I'm About To Fail NCLEX Need Help With Where To Go From Here

[magnumGI, BSN, LPN]

I graduated a BSN program in May and am taking my first NCLEX attempt in a few days. I'm almost positive I am going to fail it, and I don't feel ready at all. Basically, I've already accepted defeat and am trying to plan for my next attempt. I had originally planned to take it at the end of the month/beginning of August, but my spouse is putting a lot of pressure on me to "just take the thing." Primarily, I feel, because she's annoyed by the amount of time I spend studying (6-8 hours most days, sometimes 10-12). I feel simultaneously frustrated, burnt out, and too anxious to function. The hours I'm putting in are no longer productive. I feel frenzied, unfocused, and get lost in the details of material I'm unlikely to even see on the exam. I'm not sleeping well, eating well, and know I'm not taking great care of myself. On top of that, my current job, which was planning on me being at my new job by now, has moved me to third shift (they already hired my replacement, and only had shifts open overnight when I told them I was pushing back the new job offer until I passed NCLEX) and I am not functioning well at all with the change. The only time I've smiled or laughed in weeks was thinking this morning about how absurd it is that I'm basically wasting $200 and throwing away my new dream-job offer (they just want me to pass it by the end of August) to knowingly walk into an exam I don't stand a chance at like a lamb to slaughter all to satisfy my spouse's hunch that I'm ready.

I don't feel like she understands at all. While I get that she's trying to boost my confidence, she doesn't get (and there is no polite way to tell her) that her opinion on my readiness is completely unqualified -- she isn't a nurse, has never taken the NCLEX, and has no idea how much I don't know or feel confident in. I also get the sense that her insistence on me getting it over with has less to do with her confidence in my competence and more to do with her annoyance that I'd rather study for the exam than weed the garden or go out to eat.

Her perspective is that I'm doing well overall on practice material and was a mostly-A student in nursing school, so I'm ready. Not only am I ready, but she figures that/behaves like I also don't need to do any more studying before the 8th. In fairness to her, I am doing well on them overall: I scored an 84% raw score on my school's ATI Comprehensive Predictor (~99% odds according to them). I've taken three CAT exams on ATI's Board Vitals; Attempt 1 shut off in 75Qs (84th percentile of Hard Band), Attempt 2 shut off in 76Qs (99th percentile of moderate band), Attempt 3 shut off in 75Qs (88th percentile of Hard Band). I've taken multiple (10+) readiness exams on Archer with a "Very High" likelihood of passing and 7-ish CAT exams on Archer that all shut off at 75 and said I passed. I tried the last few days of a friends' UWorld and was scoring in the 70s on the longer quizzes. On Hurst Review, I've taken 3/4 of their Q-simulators. They recommend a 77/125. My scores have been 93, 98, and 101. Finally, I took Kaplan's free test and got a 74% raw score.

My perspective, that she is unwilling or incapable of understanding, is that being an A-student means nothing if you crammed/didn't retain the material and that a raw score or overall performance on practice tests does not save you if you're riding near or performing under the passing standard in any of the client need categories. Getting 85-100% right in Physiological Adaption and Pharmacological/Parenteral Therapies does not help me if I'm bombing it in Basic Care and Comfort or getting a 57% in Safety and Infection Control. Being able to explain mechanisms of action for drugs and pathophysiology of diseases isn't going to save me if I'm missing questions or dead guessing on fundamentals/skills content. Nor is it helpful that I'm very weak in Maternal-Newborn and Peds (especially Growth and Development questions). While I generally score fine (65-75%) in the area, I also do a lot of guessing on prioritization, delegation, and assignment questions and find myself either confused by the rationales or feeling like they're inconsistent with other similar questions I got right either on the same platform or on different q-banks.

The general pattern I see is that I do very well on "easy" questions, overperform relative to peers on "hard" questions, but only hit 50% or so on "moderate" questions in my weak areas. I might miss multiple questions 55-60% of peers get right in a single assessment. My inadequacy really shines through on ordered response questions. I miss nearly every single one of these style questions when I encounter them.

I've got a content problem. Specifically, I have a content problem with a lot of first semester stuff, Maternal-Newborn, and Peds. I was an LPN for quite some time before my BSN program and tested out of Foundations in my BSN program. I'm regretting it sorely now. A lot of this stuff are things I was taught as an LPN and knew at one time. Unfortunately, in my practice as an LPN, I've been largely working as a med pass nurse in assisted living. In my job, I basically just pass pills and respond to emergencies if they arise. We don't touch catheters, start IVs, do NG tubes, trachs, tube feedings, or even do much of any wound care beyond band-aids or placing steri-strips. 

That is where my problem is. Here is what I've been tried to do to correct it:

- Youtube videos (which I find are often inconsistent between content creators)

- Hurst Review (I regret this purchase. I'm sure this is a wonderful content refresher for people who are weak in med-surg. Their specialty content - including OB and Peds - did not impress me much. I think that their q-simulators are too easy/not realistic and on the questions I do miss, I often don't find their rationales helpful in understanding why I got it wrong.)

- ATI review module books. 

None of these materials have been helpful in significantly improving my scores in my weak areas, and I need advice on where to begin with for my next NCLEX attempt. If it is helpful, reading textbooks does not get me very far. I can read them over and over again, highlight, and take notes for hours and feel like I've retained nothing.

If it is helpful, I'm primarily an auditory/visual learner. I learn from listening to somebody explain a concept or watching someone perform a skill and then attempting to re-explain or perform the skill myself in a fraction of the time it takes me to grasp content by reading from a textbook. 

What I'm looking for is reliable visual content/lectures that cover Foundations material basically from the brand-spanking-new student point. 

[chare]

You can do this, but you have to quit telling yourself that you can't.  "Whether you think you can, or you think you can’t – you’re right," by Henry Ford, is one of my favorite quotes. 

In my opinion, you need to put the books aside and stop the "studying" as there really isn't an effective method to study for a test that you've spent the last 4 years preparing for.  If you feel the need to do something to prepare, work some NCLEX style questions using one of the many apps or programs available.

Best wishes. And again, you can do this.

[magnumGI, BSN, LPN]

This probably doesn't make much sense, but it actually feels like I stand a better chance since deciding I'm probably going to fail. It's like there is less pressure and I feel less anxious. 

I just try to push it out of my mind that the consequences of failing are going to be considerably heavier than "just try again." This is a second degree for me (previous LPN program and Bachelor's in biology), so in addition to my Fed Loans I owe private loans that are now in repayment. My hours have been cut at the current job (they weren't planning on me still working there after graduation), so I'm falling behind on bills. I'm basically just paying the essentials to keep surviving -- car payment, mortgage, day care, food, utilities. I had a lot riding on getting the new job (it was my dream position and pays well enough to fix my financial situation). 

The reality is if I fail now, I won't get another crack at it before the new job's deadline. Even if I did, I won't have time to study for it because I need to be looking for a new LPN job. I'm going to need to be working four 12's a week to catch up with bills. Also, I really can't handle third shift. I'm a zombie at work and useless during the day. I try not to think about any of that right now. Maybe I'll get lucky.

I guess my plan is going to be to do my best. I'm not realistically going to re-learn any substantial amount of content in the next 5 days. When it's over, I'll take a few months to get bill collectors off my back and see if my school will let me audit Foundations or has any remediation resources and keep doing practice questions to keep fresh on the stuff I'm actually competent at.

[NICU Guy, BSN, RN]

On 7/2/2022 at 1:51 PM, magnumGI said:

I'm almost positive I am going to fail it, and I don't feel ready at all. Basically, I've already accepted defeat and am trying to plan for my next attempt.

 was thinking this morning about how absurd it is that I'm basically wasting $200 and throwing away my new dream-job offer (they just want me to pass it by the end of August) to knowingly walk into an exam I don't stand a chance at like a lamb to slaughter 

I don't feel like she understands at all. While I get that she's trying to boost my confidence, she doesn't get (and there is no polite way to tell her) that her opinion on my readiness is completely unqualified -- she isn't a nurse, has never taken the NCLEX, and has no idea how much I don't know or feel confident in. I also get the sense that her insistence on me getting it over with has less to do with her confidence in my competence and more to do with her annoyance

Not only am I ready, but she figures that/behaves like I also don't need to do any more studying before the 8th.

My perspective, that she is unwilling or incapable of understanding, is that being an A-student means nothing if you crammed/didn't retain the material and that a raw score or overall performance on practice tests does not save you if you're riding near or performing under the passing standard in any of the client need categories.

 I need advice on where to begin with for my next NCLEX attempt.

You seriously need to stop with all the negative thoughts. You did well in school, you are putting in an insane amount of time. YOU ARE READY.

You are going to take the test on the 8th. You are going to finish in an hour at 75 questions. You are going to pass and think to yourself "Why did I waste so much time worrying about this test when it was not that difficult?"

[CKPM2RN, ASN, EMT-P]

Wow. You need to meditate, chill out, chillax, settle down, and so much more. Have you always been this anxious? If you've done that well in all your predictive programs and your classes, you've got this. And if, IF, you fail it the first time...so what? You'll be joining many people. It is not the end of the world. 

[magnumGI, BSN, LPN]

2 hours ago, CKPM2RN said:

Wow. You need to meditate, chill out, chillax, settle down, and so much more. Have you always been this anxious? If you've done that well in all your predictive programs and your classes, you've got this. And if, IF, you fail it the first time...so what? You'll be joining many people. It is not the end of the world. 

I've always had a lot of test anxiety. I know that it is probably something I should work through with a counselor. The very short story is that, growing up, A's = validation, B = "You didn't apply yourself. I know you can do better.", and <B = Shunned, mocked, or punished.

A big reason I hadn't got help for anxiety before is that, up until now, I've been able to use it as a motivator. The thought of failing a nursing exam, repeating a care plan, or getting a C in a class was literally enough to make me feel nauseous. So, days before an exam, I would cloister myself away and to try to cram anything that could possibly be on the exam. I reasoned that if I know literally everything about the subject, the instructor can't catch me off guard. 

And now, I feel lost because cram sessions can't save me. I can cram for an exam or a final in a single class. Anyone can. You can't cram two years of material in a couple of weeks. It doesn't work. Not for me, anyway. I burn out after a few days and start forgetting what I just crammed a few days ago. I never developed healthy or effective study habits, because I've always relied on brute force memorization, valued by-the-book detail over broad principles, and hoping I was clever enough to improvise the application and reasoning part come test day. 

If I've got a single big regret, it's that I tested out of Foundations for the BSN program, because that is the stuff that's getting me on practice exams and its material that most people get right. Nursing skill questions, basic care and comfort stuff. 

 

[sleepwalker, MSN, NP]

Just take it. You'll do fine.

[subee, MSN, CRNA]

On 7/5/2022 at 3:42 PM, magnumGI said:

I've always had a lot of test anxiety. I know that it is probably something I should work through with a counselor. The very short story is that, growing up, A's = validation, B = "You didn't apply yourself. I know you can do better.", and <B = Shunned, mocked, or punished.

A big reason I hadn't got help for anxiety before is that, up until now, I've been able to use it as a motivator. The thought of failing a nursing exam, repeating a care plan, or getting a C in a class was literally enough to make me feel nauseous. So, days before an exam, I would cloister myself away and to try to cram anything that could possibly be on the exam. I reasoned that if I know literally everything about the subject, the instructor can't catch me off guard. 

And now, I feel lost because cram sessions can't save me. I can cram for an exam or a final in a single class. Anyone can. You can't cram two years of material in a couple of weeks. It doesn't work. Not for me, anyway. I burn out after a few days and start forgetting what I just crammed a few days ago. I never developed healthy or effective study habits, because I've always relied on brute force memorization, valued by-the-book detail over broad principles, and hoping I was clever enough to improvise the application and reasoning part come test day. 

If I've got a single big regret, it's that I tested out of Foundations for the BSN program, because that is the stuff that's getting me on practice exams and its material that most people get right. Nursing skill questions, basic care and comfort stuff. 

 

Going for counseling is something you should "probably" do:), but a necessity that you start ASAP.  Do you realize how much potential energy you are wasting attempting to control your anxiety?  Your life will be so much easier after you have wrangled with this problem.  I'm pretty sure that since you survived getting your degree, you will be MORE than prepared to pass the boards.  If they were that difficult, we wouldn't have any nurses!

On 7/2/2022 at 2:20 PM, chare said:

You can do this, but you have to quit telling yourself that you can't.  "Whether you think you can, or you think you can’t – you’re right," by Henry Ford, is one of my favorite quotes. 

In my opinion, you need to put the books aside and stop the "studying" as there really isn't an effective method to study for a test that you've spent the last 4 years preparing for.  If you feel the need to do something to prepare, work some NCLEX style questions using one of the many apps or programs available.

Best wishes. And again, you can do this.

Good advice.  The nurses that write these review books are the same nurses that write the questions for the boards.  

[Wlaurie, RN]

You need to focus on you, not your wife. I also studied 6 hours a day and waited a month to take it. I look at it as an Olympic event, mental though instead of physical. Train for peak performance the day of the test. Right now you're experiencing something akin to stage fright before you have to perform. We're all nervous taking it. Remember it's geared toward an average knowledge of nurses just starting out. However, I remember question 2 taking the test. It was a SATA question. I freaked. I can't do it, I said. I was a good student and how embarrassing it would be if I failed. I stopped right then and there and gave myself a mental pep talk. I studied and did well in school, I know this stuff but I would just have to trust my gut and jump off the cliff and let it fly. Read the question, eliminate the wrong answers after I justified why they were wrong, and choose what I thought were the right answer/s and tell myself why I thought they were right then move on to the next question. And don't worry about the question you just answered, move on.  It took me an 1 1/2 hours and 75 questions and I passed. You can do this if you believe you can, really. However, if you go in with a bad attitude and freak out you do have a good chance of failing. Believe in yourself and what you've learned and go in confidently.

[magnumGI, BSN, LPN]

I want to thank everybody for their replies.

Here's where I'm at right now. I just took my last Hurst q-simulator and scored a 103. Yeah, I know, I shouldn't study the day before. But that just isn't me. I'm going to try my best to keep it light this evening (review the rationales from the last quiz and maybe glance over my two-page study guide). Anyway, that brings my average score to a 98.75/125 (93, 98, 101, 103). Hurst says that students who pass have a median score of 77/125. 

The stats say I'm better prepared than most. I don't feel that way. Instead, I feel like I'm a talented guesser. But I suppose no one ever feels completely ready, and if I am a talented guesser, consistent performance across so many questions suggests it is an asset rather than a fluke and that it should give me confidence. 

Wish my luck guys. I'm doing this thing tomorrow morning. The best thing I can do is take it one question at a time, expect to take all 145, and pretend it's just another Hurst quiz. I plan to try the PVT after the drive home, and I'll post when I find out. It's probably a bad idea (I work that evening), but there is no way I'll be able to stand waiting for the quick results. 

[NICU Guy, BSN, RN]

My advice that worked for me is to get a good night sleep and a good healthy breakfast in the morning. Leave plenty early so that you are not rushed to get there on time.

I forced myself to pace myself. During nursing school, we would review the tests and I missed questions that I shouldn't have. I was misreading the question. For NCLEX, forced myself to read the question and make sure I understood what it was asking. I placed my mouse hand on the table away from the mouse, read the question and determined what answer I wanted to choose, then placed my hand on the mouse. Once I answered the question, I removed my hand from the mouse. I wanted to make sure I didn't quickly read the question, answer, and move on causing me to misread the question.

[magnumGI, BSN, LPN]

... 75 and out in less than 45 minutes. Assuming that the good popup is reliable (I waited 2 hours after I received the email), I can't even describe the weight I feel off my shoulders.

I know, everybody told me so. I'm not going to lie, I walked out of there thinking "what even just happened?" I stopped counting the SATA questions at thirty, and basically got my nightmare scenario content-wise of oodles of OB and Peds. That said, at no point did I see anything I hadn't heard of before or couldn't at least describe in my head. And on more than one occasion, where I didn't know the content, I was able to get to the answer just by reading the question again and seeing which ones didn't make sense in the context of the question. 

I trusted my gut. And, provided the "good popup" is as accurate as nursing lore says it is, it paid off. 

I want to thank everybody here for believing in a total stranger that wouldn't believe in themself. I really do believe that it helped give me the last push I needed across the finish line.