SC Lamont RN > Blog > November 14, 2004 > The "new" NCLEX exam for nurse licensure.

Posted Sunday, November 14, 2004 @ 2020 PST
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The "new" NCLEX exam for nurse licensure.

I’m on a nursing list which includes several students. Questions have come up lately about the new NCLEX exams, which new grads must pass before they can register with their state Board of Nursing as an RN. As someone who teaches under-grads and has recently taken a class on how they design tests like this, I had to add $0.02. Here are some of the key points:

The new NCLEX is a kind of self-adjusting test. Computer adaptive testing (CAT) starts by providing a few "middle of the road" questions, then gives easier ones if you are doing poorly, or harder ones if you do well. It continues to flex the difficulty up and down until it can zero in on your "true" ability. Take that "true" bit with a grain of salt - there are still plenty of measurement issues here, including the validity of multiple-multiple choice, and people's response to testing rather than response based on knowledge. However, that aside, they are surprisingly accurate for most situations. It can only be done on tests where the sampling pool is huge, like the NCLEX and GRE - think of how many questions would have to be answered by how many people to create a statistically valid pool that ranges (reliably, mind you) from easy to difficult.

That said, the "score" is hidden from you. You have no idea how hard the items are considered to be, and therefore what final score will be reflected. Few questions just means the test had you pegged quickly - for better or worse. Many questions means the test had a harder time pinning you down. Your score is determined by the test trying to push you to the maximum of your ability, then just over, then drifting back until you start getting the answers right again. That threshold becomes your score. Keep to mind it only reflects your ability at that time, not only for knowledge recall, but also problem solving, priority setting, assessment, and judgment. Over time, your abilities change, so even if you miss the first pass, you can re-take it and potentially do well.

I had to take it relatively recently (my US licenses were based on my Canadian boards, but CA doesn't recognize them, so to NCLEX I went). Even as a very experienced nurse who had also just been back in school to get my degree, I found it tough to say how I was doing while writing it. I have some advice on how to approach the exam:

1) answer the first dozen or so questions very carefully - how well you do at the beginning limits how well you can do in the end

2) in relation to item one, don't worry about time at first - it is a timed exam, but almost no one runs out of time, and your performance at the beginning is what helps the most on your score (but see #4 below)

3) since you are forced to answer before moving on, use your scratch pad to not only do calculations, but also to make notes for yourself, such as keeping track of items that are obviously false from a list while you are trying to figure out the best answer

4) don't agonize if no clear answer seems to be on the list - chose the BEST one, then move on - getting stuck won't help you

5) practice in advance not only tests the ease with which you can recall knowledge, it is also confidence building, sharpens problem solving skills, and gets you used to the formatting of questions

6) as already mentioned in an earlier post, delegation questions are a big thing, like "you are in charge of a peds unit and an adult nurse is floated to you, which patient would you assign her?" then give you a list of possibilities - I had a laugh with another experienced nurse over that one, we agreed our preferred answer was "send her back to adult-world", but that wasn't an option!

As a final note - the State Boards, which sponsor the exam, do want you to pass, but their primary mission is to protect the public. To this end, they actually just bumped up the pass level for the exam (I can't remember what month, and I don't think it was by much, the info should be on the website). They want the test to ensure, to the degree possible, that the nurses entering practice have demonstrated a minimum knowledge and judgment at their disposal before beginning independent practice. Your school is a better ally - they really want you to succeed, and their outcomes on scores are carefully tracked by accrediting bodies. Poor pass rates are a real problem for schools. The test doesn't try to help you, it tries to help the safety of the public while being fair to you. A general rule is that if you do well in school and reasonably well on practice exams over time, you will pass NCLEX. So do sleep well, and ground and center before you start writing. Best wishes to all you new grads.

* updated Apr 28 - internal links added *

I have posted an advice sheet I created for my students on how to effectively study for and write exams. I hope anyone who is faced with writing exams finds it useful (and it is certainly the time of year that many are faced with exams!)

Scott Chisholm Lamont, RN.