At a time when the necessity for nurses is at an all-time high, is it reasonable to restructure the National Council Licensure Examination (NCLEX)? What are the implications of changing a national licensing test for one of the most in-demand professions?
A Walk Down Memory Lane
Our veteran nurses once sat in desks lined up next to hundreds of other students, #2 pencil in hand, while test proctors walked up and down the aisles as they scrupulously bubbled in their answers. Test questions were identical to those of their neighbor, and there were booklets to separate the specialized nursing topics.
Boards were only offered a few times per year, it took months to get the results, and you often had to travel out of state. Times have changed! The NCLEX is now an adaptive test that learns your weaknesses in real-time. You can get the results in less than a few days and take the test not far from your hometown.
The National Council of State Boards of Nursing (NCBSN) took charge of nurse licensing in 1978, and the boards were named the NCLEX (National Council Licensure Examination) in 1982. Computer adaptive testing (CAT) was officially implemented on April 1st, 1994.
What Changes are Coming?
Prospective nurses taking the NCLEX after 2017 may remember a 'special research' section at the end. The research section took approximately 30 minutes and did not count toward the tester's score. The research conducted was intended to study and legitimize a new way to test future nurses. The new method moved away from the traditional nursing process and towards clinical judgment and decision-making.
The NCLEX Next Generation new NCLEX format starts on April 1st, 2023, where the results of those years of research will culminate in a new NCLEX format called NCLEX NGN (Next Generation). Fortunately, this model will allow partial credit for qualifying answers. Check out the NCLEX Next Generation example items of the new types of questions that NCLEX will be offering, including extended drag-and-drops, highlighting, and grids: Next Generation NCLEX – Are You Ready?
Less fortunately, this test format will change the framework under which the NCLEX has operated. The new model of judgment and decision-making, called the NCSBN Clinical Judgment Measurement Model (NCJMM), may require changes in the thinking patterns of prospective nurses.
The nursing process as it stands follows the ADPIE method: Assessment, diagnosis, planning, implementation, and evaluation. In contrast, the NCJMM method follows a new structure of recognizing clues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes. While both take the core concepts of noticing, interpreting, responding, and reflecting, the NCJMM has decided to package this differently.
Student Impact
Nursing students not only juggle clinicals, tests, and labs, but will now need to ponder whether their school curriculum has set them up for success. Will their instructors have the resources needed to pivot their test questions to the proposed new styles and formats?
Between 1993–1994, when the NCLEX format moved from standardized testing to CAT testing, scores dropped from a 73% pass rate to a 63% passing rate for the NCLEX-RN. This was the lowest scores had been since at least 1983, as far back as test score data is published.
It's not unreasonable to wonder if another change to the testing system could reduce passing rates or give pause to prospective nurses before registering for their exams.
Study Methods and Research
The Journal of Nursing Education published a study in 2019 concluding that the new NCSBN-CJM (clinical judgment model) is a better model for nursing clinical judgment. Although, the study was published by the Chief Operating Officer of the NCSBN, which validated their own hypothesis.
The special research section that has been at the end of the NCLEX exam for the past few years also lends itself to scrutiny. At the end of the NCLEX, subjects may be fatigued after answering 75–145 questions that determine whether or not they can begin practicing in their field of study. However, the NCSBN did reveal that the experimental questions were taking test-takers about the same amount of time as the core questions, between 1–2 minutes. It's possible that they used the same mental energy on the research section that they did on the actual exam, but there is no method to quantify those efforts.
Financial Impacts
The market for NCLEX test prep now has the opportunity to quietly render their previous materials as outdated, and provide new books, modules, and courses for teachers and students. The NCSBN themselves made $93 million dollars in 2021 alone. Commonly, individual students may choose to hand over hundreds of their own dollars on top of their tuition to ensure nothing comes between them and their first nursing job. On top of that, colleges also pay for prep packages that offer students question banks, as well as mid-curricular and exit assessments that reflect the NCLEX testing experience.
Instructors will also have to invest their time in evaluating their own pedagogy. Tasks as simple as re-formatting outdated slideshows or concept map rubrics could take hours. Heftier tasks, such as infusing teaching plans with the clinical judgment model, could take significantly longer. Additionally, depending on how updated a school's program is, students may need to spend their efforts making sure their study habits align with the new material they will encounter taking the NCLEX NGN.
Professional Impacts
It's difficult to argue the case for placing another barrier to entry on soon-to-be nursing students as a nationwide nursing shortage rages on. While it is likely that NCSBN crafted a test method that better assesses our nurses' skills, they are not on the front lines. They aren't watching the way nurses think firsthand. Nursing prioritization used to be between patient acuity, but now nurses have to factor in their own bathroom breaks, copious charting, and a worldwide pandemic.
Our line of work holds space for incredibly talented, intelligent, and resilient members. But are we rewarded as professionals for the continuous rigor of our licensing exams and courses? If the NCLEX claims it will "help nurses think more critically" and "achieve better outcomes,” when will we be compensated as such? The connection between increasing nurse competency and respect for the career of nursing is hazy.
The Next Generation
"That's the way we've always done it" is a dangerous piece of rhetoric to hear in the health care world. Changing the NCLEX examination so it continues to be a developing entity is not necessarily a catalyst for a worsened nursing shortage.
However, as we discuss the NCLEX test's implications on the next generation of nursing students, we can be more unified as we stand up for our professional rights and prepare nurses- new and experienced- for the future of health care.
Comment down below ...
Do you think the changes to the NCLEX are fair? Why or why not?
References
1983-1994 NCLEX Pass Rates
Getting Ready for the Next-Generation NCLEX® (NGN): How to Shift from the Nursing Process to Clinical Judgment in Nursing
NCLEX Pass Rates: What You Need to Know
What Is a Computer Adaptive Test and How Does It Relate to the NCLEX?
The Evolution of the NCLEX®: 20 Years as a Computer Adaptive Exam
Next Generation NCLEX – Are You Ready?
