Nursing exam questions are terrible (according to science)

Nursing Students NCLEX

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Hi all. This is my first post. I recently graduated from an RN program and will be taking the NCLEX soon. I've been doing practice tests a lot and am getting a little frustrated. In short the questions are stupid and I hate them on a personal level which I have to work at what with them being inanimate and all. Fortunately science says I'm right.

http://www.ncbi.nlm.nih.gov/pubmed/17014932

http://www.nursingcenter.com/lnc/CEArticle?an=01709760-201303000-00002&Journal_ID=54029&Issue_ID=1526614

If you don't feel like reading these studies basically state that many nursing exam questions are poorly constructed. The second study actually finds that bad question writing could result in 10%-15% of students failing a test they should have passed. I have witnessed this in my own education as many very bright people simply couldn't do well on nursing tests. I myself struggled severely in nursing school even though I came through the prerequisite classes with all A's. Before nursing I was a physics major and did fairly well, I've always been good at academia, and so it was very bruising to my ego to struggle so much.

I remember one of my teachers early on talking about how nursing wasn't like engineering or math because you had to think critically. Now, I call bull. In fact, I think that bad questions are actually a symptom of a bigger problem in nursing education as a whole. I think the field lacks a comprehensive and rational approach to its subject and so it takes on a vague and indirect quality. Hell, every nurse I've ever met has stated that nursing school doesn't have much to do with being an actual nurse.

Sorry for the long first post but I'm a little irked and stressed right now. So what do ya'll think? Also, wish me luck on the NCLEX, I think I might need it.

Specializes in Emergency, Med/Surg.

Just a couple of thoughts:

1) I thought care plans were really dumb when I was in school. But after a couple years of practice, my thought process is much like a care plan. "My patient has shortness of breath. What could be causing it? What are some things I can do to help them?"

2) Many may disagree but I think that nursing school exam questions are very similar to real life nursing. Every single day at work, I ask myself all the time, "What's my priority now?"

3) The medical and nursing models are both similar and different. They are intertwined, but have separate purposes and goals.

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Specializes in critical care.
Doing some more thinking about this and I have a few more examples of nursing education shortfalls. This one bugged me all through school Maslow's. Our instructors kept talking about evidence based practice and then throw this antiquated and unsupported stuff out there and pretend it is valid (A causal correlational test of the need hierarchy concept). The thing that bothers me is that Maslow's hierarchy was so critical to our patient ranking structure yet there is in fact no real separation of the higher order needs into distinct ordered groups. The paper I linked too isn't the only one to reach this conclusion either, just Google it and see. I also can't stand the nursing diagnosis stuff. Why can't we just call a disease by its name a do a detailed pathology. I feel like nursing is trying really hard to pretend it is somehow not medicine and that leads to graduates unprepared to work in the medical field. I would really like to see nursing become a more scientific and rigorous field. Also, I think some sort of residency like they have with MD programs would be very helpful. Here is an excellent article on current nursing that I find interesting, though I disagree with the author on a few things. Worth a look. http://www.medscape.com/viewarticle/736236_1

I agree with a lot of what you say, and further add that it feels like nursing diagnosis is a method of showing that nursing is somehow completely different and that we need this system, or this whole different language, to prove it. It's irritating. If you say to me, "ineffective coping", yes, I get a picture of ideas that go along edit the nursing diagnosis. But I get that same picture if you tell me, "that guy has anxiety." Adding a new language gives us one new thing to learn, when we could spend that time learning things in the same language as the rest of the medical world and maybe go more in depth than we do. This irritates me greatly and I feel like we could spend our time learning wholistic care in a better way that makes sense to people outside our profession, too.

(Disclaimer: I am a nursing student, and recognize there may be more to learn. But this is the conclusion academia has led me to so far.)

Now. Back to the questions thing. A recent question that has me all riled up. This is in psych, and I'm curious to hear what the masses would say.

Q. Which of these people is most likely to experience and inpatient psychiatric hospitalization?

a. A homeless person

b. A person singing loudly in the neighborhood streets

c. A person noncompliant with their medications

d. A person with a demanding job

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Specializes in critical care.

I didn't read everything before that last response. Nursing care is very much different than medical care, and that is why I chose nursing over medical. I prefer it. But to clarify on my last response, I don't think we need to learn/create a new language to be effective nurses. We can say different thinks in the same language that everyone else speaks. (If that makes any sense at all.) I actually enjoy care plans, as laborious as they are, because I do enjoy that we are given the time and opportunity to really think about every little detail in an effort to view the bigger picture and identify what is important. I'm a little bit nutty like that. ☺️

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Specializes in SICU.
Yes nurses use drugs as part of the treatment but it's not just the sole reason for treatment. Medicine is not giving drugs. Giving drugs is giving drugs, anyone can do that. Medicine is a procedure for treating a patient. Nursing is another procedure for treating a patient. Both disciplines use drugs yes.

What happen every-time you go to a doctor? 99.99% of the times they write a prescription and send you on your way. If you are an experienced nurse and I'm just a student and you can't see the difference, then I can't help you.

So why then don't they merge the disciplines and make nurses go to medical school? Why did nurses not go to medical school and learn to push drugs? Nursing is more, that's my point.

Medicine is like being a robot. See the symptoms, make a diagnosis, treat, repeat. If the NCLEX was like that everyone would pass. I remember in one of my clinicals there was a bunch of residents going to see a patient. The doctor did not even touch the patient. The residents were all over the patient without consideration...I mean 2 of them had there stethoscope on the chest at the same time, while the 3rd was doing something else and that just looked wrong.

And to the other poster, if nursing was anything similar to engineering, I would be at the top of my class because that is what my first career entails and I have an associates in engineering and engineering is by no means related to critical thinking.

Giving drugs isn't just giving drugs. Once you're giving drugs on your own with your own license backing you up, you may see it differently. The example of whether or not to give the patient's regularly scheduled metoprolol when their heart rate is 58 pops into my mind. It takes understanding of pharmacology and medicine to know what to do. Or to give a newly scheduled dose of humalog with a BG of 79. Or checking a latest INR before giving coumadin. Yes it takes "critical thinking" (which is basically a bull crap term that doesn't mean anything more than regular thinking, which is done in every profession that I can critically think of). But the truth is, it takes a medical mind to give medicine. All the loving nursing care in the world isn't going to help you when I send you into symptomatic bradycardia because I didn't "critically think" before I gave your meds.

The OP is spot on. There are a TON of B.S. questions in the nursing field, based out of the subjective, emotional mind of whatever teacher is writing the question, and it is sadly the cause of a lot of smart people unable to complete nursing school.

If one student in the class fails a test, it's probably the student's fault. If everyone in the class fails a test (especially when everyone in the class is people who jumped through all the hoops to make it into nursing school), it's definitely the education departments fault.

Nursing education needs a major makeover.

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Specializes in Med-Surg, NICU.

Physics and Engineering don't require critical thinking? Since when? My mother was a physics major and exceled as an actuary. If anything, physics majors have the HIGHEST level of critical thinking, followed by the philosophy majors who typically score the highest on LSATs.

I find many of the questions on nursing exams to be complete crap. Real life nursing is vastly different from "textbook, NCLEX" nursing.

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Giving drugs isn't just giving drugs. Once you're giving drugs on your own with your own license backing you up, you may see it differently. The example of whether or not to give the patient's regularly scheduled metoprolol when their heart rate is 58 pops into my mind. It takes understanding of pharmacology and medicine to know what to do. Or to give a newly scheduled dose of humalog with a BG of 79. Or checking a latest INR before giving coumadin. Yes it takes "critical thinking" (which is basically a bull crap term that doesn't mean anything more than regular thinking, which is done in every profession that I can critically think of). But the truth is, it takes a medical mind to give medicine. All the loving nursing care in the world isn't going to help you when I send you into symptomatic bradycardia because I didn't "critically think" before I gave your meds.

What you're describing here is basic, competent nursing knowledge and care. What kind of "loving nursing care" are you thinking of that wouldn't include this?

IMO, a lot of people who complain that nursing isn't enough like medicine might be happier pursuing a career in medicine, rather than trying to make nursing over into what they would like it to be (i.e., more like medicine).

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Specializes in Nursing Professional Development.
I just wish we would stop trying to reinvent the wheel. A shockingly successful paradigm for healthcare already exists and it is the medical model. Why does nursing have such a strong desire to act like it isn't medicine, sure not the level of a MD, but definitely medicine.

I shouldn't have to say this but ... The medical doesn't work for nursing because we do not practice medicine! Physicians and nurses perform different roles in society and provide different services to patients. Nurses don't typically diagnose diseases and prescribe medical treatments because that would constitute the practice of medicine and that would be illegal. Because we provide different services and fulfill a different role, we need our own models and knowledge base.

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Specializes in Nursing Professional Development.

Perhaps you went to a bad school(s) when it discussed evidence based scientific theories because you do not appear to recognize what one is.

It doesn't matter who "likes" it and it doesn't matter where you went to school. My problem is that the scholarly side of nursing is NOT scholarly. The word "Theory" - capital T - has a very specific meaning in an evidence based environment. Claptrap like Rogers' "electrodynamic fields" and the so called intervention of therapeutic touch are complete and total nonsense with no place in anything labeled evidence-based.

Snip.

An evidence based Theory has to explain the underlying causes for a set of observations and it has to be falsifiable. Nursing theories are not; they are viewpoints, paradigms, approaches, "worldviews"....

Which is fine, just don't use the word "Theory," and claim it is scientific, because it isn't. Nursing "theories" are simply arbitrary ways of viewing a situation which cannot be tested or falsified. You can invent infinite ways to conceptualize something - that does NOT make it a scientific theory.

Your specific definition of the word "theory" is very limited. Scholars in many disciplines use the word "theory" in a much broader sense. Theories are simply models that describe, explain, or predict phenomena of interest. A good theory produces testable hypotheses, but the theory itself is never "proven to be true." Even in the hard sciences, scientific experiments don't "prove things true:" they simply "don't show them to be false." The results either support the hypotheses or not: they never "prove the theory true" as you seem to think they should.

All of the nursing theories that you have mentioned have successfully generated testable hypotheses that have been supported by scientific studies. Scientific studies have supported all of them and practicing nurses have found all of them to helpful in describing, explaining, and predicting phenomena of interest to nurses.

Looking at the issues from another angle: The scholarly disciplines of English, art, drama, music, etc. all have theories. They don't look like the theories in physical sciences, but they are valid theories. Your view of scholarship appears to limited to the most common theories within the physicial sciences.

But nursing is not just a hard science. It is a practice discipline -- a discipline that is both a science and an art. It is right and good that it includes a variety of types of theory -- not just ones similar to the ones common in the hard sciences.

If you are not interested in nursing beyond the phsycial science of it, then let that influence your career path. Either try another profession or follow a nursing career path that only focuses on the physical science portion of nursing. But don't try to bring down those nurses who focus on the the other aspects of nursing that don't appeal to you. (That's what I meant with the "like" comments in my earlier post. Nursing has room for all of us -- those of us who prefer the physical science portions and those who prefer the psycho-social-spirtual-artistic portions. There is no need to bring the other people down.)

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Specializes in SICU.

The point isn't whether nursing is different than medicine, obviously it is. Obviously they are two different specialties. And yes, nursing does include both science and art - "physical science portions and those who prefer the psycho-social-spirtual-artistic portions" to quote llg. The point is that you can't test the art of nursing in an objective, written, multiple choice format. That's the whole point.

The OP and I have a problem with the written tests and grading scales required in nursing school. When you try to test whether someone understands how to treat other cultures, or how to practice the art of nursing, or how to be spiritually sensitive with a written test, it tends to fail miserably. You end up with the same thing that all nursing schools struggle with - a ton of students who got horrible grades because there was little to no objectivity in the test.

Rather, the subjective "art" of nursing should be measured and tested in clinicals. That is the only place that one can truly be tested. Not play acting on a mannequin, and not by circling the right answer on a written test. It's not nursing that needs to change, it's the educational standards that do.

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Specializes in Nursing Professional Development.
The point isn't whether nursing is different than medicine, obviously it is. Obviously they are two different specialties. And yes, nursing does include both science and art - "physical science portions and those who prefer the psycho-social-spirtual-artistic portions" to quote llg. The point is that you can't test the art of nursing in an objective, written, multiple choice format. That's the whole point.

The OP and I have a problem with the written tests and grading scales required in nursing school. When you try to test whether someone understands how to treat other cultures, or how to practice the art of nursing, or how to be spiritually sensitive with a written test, it tends to fail miserably. You end up with the same thing that all nursing schools struggle with - a ton of students who got horrible grades because there was little to no objectivity in the test.

Rather, the subjective "art" of nursing should be measured and tested in clinicals. That is the only place that one can truly be tested. Not play acting on a mannequin, and not by circling the right answer on a written test. It's not nursing that needs to change, it's the educational standards that do.

Thank you for the reasoned discussion. I agree that there are many bad test questions written in nursing. Some teachers are better/worse that others. I have also experienced bad professors -- and bad test questions -- in other disciplines. That's no reason we should not try to improve nursing education, but I think it needs to be taken into consideration when we slam our profession and its leaders indiscriminantly.

I believe that well-constructed test questions can be written (even for psycho-social-spritual aspects of nursing), but that too many instructors have not been educated on how to do that. The faculty shortage and the lack of high faculty standards has resulted in many poorly constructed tests. I agree with that.

But it is difficult to raise the standards of faculty when they are struggling to find people (anybody minimally qualified) to do the job. Until they raise the working conditions and compensation for faculty, it will be difficult to require they receive more education on how to be good teachers. Many faculty members are only adjuncts who make less money than staff nurses and don't even get benefits such as health insurance. Some are hired only days before the class starts and have no time to prepare for class, much less time to make improvements. That has to change before meaningful improvements can happen.

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Pearson Vue hires nurses to write questions and pays them per question. Many "standardized" test makers test the validity and reliability of their questions by how many people get them right. If everyone is bombing the question, it gets thrown out. That's why they say that certain questions are not counted against you because their validity is being tested. So the questions are not stupid, they are valid and reliable. A lot of statistical analysis goes into it! That is why nursing boards across the country make you take the test.

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ArtClass RN: Science itself is all based on theories, the definition of a theory is a statement that can be disproven through the scientific approach of research. Science moves forward because people make a theory then work to prove or disprove it. So to say that nursing is just theories and not science is an oxymoron! Religion is not a science because you cannot disprove that God or heaven exists. There are numerous journals of nursing with studies on evidence based practice, for example, indwelling urinary catheters cause more infection than prn straight cathing, so how does this play into our everyday practice? We get foleys out as soon as they are not needed and get orders for bladder scanning and prn in and out cathing.

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