question you are given. The way it works keeps the questions from being too tough or too simple. The first question provided is relatively easy, measured as below the minimum competency. If you answer correctly, the computer picks a slightly harder question. If you give the wrong answer the computer selects a slightly easier question. The computer does this throughout the test and is then able to calculate the test takers competence.

The computer stops the NCLEX when:

  1. You have answered the minimum number of questions correctly to demonstrate basic nursing competence—75 questions.
  2. If you have answered the minimum number of questions (75) and show a lack of competence.
  3. When you answer the maximum number of questions—265.
  4. You have used the maximum amount of time allowed for the test—six hours.

There is no time limit for each individual question. You have a maximum of six hours to finish the exam, including a tutorial at the beginning. Everyone answers a minimum of 75 questions, and if you should go all the way to the maximum of 265 questions it doesn’t mean you have failed. No matter how many questions you answer, 15 are always experimental. They are questions being tested for use in the future on the NCLEX-RN or NCLEX LPN and they do not count for or against your score. In fact, you don’t actually get a score; the NCLEX is simply pass/fail.

The NCLEX is all about critical thinking skills and nursing judgment.

Most of the questions on the tests are multiple choice with four possible answers; however, as computer testing has become more sophisticated so have the question types and you are more likely now to find the occasional multiple response, fill in the blank, chart/exhibit questions, and drag-and-drop formats.

NCLEX Content

The content of the NCLEX-RN and the NCLEX-PN differ slightly since they require different levels of nursing education in order to sit for them. Both tests are based on client needs. Also, both tests include items at all cognitive levels including memorization or recall, knowledge, analysis and application. For the NCLEX-RN expect:

  • Safe and Effective Care Environment – including management of care, safety and infections control.
  • Health Promotion and Maintenance
  • Psychosocial Integrity
  • Physiological Integrity – Basic care and comfort, pharmacological and parenteral therapies, reduction of risk potential, and physiological adaptation.

The NCLEX-PN is very similar including:

  • Safe and Effective Care Environment – Including coordinated care and safety and infection control.
  • Health Promotion and Maintenance.
  • Psychosocial Integrity
  • Physiological Integrity – Basic care and comfort, pharmacological therapies, reduction of risk potential, and physiological and psychiatric adaptation.

Pass Rates

In 2011, almost 200,000 nurse candidates, educated in the U.S. took the NCLEX-RN. Of those taking the test, just over 76 percent passed. To be more specific, 154, 302 passed on the first try and 41, 005 passed after repeating the licensing exam. If the test taker does not pass the exam, they must wait a minimum of 45 or 90 days between each examination. This retake time frame is determined by each individual board of nursing and National Counsel of State Boards of Nursing (NCSBN).

Another 81,000 candidates took the NCLEX-PN in 2011. Seventy-five percent of those taking the test passed, 66, 089 on the first attempt and 14, 860 on a repeat attempt.

In order to register for the NCLEX RN exam you are responsible for sending the completed test application and the fee to the National Council of State Boards of Nursing which can be found online at www.ncsbn.org. The NCSBN has a very helpful bulletin online as well, that goes into greater depth about the test and testing.

I still remember taking my NCLEX quite clearly from 11 years ago. I remember getting to the testing center too early; so then I had to sit in the car being nervous while waiting for the center to open. I remember questions that made no sense to me; they didn’t even seem to apply to nursing as I knew it so far. I tell everyone, it is one of the weirdest tests you will ever take. Part of that is because NCLEX exams are book-based, based on ideal concepts, and not what we mostly see in our real world practice.

That last part is key to keep in mind. The NCLEX is a test to make sure you are safe enough to be a starter nurse. All the stuff you really need to know, what will make you safer, smarter and a more thorough RN or LPN you will learn on the job from your coworkers, educators, and managers. This test is the next step on a road to what can be a fulfilling and challenging career. Most people who take the NCLEX are fresh out of school and still in test mode. Don’t let it freak you out. It’s really just another fill in the circle test.

And one last thing, don’t wig out when the computer tells you to take a 15 minute break after two hours. It doesn’t mean you are passing or failing, it’s just a clock. Nurses know you need to get up and move around to stay alert and nurses design this test. My computer shut off for a break after two hours and on question number 75. I went outside, walked around a little, and worried a lot. I went back in, sat down at my computer, answered question 76 and it turned off. I was done. I had passed. So will you.

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