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Difficulty of NCLEX to be Increased

Monday March 15, 2010
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The first graduate nurses who take the National Council Licensure Examination for RNs starting on April 1 will encounter a test that is more difficult to pass than the one students took three years ago.

“Nursing practice is more difficult today than it was in 2007,” says Casey Marks, chief operating officer of the National Council of State Boards of Nursing, based in Chicago. “The bar has been raised, and, quite simply, the exam is harder. It’s projected that fewer students will pass on the first attempt.”

The NCSBN in December raised the passing standards for the national licensure examination after an analysis of the basic knowledge and skills new nurses need to practice safely. Since the last analysis in 2007, healthcare has become even more complex and sophisticated, requiring new nurses to have a greater baseline nursing knowledge and critical thinking skills.

“Nursing is a dynamic, continually evolving discipline that employs critical thinking to integrate increasingly complex knowledge, skills, technologies and client care activities into evidence-based nursing practice,” according to the NCSBN 2010 NCLEX Test Plan.

Raising the Bar
In 1989, the NCSBN decided to evaluate the NCLEX passing standard every three years. Since then, the passing standard has only been increased and never made easier, a reflection of nursing practice itself.

“The NCSBN doesn’t drive practice,” says Marks. “We’re driven by practice; we reflect practice.”

Marks compares the new standards to a track-and-field runner jumping hurdles. A runner may successfully clear a hurdle 50% of the time. But if the hurdle is raised, the runner will not clear the bar as frequently.

But in a few years, the pass rate will rebound, as it has done in the past, she says. “We are looking at more capable candidates. We have no interest in seeing people fail.”

The practice analysis by the NCSBN included a nine-member expert panel and a survey that asked 12,000 newly licensed nurses about the frequency and importance of performing 15 nursing care activities, according to the 2010 NCLEX-RN Test plan. These activities were then analyzed in relation to the frequency of performance, impact on maintaining client safety and client care settings where the activities are performed.

For graduating nursing students, there is no magic formula for passing the national licensure examination, Marks says. Nursing students need to have mastered their school of nursing’s academic and clinical content, be well rounded, and understand how the NCLEX works, Marks says.

“There is no secret,” he says. “Trust yourself and your knowledge.”

Schools Follow Suit
The American Association of Colleges of Nursing, which represents the U.S.’s baccalaureate and higher-degree nursing education programs, typically notifies its members of the raising of the test standards and how they have changed, says Geraldine Bednash, RN, PhD, FAAN, chief executive officer and executive director. However, the announcement of the new standards was made too late for schools of nursing to revise their curricula, she says.

“We know that when passing standards are changed, there tends to be a temporary dip in the pass rates,” she says.

The declines are temporary as schools adjust their curricula, if necessary, and focus on the areas that the NCBSN has emphasized in its new standards. The temporary dip should not affect nursing schools’ accreditation, she adds.

The AACN encourages nursing students to take the NCLEX as soon as possible after graduating when the knowledge they gained in school is still fresh in their minds. “The sooner they take the exam, the more successful they will be,” she says.

Kaplan Nursing test preparation services reviews its test prep course every three years based on how the NCSBN decides to change the exam. “We review our questions to determine if the questions discriminate at a higher level and meet the needs of the revised NCLEX-RN test plan,” says Barbara Irwin, RN, BSN, director of nursing for Kaplan Nursing. The new standards will require students to be prepared to answer higher level questions that require more analysis. For example, a question might describe several patients and ask who the nurse should see first. The student might say all of them, which is not necessarily wrong, but the correct response would be that the most acute patient needs to be seen first, Irwin says.

Other changes that will take place on the NCLEX in April include increased emphasis on the management of care subcategory, Irwin says. The NCSBN defines management of care as providing and directing nursing care that enhances the care delivery setting to protect clients, family/significant others and healthcare personnel.

The test will reduce emphasis on the subcategory of reduction of risk potential, defined as reducing the likelihood that clients will develop complications or health problems related to existing conditions, treatments or procedures.

Janet Boivin, RN, is a contributing writer for Nurse.com.


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