NCLEX: How many times is enough?

Nursing Students NCLEX

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I was thinking about posting this question earlier, but decided not to post until I read a thread dealing with the topic. So what do y'all think? If a person hasn't passed the test by the nth time (you change the "n"), should they give it up because they obviously (in your opinion) haven't learned what they need to learn, therefore, would not be a safe practicing nurse?

I think an interesting question (and the makings of a nice bit of research if it hasn't already been done) would be to investigate the correlation between number of attempts to pass and the "quality" of nursing provided upon passing.

I have.

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Specializes in Med-Surg.

Algernon, you brought up some excellent points that I didn't even think of. I can't wait to see the responses.

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I don't understand why you say the argument of "I'd rather have the good clinician" doesn't make sense or is ridiculous,. It's a fact. Some people are super smart but terrible in real world situations. I never said that was everybody. Most people take the test, pass it, and move on.

I say that because it is SOOO frequently said: "I'd rather have the good clinical person than the one who does well on tests", as if those were the only options. I meant that all too often it's used to say that all those people who do lousy on tests are really just fabulous nurse-to-be's, when in fact there are probably a good number who are also lousy nurse-to-be's.

I was speaking about a general statement used so broadly as to make it sound like the characteristics (good nurse/bad test taker, good test taker/bad nurse) always seem to go together. I think it gets used as a crutch in many cases--as in, "she'd be a great nurse, she just can't take tests" as if that were absolutely the only thing preventing her from being Florence Nightingale's twin.

I didn't mean to start a fuss, just kind of voice a frustration of mine. Sorry if I offended!

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Questions that must be answered, when asking this question, include:

Does the NCLEX accurately predict RN competency? Is it valid?

Even if the answer is yes, we can't absolutely conclude that it is therefore the ONLY predictor of RN competency. That would be illogical. Even if the NCLEX successfully filters out/predicts individuals who will better perform nursing duties safely and effectively this does not mean there are not other filters that would not achieve the same function (or that the two filters would not overlap for some individuals and not for others).

Is the NCLEX even necessary? (I believe that good on the job training plus good performance evaluations would eliminate the need for the NCLEX, if necessary. Obviously we do not face that necessity. I'm just saying: if for some reason we could no longer adminster the NCLEX, I find it hard to believe the RN workforce would suddenly be filled with incompetents. Nursing school and competent supervisors plus competent training should be filter enough.)

We know the NCLEX itself can be taught. There are ample review courses out there that can teach enough NCLEX strategy to enable many to passt his exam who otherwise could never do so on their own, with their own independent thinking. Yet we have many who never seek out (or who are unable to pay for) these instructors.

To arbitrarily pick a number (three times) when there are so many variables out there (far more than I mentioned here) seems senseless to me. What is the reason for picking the number three?

And, in defense of those who need to take the exam five times or more, let me ask this question: do you assume that if someone fails three times, they are incapable of "improving?"

What exactly does the NCLEX test, in your opinion, that cannot be learned? If you are not simply applying arbitrary punishment according to your timeline, you must be operating off an assumption that the NCLEX tests something that cannot be learned. Otherwise,why not give someone the chance to learn whatever "it" is and demonstrate they've learned it on the NCLEX?

If the NCLEX is truly valid, as you seem to believe, then it should be valid whether someone passes it the first time of the 30th time, should it not? The million or more reasons it may take someone that many times to pass it should have no meaning if the test is TRULY valid.

I'm not saying it is. I'm just pointing out that your own faith in the NCLEX defeats an arbitrary "three strikes and you're dumb" belief.

Either you believe someone can improve their nursing critical skills set or you do not.

Also, just because someone is anxious when it comes to exams, they will not necessarily be anxious during a medical emergency. This is more bad logic and it would be sensless at best, and cruel at worst, to judge someone as incompetent to be in medical situations simply because of their assumed test anxiety and your belief this anxiety is universally transferrable.

I would be disappointed if someone took these statements to be "flames."

I appreciate the questions asked, the ability to participate in this discussion, and I stand behind my points pending better points.

:up:

All good points, and I don't consider them flames at all. "Flames" are those nasty, demeaning posts that just rant about why what you said was stupid and they are quite obviously correct. :)

Why three strikes and you're out (not dumb, I didn't mean that)? Because I think that at some point, it seems to make sense to HAVE an end to what is currently endless testing. Don't like three? Ok, four. Five. I appreciate that you feel that someone could and should keep re-testing until they've eventually learned enough to crack the barrier of the minimum standard, but I guess I'm just not that lenient. Playing the odds that at some point they will be able to meek out the "pass" doesn't instill much confidence in me, I guess. I get that there's logic to the idea that it shouldn't matter, that once learned it should be just as valid as for those who passed the first (or second, or third...) time, but I just don't feel that good about it.

I never said, nor do I believe, that the NCLEX is a perfect indicator of RN competency. All it does is separate those who can demonstrate a minimum competency, from those who cannot demonstrate this. I think there is validity in such a distinction. There must be some standard for licensure. As for the idea that we need no test, that on-the-job training is sufficient, I'm pretty sure that the professions that also use a standardized test for licensure such as MDs, lawyers, engineers, etc would find us a pretty funny lot. How "professional" I imagine we'd appear then! Show me the law school graduate who cannot pass the bar exam and I'll show you a GREAT paralegal...

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Of course, most people's test scores reflect their knowledge/ability; but, there is a big difference between someone who does poorly on tests because they don't have the required nursing knowledge (the poor nursing candidate) and someone whose testing anxiety effects their ability to test well. My question is: have you ever seen, in normal life, a great clinical nurse who wasn't the best at taking tests?

Absolutely. My only point is that I've ALSO seen some truly poor clinical students as well, who were ALSO poor at taking tests. If you believe that there are those who are the Lord's answer to a nurse and are only prevented from being so because they are too anxious to pass this test, then you probably have to also believe that there are those who aren't passing for a reason, and taking it 9 times won't change that. That's all I was saying. If you like the idea of being able to take it 26 times and Number 27 is the charm, then fine. I just don't see the point. Except, however, it's GREAT revenue for the State ;)

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I also have worked with someone who passed the test by some strange miracle and has run an entire bag of heparin (500 ml, 25,000 units) over an hour because she thought it was vanco!

On a side not....holy CR@P!! What the heck was the PTT on THIS dude when she was done??

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I say that because it is SOOO frequently said: "I'd rather have the good clinical person than the one who does well on tests", as if those were the only options. I meant that all too often it's used to say that all those people who do lousy on tests are really just fabulous nurse-to-be's, when in fact there are probably a good number who are also lousy nurse-to-be's.

I was speaking about a general statement used so broadly as to make it sound like the characteristics (good nurse/bad test taker, good test taker/bad nurse) always seem to go together. I think it gets used as a crutch in many cases--as in, "she'd be a great nurse, she just can't take tests" as if that were absolutely the only thing preventing her from being Florence Nightingale's twin.

I didn't mean to start a fuss, just kind of voice a frustration of mine. Sorry if I offended!

I totally missed this. Great observation. I love being made aware of false sets like this (as if there are only two possibilities that are also mutually exclusive and inversely related).

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Why three strikes and you're out (not dumb, I didn't mean that)? Because I think that at some point, it seems to make sense to HAVE an end to what is currently endless testing. Don't like three? Ok, four. Five. I appreciate that you feel that someone could and should keep re-testing until they've eventually learned enough to crack the barrier of the minimum standard, but I guess I'm just not that lenient. Playing the odds that at some point they will be able to meek out the "pass" doesn't instill much confidence in me, I guess. I get that there's logic to the idea that it shouldn't matter, that once learned it should be just as valid as for those who passed the first (or second, or third...) time, but I just don't feel that good about it.

Yeah. I see I put those "three strikes and you're dumb" words in your mouth. Sorry.

You mention playing the odds...the idea that, given enough time, someone could pass by luck. But...I think the test is supposedly designed to rule out luck. I just can't get away (so far) from the concept that if the test is sound and does what it supposedly does, then luck will not actually conquer the exam. So if someone is eventually able to pass the test, then at that point they must be minimally competent (assuming the test is valid in the first place). I therefore think it's absolutely just that someone (especially after years of dedication and investment) be given the chance to continue increasing their nursing intelligence until they think well enough to answer NCLEX questions. And, I will admit my own bias: I think the NCLEX questions are pretty "out there." Most of them, anyway.

I never said, nor do I believe, that the NCLEX is a perfect indicator of RN competency. All it does is separate those who can demonstrate a minimum competency, from those who cannot demonstrate this. I think there is validity in such a distinction.

Yes. As long as the test actually does this with validity. Again, if it does, then we have to trust the results, whether they come today, tomorrow, or five years from now for someone. A lot of these questions are priority questions. As in, "Hey. Which of the following conditions is the VERY VERY VERY WORST,even though they're all, or mostly, VERY bad?" There are just a lot of bizarre questions that don't translate to real world situations, IMO.

There must be some standard for licensure. As for the idea that we need no test, that on-the-job training is sufficient, I'm pretty sure that the professions that also use a standardized test for licensure such as MDs, lawyers, engineers, etc would find us a pretty funny lot. How "professional" I imagine we'd appear then! Show me the law school graduate who cannot pass the bar exam and I'll show you a GREAT paralegal...

I understand the need to have a standard benchmark that we can use to shore up our banner of "professionalism," but I also believe it mostly serves this purpose alone. I meant to say I don't think there is an actual functional need, but I do recognize the political need in the real world. That said, I feel that way about the standardized tests for most of those professions u mentioned. They're pretty silly in the end. I doubt most lawyers or MDs could pass the Bar or MCAT a year or two into their respective professions.

Anyway. Good discussing things with you. I really like this website. Tons of cool people.

:rolleyes: I like this face, even if he is blue--or maybe because.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Questions that must be answered, when asking this question, include:

Does the NCLEX accurately predict RN competency? Is it valid?

Even if the answer is yes, we can't absolutely conclude that it is therefore the ONLY predictor of RN competency. That would be illogical.

:up:

NCLEX plus a degree from an accredited school probably is the best it's going to get as a predictor of RN/LPN competency - not just NCLEX.

I might get flamed for this but I'm a bit baffled by the "I'm a poor test taker" excuse because how on earth did one make it through the rigors of nursing school with such test anxiety? Surely some test-taking skills were learned along the way. But I'm a very calm test taker, so I shouldn't judge and I apologize for that.

I'm not a fan of NCLEX. I don't like how they word their questions, I hate how they have a variable number of questions because it causes undue stress and suffering for the taker....."OMG, it's up to 76 questions....I know I'm failing...what's up....OMG...it's up to 112 questions....I may as well just start guessing". It would be nice if everyone had the same number of questions.

If I had to say, I'd say 3 times and you haver to go back to school and then maybe one more chance.

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If I had to say, I'd say 3 times and you haver to go back to school and then maybe one more chance.

But why? What harm comes of endless chances? In other words, what would a cap on number of times specifically prevent?

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
But why? What harm comes of endless chances? In other words, what would a cap on number of times specifically prevent?

I think the purpose of NCLEX is to test for a national standard of competency in nursing, so limiting the number of tries allows for only competent people to make it through. (Not always of course, because we all know incompetent nurses....or at least nurses who do incompetent things from time to time.)

Unlimited number of tries at NCLEX would just demean the profession and you may as well drop that requirement if you allow people to take it ad nauseum until they can pass.

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I think the purpose of NCLEX is to test for a national standard of competency in nursing, so limiting the number of tries allows for only competent people to make it through. (Not always of course, because we all know incompetent nurses....or at least nurses who do incompetent things from time to time.)

Unlimited number of tries at NCLEX would just demean the profession and you may as well drop that requirement if you allow people to take it ad nauseum until they can pass.

Well...I appreciate your opinion and I'll think about it more (I always allow that I just have a giant blind spot, as I often do).

My thoughts, in response:

I think its an unproved assumption that limiting the number of tries only allows the competent to make it through. It might be true, as you say, but it might not. I'm just not sure of the evidence that relates NCLEX in fewer tries to ultimate competence on the job.

And...unlimited number of tries would not demean the profession, as far as I can see, because it already is set at unlimited number of tries. Unless you're saying it has already demeaned the profession? I know one can sit an unlimited number of times for the bar (which is also pass/fail) and this fact (as far as I know) does not demean the profession (by itself). I know many atty's who have sat multiple times for the bar, and the mayor of Los Angeles may never have passed (despite multiple attempts, and never any proof he passed). Just interesting side notes, not directly related I realize.

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