4 Things Canadian Nurses Need to Know To Pass the NCLEX

Hi everyone! I am a Canadian nurse who is doing some research on writing the NCLEX-RN exam this year. As of January 2015 all Canadian nurses will now have to write the NCLEX instead of the CRNE. Here are the top 4 things I found to be important.. please comment below if you have any other tips for me and all the other Canadians writing!

1. The Fundamentals Are The Same

Nursing in both the United States and Canada is very similar. That is why nurses usually adapt easily to working in either country. As in Canada, nursing in the United States is viewed as both an art and a science encompassing fundamentals from biology, physiology, psychology and social science. Like the CRNE, the NCLEX will cover knowledge of the human condition across the lifespan with a focus on changes in health and the relationship between an individual, others and the environment.

All competent nurses must have a strong understanding of critical thinking, knowledge of skills and client care - all vital components - situated under the umbrella of evidence-based practice. The main goal of nursing care is to prevent illness and complications, promote health, comfort and dignity. If you are a Canadian-educated nurse, you know that these are the foundations of providing safe, competent nursing care - the NCLEX will not test you on any values or ethical situations that you would not be apt to handle.

2. The Exam Competencies are Formatted In A Different Way

According to the College of Nurses, a competency is "the knowledge, skill, ability and judgment required for safe and ethical nursing practice (2014)."

On the CRNE, these competencies are organized into the larger themes of:

- Professional Practice - 20-24%

- Nurse-Client Relationship - 9-13%

- Nursing Practice: Health and Wellness - 22-26%

- Nursing Practice: Alterations in Health - 41-45%

The percentage of questions from each competency grouping is very important to pay attention to in order to effectively allocate your study time. Unfortunately, the NCLEX categories are quite different.

The test structure for the NCLEX is based upon Client Needs and Integrated Nursing Processes. The integrated processes are as follows:

- Nursing Process - assessment, analysis, planning, implementation and evaluation

- Communication and Documentation - verbal and non-verbal interactions

- Caring - collaboration in order to create mutual trust and respect

- Teaching and Learning - transfer of knowledge à a change in behaviour

These processes are integrated in the categories of Client Needs:

- Safe and Effective Care Environment

o Management of Care - 17-23%

o Safety and Infection Control - 9-15%

- Health Promotion and Maintenance - 6-12%

- Psychosocial Integrity - 6-12%

- Physiological Integrity

o Basic Care and Comfort - 6-12%

o Pharmacological and Parenteral Therapies - 12-18%

o Reduction of Risk Potential - 9-15%

o Physiological Adaptation - 11-17%

As we can see, on the CRNE almost 50 percent of questions came from alterations in health, which would be what candidates would spend the most of their study time on. Based upon the NCLEX information, now we do not have as clear a picture of where to spend our time. Due to this, it is recommended that candidates planning on writing the NCLEX next year buy a study guide created for this test, and not one created for the CRNE.

3. How you write the exam is very different

Length

The CRNE lasted for a set time of around 4 hours and had the same number of questions for every candidate. The NCLEX is very different. As a candidate writes the exam, a system called Computerized Adaptive Testing (CAT) selects questions based upon the writer's responses to previous items. The exam ends when the computer can determine if a candidate's performance is adequate.

Currently, the lowest number of questions a candidate can answer is 75, but the average is 119 for the NCLEX-RN and 117 for the NCLEX-PN. The average length of the NCLEX-RN is 2.5 hours and the average length for the NCLEX-PN is 2.3 hours.

Scoring

The reason NCLEX uses CAT is for efficiency and accuracy. Since paper tests ask the same questions to each candidate it ensures an equal level of difficulty for everyone. The disadvantage to this approach is that it is ineffective. It requires high-ability writers to answer all the easy questions on the exam, not giving much insight into their ability. In Computerized Adaptive Testing, candidates who answer difficult questions correctly will receive similar or more difficult questions instead of easier questions. If they can answer all the difficult questions correctly, the computer assesses that they are above the passing standard and concludes the examination. This reduces the number of easy questions a high-level candidate will receive and is why top candidates may only have to answer 75 questions.

Another disadvantage of paper testing is that guessing can inflate candidates' scores artificially. Each candidate has a 25 percent chance of guessing correctly, but this has nothing to do with their ability. Thus, writers closer to the passing standard will receive questions closer to their level of knowledge. This reduces the number of difficult questions a low-ability candidate will receive. They may have to answer more questions, but these questions will be closer to their ability and will thus better determine their capability as an entry-level nurse.

How this process works is that every time a candidate answers a question the computer re-estimates his or her ability based upon all previous answers. The computer will then select a question that the writer should have a 50 percent change of answering correctly (meaning the next question should not be too easy or too hard). The goal of this is to get as much high quality information as possible in the least amount of time. This continues on until the computer can effectively assess if the writer is above or below the passing standard.

Passing Standard

The passing standard marks the cut point along the ability range of all candidates for entry to practice. It is the minimum ability acceptable to practice nursing safely in Canada and the United States. For the NCLEX-RN (2013-2016) the passing standard is 0.00 logit and for the NCLEX-PN the passing standard is -0.21 logits. A logit is a unit of measurement. It is the relative difference between the ability of writers.

To assure that the passing standard accurately reflects entry-level nursing knowledge, the standard is reviewed every 3 years by the NCSBN's board of directors. The board reviews the passing records and annual candidate performance, a standard exercise by a Panel of Judges, and the opinions of both educators and employers of the competency of new graduate nurses.

While this all seems rather confusing, the main thing to remember is to know the key information required as an entry-level nurse. Do not worry if you have to answer more than 75, or even 300 questions - this does not mean you are doing poorly - it simply means you are closer to the passing standard and the computer needs more questions to assess your ability.

4. Level of Difficulty

According to numerous personal and professional sources, the NCLEX is more difficult than the CRNE. For candidates who have never written the CRNE this will not affect you as much, but for candidates who have written the CRNE, this is important to remember so that you do not underestimate the difficulty of the exam.

First-Time Canadian-Educated Writers

If you have recently graduated from a Canadian nursing program the best thing you can do is write the exam as soon as possible. This will ensure everything you learned in school is fresh in your mind and as relevant as possible. Buy a good NCLEX exam guide and take time to understand the breakdown in competencies and where you are weakest (i.e. what you should focus most of your time on).

The other key to success is being comfortable with question formats. Use the questions in the NCLEX study guide but also invest in a book of just practice questions. You can even find apps and websites that offer practice questions. Do as many as possible, and take time to look up and really understand questions that you get wrong.

Experienced Canadian Nurses

If you are an experienced nurse who wants to write the NCLEX in order to work in the states, the best course of action is to take a few months of comprehensive study. Really get familiar with the material and the practice questions. The advantage of being experienced in a particular field is often a disadvantage when being asked specific questions about the things taught in school.

Internationally-Educated Nurses

For internationally educated nurses, it is recommended that you take either an online or in-person prep course in addition to the preparation of a Canadian-educated nurse. Internationally educated nurses have the lowest pass rates out of all categories. In 2014, the pass rate for RN's was 22.38% compared with 78.59% for U.S. educated nurses.

In summary, I think that studying for the NCLEX is similar to studying for the CRNE. The fundamentals are the same, but the exam format is completely different requiring a good understanding of NCLEX competency categories and practice questions. By understanding CAT you can plan accordingly for the unique exam setting and remain calm if you are finding the exam challenging.

GOOD LUCK EVERYONE! Please comment below if you have any other tips for me!