One of the most common long-term goals that nurses have set for themselves after graduation is landing themselves a secure job, whether here or abroad. The United States is one of the most common countries listed in a majority of nurses’ goals because apart from better pay, also they are given more opportunities for professional growth and advancement. However, an aspiring nurse needs to take one hurdle before turning their dreams into reality, and that is taking the NCLEX for Nurses or the NCLEX-RN.
The NCLEX-RN is an examination that is aimed to gauge the entry-level competencies of nurses who want to practice in the United States. It is administered across various testing centers in all US states and over 190 countries worldwide in computerized adaptive testing (CAT) format. The examination itself is administered through Pearson VUE via the Pearson Professional Centers. However, the test itself is owned by the National Council of State Boards of Nursing or the NCSBN.
The NCLEX has two levels of entry-level nursing examinations: the NCLEX-PN and the NCLEX-RN. The NCLEX-PN is administered across the United States and its other territories for nurses who wish to practice as a licensed practical nurse (LPN) or as a licensed vocational nurse (LVN). The NCLEX-RN, on the other hand, is the examination that nurses take as an entry-level requirement to practice as a registered nurse in the United States and its territories.
The examination has also been offered to those aiming to work as registered nurses in Canada since 2015. To date, 10 Canadian provinces offer the test as an entry-level requirement for RNs. While the exam is also owned by NCSBN and administered via Pearson Professional Centers, there are several differences that the Canadian version has over the US version. For one, the exam is available in Canadian French for examinees who prefer to take it in the said language. Another would be the changes in spelling, terminologies, and even trade names of drugs in the examination to fit the Canadian examinee.
The Test Framework
The NCLEX-RN examination measures the entry-level competencies of the examinee. It means that the exam assesses for the basic nursing knowledge expected for all graduates. These are expressed in questions directed to determine a certain level of cognition, understanding, and application of various nursing concepts.
Questions are expressed in patient care situations, questions testing recall and memory, and those that assess how a nurse applies knowledge from nursing and other sciences.
The test framework includes four major client needs areas. These are:
a. Safe and Effective Care Environment
b. Health Promotion and Maintenance
c. Psychosocial Integrity
d. Physiological Integrity
These four major client needs area is further subdivided, as shown in the table below, and will be covered in the next following sub-sections to further elaborate on the contents
Safe and Effective Care Environment
Making up approximately one-fourth to one-third (20-34%) of the total NCLEX-RN test questions, this category evaluates the nurse’s ability to provide safe and effective care for the patients across numerous situations. These include questions that relate safety issues and protocols in different patient care settings, medication administration guidelines, prevention of injury and adverse effects of therapy to patients, and ensuring that the patient with mental health problems does not inflict harm upon himself or others. While some of these questions may be asked as stand-alone items during the examinations, there will be questions about where safe and effective care environments are integrated into the situational analysis.
In some cases, questions that also pertain to conduct of laboratory testing and how the nurse carries roles that are unique to the profession in obtaining samples, transporting them, and ensuring that the results are relayed correctly as they correspond to the patient’s condition. This category includes other aspects of care, such as observation of ethical and legal protocols in caring for patients and how nursing administration and management issues can also affect overall care safety.
Most questions about this particular category are spread randomly throughout the entire examination and may come in the form of situational analysis, objective-type questions, or innovative items.
Health Promotion and Maintenance
The category of Health Promotion and Maintenance makes up about 10-12% of the total NCLEX-RN test questions pool. This category evaluates the entry-level nurse’s ability to utilize health education and promotion skills while caring for her patients. Situations in this category include how the nurse can discuss and educate patients about reproductive health and various means of birth control; the different phases of pregnancy, labor and delivery; stages of growth and development inside and outside the utero; caring for newborns and infants; and how the patient can prevent himself or his significant others from developing illnesses or suffering from its complications.
Since this particular category is also integrative, meaning it combines health education skills of the nurse and understanding of the topic to be discussed to the patients, it also imperative for the nurse to have mastery of the subjects being taught to patients.
Most concepts being asked in this category relate to proper home-care instructions, dietary and activity restrictions, prevention of complications, stress management techniques, and teaching the patients when to alert their care providers based on the signs or symptoms that they are experiencing.
Covering approximately 12-13% of the total number of questions in the NCLEX-RN test pool, the category includes items that deal with the patient’s mental health and psychiatric problems. The category assesses the nurse’s knowledge in managing these conditions across various care settings such as home, community, and facilities. Questions not only include those with psychiatric problems such as schizophrenia but also mental health issues such as anxiety and depression.
The nurse’s ability to teach and guide patients in determining the best coping mechanisms for different stresses and anxieties, stress management techniques, and how to assess patients for signs of increasing severity of mental health problems are also tested. Questions about disorders such as depression, types of anxieties, schizophrenia and its subtypes, eating and body dysmorphic disorders, substance abuse, crisis situations, and organic brain syndromes also comprise part of this category. Throughout this particular category, the nurse’s principles of therapeutic communication must be observed in interacting with the patient and his family.
Covering the most significant portion of the NCLEX-RN test question pool, approximately 44-67% of all questions that may be given to an examinee, the category of Physiological Integrity includes questions mostly from concepts about medical-surgical nursing.
However, it also includes questions dealing with pediatric patients’ care with medical conditions, geriatric and gerontologic conditions, and caring for patients across different stages of cancer. Topics included in this particular category deal with patient conditions that the nurse regularly encounters, such as those with cardiovascular problems like myocardial infarction or hypertension, diabetes and its complications, patients with kidney disorders and those undergoing dialysis, and other common medical conditions.
The same also follows for pediatric patient situations. Management of these conditions, especially those that deal with independent nursing interventions is a focus of the questions included as well as how the nurse assess for early signs of disease conditions or their complications.
Test Format and Type of NCLEX-RN Questions
Number of items
The minimum number of questions an examinee can take when they sit down for the exam is 75 items, while the maximum is 265.
Each examinee has a maximum of 6 hours to finish the test, but there is no minimum time allotment. The exam is computer-adaptive, so each individual may be fed with questions that are different from other examinees since succeeding questions are based on how well or poorly an examinee did on the previous questions.
Moreover, should an examinee reach the 2.5 hours from the time the examinee started the test, a mandatory break will be given. This would last for 10 minutes, and the time that the examinee has taken the break will not be counted against the total time. Another break at the 4-hour mark may also be taken if the examinee needs it, but this additional break period would be taken against the whole test time.
There are approximately 15 questions scattered throughout an examinees test that are considered as “trial” questions. These questions are items intended to be included in the following revision of the test question pool and are being evaluated for examinee response. However, these “trial” questions would not be divulged to the examinee during the test so it is essential to ensure that each question is answered correctly.
Computer Shut Down
The examination is also designed to determine an entry-level nurse’s knowledge based on the percentage of the correct answers that the examinee has given to the questions fed by the computer. This is why the computer can shut down on the examinee anywhere from 75 to 265 questions or until the allotted time of 6 hours is fully consumed. Shutting down the computer screen during the exam, however, is not an indication of passing or failing the test, so the nurse should still wait for the quick results or the release of the official results to know whether the examinee passed or not.
NCLEX-RN questions are expressed differently to capture different types of learners among nurses and ensure that nurses can give the correct answers to questions because of their ability to analyze integrate and apply their knowledge rather than just selecting an answer from memory. These questions are expressed in multiple-choice format.
New NCLEX-RN Exam Format
The NCSBN has also included what was commonly-known as innovative item questions, or those that are not expressed in traditional worded format. These are questions that include multiple answers to a question, select-all-that-apply type of responses, illustrations where an examinee clicks on a part that refers to the answer to the question or answer boxes where the examinee is typing the answer on to the computer.
3 Levels of NCLEX-RN Examination
There are three levels of questions for the NCLEX-RN. The most basic level of questions is
Level 1, which composes approximately 10 percent of all the questions in the NCLEX-RN question pool. These fundamental questions assess the nurse’s recall and recognition about concepts, so they are the most straightforward questions to answer.
Therefore, level 2 questions seek to determine the ability of the examinee to understand concepts and are expressed in items requiring the nurse to analyze and choose the best possible answer from a set of choices. These questions are harder to answer than the previous level.
The last level, Level 3, is the hardest of all and includes the most complex questions in the NCLEX-RN examinations. These questions are designed to evaluate the nurses’ ability to apply concepts, decide on the best course of action in caring for patients, and even plan in anticipation of a potential care issue or complication. In most cases, Level 3 questions also come with more than one correct answer among the choices provided, and the examinee is asked to choose the best among these options.
The computer-adaptive system determines the mix and number of Levels 1, 2, and 3 questions given to an examinee during the test. There is no assurance as to the number of questions per level a person may receive. In some cases, an examinee may get all Level 2 and 3 questions without getting a Level 1 throughout the exam.
Scoring the NCLEX-RN Exam
The NCLEX-RN examination is composed mostly of multiple-choice questions where there can only be one correct answer and as scored as such. However, with the introduction of the innovative item questions, some items may have multiple correct answers. These items are scored on an all-or-nothing principle where the score is given whether the examinee gets all the right answers or not. No partial points or credits are given.
The NCLEX-RN Passing Rate
The NCSBN collects statistics for the passing rate of all NCLEX-RN examinations conducted in the US and other parts of the world. These are collected and collated every quarter and consolidated every year to give nurses, State Boards, educators, and examiners. The table below is the 2019 statistics:
The table shows the number and percentages of nurses who take the NCLEX-RN. For US-educated nurses, the statistics show that they are grouped according to their nursing education. It can be seen that there is a higher passing rate for all first-time US-educated nurses taking the exam in 2019 at 88.18%. However, US-educated nurses, who failed their exams for the first time they took their examination and repeated the test only have a passing rate of 44.02%.
Foreign-educated nurses who pass the examination the first time are at 45.47%, while repeat examinees are only at 27%.
On the Day of the Test
The NCLEX-RN is an examination, and there is a very high possibility that the examinee will feel nervous and anxious during the day of the test. While some nerves and anxiety are expected and even considered normal, this should be managed so that it does not affect how a person will perform on the exam. Below are a few tips for managing it.
1. Dress appropriately. The testing center does not allow an examinee to wear scarves, bonnets, hats, or even gloves. Coats and jackets are also not allowed, and these are asked to be left outside the testing room. It is advised that an examinee wears comfortable clothing during the test.
2. Be at the testing center 30 minutes ahead of time. The test is given on time and if an examinee arrives more than 30 minutes behind the schedule, the exam is forfeited and the examinee needs to register for a new exam and pay necessary fees.
3. Be prepared to have biometrics taken. Before being ushered into the exam room, biometric information would be taken from the examinee, such as photographs, fingerprints, signatures, and even palm vein scans.
4. Get seated at the examination room. After all preliminary steps are taken, the examinee is taken to the exam room. Materials such as pen and paper or a note board may be given to help to make notes during the test. These materials are returned after the test is finished.
5. Ensure adequate time and pacing during the exam. It is advised that the examinee keeps in mind that the test has a maximum time limit and therefore the nurse should set a pace accordingly so that the exam time does not run out. It should also be remembered that the computer adaptive testing does not allow the examinee to return to previous questions so it is vital that all answers that are entered be the final answer for an item.
6. Wrap up. Once the time allotted is fully consumed or the computer shuts down on the examinee, the next would be a short survey that the NCSBN asks all examined to answer. After this is over, the examinee is expected to notify the proctor that the exam is already done by raising a hand. The proctor then ushers the examinee out of the room and is advised to wait for the results.
Registering for the NCLEX-RN Examination
Before reviewing and taking the examination, an applicant must know the requisites that need to be submitted to qualify for the exam. These requisites vary from one State Board of Nursing to another, and there are sometimes particular guidelines that a State Board has for its applicants.
For example, in the State of California, the California Board of Nursing (CaBRN) may require a foreign-educated nurse to undergo a bridging program where applicants will need to enroll themselves in an accredited school of nursing to ensure that they have the same knowledge and training with the graduates of State of California.
The registration for the examination starts with knowing the State Board of Nursing’s requirements of the US state where the applicant wishes to be licensed in and take the exam. This can be obtained from the specific Board of Nursing’s website, which is listed in the directory of the National Council of State Boards of Nursing (NCSBN) on https://www.ncsbn.org/contactbon.html.
Following the State Board’s guidelines, an applicant should take the following steps to ensure a successful application:
- Ensure that all documents required by the State Board are prepared and in the forms that they will accept (i.e., electronic via PDF; Certified True Copy; Certified Photocopy; etc.). These documents may include:
- Certification of English language proficiency such as IELTS or TOEFL;
- Clinical Experience and/or Clinical Case records;
- US-issued Social Security Number or SSN (In some States, they may still allow a foreign-educated applicant to register and take the examination even without the SSN, but they will not issue the license without it.)
- A valid Credential Verification or Evaluation. This can be processed through the CGFNS’ VisaScreen service or with a State Board’s accredited provider.
- Registration with Pearson VUE to sit and take the NCLEX-RN Examination. This is done after the State Board notifies the applicant of his eligibility to take the examination.
- Obtaining the Authorization to Test (ATT) from Pearson VUE. The ATT is valid for 90 days upon receipt so it is important to schedule the date of the examination once this is received. This can be done in one of the following ways:
How much is the licensure fees?
Online Registration via https://www.pearsonvue.com/nclex and paying the $200 testing fee via check, credit card or money order. The instructions on payment methods are discussed in the site.
Registering via telephone call through dialing Pearson VUE NCLEX Candidate Services at 1-866-496-2539.
Though Mail by mailing the registration form and payment.
- Ensure scheduling the examination on the date, time, and testing center accessible to the applicant.
The Pearson VUE Refund Policy
The examinee needs to be sure of the schedule of the intended testing. This is because the NCBN is very clear in stating that there will be no processing of refund requests from an examinee, especially if the nurse:
- Has entered multiple registrations, especially if these registrations pertain to the same examination;
- Failed to confirm the schedule of an examination within 24 business hours since it has been made;
- Failed to cancel an examination within the 24 business hour-window since the registration has been made; and
- Not appearing at the testing center on the date and time of the scheduled examination.
Because of these strict rules, the examinee should contact the NCLEX Candidate Services at the NCSBN if the nurse has not received any confirmation of registration two weeks after registration approval has been submitted.
These rules apply to both US-educated and based nurses and nurses who were educated and living outside the US.
Taking the Examination and Awaiting Results
Applicants who have already confirmed their schedules to sit for the exam may take it in any of the Pearson Professional Testing Centers in the USA or any country with a Pearson VUE Center. In the Philippines, there is a center located in Makati City, and Filipino nurses can schedule and take their examinations there.
Because of the Quick Results service of a majority of State Boards, applicants can check their examination results 2-3 days after the date the test was taken. However, applicants should also remember that it would take at least 4-6 weeks before the official results of the exams are emailed to the candidate.
In Case of Failure on the Exam
In the unfortunate event, however, that the candidate failed the NCLEX-RN examinations, the NCSBN would only accept applications to retake the test after three months or 90 days from the day of the exam.
The NCLEX-RN examination should not be seen as a hurdle to stop a nurse from practicing in the USA. Instead, it should be viewed as an entry-level requirement that all RNs must pass to lawfully practice the profession in the United States. This exam is used to determine if a nurse possesses all entry-level competencies expected of a bachelor’s degree graduate.
Like any exam, the NCLEX-RN should be taken after a thorough preparation since taking it prepared is the best way to pass it and earn that coveted USRN license.