I hate nursing exams

JBMmom, MSN, NP · Apr 15, 2012

I can see you have a lot of passion for trying to improve what you see is a shortcoming in the system. I'm not one to go with the whole "we do it this way because this is how it's always been done" theory that doesn't encourage improvement. However, I think that for many reasons this system is acceptable. (By the way, I've also got a BS and MS in the biological sciences, and adjusting to these tests wasn't the easiest for me either.)

I think that essay tests are a great way to test knowledge. You've got to know your stuff and really connect the dots to complete those. But, with 48-55 students in my class- depending on the semester- and 2-3 professors providing test questions, how long would it take to grade those?! And, then the grading becomes subjective, partial credit, do they really understand, the does the teacher like how it's worded, etc. Anything that cannot be objectively graded adds a dimension into the grading that I don't think is very practical. In our system, the clinical portion is pass/fail and your entire grade is based on the MC exams. I think it would be awesome if the clinical portion counted for at least one test grade. Then the students in class that are really great in a clinical aspect, but not as strong in taking tests, would have a better shot. Again, this brings in subjective aspects to the grades.

And really, whether you think it's the best way to train people to be nurses or not, this has been the way for many years. Are nurses leaving school and promptly killing patients in droves? Nope. So there must be something substantial enough in the education they received to yield competent nurses in the end. I mentioned previously my own opinion on clinicals as the main predictor of success and provider of experience. For me it reminds me of my first career. When I finished my education in science, was I really a scientist? No, all the academic testing in the world didn't make me a scientist. When I started working and applying and putting things together I became a scientist. The same thing will happen when I'm a nurse. No education can truly prepare you for what your career will bring. Just my opinion, good luck with your education and career.

RNbethy · Apr 15, 2012

It would be a scary test to grade in a nursing course. Take the question from earlier in this thread. The question was designed to test the student's understanding of what a sexual health history is. In order to choose the correct answer, the student doesn't really need to know the gender of the patient, just what a sexual health history is comprised of and what, as a nurse, you would ask a patient. If you instead turned around and asked a fill in the blank question, there would be potentially dozens of answers that people could put down as appropriate questions to ask in a sexual health history. If you did it essay style, would you take off if they failed to mention 1 of the potential questions? How many would you expect them to know?
By asking it as a multiple choice question, the student needs to understand the purpose of the history as well as a basic understanding of what information is pertinent to that history. It would be easy to pick TSE because testicular cancer is probably a much worse condition than pregnancy. But, it wouldn't be the right answer.
Ultimately, that multiple choice question is a decent assessment of basic knowledge a new nurse should possess, where the essay question might be appropriate for a CNM and the fill in the blank question leaves students simply memorizing one or two pieces of information on each topic.

So that particular question is not suitable for an essay or fill in the blank question. Point taken. BASIC questions like that might be more suitable for M/C... but an entirely M/C based test is not testing our understanding comprehensively.

shortnorthstudent · Apr 15, 2012

Think of your clinicals as your essay questions and your fill in the blanks. You have to arrive at the correct dosages for your meds. There is no multiple choice there. But, if you fail to pass them safely, you are out the program just as surely as if you cannot answer the multiple choice questions. Your essay questions are your care of your patient - ADOPIE in process, you SBAR, care plans, concept maps and the like. All of those things are testing your knowledge and understanding of the information covered in your program. Those things prepare you for floor nursing while your theory exams are preparing you for NCLEX. Clinical does not prepare you for NCLEX because NCLEX world and the real world do not match up all the time and it is important to remember to answer by the book, not by the practice when you are answering NCLEX or standard nursing exams.

Theory tests do not prepare you to be a nurse, they prepare you to take NCLEX. NCLEX is there to insure that you have a minimum understanding. Clinical prepares you to be a nurse and your first job will hopefully move you further in that direction as well.

RNbethy · Apr 16, 2012

I can see you have a lot of passion for trying to improve what you see is a shortcoming in the system. I'm not one to go with the whole "we do it this way because this is how it's always been done" theory that doesn't encourage improvement. However, I think that for many reasons this system is acceptable. (By the way, I've also got a BS and MS in the biological sciences, and adjusting to these tests wasn't the easiest for me either.)
I think that essay tests are a great way to test knowledge. You've got to know your stuff and really connect the dots to complete those. But, with 48-55 students in my class- depending on the semester- and 2-3 professors providing test questions, how long would it take to grade those?! And, then the grading becomes subjective, partial credit, do they really understand, the does the teacher like how it's worded, etc. Anything that cannot be objectively graded adds a dimension into the grading that I don't think is very practical. In our system, the clinical portion is pass/fail and your entire grade is based on the MC exams. I think it would be awesome if the clinical portion counted for at least one test grade. Then the students in class that are really great in a clinical aspect, but not as strong in taking tests, would have a better shot. Again, this brings in subjective aspects to the grades.
And really, whether you think it's the best way to train people to be nurses or not, this has been the way for many years. Are nurses leaving school and promptly killing patients in droves? Nope. So there must be something substantial enough in the education they received to yield competent nurses in the end. I mentioned previously my own opinion on clinicals as the main predictor of success and provider of experience. For me it reminds me of my first career. When I finished my education in science, was I really a scientist? No, all the academic testing in the world didn't make me a scientist. When I started working and applying and putting things together I became a scientist. The same thing will happen when I'm a nurse. No education can truly prepare you for what your career will bring. Just my opinion, good luck with your education and career.

I appreciate your perspective JBMommy. It seems that there's a bigger issue with your program, especially since ALL the grades are allocated to the test. That doesn't make any sense at all. I don't know that essay or written questions would be that difficult to mark, as long as the faculty had clear guidelines and the questions were written to elicit a specific type of answer. Perhaps I was lucky in my BS program - I never had an issue with a teacher being unfair... I don't think this is an issue of being too subjective; I think it boils down to the fact that there are not enough instructors to mark the exam. Also I'm not suggesting that the ENTIRE exam should be essay based - there are certain types of basic questions that need to be tested with short answer or M/C.

Nurses are not leaving school and "promptly killing patients in droves" - you are certainly right about this (thank goodness). However, our bar should be high and, while no education can prepare you for what your career will bring, an education can inspire you and give you a wealth of knowledge that CAN be utilized to SET AN EXAMPLE in the field.

RNbethy · Apr 16, 2012

NCLEX is there to insure that you have a minimum understanding. Clinical prepares you to be a nurse and your first job will hopefully move you further in that direction as well.

Interesting perspective and I agree with much of it. However, why should our tests not also prepare us to be a nurse? As you say, NCLEX is there to ensure that we have a "MINIMUM" understanding... Our tests should go beyond NCLEX and cultivate the type of critical thinking you want to see in practice.

ThePrincessBride, MSN, RN, NP · Apr 16, 2012

I hate nursing exams too. I hate how there can be multiple correct answers but the "right" one is the "best" one. It is complete BS considering the fact that patients are rarely "by the book" in terms of care.

My averages have been low as well. B/B+ range...usually.

Unknown member · Apr 17, 2012

I, too, hate nursing exams. Often times I think "well the nurse would assess ALL of these, not just one" but the question is asking what would you assess FIRST. It's extremely frustrating but I've learned to adapt. I was a biology/pre-med major and I'm sorry to agree with others....science tests were MUCH easier for me because I have somewhat of a photographic memory and can regurgitate facts pretty easily. And it wasn't just bio 101...I guess we all have different opinions about that.

I have to disagree that essay exams would be beneficial. For one, patient care is based on individual circumstances. If I had an essay question about a patient, I would expect to see every lab, med, dx, tx, full FHP, etc. in order to answer it properly and we all know that would take WAY too long. I can't think of ONE exam question that would really test critical thinking without requiring too much background info.

I think everyone needs to remember...nursing schools (atleast in today's age) are teaching students how to pass the NCLEX. My school has had 100% pass rate for the last 5 yrs. My grade consists of 4 tests and a final. Clinical is pass/fail. It's clear what the school's goals are....and it does make sense because many people choose their school based on NCLEX pass rate (as well as cost and other things, I go to a CC).

I think it's also important to remember that there is NO WAY you will EVER learn everything in school to be an "amazing nurse" post-graduation. As a nurse, you are forever learning, seeing new things every day. You CANNOT expect 2 or even 4 yrs to teach you everything to make you perfect. You really do not learn how to be a REAL nurse until you are out in the field practicing. School is NOT real nursing. That's just my opinion. Some may see this as a problem, but it's the most practical and most cost effective way to produce nurses. If schools focused on essay exams, creating AMAZING nurses who know everything, well then you'd be in school for about 20+ years!

acerbia · Apr 17, 2012

I haven't had any problems with taking nursing school tests. I've enjoyed taking them far more than chemistry tests, for example. So far, everything has been very common sense. A few facts to memorize here and there, but how you apply the information to the situation (or question, in this case) is what counts. And if you think about it, that's what you'll be doing in practice. The goal with these types of questions is to get you to critically think. If all options seem ridiculous, that forces you to really stop and think what option would be best, given all the others. I like these types of questions because it makes me call upon information from other subjects and nursing courses. It's a challenge, and I welcome it. I feel like I have to bring my A-game at all times.

If you don't feel like you're learning enough or that you are inadequately prepared to be a nurse, then you should study what you feel you SHOULD know on your own. There are some things I have not committed to memory yet or learned, but that's because I will be going over that more in depth in the fall. Until then, however, I'm still going to read and study for my own benefit. If I'm not tested on it, that doesn't matter to me. Either way, I need to know it and it will come up eventually, so I go over it when I have some extra time (or during breaks...).

In my school, we test on scan-trons, but we can write on the test booklets. If I'm stumped on a particular question, and I'm going through the various options, I will write my rationale as to why I chose that particular answer. If there is a dispute, my professor goes over the questions I got wrong with me, and I present my rationale. My professor may give me credit for what I got wrong if I can demonstrate the right thought process. Sometimes it's just a poorly-worded question, other times I completely over-looked or over-thought something. Either way, going over the exam later with my professor helps her understand where my thinking is coming from (thus giving her insight into what other students may be thinking, since not everyone goes over their tests like I do), and in turn, I understand how to "think like a nurse" - win-win! That might be something you could try with your professors. If you do teacher reviews at the end of your semesters, that would be a great time to make a comment about the testing as well. You might not be able to "fight the power", but there's no harm in trying to understand it. Who knows, maybe you can come up with something new that your school hasn't thought of yet!

wooh, BSN, RN · Apr 18, 2012

OP, nursing exams are testing you on "bits of information scattered everywhere, nothing feels cohesive about it" because that's what nursing is. Patients don't build upon each other. There's nothing cohesive about multiple morbidities.

I was always a good test taker. Then came nursing tests. The joy of picking "the best answer." I got over it by using NCLEX study guides. Pick one or two that group questions based on subject, and practice with them before your tests. Read some NCLEX testing strategy. It helps. Got me back to being a good test taker. :)

NCRNMDM, ASN, RN · Apr 18, 2012

anonymousstudent, I couldn't agree with you more. You hit the nail on the head. Great answer!

madareebrahim · Apr 21, 2012

I have a similar problem...cept I use NCLEX books and practice exams ALL the time and I rock those practice exams but then like this past 8 weeks just totally watched my grader fall...fall...fall and I'm at a loss to understand why!!! I like you have a previous degree so I do KNOW how to study my butt off, yet no matter how much I studied I just was sooo disappointed. I am so frustrated as I dont know how to change things. My school is very all about NCLEX stuff so we are very NCLEX preparation heavy from the start. How can I do good on the practice NCLEX exams yet do so poorly on the "weird" nursing exams...??

i<3u · Apr 21, 2012

That's basically my mindset when taking exams! I see classmates stress over topics that the instructor didn't cover, won't be included on the exam, and/or basic A&P. If it's not mentioned in lecture and won't be included in exams, then I'm not concerned about it. I refuse to stress my self out and study 24/7. Read beforehand, listen to lecture, review notes from lecture, and study guides/NCLEX questions. After that, either I know it or don't. I failed (D) my first exam early this semester and stressed over it at first. I told myself, "You know what? You can't cry over spilt milk. You can stress and be sad or change your study methods for this class and figure out what this particular instructor expects you to know". By the way, this instructor is known for their ridiculous exams. Anyway, I still can't stand those exams but I'm not stressed and I'm doing very well on my exams. I learned how to play the game :-D.