Prepare Nurses to Pass NCLEX, or Prepare Nurses for Real World?

[Hoosier_RN]

On 7/28/2020 at 5:42 PM, KatieMI said:

I do not know how schools nowadays let out nurses who literally do not know ABCDs of pathology and pharma and how these nurses successfully pass NCLEX in droves and get employed without having the slightest idea of what they are playing with.

Oh, bother....

Schools teach to the NCLEX because of the all important pass rates needed to stay in business. Students don't get the same education that I got 30ish years ago, that taught me to learn in depth and develop the critical thinking skills needed to adequately care for patients once I left school and got my license. Nowadays, they depend on facilities to fill in the blanks, which is proving to be detrimental to nurses, as well as patients. Not all residencies are good, and not all new nurses get the training and support that they need. I don’t blame nursing instructors, per se, they are hired to teach a class by the model the school wishes. I blame the schools that take these students money and leave many of them grossly under prepared.

[Wuzzie]

Bruse, your pain is so very evident and we all really do feel badly for you. Not only that but we all get it. The test is hard. When I took it it was 2 days long ( 8 hr/day 2000 questions) so no possibility to study every single thing they could possibly ask. Probably less of a chance than those testing today. In a lot of cases we just shot from the hip and hoped a lot. So right now go ahead and rail against the situation. Get it out of your system and then use the left over energy to try again. Focusing on lawsuits will get you nowhere at the moment. It’s true that much of what you learn is OTJ but you must also have a solid grasp of the basics otherwise patients will get hurt. The test is necessary because otherwise we would have students graduating from sketchy programs without even the very most basic level of knowledge. The skills aren’t that important, it’s the “whys” that matter. I wish you the best as you move forward and hope you keep this passion once you are a nurse.

Also wanted to add, I have no idea what you meant by the Trump reference. I don’t recall mentioning him.

[Hoosier_RN, MSN]

32 minutes ago, emtpbruse said:

Hoosier RN

"Boards for licensure are to help ensure public safety at a basic level, not to make people feel bad or feel like failures".

I just took a handful of prilosec to swallow that statement. Why are nurses claiming to be suicidal yet along depressed? That was one of the topics Allnurses.com elected to address right? Depression and the nursing practice.

So when your entire career is banking on the passing of a single test so you can provide for your family, make ends meet, feel resolved after thousands of dollars of students loans you have to repay...but can't pass a manipulative test, how is a licensure suppose to not make people feel bad or like a failure. Do you even know what it was like to have to tell my peers, my former professors, my employer, my family and friends that I failed for the "second" time. Do you have any idea what that feels like?

Bruse

No I don't Bruse. I passed it the 1st time at 75 questions, like many others have. But I remember knowing that I had to pass that test because I had children who depended on me. So, Bruse, you don't corner the market in knowing what it's like to worry, we've all been there.

I'm sorry, I've almost got to laugh at "manipulative", like the test has a beef with you, and is out to get you. WOW!...

Suicidal...I've only seen a couple of those on here...suicidal persons exist in every job title and walk of life, not just nursing. Grow up and take your temper tantrum elsewhere. You're wanting to throw blame, where blame is not appropriate

[londonflo]

1 hour ago, emtpbruse said:

I require additional remediation here and there on medications because I'm not well versed to using so many in the pre-hosp. arena. Based on all the med questions, isn't that what a PDR is for? I feel like the NCLEX exam is requiring me to take a test for the entry level of Pharmacist! I'm not a Pharmacist. If I don't know a medication, that is what we do research for before administering the medication.

While NCLEX does not give you a list of medications that you will be tested on. Did your college provide instruction or a course devoted to pharmacology? What about when you provided care in clinical? Were you administering medications? How did you evaluate the effects of the medication? Did you have a nursing drug handbook such as Davis? Did you use it? A PDR or Micromedix is not an adequate sole reference for a nurse.

NCLEX provides a test plan:

https://www.NCSBN.org/2019_RN_TestPlan-English.pdf

Quote

The test plan serves a variety of purposes. It is used to guide candidates preparing for the examination, to direct item writers in the development of items, and to facilitate the classification of examination items. This document offers a comprehensive listing of content for each client needs category and subcategory outlined in the test plan.

to guide you and your college in what is on NCLEX. 12 - 18% of the questions will focus on Pharmacology and Parenteral Therapies. This is stated on pg.5. Pages 30-33 cover this in depth. Please do not expect a recipe book approach for preparation of the nurse's role in drug therapy and a list of drugs to memorize.. Instead (and I would of thought this was covered in your curriculum) know the common categories of drugs, focusing on the suffixes of the generic names to help you group them in your mind. Drugs in the same categories have similar actions, may be given for similar health problems, etc. I have also recommended that students know the top 100 drugs prescribed in the US as these are the drugs they will most see when working. (You will have to Google search for it - but a lot of insurance companies publish such a list and they would know as they may be involved in paying for them).

With regard to being able to look up drugs on a "need to know basis" there is no guarantee that you will have sufficient time when providing care to look up everything and actually acquire the knowledge needed for safe practice. Somehow you need to re frame your brain to understand that the majority of what you need for licensure is NOT on the job training. We all have to look up an unfamiliar drug at times, but how could you provide efficient care with your nose in a book the majority of the time? How could you plan what to teach the patient about medications, when they will probably know more about the RX than you? (I am aware though that medication teaching is a new role for you but didn't you just spend 2 years focusing on nursing's role in healthcare?)

I have taught many students who come with years of knowledge from a specific area of health care. Paramedics like you, surgical techs, ophthalmology techs, respiratory therapists, etc. Their knowledge base in their particular area can be phenomenal but we usually have to get past their perception that they know more than the faculty on what they need to learn about nursing in the first semester. For example, a paramedic who was on the flight team just couldn't understand why a test question asked the newborn nurse which assessment data should be acted on first: hypoglycemia or hypothermia? This was a forced choice question -- not a SATA. He kept insisting that on the helicopter one paramedic treated the hypoglycemia, while another treated the hypothermia. (I do not teach OB -- he just came to me to vent.) And yes, he is a phenomenal paramedic who presented at many conferences and was a leader in his company but unfortunately he did have to repeat a course and also was not successful on NCLEX on first writing.

I am glad you are starting to look at what you have done well on. That is something to build on and feel good about. BTW you really don't have to tell anyone besides significant others when you go test again. Even though I had taught medical surgical nursing for 25 years, when I went to test for certification, I didn't tell anyone. It relieved a lot of my anxiety about having to admit it if I didn't pass, and it was a lot of fun to surprise other faculty with the fact I had studied and passed without their knowledge!

[londonflo]

1 hour ago, Wuzzie said:

When I took it it was 2 days long ( 8 hr/day 2000 questions) so no possibility to study every single thing they could possibly ask. Probably less of a chance than those testing today. In a lot of cases we just shot from the hip and hoped a lot.

Was your test in a huge convention center like mine? And it was given only twice a year.I took it in February - cough and cold season with hundreds of candidates sitting at long conference tables! And then it took over 3 months for the results!

[Wuzzie]

7 hours ago, londonflo said:

Was your test in a huge convention center like mine? And it was given only twice a year.I took it in February - cough and cold season with hundreds of candidates sitting at long conference tables! And then it took over 3 months for the results!

Rabbit and Chicken barn at the state fairgrounds. February. Propane heaters. Girl next to me barfed on the table. The whole experience was ghastly.

[Wuzzie]

8 hours ago, londonflo said:

Please do not expect a recipe book approach for preparation

I think Bruse may have been expecting this because the licensing test for paramedic is exactly this!

FTR: yes, I've taken the paramedic exam so I'm not just blowing smoke.

[Hoosier_RN, MSN]

8 hours ago, londonflo said:

Was your test in a huge convention center like mine? And it was given only twice a year.I took it in February - cough and cold season with hundreds of candidates sitting at long conference tables! And then it took over 3 months for the results!

My mother's was like that, she was amazed when I took mine at a testing center, on a computer, on any ol' day, 30 years later. Before she retired, she would talk about how these "young uns" would cry at having to wait 3 or 4 days to a week to find out, when she said it took forever back then, and it came by snail mail. Oh, the horrors!

4 minutes ago, Wuzzie said:

I think Bruse may have been expecting this because the licensing test for paramedic is exactly this!

FTR: yes, I've taken the paramedic exam so I'm not just blowing smoke.

I was a paramedic prior to nursing, for a few years. And yes, the tests are vastly different, as well as preparation

[JKL33]

I'm curious about how the NCLEX is lately. I have my questions about whether I would pass it or not, though I passed easily when I took it.

Just from things I've read and heard (and in helping others study)...it does kind of seem like some of the questions are a little out there. Not the ones that deal with the 3Ps, but some of the rest of it....yikes.

"The nurse is performing the charge nurse role on the unit. A new nurse approaches and states that one of her patients is having difficulty breathing. The charge nurse's best response or action would be to:

a) Ask pertinent questions in order to help properly direct care of the situation...blah, blah, blah...

b) Go to the room to assess the patient

c) Assist the nurse to review resources related to caring for the patient

d) Instruct the nurse in calling the healthcare provider regarding the patient's change in condition

e) Ask the nurse if she needs assistance in caring for the patient"

??‍♀️

Yeah, I made that up and I know it isn't a proper question but this is the general type of question that bugs me.

I'm not trying to be mean but sometimes I think schools/instructors are a little too fascinated with the thought of Bloom's Taxonomy and the idea that for all of these goofy questions there is some nonsense right answer according to higher ordered thinking...

Meanwhile it seems as if people do struggle over hypoglycemia vs. hypothermia type questions....my guess is because too much time is spent on ^ this ^ !! And, well, almost any amount of time is too much.

?

[londonflo]

34 minutes ago, JKL33 said:

I think schools/instructors are a little too fascinated with the thought of Bloom's Taxonomy and the idea that for all of these goofy questions there is some nonsense right answer according to higher ordered thinking...

Yes, education has become ruled by the application of "assessment" on all aspects of a curriculum. Bloom's taxonomy is the darling of regional and programmatic accreditation and I too wonder if the "tail is wagging the dog." But in the defense of it's use, students who do not meet a standard of learning may cry "foul" and the college has the burden of proof to show how the student has not met the required standard versus the student being required to demonstrate their competence. I think Bruse has illustrated some of the current thinking of a student along those lines.

A lot of the push for test questions that measure complex and critical thinking has come from the need to offer a licensure exam that is quicker and easier to administer than the days of old --- ie. 2 day, 2000 questions set of 5 specific test areas (OB, pediatrics, medical, surgical, psych). Many states do not allow students to begin their practice on a permit; instead they cannot be hired until they are licensed. Test questions like SATA, rank ordering etc. can test multiple related things in one question. And of course, there is a great demand for a determination of competence "now" on today's consumer.

In my experience, it seems like students enter the NCLEX testing situation thinking they will receive a "pass" after completing the lowest possible number of questions. Students often describe tremendous anxiety when the computer does not shut off after 75 questions. Even students who struggled throughout nursing school, expect they will demonstrate a satisfactory knowledge base quickly. I am not trying to be mean, but sometimes there seems to be an inflated idea of their proficiency when that has not been the norm in their traditional education.

[subee, MSN, CRNA]

17 hours ago, emtpbruse said:

Wuzzie,

Thank you for the inquiries. I promise, I'm no Trump and I will be glad to see him go but this a topic for a different venue.

I have done extremely well using UWorld, mostly in the 80% area of testing. I require additional remediation here and there on medications because I'm not well versed to using so many in the pre-hosp. arena. Based on all the med questions, isn't that what a PDR is for? I feel like the NCLEX exam is requiring me to take a test for the entry level of Pharmacist! I'm not a Pharmacist. If I don't know a medication, that is what we do research for before administering the medication.

I have also used Saunders Comprehensive Review (8th ED.), Exam Cram for NCLEX Review followed by the 5-wk NCSBN study plan. I can't reiterate how the questions I was exposed to on the NCLEX had no reflection on all the studying and review.

I don't want to violate any particular rules or regulations but the NCLEX asked me about several medications (at least 5) that I recalled after the test. I went to my car, wrote them down and then went home to my resources. NONE...I mean NONE of those medications were even discussed or listed in any of the resources I utilized. How am I suppose to take a test when material isn't even covered on the exam? I'm just asking?

Bruse

Bruse: What was the pass rate in your class? You would have better standing for a lawsuit if your class's pass rate was out of line with other schools'. There are multiple posts on this forum from nurses that had to take the exam more than 2 times. I have made the assumption that this school is even accredited. And what was the pass rate for your state? If the majority of takers failed, that would give your argument more credence.

[meanmaryjean, DNP, RN]

16 hours ago, londonflo said:

Was your test in a huge convention center like mine? And it was given only twice a year.I took it in February - cough and cold season with hundreds of candidates sitting at long conference tables! And then it took over 3 months for the results!

Took both LPN and RN versions a loooong time ago. McCormack Place annex in Chicago- RN test in Jan/ Feb, LPN in October. Left my coat on the entire time. Had a cold so took a box of tissues which were removed from the box and individually examined. Had to pee during one of them and was watched by a proctor. My LPN results arrived on December 24 and I would not open them for fear of ruining Christmas!

[londonflo]

1 minute ago, meanmaryjean said:

My LPN results arrived on December 24 and I would not open them for fear of ruining Christmas!

Was it a fat envelope or a thin one! LOL