course taught by someone who purportedly participated in the actual NCLEX question writing process at one point in her career. Time and time again she would reply when explaining the answer to a seemingly confusing question (one which the class clearly had a wrong answer that was less correct than other choices) with the mantra "the author felt". According to her there is an advisory board that reviews the questions, BUT the authors have final say.
The problem with this approach is that what is correct becomes at least partly a matter of the "authors opinion" rather than objective fact. Contrast this with the approach used in other fields. For example my father who was a an MD of Internal Medicine helped to write questions for the boards. He was REQUIRED to provide specific citations for ALL answers, and questions. Furthermore, these citations could only come from approved medical journals or texts. In addition, all questions were subject to rigorous review, and appeal. Much the same situation occurs with many major standardized tests such as the SAT. It is not uncommon to hear about a student who successfully challenges an SAT question. With the NCLEX we are not even advised of the specific questions that we miss or offered the opportunity to challenge the validity of the supposedly correct answer. Who audits these questions to ensure they are accurate and valid (not to mention "keyed" correctly)?
Here is an example of the type of question (one which supposedly appeared on an actual NCLEX exam) of which I am speaking:
The school nurse is teaching an accident prevention program to the parents of school aged children. Which of the following statements, if made by a parent to the nurse, indicates that teaching has been effective?
a. "I am going to make sure that my child wears a helmet, shin guards, and gloves when he rides his bike."
b. "I'm going to reinforce to my child our family's values about what we consider to be appropriate behavior."
c. "The next time we go to the park, I'm going to teach my child the correct way to climb on the monkey bars."
d. " I am going to make sure that my wife and I observe our child when he plays outside with friends."
Answer: "C" according to the Kaplan instructor. Now almost everyone in my class chose "d" or "b". However, that's really not the point as you could make an argument for several of the answers. Instead, the point is that before someone can say that "c" is the correct answer they should have to cite a reference
in approved nursing literature that justifies their position (for example a study published in the American Journal of Nursing that demonstrated a reduction in play ground injuries after teaching on the proper method to climb on monkey bars). Furthermore, they should have to show that the alternative answers are not equally supported in the "mainstream" nursing literature (thus if there were another study which showed that observing children while in play greatly reduced playground injuries then that would no be an acceptable "wrong" answer).
It is very possible that this one question may have caused a nurse somewhere, at some point tofail
the NCLEX (and possibly lose her house due to the subsequent pay cut with her kids being taken to foster homes as a result). Call me sexist, but I do not believe that a male dominated profession would tolerate this sort of paucity of due process in something so fundamental to their futures.
Here is a possible solution. A sort of "Blue Book" of approved nursing knowledge should be authored by a panel of nursing experts at least every few years (think of Harrison's Guide to Internal Medicine for an example of what I am proposing). This would undoubtably be a multi volume set covering all aspects of nursing practice and would in turn reference many journal articles and studies in its index . However, it would provide a "starting point" for what was most important for a nurse to know. Then, it should be a requirement that every NCLEX question (and I would argue nursing school
exam question from an accredidated school) MUST reference the page number which makes their correct answer, correct. Although, one might disagree with The Book answer, at least there would be an objective reference that wouldn't waiver with the opinions and experiences of the particular question writers.