Flying Colors
Alicia Hugg, RN

Nursing instructors offer advice for new grads to ace the NCLEX.

One of the most exciting times in the life of a nurse is the taking and passing of the National Council Licensure Examination (NCLEX), also known as the “state boards.” Encouraged by rave reviews from instructors and passing scores on classroom exams, new graduates look forward to the NCLEX as their port of entry into the world of professional nursing.

The bad news is that some do not make it the first time around, and for them, the experience is traumatic. The good news is that most pass the exam on the first try and those who fail may retake it after three months.

According to nursing instructors and administrators familiar with the NCLEX, the major reason for students not passing on the first try is lack of preparation. During the last decade, the state board examination has moved from pencil and paper to computer, and this technological migration has created the greatest challenge for test takers.

Based on her experience, Deborah Lindell, ND, APRN, assistant nursing professor at the Case Western Reserve University Frances Payne Bolton School of Nursing in Cleveland, focuses on this challenge and offers the following tips for a successful NCLEX experience:

Be prepared. Adequate preparation before taking the NCLEX may make the difference between a “Pass” or “Fail” score. Lindell says the examination is too complex to try taking “cold.”

Because the NCLEX is computer generated, not everyone gets the same questions. The number of questions also may vary with each student.

“The computer continues giving you questions until it comes to a statistically valid number. Many will pass or fail after answering the minimum 75 questions, while others may be required to complete the 265 maximum,” Lindell says. There are wide variations in numbers depending on the computer decision, and students may become stressed when their numbers exceed the minimum. The computer will continue to feed questions to the student until it reaches a level of statistical confidence to aid its final decision.

Take a predictor test before taking the NCLEX examination. A predictor NCLEX simulation test is specifically designed to predict the student's ability to pass. A student’s testing scores are compared to those of other nursing students. From this information, students are given their statistical likelihood of passing the NCLEX, such as 50% to 90%. These tests also provide a sub-score in the different areas of nursing and define areas of strength and weakness. Results help students target areas that need more study.

Work on areas that need strengthening. Start with the weakest area identified by the pretest, then narrow the focus to maximize the use of study time. Review questions with wrong answers until there is a clear understanding. “We tell all of our students to study, but weaker students must take a complete review course. When students pick the review course, they should consider time frames and format to see if it is a good match for their learning abilities. Students prefer resources that include little tricks to help them remember,” Lindell says.

Constance Smith, RN, MSN, a nursing instructor at San Joaquin Delta College in Stockton, Calif., says that some students who have demonstrated excellent nursing care skills are challenged when it comes to taking the NCLEX. She counsels her students to carefully review the question being asked and then remember the basic principles of what they are looking for.

Use critical thinking skills. “It is critical thinking that really matters with NCLEX, so look at the big picture when you are taking the examination. Focus on key points within the question. Instead of trying to memorize a bunch of facts, students need to look at the big picture. The test is predicated on questions.”

Take computer-based practice tests. Students should take as many computer-based practice tests as they can. Most California schools have practice tests on computer. The data show that “the sooner after graduation students take the test, the better the outcomes,” Smith says.

Know why states require graduate nurses to pass the NCLEX. Concerned that some students are not fully aware of the reasons for taking the NCLEX, Glenda Walker, RN, DSN, nursing director at Stephen F. Austin State University in Nacogdoches, Texas, thinks it is important for students to know they are required to take the examination to ensure the safety of the public.

“The state has a legal obligation to demonstrate that the people caring for its residents have adequate knowledge,” she says.

Her nursing students are given computer-based tests “identical” to the NCLEX throughout the curriculum. Upon completion of the program, students undergo an “exit examination,” a comprehensive test that most pass at the 88% level. This examination allows instructors to place students into remediation before taking the real NCLEX. Walker becomes concerned when students delay taking the NCLEX. She notes, however, that working reinforces students’ knowledge base.

As an associate professor of gerontological nursing at the University of Pennsylvania School of Nursing in Philadelphia, Sarah Kagan, RN, PhD, also stresses that students remember that the NCLEX is designed as part of their social contract as a nurse that ensures they are “competent to practice nursing in [their] state, as opposed to a faculty member saying you are good.”

Let your faculty adviser know of learning disabilities. Kagan points out that some students may not know that they can get help should they have a documented learning disability such as dyslexia. Such students may work with their state boards.

Look for key words to pinpoint the stem of the question. “Students should remember to read the stem of the question thoroughly, look for key words, and identify which answers are clear distractions from the real answer to the question. Some questions may be easy, others take a bit more thinking through and more time,” Kagan says.

Alicia Hugg, RN is a freelance writer. To comment on this story, send e-mail to editorca@nurseweek.com.