NEW YORK NURSE: June 2010
by Erin Silk
The NCLEX-RN exam is the ultimate test of years of coursework, cramming and clinical. The exam has a storied history of grueling content and a recent increase in passing standards may prove difficult for some.
The NCLEX exam is a reflection of the basic knowledge and skills new nurses need to safely care for patients. The National Council of State Boards of Nursing (NCSBN), which administers the 265-question test, reevaluates the exam’s difficulty once every three years. Based on recommendations from an independent group of practitioners who review care and practice, this standard-setting exercise has been in place for over 20 years.
According to a press release, the board of directors of the NCSBN voted in December of 2009 to increase the passing standard to meet “increasing competency standards of nursing practice.” This base standard is driven by expectations of practitioners at the entry level.
The new standard, which became effective April 1 of this year, raises the passing rate -0.16 logits on the NCLEX-RN logistic scale, or 0.05 logits higher than the previous standard of -0.21.
A logit is “a unit of measurement to report relative differences between candidate ability estimates and item difficulties.” In layman’s terms, Dr. Casey Marks, chief operating officer for the NCSBN summarizes that the increase “makes the examination slightly more difficult than before.”
The nuts and bolts of the test are the same. RN candidates are tested on their knowledge of everything from safe use of equipment to high risk behaviors, to helping a client die with dignity. Question difficulty is adjusted based on ability throughout the computerized exam. Skill level is assessed on four major “client needs” categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity.
Nursing schools and test preparation companies are made aware of the increased standard prior to test time and most try to adjust accordingly. However, the NCSBN contends that schools should not be teaching to pass the exam, but rather to educate nurses for the profession. “We don’t want nurses to concentrate only on what questions they think might be asked on the NCLEX exam and ignore other vital areas of patient care,” said Marks.
While Marks admits that a certain percentage of people who would have passed the exam prior to the increase will not pass this time around, the exam is still an appropriate hurdle used to determine skill level. “High standards benefit everyone. If the exam did not increase in difficulty, you wouldn’t know if the RN taking care of you, or working next to you, has the necessary skills to practice safely,” he said.
According to Marks, the test is a true reflection of a wide continuum of nurses. “Literally thousands of nurses are involved with creating the NCLEX-RN exam,” he said.
He acknowledged the exam’s reputation for being “brutal,” but insists the test is not set up for people to fail and points to the “rebound of passing rates” that typically occurs when candidates adjust and become more able.
“Nursing is getting harder and harder. The exam doesn’t try to get out in front of practice, but instead tries to reflect practice and assess nurses’ abilities in the best possible way,” said Marks.