To enter the professional world, nursing graduates must meet the specific requirements of their state boards of nursing. These boards use the National Council Licensure Examination (NCLEX) for both RNs and practical nurses, developed by the National Council of State Boards of Nursing. The exams measure competencies needed to perform safely and effectively as new nurses.
While many nursing students and new grads experience anxiety over the NCLEX, around 70% pass the RN exam the first time, and a slightly higher percentage pass the practical nurse exam on the first try. Future nurses can take further comfort in knowing practicing nurses from around the country help develop the test.
Louellyn Monera, RN, BSN, a certified psychiatric nurse in California, developed items for the RN test, evaluating exam items for graduates of foreign nursing schools. She also worked on the practical nurse test.
The experience began with a day of training, she says. “[The test items] dispelled a lot of myths about test-taking,” says Monera. “They explain how the test is given and how it works. I don’t think all test-takers understand that.”
Duane Anderson, RN, staff nurse in the child and adolescent psychiatric unit at the University of California, San Diego Medical Center, also helped develop items for the practical nurse test.
“It was obvious to me that it was important to NCSBN to make the test meaningful and fair,” Anderson says.
Nurses such as Anderson and Monera go to NCSBN’s offices in Chicago. They work individually on laptops writing test items, with ready access to reference materials and NCSBN staff.
“They had made a sincere effort to get a cross-section of nurses geographically, ethnically, across the spectrum,” Anderson says. “They had nurses from different backgrounds so they would have a wide array of questions. I saw this as my chance to make a contribution on a personal level and tried to be reflective of my experiences as a nurse.”
Exam items, once written, are reviewed and thoroughly tested.
“It is a very laborious process for one question to get on the exam,” says Linda Gabriel-Marin, RN, MSN, an assistant professor of nursing at Dominican University of California, who also has written items for the exam. “Obviously, each question is multidimensional, which is why you can pass with as few as 75 questions. The test is researched, validated with current knowledge, fine-tuned, and tested extensively.”
Newly written test items undergo comprehensive content review, which includes checking each for clarity, grammar, punctuation, and spelling, as well as accuracy of content. Reviewers also ensure there is only one correct answer to an item, and they seek to eliminate words that have varied meanings to different groups or wording that could be considered elitist or stereotypical, says Anne Wendt, RN, PhD, CAE, director of the NCLEX Examination Department.
New items are administered to at least 400 first-time, U.S.-educated test takers, and items that performed significantly different for a minority group are flagged and reviewed again to determine if the differences are plausible and relevant to nursing practice. Often, says Wendt, an item is appropriate, but the group did not answer it correctly because of a lack of knowledge of the content tested.
The NCLEX is a computerized adaptive test, says Wendt. “CAT increases the efficiency of the testing process,” Wendt says. “Each candidate’s test is unique and assembled interactively as they are tested.”
The computer calculates a candidate’s ability based on the individual’s responses to items, and then it searches for an item that matches it to show next. This process is repeated until a pass or fail decision can be made. CAT therefore administers only those items that best measure a candidate’s ability.
Knowing how that works can help test takers, Monera says. “Item difficulty changes depending on your answers,” she says. “Everybody starts with an easy question, and if you don’t answer that, you’re given another easy one. If you do answer it, then you get a moderate question, and if you answer that, a hard one. At some point, it becomes clear you are going to pass or not, and the test stops. It’s a myth that if the test stops at 75 questions, it means you’ve passed, because it can go both ways.”
Exam results are based not on the number or percentage of items answered correctly, but the difficulty of the items a candidate can answer correctly 50% of the time.
“Passing candidates answer 50% of the more difficult items correctly, and failing candidates answer 50% of easier items correctly,” says Wendt.
Gabriel-Marin believes the biggest mistake nursing students make is waiting until they graduate to prepare.
“You need to prepare all along, and you definitely need a copy of the test plan, which is on the NCSBN Web site,” she says. “The verbiage and layout of this exam is different from the model we use teaching courses. You need to do hundreds and hundreds and hundreds of NCLEX questions over your student career. That teaches you the thinking process, and the more questions you do, the better you get at identifying the kind of thinking an RN license requires.”
Exams are increasingly harder, she adds, because the acuity of patients is demanding a smarter nurse, making thorough preparation all the more important.
Monera tells nursing graduates, especially those of foreign schools, to read carefully and take plenty of time on the test.
“It is important to understand the question, so read it two or three times,” says Monera. “People are in a hurry to answer a lot of questions, but that doesn’t work. You can’t go back to review answers, and the more you hurry, the more mistakes you make.”
Monera and Anderson also both worked on the standards panel, which rates test items as easy, moderate, or difficult. Members of the panel are asked whether, as a new graduate, they would consider an item easy, hard, or moderate.
“We vote on each question, and that is correlated with data from the actual use of the item,” Monera says. “It’s a very long process for every question.”
Psychometricians are present during this standards setting. Psychometrics is the science of educational and psychological measurement, specifically achievement, aptitude, and mastery as measured by testing instruments.
“Psychometrics is used to ensure the NCLEX is legally defensible, valid, and sound,” says Wendt.
The take-home message for nursing students is study early and study often for the NCLEX. Nursing colleagues have made sure that, once you pass, you’re truly ready to step into the nursing profession.