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NCLEX FAQs

NCLEX FAQs about the RN exam.

posted Jan. 29, 2013

The following frequently asked questions were prepared by the Canadian Council of Registered Nurse Regulators and the National Council of State Boards of Nursing for Canadian educators and students. 

 Exam development

How do you determine that the practice assessment of entry-level nurses coincides with standards of practice and expert opinion of the expected practices? How do you determine what questions are on the practice analysis surveys?

NCSBN conducts practice analyses to determine the level of competency that entry-level nurses must possess in order to provide safe and effective care. Results obtained from the practice analysis studies are used to construct the NCLEX-RN Test Plan. The current NCLEX-RN Test Plan can be downloaded for free on the NCLEX Test Plans page of the NCSBN website. The Test Plan then guides subject matter experts serving as item writers and reviewers in the development and review of NCLEX items. All NCLEX items undergo rigorous reviews prior to being used in actual examinations. Item content is scrutinized for currency, accuracy and adherence to entry-level nursing scope of practice.

Scope of entry-level nursing practice provides the foundation for the NCLEX item development process.The practice analysis process starts with a comprehensive literature review of those resources that students preparing for a career in nursing are expected to study and understand. A subject matter expert panel is then convened to discuss activities that entry-level nurses perform on the job. This expert panel is made up of representatives from various NCLEX test-user areas, major nursing specialities and nursing practice settings. In addition to 10-12 experienced nurses, the expert panel also includes 2 entry-level nurses. These entry-level panelists provide the incumbent perspective. After extensive discussion and review of related documents, the expert panel constructs a comprehensive list of job activity statements that are relevant to entry-level nursing practice. This list of entry-level activities will be used in the subsequent practice analysis surveys. The results from the current practice analysis can be downloaded from the Practice Analyses page of the NCSBN website.

The selection and input of subject matter experts provides assurance that the practice analysis assesses the current expected practices of entry-level nursing.

Will practice analysis be done with Canadian nurses?
Yes, Canadian nurse representatives will be involved in the Subject Matter Expert Panel for RN practice analyses along with nurses from other NCLEX-RN test-user areas. NCSBN conducts practice analysis studies every three years to survey the nursing profession regarding entry-level practice. Results of these practice analyses will form the basis of NCLEX-RN Test Plan. The next RN practice analysis cycle, which will include Canadian representatives on the Subject Matter Expert Panel and Canadian nurses in the practice analysis survey, is scheduled to begin in November 2013.
How do you ensure that the practice analysis is representative of all settings (i.e., not just acute care)?
When assembling the practice analysis subject matter expert panel, NCSBN ensures that a wide variety of practice settings are represented. A representative panel composition ensures that the list of entry-level nursing activities developed by the panel is inclusive and accurately reflects entry-level nursing practice. Examples of different practice settings that have been represented on recent NCSBN practice analyses include acute care, critical care, community health, mental health, paediatrics, woman’s health, obstetric, surgery and home health.
How will item development panels be selected?
Panel dates and the number of panels are determined according to item inventory needs. Item development panels take place throughout the year in Chicago, IL and typically last three to five days. For each panel, NCSBN staff select qualified volunteer applicants from an item development database depending on the type of panel and specific item pool needs. Volunteers are then approved by their provincial/territorial regulatory body. Additional information about volunteering may be found on the Exam Development Opportunities page of the NCSBN website.
How will you ensure diverse practice settings are represented on review panels?
To ensure each item development panel consists of a diverse group of nursing experts, NCSBN staff selects volunteers representing a variety of practice settings and nursing specialties. Additional panel selection criteria include a variety of geographic representations and years of nursing experience. NCSBN continuously solicits qualified nursing experts to participate in the NCLEX development process.
Will reviewers come from all Canadian provinces?
All qualified Canadian nurses who are registered with the provinces and territories that will utilize the NCLEX-RN as entry-to-practice examination in 2015 are eligible to participate in the examination development process, and volunteers will be selected from across Canada to ensure diversity of practice setting, clinical specialty, experience and geographic representation.
How will you ensure review panels are current with standards being taught?
To ensure item review panelists are familiar with current nursing practice, only clinicians who work directly with entry-level nurses are eligible to volunteer for the item review process.
Can you further explain the rationale behind the criteria for item writers and reviewers?
NCSBN recruits nursing instructors in clinical areas as item writers and nurses who are employed in clinical settings as item reviewers.
 
To construct meaningful examination items, NCLEX item writers must be familiar with entry-level nursing knowledge, test construction process and item development theories. These necessary qualifications are in-line with those of nursing educators. Educators with a master’s level or higher degree are invited to participate in the NCLEX-RN item writing process. In terms of reviewing NCLEX items, nurse clinicians, who work with entry-level nurses by providing preceptorship, mentorship and supervision, see entry-level practice first-hand. These expert nurses are able to bring their knowledge of the clinical settings to the item review process and ensure that NCLEX items are reflective of current entry-level nursing practice. Clinicians who spend at least eight hours per week working with entry-level RNs are invited to serve on NCLEX-RN item review panels. Together, the participation of both educators and nurse clinicians ensures that the exam meets the requirements of a regulatory, entry-to-practice requirement focusing on public safety.
Why can’t educators who have previous experience in nursing licensure exams item writing participate in NCLEX development?
We ask that subject matter experts with nursing licensure examination item development experience or who have been involved in the development of prep guides or courses in the previous two years to not volunteer for the NCLEX to minimize potential biases that these previous experiences may bring to the NCLEX development process.
How do review panels decide if an item is removed/sent back for further work?
Clinicians who work directly with entry-level nurses are recruited to participate in the test development process as item reviewers. Their charge is to review items based on currency and accuracy of entry-level practice as they see in various clinical settings. If items are deemed not reflective of current nursing practice, they are sent back for rework.
Will travel costs for item writers and reviewers be covered? Where will they need to travel to?
NCSBN will cover all expenses for volunteers participating in item development panels including food, lodging and travel. All item development panels are held in Chicago, Illinois.
How will the exam be translated?
In order to meet the needs of French-speaking, Canadian NCLEX-RN candidates, NCSBN will offer the NCLEX-RN examination in French. NCSBN will translate two operational item pools each year into French. Following this forward translation by a translation professional with expertise in Canadian French, NCSBN will work with Canadian regulatory bodies to identify a Canadian Translation Panel. The panel will consist of three nurses proficient in English and French who will review each translated item for accuracy and contextual equivalency. This method, referred to as a mixed method, process oriented approach, is supported in the literature as a preferred method for ensuring construct equivalence in health care measurement instruments.

Following the Canadian Translation Panel’s approval the French NCLEX Operational pool will be administered to French Canadian NCLEX-RN Candidates. Once sufficient candidate response data is obtained, the items will be subject to a separate Differential Item Functioning (DIF) analysis, to ascertain whether the items appropriately measure candidates’ nursing ability irrespective of the language in which these test items were administered. Items identified as possessing DIF will be reviewed by the NCLEX DIF panel for presence of bias. In addition to the construct equivalence confirmed by the Canadian Translation Panel, the use of DIF analysis is supported in the literature as a preferred method to ensure measurement equivalence.
Will reference material be available in French?
Yes, the NCLEX-RN Test Plan, NCLEX tutorial and Candidate Bulletin will be available in French prior to 2015.

 Exam content

How do the Entry-to-Practice (ETP) competencies in Canada relate to the items that will be on the exam?
The NCLEX-RN is based on the data collected from the practice analysis studies (see the Exam Development FAQ section) conducted every three years. NCSBN conducted background research on the nursing practice in the U.S. and Canada, which included a comparison of the Canadian ETP competencies with the entry-level nursing activity statements as used in the RN practice analysis. Study results revealed a high degree of correspondence between the Canadian ETP competencies and the RN entry-level nursing activity statements. Additionally, NCSBN conducted practice analysis verification studies in collaboration with College of Nurses of Ontario and with College of Registered Nurses of British Columbia. Study results indicated that entry-level practice characteristics among the U.S., Ontario and British Columbia are highly similar. Full reports for the Ontario and British Columbia studies are available on the Exams Publications page of the NCSBN website.
 
Prior to writing the NCLEX-RN, nursing students complete an educational program that teaches them the knowledge, skills and abilities that will prepare them to enter the nursing profession. Nursing candidates’ academic preparation provides a starting point for them to practice in a variety of settings.In complement,the NCLEX-RN is developed to assess whether nursing candidates possess the minimal entry-level competence to provide safe and effective care.
Does the exam assess components related to community health?
NCLEX-RN items are developed based on healthcare settings in which entry-level RNs practice. These settings include acute/critical care, long-term/rehabilitation care, outpatient care and community-based/home care.
 
Each item development subject matter expert panel is carefully assembled to ensure that a diverse group of nurses are represented. These panels include item writing, item review, practice analysis, and every other panel along the test development process. NCSBN pays attention to demographic characteristics such as geographical areas, gender, practice settings and nursing specialties, to name a few. Community-based nursing practice along with other nurse practice settings, are selected to ensure comprehensive representation in the overall test development process.
 
Community health concepts, including social determinants of health and the care of populations, are incorporated throughout the test plan categories and the items that are subsequently developed based on these categories. The entry-to-practice exam focuses on the validation of required entry-to-practice competencies and is not intended as a comprehensive validation of the acquisition of program content.
Can you describe the risk management category of questions?
NCLEX-RN items that assess risk management are categorized in the Safe and Effective Care Environment section under the Management of Care test plan area. Management of Care items measure areas where nurses provide and direct nursing care that enhances the care delivery setting to protect the client and other healthcare personnel. This area addresses professional responsibility competencies where nurses manage client care, engage in client advocacy and provide care continuity.
How are ethical components of nursing practice and critical thinking measured on the NCLEX exam?
Ethical components of nursing practice are addressed in the practice analysis and as a result are represented among the entry-level job task statements that form the test plan categories. Questions measuring nursing ethics are asked on the NCLEX-RN exam just as questions that measure other nursing competencies. The exam as a whole assesses the student’s application of critical thinking across the test plan categories and the competencies associated with the provision of nursing care.
How will issues regarding American drug names and measurement values be addressed for Canadian writers?
The NCLEX-RN items currently include both metric and imperial measurement options. Over the next two years, our transition process and the review by Canadian experts will ensure the appropriateness of terms used in the exam for both Canadian and American candidates, and that all writers of the NCLEX-RN in 2015 will be assessed based only on nursing competence, not his or her place of origin.
How will content related to Canadian health care history, the Canadian medical care system, and Canadian legislation be addressed on the exam?
In order to be psychometrically sound and valid as a regulatory entry to practice examination, the NCLEX-RN exam must measure nursing competence, not the candidate’s knowledge of a particular health care system, history or legislation. However, candidates must be able to identify the potential impact of the context in which care is provided on his or her approach to providing nursing care. The NCLEX will include questions that will assess the candidate’s ability to apply critical thinking in these scenarios.

Differential item functioning (DIF) analysis is conducted on all exam results to ensure that the exam items are measuring only nursing competence. If items perform differently based on an individual’s place of origin, then what is likely being measured is not nursing and the item would be removed.

Canadian nursing students will continue to acquire the required knowledge about legislation, policies, standards, and context affecting their practice as a nurse in Canada in their educational programs, and will build on this knowledge as they progress in their career as a nurse.

 Exam administration

How long does it take for candidates to receive the results and how are they notified?
The regulatory bodies will be developing administrative processes to support the delivery of the NCLEX as of 2015. Detailed information will be available in the second half of 2014. NCLEX candidates will receive their results directly from the regulatory bodies, and CCRNR’s collective goal is to provide the results to candidates as soon as possible after the examination.
What will the cost to students be?
The cost for Canadian students to take the NCLEX-RN has currently been established at $360 CAD. There may be additional administration fees payable to the regulatory body in the jurisdiction to which the student is applying for licensure or registration. These administrative details will be finalized over the next two years and communicated to students as soon as they have been determined.
Do students get more anxious if they continue to write and they know that a longer exam means the less well they are doing?
As a candidate takes the examination, items are selected based on the candidate's response to previous items. The examination ends when the computer can determine that a candidate's performance is either above or below the passing standard based on pre-established scoring criteria, regardless of the number of items answered or the amount of testing time elapsed. A longer exam does not indicate that a candidate is performing poorly. It only indicates that the candidate’s ability is close to the passing standard and more questions are needed to ascertain the candidate’s ability is either above or below the passing standard. Additional information on the pass/fail rules can be found on the Computerized Adaptive Testing page of the NCSBN website.
Can candidates skip questions? Do they have the ability to go back to a question?
Every time a candidate answers an item on the NCLEX, the computer re-estimates the candidate’s ability based on his or her responses to all of the previous items. The computer then selects the next item targeted to the candidate’s ability. In order ensure items are targeted to a candidate’s ability, the computer will not allow a candidate to skip items or return to previous items.Candidates are encouraged to consider each question carefully and answer as best they can.
Six hours is a long time for writing an exam. How will breaks be provided to allow for nutrition?
Candidates are provided two pre-programmed breaks during the NCLEX examination. The first break occurs after two hours of testing, and the second occurs after three and half hours of testing. Candidates may take or skip any pre-programmed breaks provided. Candidates are also permitted to take unscheduled breaks during the testing session. The exam clock does not stop during scheduled or unscheduled breaks.
If a Canadian writes the NCLEX will he/she be able to apply for registration in the U.S. as well as Canada or in more than one province?
NCLEX-RN is developed as an assessment of entry-level nursing practice competency. Passing the NCLEX-RN is one important component of obtaining the privilege to practice registered nursing at the entry-level. In addition to successfully completing the NCLEX-RN, boards of nursing in the U.S. and regulatory bodies in Canada may require additional evidence, such as successful completion of approved nursing education and meeting language proficiency requirements, prior to granting that privilege. Since specific licensure/registration requirements may differ from jurisdiction to jurisdiction, reciprocity of registration is at the discretion of the regulatory bodies involved.
How is the passing standard determined?
To ensure that the passing standard for the NCLEX-RN accurately reflects the amount of nursing ability currently required to provide safe and effective care at the entry level, the NCSBN Board of Directors evaluates the passing standard every three years when the test plan is reviewed. In evaluation of the passing standard, they consider information from a variety of sources, including (1) the results of a criterion-referenced standard setting study undertaken by a nursing subject matter expert panel; (2) historical record of the passing standard and annual summaries of candidate performance on the NCLEX examination since the implementation of the CAT methodology in 1994; (3) the results from annual standard setting surveys, which solicit the opinions of employers and educators regarding the competence of the current cohort of entry-level nurses; and (4) information detailing the educational readiness of high school graduates who expressed an interest in nursing.
What is the pass mark in terms of percentage?
The NCLEX examination is developed using the Rasch measurement model, which is an item response theory model. Compared to classical test theory, the Rasch model allows person-free item calibration and item-free person measurement. In this framework, candidate performance on the examination is measured in logits as opposed to the traditional totals and percentages. A mathematical explanation of logits can be found on the NCSBN website.

In December 2012, the NCSBN Board of Directors voted to raise the NCLEX-RN passing standard. The NCLEX-RN passing standard was changed to 0.00 logit. This standard is effective starting April 1, 2013, in conjunction with the implementation of the new 2013 NCLEX-RN Test Plan, and will remain in effect until March 31, 2016.
What is the pass rate and do you know if there is a difference between those attending prep sessions and those that do not?
The pass rate for all first-time NCLEX-RN candidates was approximately 89% for candidates testing from January to September 2012. Additional information can be found on the NCLEX Examination Pass Rates page of the NCSBN website. NCSBN does not track candidate performance according to test preparation practices.
What information will schools receive regarding the school’s candidates performance?
All nursing programs recognized by their regulatory colleges may subscribe to NCLEX Program Reports. Program Reports are produced semi-annually and annually. One of the two semi-annual reports covers graduates from a program testing between October 1 and March 31, while the other semi-annual report covers the span between April 1 and September 30. The annual Program Reports cover graduates testing between April 1 and March 31. Additional information on NCLEX Program Reports may be found on the Mountain Measurement website. NCLEX Program Reports will be available for Canadian subscription prior to 2015.
How will students with disabilities be accommodated?
Students meeting accommodation requirements will be provided accommodation on the NCLEX-RN examination. Specific policies around the criteria for accommodation will be developed by CCRNR in accordance with Canadian legislation.

 Educator and student preparation

What can nursing schools do to prepare for the NCLEX exam? Is there anything we should be doing to assist our students?

To better prepare students for the NCLEX-RN, educators can gain familiarity with the current NCLEX-RN Test Plan, its corresponding content distribution and examination delivery methodology. NCLEX resources are available free of charge for educators and students. These resources include:

NCSBN encourages educators and students to utilize these resources and become familiar with the NCLEX-RN exam, its delivery, anticipated item types, specific terminology and test site administration rules. All NCLEX online resources may be found at www.ncsbn.org/nclex.htm.

If educators review the practice analysis, will we have a good understanding of what is covered on the NCLEX exam?
Yes. The practice analysis report, available for download on the NCSBN website, very clearly details the survey process and, at the very end of the report, includes the task statements both in survey form and result format. The report includes all the questions asked of entry-level nurses as well as their ratings of how important each task is and how often each task is performed in their work setting. The results of the practice analysis are translated into the test plan, so educators can also see what types of tasks entry-level nurses are performing in the detailed test plan found on the NCSBN website.
What do you recommend for students to practice writing the exam?
NCSBN does not recommend or endorse any review courses or study materials.

**Some materials referenced and/or suggested will be available in French in the future; as materials become available, interested stakeholders will be advised.

 Related NCLEX Announcements

 Webinar

The Canadian Council of Registered Nurse Regulators (CCRNR) and the National Council of State Boards of Nursing (NCSBN) hosted the NCLEX Examination Webinar on Dec. 3, 2012 (English) and Dec. 10, 2012 (French).

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