Don’t take any chances…understand the NCLEX-RN® examination process.
After completing this chapter, you should be able to:
• Discuss the role of the National Council of State Boards of Nursing (NCSBN).
• Discuss the implications of computer adaptive testing.
• Identify the process and steps for preparing to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN® Examination).
• Identify criteria for selecting a NCLEX-RN® examination review book and review course.
• Identify the characteristics of the alternate item format questions on the NCLEX-RN® examination.
The National Council Licensure Examination for Registered Nurses (NCLEX-RN® Examination)—this is the really big test for which you have been preparing since you entered nursing school. Consider the opportunity to take the NCLEX-RN® Examination a privilege; it took a lot of hard work to achieve this level, and you should have confidence you are prepared to pass the NCLEX-RN® and begin your professional practice as an RN. As with other aspects of transition, planning begins early, before you graduate. Planning ahead will help you develop a comprehensive plan for how to attack that mountain of material to review. When you plan ahead and know what is expected, your anxiety about the examination will be decreased. Being prepared and knowing what to expect will help you maintain a positive attitude.
The NCLEX-RN® Examination
Who Prepares It and Why Do We Have to Have It?
The National Council of State Boards of Nursing (NCSBN) is the governing body for the committee that prepares the licensure examination. Each member board or state determines the application and registration process as well as deadlines within the state. The NCLEX-RN® examination is used to regulate entry into nursing practice in the United States. It is a national examination with standardized scoring; all candidates in every state are presented with questions based on the same test plan. Every state requires the same passing level or standard. There is no discrepancy in passing scores from one state to another. In other words, you cannot go to another state and expect the NCLEX-RN® examination to be any easier.
According to the NCSBN, the NCLEX-RN® examination is designed to test “knowledge, skills, and abilities essential to the safe and effective practice of nursing at the entry level” (NCSBN, 2016a). On successful completion of the examination, you will be granted a license to practice nursing in the state in which you applied for licensure. The status of state licensure continues to be in a transition process of its own. There are many nurses who maintain a current license in multiple states. The increase in nursing practice across state lines, the growth of managed care, and the advances in telehealth medicine prompted a research project conducted by the NCSBN in the late 1990s. Results of the research resulted in the development of the Mutual Recognition Model for Multistate Regulation. This is now referred to as the Nurse Licensure Compact (NLC). As of January 2016, the NLC has been enacted through the legislatures of 25 states (NCSBN, 2016h).
How Will the Nurse Licensure Compact Affect Your License?
The nursing license in the participating compact states will function much like a driver’s license. The individual holds one license issued in the state of residence but is also responsible for the laws of the state in which he or she is driving. The individual nurse will be licensed to practice in his or her state of residence but may practice nursing in another state; however, the nurse must comply with the Nurse Practice Act of the state in which he or she practices. The transition process for the Nurse Licensure Compact began in 2000 and is continuing to progress. The Nurse Licensure Compact must be passed by the state legislature in each participating state. Watch your state nursing organization and Board of Nursing newsletters, or check the NCSBN website (www.ncsbn.org) to see where your state is in the process of implementing the NLC (Critical Thinking Box 5.1).
Before the Nurse Licensure Compact is implemented, the respective states will continue to require the nurse to be licensed in the individual state of practice. Transfer of nursing licenses between states is a process called “licensure by endorsement.” If you wish to practice in a state in which you are not currently licensed, you must contact the State Board of Nursing in the state in which you wish to practice. The State Board of Nursing will advise you of the process to become licensed in that state (see Appendix A, State Boards of Nursing, on the Evolve website). Transferring your license to practice from one state to another does not negate your successful completion of the NCLEX-RN® examination, nor do you have to take the examination again. All states recognize the successful completion of the NCLEX-RN® examination, regardless of the state in which you took the examination or where your initial license was issued. You can get the most recent list of state boards of nursing from the NCSBN website (https://www.ncsbn.org/contact-bon.htm).
CRITICAL THINKING BOX 5.1What is the status of the Nurse Licensure Compact in your state?
What Is the NCLEX-RN® Examination Test Plan?
The content of the NCLEX-RN® examination is based on a test blueprint that is determined by the National Council of State Boards of Nursing (NCSBN). The blueprint reflects entry-level nursing practice as identified by research published in an RN practice analysis study of newly licensed registered nurses. The NCSBN conducts this research study every 3 years. The RN practice analysis research in 2014 indicated that the majority (72%) of new graduates was continuing to work in hospitals with approximately 14% working in long-term care and 10% in community-based facilities. A slight shift was noted in newly licensed RNs working acute care and long-term and community facilities since the previous practice analysis study. The overall practice settings were in medical-surgical (27.7%) and critical care settings (18.7%), which represent a decrease in these settings from the previous practice analysis study in 2011. There was an increase in nursing home, skilled or intermediate care (from 9.5% to 11.2%), and rehabilitation (from 4.9% to 5.5%) settings. Additionally, the 2014 RN Practice Analysis: Linking the NCLEX-RN® Examination to Practice reflected two new categories, Short Stay/Observational (1.2%) and Step-Down Progressive Care (4.3%), which affected the decrease in medical-surgical and critical care practice settings. Most entry-level nurses indicated that they cared for acutely ill clients. The majority of entry-level nurses indicated they cared for adult and geriatric clients who were acutely ill, as well as adults and geriatric clients with stable and unstable chronic conditions. The majority of the new graduates surveyed responded that they were receiving some form of formal orientation. Hospitals and long-term care facilities were the primary employers of new graduates. Respondents (43.4%) reported having a primary administrative position. Newly licensed RNs working in long-term care facilities were more likely to report having primary administrative responsibilities than those working in hospitals (60.6% in long-term care versus 9.4% in hospitals). The test plan in this chapter was implemented in April 2016 and will be used until April 2019. A new test plan is implemented every 3 years. This represents the time required to conduct the research, analyze the data, and implement the new test plan for the NCLEX-RN® examination (NCSBN, 2015).
The examination is constructed from questions that are designed to test the candidate’s ability to apply the nursing process and to determine appropriate nursing responses and interventions to provide safe nursing care. The distribution of content is based on the areas of client needs. The nursing process is integrated throughout the exam. There are four levels of client needs identified in the 2016 NCLEX-RN® Detailed Test Plan (NCSBN, 2016a). Each level of client need is assigned a percentage that reflects the weight of that category of client need on the NCLEX-RN® examination. The approximate percentages of each area are as follows:
| Safe, Effective Care Environment | |
| Management of care | 17%-23% |
| Safety and infection control | 9%-15% |
| Health promotion and maintenance | 6%-12% |
| Psychosocial Integrity | 6%-12% |
| Physiological Integrity | |
| Basic care and comfort | 6%-12% |
| Pharmacological and parenteral therapies | 12%-18% |
| Reduction of risk potential | 9%-15% |
| Physiological adaptation | 11%-17% (NCSBN, 2016a) |
In April 1994, the NCSBN implemented computer-adaptive testing (CAT) for the NCLEX-RN® examination for both practical/vocational nurses (NCLEX-PN/VN®) and registered nurses (NCLEX-RN®). The information presented here is a brief introduction to the NCLEX-RN® computer adaptive test (CAT). It is important that you download the Candidate Bulletin for your testing year from www.ncsbn.org and carefully follow the instructions; you will receive additional information from your state board of nursing.
Pearson VUE is the company contracted by the NCSBN to schedule candidates, administer, and score the NCLEX-RN® examination. The NCSBN is responsible for the content and development of the test questions, the test plan, policies, and requirements for eligibility for the NCLEX-RN® examination. Pearson VUE will assist you in scheduling your examination and will provide a location and equipment for the administration of the examination.
What Does CAT Mean?
With CAT (computer adaptive test), each candidate receives a different set of questions via the computer. The computer develops an examination based on the test plan and selects questions to be presented on the basis of the candidates’ responses to the previous question. So, every time a candidate answers a test question, the computer re-estimates the candidate’s ability based on all the previous answers and the difficulty of those items. The number of questions each candidate receives and the testing time for each candidate will vary. As candidates answer questions correctly, the next question will be either a degree of difficulty equal to the previous question or a higher level of difficulty. All of the questions presented will reflect the categories of the NCLEX-RN® examination test plan (NCSBN, 2016a).
“Pretest” questions have been integrated into the examination in the past and will continue to be integrated into the current examination. The NCSBN Examination Committee evaluates the statistical information from each of these “pretest” questions to determine whether the question is valid and to identify the level of difficulty of the test item (NCSBN, 2016a). Do not be alarmed—these questions are not counted in the grading of your examination, and time has been allocated for you to answer these questions. It is impossible to determine which questions are “pretest” questions and which ones are “scored” test questions, so it is important that you answer every question to the best of your ability. These pretest items ensure that each question that counts toward your score has been thoroughly evaluated for content as well as statistically validated.
What Is the Application Process for the NCLEX-RN® Examination CAT?
In the beginning of the semester in which you will graduate, your school of nursing will have each student complete an application form and send it to the state board of nursing. When you complete the nursing program, the school will verify your graduate status with the state board of nursing. After the forms have been processed, you will receive an Acknowledgement of Receipt of Registration. You will then receive by e-mail the Authorization to Test (ATT) with instructions regarding how to schedule your examination with Pearson VUE. You cannot schedule your examination until you have received your ATT. Read your instruction packet and your Candidate Bulletin carefully (the Candidate Bulletin may be found at www.ncsbn.org, navigate to NCLEX Examination Candidates). All registrations must be processed via the Pearson VUE website or through the Pearson VUE call center. After you schedule your appointment, you will be emailed a Confirmation of Appointment from Pearson VUE. First, verify that all information is correct. Then, call or go online to check that your appointment has been scheduled/rescheduled. If you do not receive a confirmation every time that you schedule or reschedule an appointment, contact Pearson VUE NCLEX Candidate Services immediately to correct any errors to the appointment (NCSBN, 2016c). Your ATT will contain your authorization number, candidate ID number, and an expiration date. The expiration date cannot be extended for any reason; you must test within the dates on the ATT. It is to your advantage to schedule your examination date shortly after receiving your ATT—even if you do not plan to take the test for several weeks. Testing centers tend to fill up early; if you wait too long you may not be able to get your desired testing date. Pearson VUE will email a confirmation of your testing appointment. As a first-time test taker, you will be offered an appointment within 30 days of the request to schedule an appointment (NCSBN, 2016e).
When you provide an email address at the time you register for the NCLEX-RN® examination, all future correspondence from Pearson VUE will be via email, regardless of whether you registered by telephone or via the Internet. To gain access to the NCLEX-RN® exam, you must present one form of identification that matches exactly the name they provided when registering. The first and last name on your identification must match exactly the name you provided when registering. You will be required to provide your digital signature and a palm vein scan and will have your photograph taken (NCSBN, 2016e).
Where Do I Take the Test?
There are testing sites in every state. A candidate may take the test at any of the Pearson VUE testing sites listed in the Candidate Bulletin. However, the license to practice will be issued only in the state where the candidate’s application was submitted. Information regarding the location of the centers can be found at the candidate area on the NCSBN website. There will be multiple testing stations at each center.
When Do I Take the Test?
After receiving the ATT, a candidate may contact the examination Candidate Services at the phone number provided in the Candidate Bulletin or go to the NCLEX examination area of the Pearson VUE website (www.pearsonvue.com/nclex) to schedule the examination. The location and telephone numbers of the testing centers will be included in the information from the NCSBN. Remember, you must test within the dates on your ATT. You may schedule your examination as soon as you receive the emailed ATT. This means that you could receive the ATT on Wednesday, call or go online to the location of your choice, and if you wish, take the examination the next day, if there is space available. Or you can call and/or go online and schedule your examination date within the next 2 to 3 weeks.
During the last 2 months of school, begin to make plans for when you would like to take the examination. The examination should be taken within approximately 4 to 6 weeks of graduation. Allow for some study time, and consider whether you want to take a formal review course. It is important that you take the examination soon after graduation. If you wait too long, your level of comprehension of critical information will be decreased. Finish school, take a review course if you desire, obtain your ATT, and go take the examination. This is not a good time to plan a vacation, get married, or engage in other activities that could cause a crisis in your life (Critical Thinking Box 5.2).
How Much Time Do I Have and How Many Questions Are There?
Each candidate is scheduled for a 6-hour time slot. You should plan to be at the site for 6 hours. Each candidate must answer at least 75 questions. Within those first 75 questions, there are 15 pretest items that are not scored on your examination. The number of questions you answer and the length of time that you test are not indications of whether you will receive a pass or fail score. The length of your examination depends on how you answered the questions. When the computer indicates that you are finished, regardless of how long you have been testing or how far past 75 questions you have gone, it just means you have “turned your test in,” and your test is completed. The examination will end when the student:
CRITICAL THINKING BOX 5.2When do you want to take your NCLEX-RN® examination? Refer to this book’s Evolve website for information on selecting an NCLEX-RN® examination review course to help you start thinking about this process and assist you in deciding how to select a review book.
▪ Measures at a level of competence above or below the established standard of competency and at least 75 questions have been answered
▪ Completes a maximum of 265 questions
▪ Has been testing for the maximum time of 6 hours (NCSBN, 2016f)
Do I Have to Be Computer Literate?
It is not necessary to study from a computer, nor is it necessary that you be “computer literate.” Research has demonstrated that candidates who were not accustomed to working on a computer did as well as those who were very comfortable with the computer (NCSBN, 2016g). So, previous computer experience is not a prerequisite to passing the NCLEX-RN® examination!
How Will I Keep the Computer Keys Straight and Deal With a Mouse?
At the testing site, each candidate is given a tutorial orientation to the computer. This tutorial will introduce you to the computer; demonstrate how to use the keyboard and the calculator, as well as how to use the mouse to record your answers (Fig. 5.1). It will also explain how to record the answers for the alternate item format items (more about this later). If you need assistance with the computer after the examination starts, a test administrator will be available. Every effort is made to ensure that you understand and are comfortable with the testing procedure and equipment.
There will be only one question on the screen at a time. You will read the question and select an answer. After the answer is selected, select “enter” from the lower right corner of the screen, and the computer will present another question. Previously answered questions are not available for review. There is an onscreen optional calculator built into the computer. The tutorial program will demonstrate the use of the calculator in calculating numerical answers.
What Is the Passing Score?
Every state has the same passing criteria. Specific individual scores will not be available to you, your school, or your place of employment. You cannot obtain your results from the testing center. Your score will be reported directly to you as pass or fail. A composite of student results will be mailed to the respective schools of nursing. There is no specific published score or number that represents passing.
How Will I Know I Have Passed?
The examination scores are compiled at the Pearson VUE center and are transmitted directly to state boards of nursing. Most boards of nursing can advise the candidates in writing of their results within 4 to 6 weeks of taking the examination. Some states allow you to access your “unofficial” results after 48 business hours through the quick results service of Pearson VUE. There is a small fee for this service. Check your Candidate Bulletin, as well as online verification from your state board of nursing, regarding the availability of results online or from an automated telephone verification system. Do not call the state board of nursing, NCLEX Examination Candidate Services, or the Pearson VUE Professional Centers to inquire about your pass or fail status; they cannot release information over the telephone.
What Types of Questions Will Be on the NCLEX-RN® Examination?
Most of the questions are in multiple-choice format, with four options. Each question will stand alone and will not require information from previous questions to determine the correct answer. All of the information for the question will be available on the computer screen. You will be provided an erasable board for any notes or calculations you would like to make. You may not take calculators into the examination; the “drop-down” calculator will be available on the screen for math calculations. Everyone will be tested according to the same test plan, but candidates will receive different questions. There is only one correct answer to each question; you do not get any partial credit for another answer—it is either right or wrong. All questions must be answered, even if you have to make a wild guess. The computer selects the next question based on your response to the previous question. (You do not get another question until the one on the screen is answered.) You will not be able to go back to a previous question after that question is removed from the screen. (This means you cannot go back and change your answer to the wrong one!) There will be an optional 10-minute break after 2 hours of testing. If you need to take a break before the 2 hours, notify one of the testing center administrators. A second optional break is offered after 3½ hours of testing. The tutorial and all breaks are considered part of the 6 hours allowed for testing (NCSBN, 2016b).
There is not much storage space at the testing sites. There are some small lockers for your personal items. Therefore, do not take your textbooks, your notes from school, your lucky stuffed bear, or any other materials you have been carrying around in that pack for the past 2 years! All electronic devices (cell/mobile/smartphones, tablets, pagers, or other electronic devices) are required to be sealed in a plastic bag provided by the Pearson VUE Testing Center. If you refuse to store your mobile device(s) in the plastic bag provided, you will not be allowed to take the exam and will be required to repay a $200 examination fee and reschedule to take the exam (NCSBN, 2016i).
What Are Some of the Other Things I Really Need to Know About the NCLEX-RN® Examination?
What If I Need to Change the Time or Date I Have Already Scheduled?
You can change your testing date and time if you advise NCLEX examination Candidate Services 24 hours or 1 full business day before your scheduled examination appointment. You may go to the NCLEX candidate website (www.Pearsonvue.com/nclex) to reschedule or you may speak with an agent at Pearson VUE and receive confirmation of the unscheduled/rescheduled appointment letter. The phone number will be listed in your Candidate Bulletin. You can then reschedule the test at no additional cost. If a candidate does not reschedule within this time frame or does not come at the scheduled testing time, the ATT is invalidated, and the candidate will be required to reregister and repay the $200 registration fee. There are no exceptions to this policy (NCSBN, 2016c).
What About Identification at the Testing Site?
At the testing site, you will submit a digital signature and will be digitally fingerprinted and photographed. An additional security screening is the palm vein screening. It will be required for admission to the exam. You will also be required to provide one form of identification. All identification documents must be in the original form; no copies will be accepted. Be sure that the first and last name printed on your identification match exactly the first and last name printed on your ATT. The following are acceptable forms of identification (must be in English, valid and not expired, with a photograph and a signature):
▪ U.S. driver’s license
▪ U.S. state-issued identification
▪ Passport
▪ U.S. military identification (NCSBN, 2016f)
What Are the Advantages of CAT for the Candidate?
The environment is quiet and conducive to testing. The work surface is large enough to accommodate both right-handed and left-handed people, with adequate room for the computer. Each candidate can work at his or her own pace and is allowed to test up to 6 hours. Each candidate has his or her own testing station or cubicle. There should be a minimal amount, if any, of distraction by the other candidates who are testing at the same time. If a candidate has to retake the examination, the parameters for retesting are established by the respective state board of nursing. The NCSBN requires the candidate to wait at least 45 days before rescheduling the examination. Some individual boards of nursing require a waiting period of 90 days after the first examination before scheduling. Candidates who take the examination again will not receive the same questions (NCSBN, 2016f).
Preparing for the NCLEX-RN® Examination
Where and When Should I Start?
Six Months Before the NCLEX-RN® Examination
Make sure you know the dates and deadlines in the state in which you are applying for licensure
Your school will advise you of the specific dates the forms are due to the state board of nursing. If you are registering individually, contact the state board of nursing in your state of residence (or in the state where you wish to file for licensure) and find out the filing deadlines. Make sure you follow the directions exactly. State boards of nursing will not accept applications that are not submitted on time or are submitted in an incorrect format. A listing of the state boards of nursing can be found on the Evolve website. If you plan to apply for licensure in a state other than the one in which you are graduating, it is your responsibility to contact the board of nursing in that state to obtain your papers for application. Plan early (at least 6 months ahead) to investigate the feasibility of taking the examination in another state.
Investigate review courses
Review courses can be an excellent resource in your preparation for the NCLEX-RN® examination. Review courses will assist you in organizing your study materials and identifying areas in which you need to focus your study time. These courses will help you to understand the NCLEX-RN® examination test plan. Understanding the test plan will help you to prioritize your studying.
Plan an expense account for the end of school and for the NCLEX-RN® examination
Frequently, students face unexpected expenses at the end of school; one of these expenses may be the fees for the NCLEX-RN® examination. Start a small savings plan—maybe $10 a week—to help defray these expenses. For family and friends who want to give you something for graduation, you might tell them of your “wish list,” including those expenses incurred at graduation (Box 5.1).
Two Months Before the NCLEX-RN® Examination: What Do I Need to Do Now?
If you have a job, discuss your anticipated NCLEX-RN® examination test date with your employer
You can estimate your test date by checking your graduation date, determining from previous students or nursing faculty the approximate time to receive the ATT in your state, and then considering review courses and study time and how these might affect when you want to schedule your examination. Remember, you can change your testing appointment without penalty, as long as you do it within 24 hours (or one full business day) of your scheduled appointment and within the dates on the ATT. Submit your request for days off work in writing as soon as you have confirmed your examination date. This is something you want to make sure that your manager understands. Plan to take off the day or two before the examination and, if possible, the day after as well. This will allow you time to relax and, if necessary, travel to and from the testing site.
BOX 5.1 Budget for the End of School and the NCLEX-RN® ExaminationHow Much Is It Going to Cost Me to Complete School?
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