Is the Nursing Licensure Exam effective?

[Double-Helix]

I'm posting this here, rather than the NCLEX board because I wanted the opinion of seasoned nurses, and the NCLEX board is primarily visited by students.

Spend a day on the NCLEX board and you'll see numerous threads that contain the phrasing, "I just took the NCLEX and I KNOW I failed!" or "It was so hard there is no way I passed!" or "I got the good pop-up but there is no way that I passed!"

It's gotten me thinking recently. The NCLEX gives you the opportunity to pass in 75 questions (only 60 of which count). It's a huge difference from the two day, multiple hours per day testing that many of you went through to get your license.

What often concerns me is that graduates can leave the NCLEX feeling sure that they failed, thinking that the test was super hard, and there is no way they could have passed. But, they did. Is this right? Should nursing licensure be summed up in 60 questions? If a student passes the NCLEX, but feels their performance was terrible, is that a red flag?

What's your opinion of the nursing licensure exam, and what changes should be made to the system?

[OCNRN63, RN]

Gah! I have redone this post, and the formatting keeps screwing up when I hit "post."

[HeartsOpenWide, RN]

Those that pass with 75 questions get the hardest of the hard questions, it's not a "potluck". Imagine a lateral line, the pass line. Imagine everyone starting out at the passing line at question #1. If you get it correct you move farther above the line and the next question is harder, and so on for every correct question. If you get the question wrong, you drop below the pass line and get an easy "killer"question; a question that doesn't matter in real nursing because your not proving your knowledgeable to answer questions that matter . The HURST review lady said that if you think you failed and it felt like the hardest test ever, you probably passed because you were in the really hard passing questions.I passed the NCLEX with 75 questions and it took me an hour and a half. I walked out worried that I didn't pass because I didn't think it was as hard as people were making it out to be. I did pass though. I also graduated with honors and raised my GPA in nursing school while most dropped. It's a test filled with anxiety...That aside, the NCLEX does not determine a "good" nurse, it is mearly a test of the MINIMUM competency required to be a nurse...it's the people that fail several times before passing tha worry me...

(sorry for any typos, I am on my phone)

[BlueDevil,DNP, DNP, RN]

I am confident that computer adaptive testing is sufficiently sophisticated to accurately measure if the candidate meets what has been determined to be the minimum passing criteria. I am not satisfied that the minimum criteria for passing the NCLEX is high enough.

[dudette10, MSN, RN]

What often concerns me is that graduates can leave the NCLEX feeling sure that they failed, thinking that the test was super hard, and there is no way they could have passed. But, they did. Is this right? .... If a student passes the NCLEX, but feels their performance was terrible, is that a red flag?

That's just high-stakes test anxiety, regardless of test format or length.

Should nursing licensure be summed up in 60 questions?

...

What's your opinion of the nursing licensure exam, and what changes should be made to the system?

CAT NCLEX was introduced in the early 90s. Looking at the first-time pass rates within a few years of CAT NCLEX introduction, the rates have stayed approximately the same (within 2-3%), so the argument that the CAT NCLEX group's nursing curricula taught to the test is moot. There just wasn't enough time to change curricula to accommodate the new testing format.

Many active nurses with more than 15 years experience took the CAT NCLEX with very few questions relative to the old way of earning licensure, so, no, I don't see why it should change. Should they be questioned on their nursing competence just because they didn't take the old two-day examination? Are they somehow less effective and competent nurses?

That question was rhetorical because the universal answer would be, "No." Why? It's not the test, regardless of format, that equals competency; it's the experience, for the most part. Plus, full competency in a given specialty is relative to where work experience has been gained.

Much ado is made about the wait time for results. That has zero influence over nursing competency. It just sounds like a desire to inflict the same terrible anxiety on others. My stepmother graduated sometime in the late 40s. Her biggest anxiety came with bedmaking and the head nurse who would test them all by bouncing a quarter off it. If we were having this discussion in the 1970s, maybe that would be the comparison made.

I have a question on re-takes. Now, it's 45 days with an unlimited number of tries. Based on a previous poster, retakes were allowed pre-CAT, but it was six months between re-takes. Were there an unlimited number of tries? I'm thinking that the wait time--not the re-take itself--would discourage those who had trouble passing the first time. Now, one could theoretically take the NCLEX five to six times in a single year, whereas the same number of retakes pre-CAT would be over three years.

[Double-Helix, BSN, RN]

Many active nurses with more than 15 years experience took the CAT NCLEX with very few questions relative to the old way of earning licensure, so, no, I don't see why it should change. Should they be questioned on their nursing competence just because they didn't take the old two-day examination? Are they somehow less effective and competent nurses?That question was rhetorical because the universal answer would be, "No." Why? It's not the test, regardless of format, that equals competency; it's the experience, for the most part. Plus, full competency in a given specialty is relative to where work experience has been gained.

No one has meant to imply that nurses with 15 years of experience are incompetent simply because they took the modern NCLEX. However, I do question whether the new graduates of today are as compentant as the new grads of 20 years ago. That's both an education and an NCLEX issue. I just don't see how, when trying to elevate the view of nursing to that of a true professional, it makes sense to grant licensure based on a test of a maximum of 250 questions. When doctors, lawyers, psychologists, etc. take much more comprehensive exams.

[netglow, ASN, RN]

I've noted many times that the NCLEX of today is purely a game. Learn the rules of how to play the NCLEX game and you will easily pass. When asked advice on when to take the test in relation to how much time is needed to study, I always recommend that you take it as soon as you understand how to take it - if you "get how to take the test" in 5 minutes then, that is enough time. The NCLEX is a total joke and a disgrace.

What is so unfortunate is that if you were serious in your approach to your education, you will be insulted by this test as I was. It literally is not concerned with what you had better be able to understand to be an entry level nurse - or - any type of nurse at all. If schools attempt to build an entire program in anticipation of the NCLEX (which many do) - their graduates will not have even the most basic understanding of medicine or nursing - actually not much of anything useful at all.

[OCNRN63, RN]

We did. I remember running to the mail box every day to see if I had the "thin envelope." One day, I didn't bother. I was at work and called my mother to see if I had gotten mail. She said I had. I asked her who it was from, and she told me it was from the Bureau Occupational and Professional Affairs (BOPA). I said, "Is it a thin envelop or a fat envelope?" She told me it was thin, so I told her to open it. I held my breath, and then

she told me I passed. Then I really started to cry. All that stress for nearly three days just melted away.

That should read, "All that stress for nearly three months just melted away."

[melmarie23, MSN, RN]

I dont really see how the sheer volume of question one gets has any bearing on one's competency. I could have had all 265...heck, they could have throw me hundreds more, and I still would have passed. Not because the exam was easy, quite the contrary in my opinion. But because I was adequately prepared.

In terms of clinical competency, that was determined by my specific program and I met the applicable standards there (which are BON determined minimum standards mind you).

[melmarie23, MSN, RN]

and lawyers passing the bar or med students passing their steps and boards...that doesnt necessairly make them "good" coming out of the gate either. That comes with applicable, real life/on the job experience. Same with nursing.

[tothepointeLVN, LVN]

Personally I thought the NCLEX-PN was relatively easy and straightforward compared to the content tested on in school and the material covered in review books. The language is writing for ESL speakers and the questions are unambigious. You don't even have to know lab values just what an out of range value means. I think you could pass and end up being an incompetent nurse thats for sure so it's really not a barrier to entry.

What does it matter how you feel about an exam. Only pass or fail matters. I think a 3 day exam process would leave you exhausted and more likely to make mistakes.

A little bit of nerves can be a good thing. Makes you careful.

I got the minimum amount of questions for the NCLEXPN was out the door in 45mins. I knew I passed because I studied 100 questions a day since the day I started nursing school. Is it a stressful day? Yes but its just that one day.

Relax and good luck.

[Jolie, BSN]

I don't think that NCLEX is failing at its mission of evaluating candidates for licensure. But I think there are many nursing education programs and state boards of nursing that are dangerously close to failing at preparing these candidates.

I am also a seasoned RN, licensed in 1986 after graduating from a BS program, taking 2-day pencil and paper boards in a convention center, one of dozens of sites state-wide, waiting 2 months for results, thankfully to get the "good" letter.

My program was long on theory and very short on clinicals, as many here have lamented. My mother, a diploma grad of the 1950's was shocked and dismayed. But upon graduating, I, like virtually all of my classmates, immediately began working as an RNLP (or GN depending on your state), getting in a month's worth of experience before driving to the Rosemont Horizon for 2 days of testing, and a fun reunion with my classmates. In the time since we were pinned, some of us had moved, gotten married, gone on honeymoons and other vacations. I did all 3. What NONE of us did was to enroll in a NCLEX prep course. Our instructors poo-pooed them as unnecessary. They were right. Without cracking a book in those 2 months, 95% of our class passed. Why? 2 reasons:

Despite a dearth of clinical time, we were well prepared for NCLEX. Our instructors presented a well-prepared curriculum that was current and evidence based. We were taught by experts in their fields. Not only were they experienced nurses, they were experienced teachers. The turnover was very low, and because of that, they developed strong relationships with our clinical sites. While not lengthy, our clinicals were intense, and we were allowed to do much that other students from other programs were not. That was based upon reputation and trust.

Our curriculum was also unique in that we were not allowed to take multiple choice or T-F tests. All tests had to force the student to provide the answer, along with the rationale for that answer. If we got the answer right, but couldn't explain why it was right, it didn't count. This was based upon educational research that demonstrated that students who learn to the point of providing and explaining the correct answer have mastered the material to a much higher level than students who are allowed to simply identify the correct answer from a list of choices. We ASKED for NCLEX-type questions on tests, and were told not to worry. We would do fine. And we did. The school has had a decades-long streak of 95%+ pass rates on NCLEX.

The second reason was that, in those days, it was necessary for employers to accept pre-licensed candidates in order to fill their staffing needs. We were hired and oriented on the basis that we would presumably pass NCLEX. That orientation time usually took place before we ever sat down and filled in our first NCLEX scan-tron. We had the benefit of working as professional nurses, and learning to think like professional nurses. It's amazing the safety, prioritization, time management and critical thinking skills that can be (and are) developed in such a short time in a real-life professional setting. Disallowing this type of training for recent graduates awaiting NCLEX is a dis-service to the candidates and the institutions that hire them.

Unfortunately, I don't see the clock being set-back on either issue. Programs will continue to teach to the test without properly instructing their students, and state boards (and employers) will continue to require a passing NCLEX score before allowing new grads to practice, even in a controlled and well-supervised setting.

[Leonardo Del Toro, RN]

I've noted many times that the NCLEX of today is purely a game. Learn the rules of how to play the NCLEX game and you will easily pass. When asked advice on when to take the test in relation to how much time is needed to study, I always recommend that you take it as soon as you understand how to take it - if you "get how to take the test" in 5 minutes then, that is enough time. The NCLEX is a total joke and a disgrace.

What is so unfortunate is that if you were serious in your approach to your education, you will be insulted by this test as I was. It literally is not concerned with what you had better be able to understand to be an entry level nurse - or - any type of nurse at all. If schools attempt to build an entire program in anticipation of the NCLEX (which many do) - their graduates will not have even the most basic understanding of medicine or nursing - actually not much of anything useful at all.

I tend to agree with that. I often tell people that passing the NCLEX is like learning how to play a video game and they look at me as if I had two heads. I often tell people who's having difficulty passing to treat it as if they are playing a fast video game, learn the basic NCLEX language and then shoot at the monster as fast as you can and see how many points you score. If you miss a few your little man begins to flash as you're losing life but if you shoot faster you regain your life and go on to beat the beast.