What Is the NCLEX-RN?

The National Council Licensing Exam (NCLEX) is the test that every nursing graduate must pass in order to become a licensed registered nurse.

While students often feel worried about getting beyond this hurdle, understanding how the test is designed and scored can provide a greater sense of confidence.

Taking the NCLEX

The exam is developed and administered by the National Council of State Boards of Nursing (NCSBN). To practice as a registered nurse (RN) in the United States, candidates must both pass the NCLEX-RN exam and apply for licensure in the state where they plan to practice nursing (or through the Nurse Licensure Compact if they want a multistate nursing license).

After students complete an accredited nursing program, they will be eligible to take the NCLEX as part of their initial licensing process. Eligible prospective nurses will be provided with an Authorization to Test (ATT) by their state board, and they can then register to take the NCLEX. Keep in mind that these ATTs remain valid for 60 to 365 days, according to the individual state board’s guidelines. Candidates must sit for the NCLEX within this time period, and they cannot extend their ATTs. Typically, ATTs arrive within two weeks of registration, so it is important to check with the NCSBN if there is a delay.

Learning About the Test

The Format

The NCLEX is a computerized test, and it is no longer offered in a paper and pencil version. It uses computerized adaptive testing (CAT) to determine a candidate’s competency with the skills necessary to provide safe and effective nursing care. On CAT exams, each question is based on the response a test-taker gave to the previous question. The exam continually adjusts questions so they increasingly align with each test-taker’s ability. Because the questions asked change according to testers’ responses, each candidate will have a unique exam. In addition, because each new question is based on the previous question, test-takers cannot skip questions. Pass/fail results are determined according to one of three rules:

95 Percent Confidence Interval Rule: Once the computer is 95 percent certain that a test-taker is clearly above or below the passing standard, it will stop generating questions for the test-taker to answer, and the test will be concluded. The passing determination will be made based on the test-taker’s responses to that point. This is the most commonly-applied rule.

Maximum-Length Exam Rule: If a test-taker’s ability is very close to the standard for passing, then the computer will continue to generate questions until the maximum limit is reached. The test-taker’s final score will be based on all questions answered.

Run-Out-of-Time (R.O.O.T.) Rule: If a test-taker runs out of time before answering enough questions for the computer to determine passage with 95 percent certainty, then this rule applies. Test-takers who do not answer the minimum number of questions will automatically fail. Those who do answer the minimum number will have their last 60 ability estimates evaluated by the computer. If they remain above the passing standard (even with some incorrect answers), then the test-taker will pass; if they dip below that standard at all, then the test-taker will fail.

The Categories

According to the NCSBN, the NCLEX’s “test plan” — that is, its broad content sections — is divided into four major patient-need categories: safe and effective care environment; health promotion and maintenance; psychological integrity; and physiological integrity. The fundamental areas of nursing care — the nursing process, caregiving, communication, documentation, and teaching/learning — are assessed throughout the questions. The percentage of test questions assigned to each patient-need category is determined in advance, based on practice analysis reports and the expert judgment of the NCLEX Examination Committee. Nursing students can find a complete breakdown of the test plan on the NCSBN website.

The Timing

Testers will have up to six hours to answer a series of questions based on the test plan. Nursing candidates must answer a minimum of 75 questions and up to a maximum of 265 questions. Most of the questions on the NCLEX are standard multiple-choice format, although the NCSBN added several new format questions in recent years. These include multiple correct response questions, fill-in-the-blank math calculations, the correct ordering of certain procedure steps, and the identification of body parts or areas on drawings.

The Results

Test results are not available immediately. Following the NCLEX, moreover, testers will not receive their scores, but they will be notified if they passed the exam. Exam results are provided to the state board of nursing where the nurse graduate applies for licensure. It can take up to six weeks to receive official results from the state board of nursing, although some states allow applicants to learn unofficial exam results within 48 hours. Candidates can find a list of state boards that permit this on the NCSBN website.

If a prospective nurse answers at least 75 questions and does not pass the NCLEX, she will receive a Candidate Performance Report (CPR). The first page of this report contains a brief explanation of how CAT works, how many questions a tester answered, and some suggestions on how to use other diagnostic information provided.

On the second page, the CPR provides information about the candidate’s specific performance in the different areas of the test. The report identifies strengths and weaknesses to enable candidates to focus their study efforts as they prepare to re-take the exam. Prospective nurses are allowed to sit for the NCLEX up to eight times in a given year (though some states limit this further), but they must wait at least 45 days between each attempt.

Most aspiring RNs — about 88 percent — pass the NCLEX the first time they take it. Even though it’s a challenging exam, take heart that if you prepare, you are likely to fare well.

Getting Prepared

Although most students are well prepared in nursing school to take the NCLEX, there is still a high level of stress about the exam. After all, many years of work have led up to this milestone.

Beyond the NCSBN’s excellent resources and information, including several online review courses of varying lengths and costs, there are independent tutors who prepare students for the NCLEX and related academic areas. There are also test-prep classes offered by companies such as Kaplan, and free online courses available at websites like Khan Academy. Finally, there are many NCLEX review books to choose from at different prices.

You can use Noodle to search for NCLEX tutors and tutoring centers based on your preferred location, price, and other factors.

By becoming familiar with the exam and reviewing the concepts and skills covered, much of the test-related anxiety can be minimized. It’s important to remember that the past several years spent in nursing school have prepared graduates well — this is just the final hurdle to beginning your new career.

Good luck!

Sources: (n.d.). Retrieved February 10, 2015, from National Council of State Boards of Nursing.