Is the Nursing Licensure Exam effective?

xoemmylouox, ASN, RN · Apr 8, 2012

If I remember right the minimum is 75, it can offer more than 100 questions. I think that many even left those 2 day long tests thinking they failed. It is a very stressful situation. I knew my stuff, but until you get that notice that you passed you are left wondering. Most people say they think they failed just because they are scared, not that they really think they failed.

elkpark · Apr 8, 2012

If I remember right the minimum is 75, it can offer more than 100 questions.

Minimum is 75, max is 265 (IIRC). However, on every test, regardless of how many questions, 15 of the questions are proposed future questions included in the exam for validation purposes, and do not count toward the final results of the exam. So, when the computer shuts off at 75 and you passed, you actually only answered 60 questions that counted.

I know I'm not the only older (pre-CAT NCLEX) nurse who is deeply disturbed by the idea of people getting an RN license on the strength of having answered 60 questions to the computer's satisfaction. In the two-days-of-testing era, we had more questions on each individual area of nursing practice than the maximum number of questions possible these days, and we were tested comprehensively on all basic areas of nursing practice and knowledge, not the "potluck" approach used now.

Of course, as usual, nobody asked me what I thought when they made the change ... :)

OCNRN63, RN · Apr 8, 2012

I'm concerned that schools sam to be geared toward teaching students to pass NCLEX, not how to be nurses. I blow off the comments from newer nurses that seasoned nurses weren't taught how think critically. What do they think we've been doing all these years? Just acting like robots? "Yes, Doctor." Of course we've been thinking critically. It's just that it wasn't the catch-phrase of the day when we were students. (Same thing applies to "evidence-based practice.")

I think I've stated on many threads before that I do not approve of the 75 question, "Yay, you passed!" NCLEX. I have to wonder if there's a connection to this and all of the threads about nurses having such difficulty transitioning from student to novice nurse.

elkpark · Apr 8, 2012

I'm concerned that schools sam to be geared toward teaching students to pass NCLEX, not how to be nurses. I blow off the comments from newer nurses that seasoned nurses weren't taught how think critically. What do they think we've been doing all these years? Just acting like robots? "Yes, Doctor." Of course we've been thinking critically. It's just that it wasn't the catch-phrase of the day when we were students. (Same thing applies to "evidence-based practice.")
I think I've stated on many threads before that I do not approve of the 75 question, "Yay, you passed!" NCLEX. I have to wonder if there's a connection to this and all of the threads about nurses having such difficulty transitioning from student to novice nurse.

I completely agree on both points. I've posted before that I graduated from a hospital-based diploma program 'way back before the term "critical thinking" was invented, and all one seems to hear these days in nursing is how the problem with diploma programs was that they were only focused on tasks and skills, not the much-vaunted "critical thinking," and yet my program managed to somehow turn out graduates who were not only clinically competent and well-prepared to enter practice without all the hullabaloo we hear nowadays, but also accustomed to thinking critically about our clients and clinical situations (much more so than the new graduates I encounter nowadays). I also agree with you about "teaching to the test" rather than teaching nursing, and whether that may be contributing to the greater problems we see more recently with transitioning from nursing student to practicing nurse.

Double-Helix, BSN, RN · Apr 8, 2012

I also agree with you about "teaching to the test" rather than teaching nursing, and whether that may be contributing to the greater problems we see more recently with transitioning from nursing student to practicing nurse.

I couldn't agree more. As a nursing school graduate, I could easily say:

"You want me to answer a test question and prioritize the order I need to see 5 patients? Absolutely. You want me to actually see those five patients.... "

I think emphasis on clinical skills- primarily the ability to manage a multiple patient load independently- is sorely lacking in today's nursing schools. In my school, in every clinical (except my preceptorship), we were only ever assigned a maximum of 2 patients, and we did not get to do all the care for those two patients. So depending on where the preceptorship was completed, it's very possible for students to graduate having never managed more than two patients at a time.

TopazLover, BSN, RN · Apr 8, 2012

I took boards many years ago. I was sure of my stuff. I knew the material. I walked into The Colosseum when the outside temp was 102 F. Inside was AC to the max. I sat huddled under a sweater. I quickly answered and felt confident until I walked out. The heat hit as if I had walked into an oven. I saw people handing out combs and rain bonnets (see how old I am, rain bonnets?) that gave a number to call to study for the next exam. I felt crushed. They knew I had not passed. Each set of tests started and ended with the blast of the heat (up to 107 F.), the freeze of AC, the blast of the heat combined with the people handing out those disgusting combs and bonnets.

Three months later I got a call at work (evenings) and my now ex-husband read each number for each test. It took a couple of seconds for it to sink in that I had passed.

I tell this story for a couple of reasons. We had to have comprehensive knowledge in all areas. There was no way to study for the testing. It demanded ongoing knowledge accumulation and incorporating this knowledge into critical thinking. We did not use that wording. We knew signs and symptoms so we were ready to differentiate immediately what was the next thing.

The second thing I found had great meaning was having to wait for the results. Three months I worked and because of the nagging thought that I might not have passed I sucked in new information like a sponge. Anything I saw I worked into my memory center in case I needed it for another try at the Boards. I valued that testing not as something I had to get past into order to make big bucks (nurses made very little then), but something I had to pass in order to validate my knowledge base.

That is one thing I think may be lacking with the new testing. It does not validate a personal broad base of knowledge. Teaching and focusing on passing a test at 75 questions does not allow you to get that same feeling of validation of broad base knowledge.

I remain proud that I passed those two days to testing. Never have I had the same feeling as the hot and cold of those two days of testing. It was not just a test. It was a rite of passage.

OCNRN63, RN · Apr 8, 2012

IIRC, back then you had to wait 6mo. to retest. I don't think I could have survived a second go-round with that.

In a way, I feel sorry for new grads. They're bombarded with which study plan is better: Kaplan? Saunders? LaCharity? I remember briefly looking over a few things, but I don't remember really studying. There wasn't anything out there to help you prepare.

I agree with aky. Sitting there with hundreds of people in a huge auditorium for two days was indeed a rite of passage.

melmarie23, MSN, RN · Apr 8, 2012

I would like to think that in 75 questions, that I am darn good nurse. Now do I think that I am perfect and require no room to grow? Absolutely not. Do I learn on the job each and every day? Yep, sure do. Am I capable of thinking critically in a moment of crisis? You betcha.

I studied my lil tush off for almost 2 months straight before sitting for my CAT NCLEX. Those 75 questions spanned all areas of nursing believe it or not. They really challenged me intellectually. There were diseases and meds and s/s that I never even encountered in my clinicals or text books. How else was I to answer those ?s if I had not used my critical thinking skills? Could some of it had been dumb luck? I suppose. But I'd like to give myself more credit than that!

allnurses Guide · Apr 8, 2012

The fact that one can get a license after 75 -265 exam questions is troubling, but not as troubling as the fact that one can attempt it as many times as it takes.

I passed in 75 questions. I was hopeful I passed but fearful I failed and in that fear shed tears on the way to the car after taking it. I think that is more attributed to the anxiety and pressure of the testing situation than to whether or not I am going to be a good nurse. I am sure GNs that took the written three day test sweated whether or not they passed just as much as the current day GN does. And, frankly, for a lot longer given how long it took to get the results back. I think it is a stretch to link that anxiety to being a good nurse.

AMN74 · Apr 8, 2012

I posted a thread a week or so ago about "What do nursing schools teach these days?" because I'm seeing that hospitals do not want to hire new grads, and I see on threads on this board that people are taking the test for the 3rd of 5th time. I came from the era where we sat for 2 days in a large room and took tests. I failed my NCLEX the first time I took it, and had to wait 6 months to take it again. I knew my stuff, but simply got board sitting in a room that was so quiet you could hear a pin drop, and when I wanted to skip a question I was not sure of, and wanted to come back to it...I'd forget to skip a line on my test answer sheet. And that made the problem. I know that it was over 1000 questions, I can't remember how many anymore... but I was told when I got my "you failed" letter in the mail that I failed by 2 points. I was devastated. But at the time my new hospital job allowed me to stay on at "new grad" pay and wait the 6 months to retake the test. During that 6 months I bought many books that were just questions with rationals and I would study every day and read all the answers with rationals whether I got them right or not. And I passed my second test. I remember that within a month of passing my NCLEX and becoming a RN...I started taking charge on the 3-11 shift on our 22 patient pediatric ward. I was ready to do that. What I see now is that the new grads can't even handle a case load of clients when they get out of school.

The responses I got on my thread were that nursing schools now teach students to take the test..not so much about teaching how to become a nurse. I feel like if you teach nursing, the test questions will be able to be answered automatically. If youre in nursing school and have to learn to think critically, then you should be able to think critically when you take the test. But I have no clue what the test is like now, and I doubt I could pass it. Also I heard from many that there are so many nursing schools in each hospital facility that they don't get a chance to practice many skills except in a lab. That is sad. Why so many nursing schools if there is an influx of nurses right now, and these new grads can't find jobs?

Who decides what questions are going to be on the NCLEX and how many nursing schools can be out there? What is happening to nursing?

OCNRN63, RN · Apr 8, 2012

The fact that one can get a license after 75 -265 exam questions is troubling, but not as troubling as the fact that one can attempt it as many times as it takes.
I passed in 75 questions. I was hopeful I passed but fearful I failed and in that fear shed tears on the way to the car after taking it. I think that is more attributed to the anxiety and pressure of the testing situation than to whether or not I am going to be a good nurse. I am sure GNs that took the written three day test sweated whether or not they passed just as much as the current day GN does. And, frankly, for a lot longer given how long it took to get the results back. I think it is a stretch to link that anxiety to being a good nurse.

We did. I remember running to the mail box every day to see if I had the "thin envelope." One day, I didn't bother. I was at work and called my mother to see if I had gotten mail. She said I had. I asked her who it was from, and she told me it was from the Bureau Occupational and Professional Affairs (BOPA). I said, "Is it a thin envelop or a fat envelope?" She told me it was thin, so I told her to open it. I held my breath, and then

she told me I passed. Then I really started to cry. All that stress for nearly three days just melted away.