After graduating a BSN course in college and pasing the RN licensure examination given by the Philippine Regulations Commission, an RN seeking employment in the US needs to meet the specific requirements of the US National Council of State Boards of Nursing (NCSBN). These boards use the National Council Licensure Examination (NCLEX) to measure competencies needed to perform safely and effectively as new nurses employed in  US hospitals, medical and other care facilities.

But what is NCLEX? According to NCSBN, ” Entry into the practice of nursing in the United States and its territories is regulated by the licensing authorities within each jurisdiction. To ensure public protection, each jurisdiction requires a candidate for licensure to pass an examination that measures the competencies needed to perform safely and effectively as a newly licensed, entry-level nurse. The National Council of State Boards of Nursing (NCSBN) develops two licensure examinations, the National Council Licensure Examination for Registered Nurses and the National Council Licensure Examination for Practical Nurses that are used by state and territorial boards of nursing to assist in making licensure decisions. “ It’s like trying to pass the PRC examination for RN again, but this time in US terms and standards.

According to Anne Wendt, RN, PhD, CAE, director of the NCLEX Examination Department, ”NCLEX is a computerized adaptive test”. “CAT increases the efficiency of the testing process”. “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. Says Louellyn Monera, RN, BSN, a certified psychiatric nurse in California, and developed items for the RN test. “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.

Linda Gabriel-Marin, RN, MSN, an assistant professor of nursing at Dominican University of California, who also has written items for the exam 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.”

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 that participates in the making of NCLEX have made sure that, once you pass, you’re truly ready to step into the nursing profession.

( Sources: Nurse.com, NCSBN )