New NCLEX Exam to Replace Nursing Process With An Untested Clinical Judgment Model

Crash_Cart · Jul 20, 2019

13 hours ago, Rosalinda Alfaro-LeFevre said:
Increasingly, NCLEX takers are reporting that the felt they HAD to complete the test, but were too tired by then. So they clicked away without much thought to the questions.

Many of the questions on NCLEX are an exercise in trickery and attempts to confuse the test taker with ambiguously worded questions with multiple interpretations, depending how you read or look at the question.

How about instead of using trickery and other tactics intended to confuse everyone for no real practical reason on the exams, test a person's actual knowledge in a straightforward way about the subject matter instead?

They either know the subject material, or they don't. Simple as that.

kbrn2002, ADN, RN · Jul 21, 2019

13 hours ago, Crash_Cart said:
Many of the questions on NCLEX are an exercise in trickery and attempts to confuse the test taker with ambiguously worded questions with multiple interpretations, depending how you read or look at the question.
How about instead of using trickery and other tactics intended to confuse everyone for no real practical reason on the exams, test a person's actual knowledge in a straightforward way about the subject matter instead?
They either know the subject material, or they don't. Simple as that.

If all the questions were easy and straight forward it wouldn't really be a test that incorporates thinking skills now, would it? If you got to some of those questions that use "trickery" that means you were doing well enough on the easier questions to advance to those difficult questions. Nursing has always been about more than just knowing subject material and the test is designed to reflect that. It's not only what you know, as a nurse it's just as much how you use what you know.

BrentRN, PhD · Jul 22, 2019

On 7/20/2019 at 5:32 PM, Crash_Cart said:
Many of the questions on NCLEX are an exercise in trickery and attempts to confuse the test taker with ambiguously worded questions with multiple interpretations, depending how you read or look at the question.

Are you referring to actual NCLEX-RN questions or those found in prep resources. Those are two different issues.

Assuming you are referring to the actual exam, it reminds me of the questions I wrote for exams that require application of knowledge rather than recall of facts. Some students struggled with those and claimed I was trying to trick them. I think that comes from too many students being tested on recall rather than comprehension in their academic careers.

Crash_Cart · Jul 22, 2019

I guess I need to provide an example to demonstrate my point.

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Of course, everyone knows each facility is going to have different policies right?

Crash_Cart · Jul 22, 2019

Also just to clarify I am aware RN's are not permitted to label any medications and that's not the issue. The question comes down to whether you choose to send it back to the pharmacy, or waste the medication. (Assuming there is a pharmacy department?)

The question doesn't clarify if the medication is a narcotic or a bottle of maalox. I guess how things are handled depends on facility policy and what's inside the bottle doesn't it.

This is what I mean by the use of trickery and ambiguously worded questions with multiple interpretations.

BrentRN, PhD · Jul 22, 2019

1 hour ago, Crash_Cart said:
I guess I need to provide an example to demonstrate my point.
Of course, everyone knows each facility is going to have different policies right?

What is the source for this question? Unless it is from the NCSBN site this is not an example of an actual NCLEX question.

Crash_Cart · Jul 22, 2019

5 hours ago, BrentRN said:
What is the source for this question? Unless it is from the NCSBN site this is not an example of an actual NCLEX question.

The source is an open source mobile app for independent learning similar to making flashcards. No, it's not an actual NCLEX test question because we're not permitted to post those here.

The example was simply to demonstrate the type and scope of ambiguity existing in some of the actual test questions, and perhaps in some other nursing study material for that matter.

I respect your opinion, but respectfully disagree that such a great deal of ambiguity should be necessary in the testing materials. We shouldn't be finding more ways to confuse people, we should be testing them about the relevant content of the material they have studied per the nursing courses they have taken.

Similarly, in many cases people study for weeks, or even months only to find very little study content actually showing up as questions on the tests. They often encounter questions that have very little clinical content, or the questions have nothing to do with what they have been instructed to study.

Here's an article to further demonstrate my point for additional thought:

https://gomerblog.com/2014/08/nclex/

BrentRN, PhD · Jul 23, 2019

1 hour ago, Crash_Cart said:
I respect your opinion, but respectfully disagree that such a great deal of ambiguity should be necessary in the testing materials. We shouldn't be finding more ways to confuse people, we should be testing them about the relevant content of the material they have studied per the nursing courses they have taken.

I think you are mixing up what nursing instructors and NCLEX-prep resources do to try and prepare you to be be a nurse and pass the boards.

Nursing instructors are trying to prepare students for more than the exam. The exam only tests minimum safety by a new nurse. The nurse prep resources are just guesses based on the standards posted by the NCSBN. The questions themselves are highly secret so anything you see outside of the NCSBN site are just guesses as to what is on the test.

Some resources are much better than other. The NCSBN says that all questions are higher level, i.e. analysis and evaluation measures. By their nature they will not be a question about a fact, it will be a question that requires you to apply your knowledge and make a judgment about care.

For example, a question about a client on Dilantin asks about nursing care needs would give 4 options. The correct answer would involve providing careful oral hygiene. This is a question that may seem "tricky" until you remember that Dilantin causes hyperplasia of the gums. Dilantin is a seizure med but this is testing your knowledge at a higher level, and your ability to provide a higher level of care.

I hope you can see that the question is not trying to trick or confuse but, rather, to test a student's ability to think beyond recall of a fact.

Rosalinda Alfaro-LeFevre · Jul 23, 2019

On 7/20/2019 at 5:32 PM, Crash_Cart said:
Many of the questions on NCLEX are an exercise in trickery and attempts to confuse the test taker with ambiguously worded questions with multiple interpretations, depending how you read or look at the question.
How about instead of using trickery and other tactics intended to confuse everyone for no real practical reason on the exams, test a person's actual knowledge in a straightforward way about the subject matter instead?
They either know the subject material, or they don't. Simple as that.

On 7/21/2019 at 6:54 AM, kbrn2002 said:
If all the questions were easy and straight forward it wouldn't really be a test that incorporates thinking skills now, would it? If you got to some of those questions that use "trickery" that means you were doing well enough on the easier questions to advance to those difficult questions. Nursing has always been about more than just knowing subject material and the test is designed to reflect that. It's not only what you know, as a nurse it's just as much how you use what you know.

Interesting discussion! My 2 cents: Questions should mimic real life decisions. Many of them do not. I tell students that NCLEX is like a trivia game with very specific, sometimes quirky rules. It will reduce their stress if they look at it this way.

If they try to connect the questions to real practice situations they will overthink the questions. I’ve had a LONG successful career in ICU, ED, supervision, education and publishing. Yet, I’m one of those people who needs a real situation to think well. Give me convoluted test questions, where I miss-understand one silly adjective, and I’m off in the wrong direction and upset that I don’t get the question

Its not a matter of either knowing the material or not. You have to be WELL SCHOOLED in applying exam rules or even the brightest mind can fail.

Rosalinda Alfaro-LeFevre · Jul 23, 2019

On 7/20/2019 at 4:41 AM, Rosalinda Alfaro-LeFevre said:
Thank u for the above! I agree. Part of this issue is that the NCSBN makes their communications look like all is great with their process, so many think it’s a great idea.
At a closer look there many issues, not only with the CJM (as Pat Benner and I both independently noted), but with the research section: Increasingly, NCLEX takers are reporting that the felt they HAD to complete the test, but were too tired by then. So they clicked away without much thought to the questions. ThIs calls into question how they can be so happy with the research section results. Coincidence?
I’m new to this group and am struggling a bit with how to reply. I hope I did this right. If not, since I’m out of the country, can you re-post for me?

A huge issue with NGN is the time and money it will take to learn and implement the (flawed) new CJM. Yet, as it says above and is being said by many, the questions aren’t that different.

The NCSBN has done a bunch or renaming and shuffling of concepts just to end up with something that at a closer examination, is the same. Terrible for faculty, students, and ultimately patients.

Have we not learned from NANDA? They too trotted out a lot of renaming and convinced us all it was evidence based.

Nursing has GOT to speak up to the NCSBN or we will be wasting valuable time and money AGAIN. Haven’t we LEARNED???