The respect and high esteem that the nursing profession enjoys is no accident. Generations of nurses have worked diligently to provide the quality care and advocacy that has earned the trust of patients and their families. That’s why qualifying to work as a registered nurse is difficult. Prospective nurses must demonstrate that they possess the skills and character to meet the nursing profession’s standards.
The National Council Licensure Examination for Registered Nurses (NCLEX-RN) and its partner examination for practical nurses (NCLEX-PN) are intended to confirm that a nursing student is prepared to work as an entry-level RN or PN. In addition to testing a candidate’s medical knowledge, the exams require that students demonstrate the critical thinking skills necessary to make sound nursing decisions.
The American Association of Critical-Care Nurses describes the benefits of nurse certification for patients, employers, and nurses:
- It gives patients and their families confidence in the nurse’s decision-making skills and work experience.
- It contributes to the professionalism of healthcare employers’ work environments and promotes retention, which becomes critical in light of the continuing nursing shortage.
- It positions nurses to receive the recognition and advancement they deserve while boosting their confidence and sense of achievement.
Becoming a nurse begins by earning a postsecondary degree in nursing. The most recent National Nursing Workforce Study conducted by the National Council of State Boards of Nursing (NCSBN) and the National Forum of State Nursing Workforce Centers found that 45% of RNs have a bachelor’s degree in nursing as their highest education level achieved. This was followed by 28% with an associate degree in nursing and 17% with a master’s degree in nursing.
The percentage of nurses holding a bachelor’s or master’s degree is increasing, according to the study. By contrast, the percentage of nurses whose highest education level is an associate degree or a nursing diploma is decreasing.
In addition to passing the NCLEX-RN exam, RNs must be licensed by the state in which they practice; the NCSBN notes that the Nursing Licensure Compact (NLC) allows nurses to practice in multiple states with a single state-issued license. The NLC has been approved or is pending in 39 states, although California and New York are among the states that are not members of the compact.
Types of Nursing Degrees
Advanced nursing degrees include the Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), and PhD in nursing. However, the most common types of nursing degrees are the Associate Degree in Nursing (ADN) and the Bachelor of Science in Nursing (BSN).
Nursing Degrees vs. Nursing Licenses
- Licensed Practical Nurses (Also Referred to as Licensed Vocational Nurses): The U.S. Bureau of Labor Statistics (BLS) describes the duties of LPNs as providing basic patient care, such as taking vitals and changing wound dressings. They comfort and discuss care with patients, maintain health records, and collaborate with RNs and doctors. They receive a certificate or diploma after completing an education program that typically takes about a year. They must also pass the NCLEX-PN exam.
- Registered Nurses: According to the BLS, an RN’s duties include assessing and diagnosing patients’ health, recording their health histories, administering treatments and medicine, and collaborating with doctors and other healthcare professionals. They run and monitor medical equipment, administer diagnostic tests, and analyze results. They also educate patients and families about continuing treatment. RNs earn a nursing diploma or certificate, ADN, or BSN. Some states also require a criminal background check in addition to a passing score on the NCLEX-RN exam.
Graduate Degrees in Nursing
- Master of Science in Nursing: The American Association of Colleges of Nursing (AACN) describes the types of master’s degrees earned by nurses:
- Entry-level master’s degrees include baccalaureate-level material and typically take two to three years to complete.
- RN to master’s degrees are intended for nurses who hold associate degrees; they also require two to three years to complete on average.
- Bachelor’s to master’s degrees are the most common graduate degrees for nurses, offering courses that build on the baccalaureate curriculum; they typically require 18 to 24 months to finish.
- Dual master’s degrees serve nurses looking to combine a degree with a concentration in a specific aspect of health, such as business (Master of Business Administration), public health (Master of Public Health), or health administration (Master of Health Administration).
- Post-master’s certificates provide master’s program graduates with the opportunity to gain clinical skills and knowledge in healthcare specialties, such as leadership, education, and informatics.
- Doctor of Nursing Practice: The practice-focused doctoral degree in nursing prepares advanced practice nurses for leadership positions as nurse practitioners, clinical nurse specialists, certified RN anesthetists, and certified nurse midwives. DNP degree holders also serve as health educators, administrators, and public health nurses.
- PhD in Nursing: The research-focused doctoral degree for nurses prepares them to conduct clinical research in such areas as diabetes treatment, cancer treatment, and eating disorders. Some nursing education programs offer a Doctor of Nursing Science (DNS) or Doctor of Education (EdD) rather than a PhD in nursing.
Nursing School Accreditation
A nursing school’s accreditation indicates to potential students that the institution’s bachelor’s and master’s degree programs in nursing have met an established standard of quality. The AACN explains the benefits of nursing school accreditation for patients, nurses, educators, and students.
- Accredited programs gain the trust of the public, prospective students, financial backers, educational institutions, government agencies, and other institutions. To receive federal support under the Higher Education Act of 1965 or Title VIII of the Public Health Services Act (Nursing Education Act), a program must be accredited by an agency acknowledged by the U.S. Department of Education.
- The two types of nursing school accreditation are institutional and specialized (or programmatic):
- Institutional accreditation is conducted by regional organizations and the National League for Nursing (NLN) for schools not affiliated with a higher education institution.
- Specialized accreditation is conducted by the NLN and specialty nursing associations for schools that operate within a higher education institution.
- In addition to the NLN, nursing schools are accredited by the American Nurses Association, American Association of Nurse Anesthetists, and other nursing organizations.
NCLEX-RN and NCLEX-PN Exams
For nursing students, the NCLEX-RN and NCLEX-PN exams can be daunting, yet each year far more first-time exam takers pass than fail. The key to success is thorough preparation.
To work as an RN, a person must be licensed, which involves passing the NCLEX-RN exam and meeting other licensure requirements that vary by state. NursingLicensure.org lists the LPN/LVN and RN licensing requirements for each state and the District of Columbia.
- RN and LPN licenses are issued by state agencies; they must be renewed after a number of years, and they may be revoked by the state for a number of reasons.
- A nursing credential is issued by an educational institution or a professional association as proof of qualification for a specific practice area.
- A nursing certification requires meeting education, experience, and skill levels demonstrated by passing a certification exam, such as that for certified emergency nurse (CEN).
Resources for Nurse Requirements
- American Nurses Association, Resources to Succeed — Information for nursing professionals and nursing organizations
- American Nurses Association, Nurse Focus — Links to sources for professional development
- The Joint Commission, Nursing Resources — Standards and guides relating to nursing practice on topics such as pain management and safety in nursing
Nursing students begin to think about the NCLEX exam long before they graduate. The first step in preparing for the NCLEX is to obtain an Authorization to Test (ATT) from the appropriate nursing regulatory body for the location where the student will practice. This is typically done well in advance of the test date.
- The nursing regulatory body declares the student eligible, and the student receives the ATT via email.
- The ATT email is required to register for the exam and schedule the student’s NCLEX test date.
- The ATT contains an authorization number, candidate identification number, and expiration date.
- The ATT remains valid for the period specified by the nursing regulatory body, which is typically 90 days.
NCLEX Facts and Figures
The NCSBN’s 2020 NCLEX fact sheet provides statistics on the number of students taking the test each quarter, the number who pass the test, and other information about the test results.
- NCLEX Pass Rates: The NCSBN provides fact sheets that include NCLEX pass rates dating back to 1983. The fact sheets break down testing by the number of U.S.-educated and international-educated students who took the test, the number of first-time takers, the number of repeat takers, and the pass rates in each category.
- Computerized Adaptive Testing (CAT): The NCSBN administers the test using a technique that is intended to make the examination process more efficient. CAT adjusts the question difficulty based on the student’s incorrect answers as the test proceeds. For example, high-ability students get fewer “easy” questions because such questions don’t fully represent those students’ knowledge. Similarly, low-ability students receive fewer “difficult” questions to minimize the number of answers that are guesses.
- Causes of a Failing Score on the NCLEX: Daily Nurse explains the reasons why students are unsuccessful when taking the NCLEX exam.
- Inability to answer the minimum of 75 questions in the six-hour test period
- Failure to reach a certain competency level after answering the maximum of 265 questions
- Answering so few questions correctly that the system determines a passing score is impossible
How to Prepare for Taking the NCLEX Exam
Before registering for the NCLEX, the NCSBN recommends that students read the NCLEX Candidate Bulletin, which details the test registration process, eligibility requirements, test fees, and registration time limits. The bulletin covers a range of topics related to the NCLEX:
- Domestic and international test appointment scheduling
- Personal identification requirements
- Testing rules and grounds for dismissal or cancellation of results
- Check-in process and breaks
- Test environment and technical issues
- How the test results will be reported
The bulletin explains the steps used to develop the NCLEX and includes definitions of terms used in the exam questions.
After becoming familiar with the necessary test preparations, students turn their attention to the NCLEX test plans, which act as frameworks for the outlines students will use to study for the exam. Each test plan includes the following components:
- Definitions of the exam’s Client Needs categories
- Nursing activity statements
- Examples of test content
- Sample questions
- A guide to item writing
These are among the other steps that students can take to prepare for the NCLEX exam:
- Take the NCSBN’s NCLEX tutorial, which helps students get accustomed to the Pearson VUE exam software.
- View the NCSBN’s CAT educational video and presentation that explains how the system works and why it is used.
- Peruse the NCSBN’s FAQs, which cover topics such as changing registration, choice of testing jurisdiction, and the forms of identification accepted at test centers.
- Read the organization’s exam-day advice that recommends wearing comfortable attire, arriving early, and setting a pace, and explains what to do when you’ve completed the test.
- To stay a step ahead, review the NCSBN’s after the exam instructions to learn about unofficial and official results, and, for candidates who don’t pass, how to retake the exam.
Resources for NCLEX Preparation
- California Board of Registered Nursing, NCLEX Review Resources and RN Refresher Courses — A directory of resources for preparatory material as well as organizations offering RN refresher courses
- Canadian Nurses Association, NCLEX-RN Exam Resources — Free resources from the NCSBN and other organizations, as well as various resources to purchase
- National Council of State Boards of Nursing, Resources — A searchable database including brochures and magazines, videos, and webinars
Study Tips for the NCLEX-RN Exam
The more students know about how the NCLEX-RN exam works, the types of questions posed by the test, and the topics it covers, the more likely they are to achieve a passing score. A successful NCLEX strategy begins by creating a study plan that includes answering dozens, perhaps hundreds, of sample questions. The strategy will help students adopt a test-taking approach that identifies difficult questions and parses them so they are easier to answer.
Devising a Study Plan
The best way for students to familiarize themselves with the topics and types of questions included on the NCLEX exam is to carefully review the NCSBN test plans, which are updated every three years to ensure they reflect current trends in nursing and healthcare. The most recent test plans were released in April 2019.
- The test plans describe in detail the content covered on the exam and the appropriate writing process for exam answers.
- They define each Client Needs category (listed with the percentage of questions from each):
- Safe and Effective Care Environment
- Management of Care (17% to 23%)
- Safety and Infection Control (9% to 15%)
- Health Promotion and Maintenance (6% to 12%)
- Psychosocial Integrity (6% to 12%)
- Physiological Integrity
- Basic Care and Comfort (6% to 12%)
- Pharmacological and Parenteral Therapies (12% to 18%)
- Reduction of Risk Potential (9% to 15%)
- Physiological Adaptation (11% to 17%)
- They include nursing activity statements, content examples, sample NCLEX items, and an item-writing guide.
- Safe and Effective Care Environment
Five processes are integrated into the questions for all Client Needs categories:
- Nursing Process: Applying scientific and clinical reasoning to patient care
- Caring: Mutual trust and respect in all client interactions
- Communication and Documentation: Verbal and nonverbal interactions with patients, their families, and fellow healthcare professionals
- Teaching/Learning: Promoting changes in behavior by acquiring knowledge, skills, and capabilities
- Culture and Spirituality: Recognizing and acknowledging the unique preferences of individual patients in light of standards of care and legal considerations
Types of Questions
The number of questions the CAT system presents to students ranges from 75 to 145, 15 of which are unscored pretest items. The test must be completed within five hours (plus a one-hour break), which includes the introductory screen and optional breaks. The types of questions, or “items,” on the NCLEX-RN exam include the following:
- Fill-in-the-blank calculation
- Multiple choice
- Order response
- Select all that apply (SATA)
Order response and SATA tend to be the most problematic for students, according to Daily Nurse.
- Order response questions present students with a scenario and a list of actions; students are asked to put the actions in the correct order to address the situation described in the scenario.
- SATA questions present students with a statement or scenario along with a list of potential answers; they must determine which answers apply to the scenario.
NCLEX Study Tips for Tackling Difficult Questions
A study plan for the NCLEX exam should set aside at least one to two hours of study time each day beginning at least several weeks before the test date. Daily Nurse describes strategies for increasing the chances of answering the exam’s most difficult questions correctly:
- Study unit conversions to prepare for questions that involve drug dosage calculations.
- Be familiar with prioritization in the nursing process: assess, diagnose, plan, implement, evaluate.
- Approach SATA questions as extended true or false: determine whether each independent answer option pertains to the question.
Students often review general nursing concepts before focusing on the detailed information that the NCLEX tests, but Brilliant Nurse explains that a more effective strategy is to begin by studying the details. Once students feel they have mastered the facts, they can gain a better understanding of the overarching principles that link them.
Brilliant Nurse’s other study tips include the following:
- Go over practice test results carefully to understand why mistakes were made.
- Join a study group or study with a friend, but only if the group is focused on success.
- Answer sample questions out loud to reinforce the material.
- Read questions carefully, looking for keywords and details.
- For multiple choice and SATA questions, eliminate obvious wrong answers.
- Spot the small differences in similar potential answers.
- When two options are opposite, one of the options is usually the correct answer.
Resources for NCLEX Study Tips
- Canadian Nurses Association, NCLEX-RN Exam Writing Tips — Preparatory steps, study tips, and typical routines for exam day, during the test, and after the test.
- National Council of State Boards of Nursing, NCLEX Practice Exam for RN and PN — Downloadable tests designed to represent the actual test environment that feature questions from previous exams.
- Onward Healthcare, “Do’s and Don’ts for Passing the NCLEX” — Test advice, including start studying early, avoid cramming, take as many practice tests as possible, eat a nutritious breakfast on test day, take deep breaths, and relax.
Preparation Is Key to NCLEX Success
It’s much easier for students to relax while taking the NCLEX exam when they’re confident that they have mastered the material. Students usually have more nursing knowledge than they give themselves credit for. By focusing on their test-taking strategy and the material they have mastered, students are much less likely to have any single question or topic throw them for a loop. The more work a student does in the weeks leading up to the test, the calmer they’ll be on test day, and the happier they’re likely to be when the test results are announced.