Sunday 5 September 2021

NCLEX, Nursing Responsibilities, Nursing Degree, Health Professionals, Nursing Practitioners, Nursing Exam US

The final hurdle to become a fully licensed Registered Nurse is the National Council Licensure Examination (NCLEX).

To some, this is a daunting feat requiring countless hours of preparation and thousands of sample questions. Others take lengthy review courses in conjunction with online study programs. According to the National Council of State Boards of Nursing (NCSBN), 85% of new graduates passed the NCLEX on their first attempt in 2021.

So what does that mean for the other 15%?

Nurses who’ve failed their boards on the first attempt -- as well as nursing experts -- explain that it takes commitment, perseverance, humility, and grace to overcome this hurdle. A shocking number of new graduates fail their boards on the first attempt, but it’s rarely discussed.

Interestingly, a large number of nurses have a coworker who failed the NCLEX. In fact, including internationally educated nurses and repeat test-takers, the pass rate in 2021 was only 66% on the first attempt, per the NCBSN.

Signs You Failed the NCLEX RN

While the only way to know for sure whether or not you passed the NCLEX is to wait for the official results, we all know it can be impossible to wait. Especially when it can take up to 6 weeks to get those results.

So you can have some sense of how you did on the NCLEX exam, let's dig into how it's scored. 

How the NCLEX RN Is Scored

The NCLEX is taken using a Computerized Adaptive Testing (CAT) format. Basically, the computer adjusts the type of questions and number of questions you answer based on how you responded to previous questions.

Because of this, many people try to gauge whether or not they passed the test based on how many questions they were given. 

According to the NCBSN, there are 3 different scenarios their testing software uses to determine whether or not a candidate has passed the NCLEX:

1. 95% Confidence Interval Rule

With this rule (the most common way they judge test-takers), when the computer has determined with 95% confidence that you've either passed or not passed the test, it will stop giving you questions.

Since the minimum number of questions you'll take on the NCLEX is 75 and the maximum is 145, this could happen at any point between those 2 numbers. Theoretically, the computer could know from your first 75 questions that you failed and stop giving you more, or it could know that you passed. It's impossible to know which scenario you fall into based on how many questions you answered alone.

2. Maximum-length Exam Rule

If you end up answering the full 145 questions, that is an indication that you're close to the passing standard and the computer is going to keep giving you questions until you've reached the full number of possible questions.

So, don't think just because you had to answer all the questions, or the test is taking you longer than others, that you failed! The computer is just doing its best to determine where you are at. It will look at your final ability estimate to determine if you've passed, rather than the 95% confidence rule mentioned above. 

3. Run-Out-Of-Time-Rule (R.O.O.T.)

If you run out of time before reaching the maximum number of items, one of two things can happen.

◉ If you answered the minimum number of questions, then the computer will score you based on your final ability estimate.

◉ If you didn't answer the minimum number of questions, you'll fail the exam.

So, one sign that you did fail the NCLEX is if you ran out of time before completing the minimum 75 questions. Other than that one scenario, unfortunately, you're going to have to wait for those official results to really know whether or not you passed. 

What to Do If You Did Fail the NCLEX

If you did fail the NCLEX, don't freak out! You can take it again. And now that you have some experience with the exam, you're even more well-equipped to nail it the second time around. Here's what to do if you failed the NCLEX:

1.) Analyze Why You Failed the NCLEX

It’s important for nurses to recognize why they failed, and for every nurse the reason will be different. Some fail due to personal responsibilities, including family. Others suffer from lack of preparation, difficulty with critical thinking and multiple choice questions, the inability to focus during studying, or being distracted during testing.

Each of these can be overcome but require immediate and focused attention.

A study conducted in 2008 by the NCSBN concluded that for those who fail, it’s important to retake the NCLEX as soon as possible. It found that delaying the exam after graduation doesn’t increase the chance of failure. Rather, delaying after initially failing can increase the chance of failing a second time.

Once it’s been determined why you failed, think about what you need to do differently in order to change the outcome.

Enrolling in NCLEX prep courses can be helpful for those requiring personalized attention and in-person reviews. Many of these courses are instructor-based and offer a money back guarantee. Review courses can increase confidence and help with critical thinking skills.

It’s important to take multiple practice tests and answer hundreds of questions in order to become increasingly familiar with the test format and questions. Some questions have multiple answers that may in fact be correct, but the NCLEX searches for the best possible answer. Sample online tests can be found through various websites or through NCLEX study books.

2.) Take Action to Make Sure You Pass the Next Time Around

After determining why you failed, it’s time to take action with this information. First, write down as many of the topics from the initial test that you can remember. These could include lab results, obstetrics, cardiology, or time management questions.

If there’s one area where you feel especially weak, spend some time reviewing content material related to this subject. Some experts suggest answering 50 questions per day with a specific focus on areas of weakness. 

Study guides containing review questions are a potential nurse’s best friend. Every day, regardless of outside factors, experts recommend at least 150-250 questions should be answered. The questions answered incorrectly should be reviewed and content material reexamined if there is still confusion. 

Lippincott's NCLEX Review Guide contains more than 3,000 sample questions with correct and incorrect answers and rationales, as well as a diskette containing an additional 100 questions. The book is separated into different clinical areas so that you can concentrate on your weak area and not spend too much time on areas where you’re more comfortable. 

3.) Stay Positive!

Despite the hours of preparation, the most important advice any nurse can give is to stay positive and expect to pass. Failing the NCLEX on the first attempt doesn’t adversely affect one’s future nursing career. It’s important to not get stuck in a cycle of depression or self-doubt after failure.

Don’t give up. Remember, you made it through nursing school, so you have the persistence to pass the state boards and earn your license to practice.



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