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?

[SHGR, MSN, RN, CNS]

But I think there are many nursing education programs and state boards of nursing that are dangerously close to failing at preparing these candidates...

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.

I love this, and it's the study method I'm using for my advanced patho class. Because, in the real world, you really do have to understand things to that level. If I can explain a concept, then I know I have it.

[wish_me_luck, BSN, RN]

I do understand your point, Ashley. And I am getting ready pretty soon to take boards...and even I think the old method was more comprehensive. But, I am wondering if other than the use of technology now; it's because most nursing schools have standardized testing at the end of the courses. Now, some schools do not require the students to get a "passing grade" on them, which makes them pointless; but what I am saying is we get tests are each course and my school's is attached to whether or not we pass or fail the course based on whether we passed the test. Then, we have a calculations test at the beginning of each semester and a comprehensive at the end of nursing school. Then, we take boards. So, I think we are tested right along versus the two day testing in an auditorium with hundreds of people. Plus, come on, with hundreds of people; there's no way that there was zero cheating.

[OCNRN63, RN]

I do understand your point, Ashley. And I am getting ready pretty soon to take boards...and even I think the old method was more comprehensive. But, I am wondering if other than the use of technology now; it's because most nursing schools have standardized testing at the end of the courses. Now, some schools do not require the students to get a "passing grade" on them, which makes them pointless; but what I am saying is we get tests are each course and my school's is attached to whether or not we pass or fail the course based on whether we passed the test. Then, we have a calculations test at the beginning of each semester and a comprehensive at the end of nursing school. Then, we take boards. So, I think we are tested right along versus the two day testing in an auditorium with hundreds of people. Plus, come on, with hundreds of people; there's no way that there was zero cheating.

I suppose cheating could have been possible. I guess you had to be there to know how hard you were watched. I have a chronic runny nose and have to have a tissue with me at all times. I was terrified they would call me out for cheating because I needed a tissue. With 1000 questions, it would have been pretty hard to get all the questions you would have needed to pass.

[Rose_Queen, BSN, MSN, RN]

I'm one of those who passed with the minimum 75. I walked out thinking "That was it?!?" I find it hard to believe that a single test with that few questions can really determine minimum competency. And my education certainly didn't prepare me for real world nursing; it taught me how to provide total care for one single patient- I only had 2 patients twice. Our "leadership" rotation meant we were to take an entire team of patients with the RN, but most of those RNs didn't trust us and didn't let us out of their sight. (New clinical site for our school, they didn't know us from earlier clinicals nor did they know the instructors.)

[wooh, BSN, RN]

I'm not going to argue CAT testing versus 2 days of paper, as I've seen that argument over and over and don't think we'll ever change minds on that.

I had a classmate that fell asleep during her NCLEX. Still passed. There's no excuse for not passing after two tries if you know the material. I understand people with test anxiety. I understand people are good versus bad test takers. But you know all the way through nursing school that you're going to have to take a test. You have 9 months to 4 years to prepare for that. I'm a fan of the Candadian three strikes and you're out or at least have to take a refresher. To be confident taking a test, you have to know the material. If you don't know the material, then you're going to fail, and you can't blame the test, your anxiety, God, the testing center's rules, whatever else for failing.

Choose your nursing program wisely. Look at the NCLEX passage rate. As you take your classes, study to know the material. Not just to pass the next test. Strive for at least a B in the classes (although striving for an A would be optimal), not to whine that you failed because you got a 74.5 and a 75 was the minimum.

And if that's all too difficult? Then I don't care how much you "care" or that it's your dream or how good you are at inserting foleys and NGTs and IVs. I want to be taken care of by somebody that has a freaking clue what the Hades is going on with me. And if you can't pass the test for minimum competencies within your first two or three tries? You're likely to kill someone once you get in the real world of nursing. Experienced brilliant nurses have killed people. Think how much easier it is if you're dumb and/or don't know the basic material on the NCLEX well enough to pass the test.

[Klimpys]

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.

Thank you for this comment! I have just finished my pre-reqs and will be starting the nursing program this fall. I am a fairly good test taker when it comes to T-F and multiple choice. I can memorize and regurgitate with the best of them. However, I was recently talking to a guy who flunked out of the program and he was giving me pointers, and he mentioned the NCLEX style questions. I realized that I my way of learning isn't going to cut it. I have ordered several books that will hopefully help, and your comment made a light go off in my brain regarding the need to understand "why" things are done a certain way, etc..

[realnursealso/LPN, LPN]

I took my "State Boards", as they called them, in April of 1980. I graduated from LPN school in December of 1979. I got a job right after graduating, as was the case for almost every person in my class. We went for two days at our local war memorial. As we entered we were fingerprinted, and our id's were checked. We were told where to sit, later that day, when we returned from lunch, we were again told where to sit in a totally different spot. The next day, the same, fingerprinted, and told where to sit. To be perfectly honest, I didn't really study for my boards. I just read my Saunders Review book we purchased when we started school. I really don't remember how many questions, just 2 days worth. I do remember that the only med questions were about colace and insulin. Was thinking of that darn recipee box at home, with all those 3x5 cards in it. Every patient we had, we had to look up every drug they were on and make a card. Now if you already had a drug card for that med, you didn't have to make another, but there were quite a few cards in that box when I graduated. When my classmates and I got done the second day, we were all sure we must have failed, the next testing time wasn't until October.

We worked on a permit that was issued by our BON, we were GPN's (Graduate Practical Nurses). The thing that scared us the most was, if we didn't pass our boards, we lost our GPN status, and our jobs. Back then you could only take your boards twice, and failing the second time our state required you to take a review class, before you could apply to take your boards again. Also we didn't get our results until July.

I remember reading on this BB, that things had really changed regarding your boards. I thought wow, only 265 questions at the most, 75 at the least, I was happy for you new grads. Then I started to be really puzzled when I realized that alot of you were spending lots of bucks for review classes before you took your boards. I was even more puzzled when I found out you could keep taking the boards until you passed. But as they say times have changed, I don't have any miracle answers as to which way is better. It's a stressful time for graduate nurses no matter which way. But I have to be honest here, I am a bit concerned that so many seem to be very unprepared to take their NCLEX. It makes me wonder how things are being taught now, because no matter it all starts with your schooling.

Hope all of you had a blessed Passover, or a Happy Easter. GOD Bless

[Jolie, BSN]

Thank you for this comment! I have just finished my pre-reqs and will be starting the nursing program this fall. I am a fairly good test taker when it comes to T-F and multiple choice. I can memorize and regurgitate with the best of them. However, I was recently talking to a guy who flunked out of the program and he was giving me pointers, and he mentioned the NCLEX style questions. I realized that I my way of learning isn't going to cut it. I have ordered several books that will hopefully help, and your comment made a light go off in my brain regarding the need to understand "why" things are done a certain way, etc..

You are wise to examine your learning style and try to adapt to a method of studying that will be effective for you.

I found 2 things to be particularly effective: I would recopy my notes ASAP following a lecture, every time, no exceptions. By re-writing notes while the information was still fresh in my mind, I could add examples and comments the teacher made that I didn't have time to write during the lecture. I could also identify questions immediately to ask at the next class.

When preparing for tests, I would use my notes and a whiteboard to teach to an imaginary audience, giving full explanations, examples, etc. That goodness my roommate was never home, because she would have thought I was nuts. But being able to teach the material from top to bottom was an excellent preparation for the type of tests we were given.

Test taking skills can always be taught. The material content of nursing courses must be learned, or all the test taking skills in the world won't help, either in the lecture hall or for NCLEX.

Good luck to you.

[mmc51264, BSN, MSN, RN]

I thought about this all day (I am a senior ADN student) and I have quite a rigorous program. It is difficult to pass. I have to pass the program before I can take the test. We took a "readiness" test last week, which I did minimal studying for. I was in the 97 percentile. I had a class mate that has done ZERO NCLEX review (she wants to wait until she passes the program) and she was in the 78 percentile. We are getting the material and tested 3 ways: the tests we take in class, the online readiness tests and we have quite a clinical component. We will have somewhere between 550-600 clinical hours put in. Depending on capstone facility, some classmates have had 4 patients-total care. Others have been s/ticu, pacu, ED so the experiences are varied. I was on a med/surg/peds floor. I am not sure the NCLEX is a valid test, but I do like that it is national. I would like to move back to my hometown at some point and it comforts me to know that it will be a little easier to transfer my license.

I was a teacher before Nursing and the testing is the same. I met a girl who was taking her teaching boards for the FIFTH time!!! I passed the first time and did not think they were difficult. THAT scared me.

I think the test is ok. What kind of nurse you are depends on how motivated you are. I am looking to get into an RN residency/GEMS program so I have extended orientation.

[evolvingrn, BSN, RN]

I feel I was adequately prepared when I graduated from college 2 years ago, i have had two jobs since graduating and have not had problems doing either job. The floor i work on has hired several other nurses with similar experience recently and they all have adjusted fine as well. I do get a little concerned with some of the nursing students i see....and the 'one' pt they have....and really don't even do a great job even charting on them. I think it has to do with structure of a nursing instructor with so many students they have to supervise.

[sunsandandsurf]

I am in nursing school right now and will graduate in September of 2013. We are required to have a "B" or better to continue in the program which, quite honestly, shouldn't bother me but when you tell someone that you HAVE to make a certain grade it seems harder. I also work full time on the Neuro Spine/Neuro Surgery unit at my hospital. I have learned that I have to separate "real world" from "nursing school world" because "nursing school world" is taught as though you will be working in a utopia where each nurse may have one or two maybe three patients, everything going exactly as planned, etc. How far away from the truth is that? I have worked in the medical field for 20+ years and now, children are grown and gone, I am working on my nursing degree with the intention to go forward to nurse practioner with emphysis on adult acute care. I am hoping to precept on a burn unit but not sure if I will be allowed, we will see. I have to say that it kind of worries me that people are allowed to keep taking the test over and over and over..... I can understand failing once because of stress or whatever, but after that? You know what the test will be like and if you don't know the material perhaps you should retake what you are having issues with before trying to care for a patient whose life you hold in your hands.

[That Guy, BSN, RN, EMT-B]

The NCLEX is a ******* joke. I have said that numerous times on this website and will say it to anyone who asks me about it. Im sorry but you cannot acurately judge a person and their judgement by 75 questions. I passed in 75 questions. Almost 10% of my test was on isolation. Really? Dont you want to ask me about oh say what I should do for certain pts, not what gown glove mask I should be wearing. Sure it is important but is it more vital to know what to do with my pt? The sheer crap that surrounds the fact that they have to teach you how to take the test in school is a joke too.