Letters to the Editor

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To the editor:

The letter in response to my Guest Editorial “What is the NCLEX really testing?” is thoughtful and it clearly describes the process of NCLEX testing. What I had hoped to raise in my editorial, however, was a larger question for our profession—namely, how do we prepare nurses for evidence-based practice in the realities of well-documented unmet health care needs and critical problems with health care quality and patient safety. It is too simplistic to assert that a licensure examination “should not be used to drive practice or education.” Any educator will tell you that, while it may be an unintended consequence, this examination does drive both, and as long as we base our licensing examination solely on the practice of new graduates, nurses will never be a part of the transformation of the health care system.

I would like to see nursing rise above the “legally prescribed psychometric methods” and design a testing process based on both practice analysis and the knowledge needed to provide quality care as determined by data and research evidence. Specifically, the Institute of Medicine (IOM) report, A Bridge to Quality,¹ suggests just such a focus with the identification of 5 core competencies for future health professionals:

I do not see how the NCLEX process as currently designed allows the profession to test competencies in these or other emerging areas. And the reality is that if they are not tested in the NCLEX, they are far less likely to be taught in basic nursing education programs.

It is time for nursing to re-examine the practitioners we wish to prepare and the examination that affirms their practice abilities. Perhaps this is an opportunity for us to demonstrate the fourth IOM competency—apply quality improvement—to our collective work as a profession.

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Reference 

1. Institute of Medicine. Health professions education: A bridge to quality. Washington, DC: The National Academies Press; 2003;
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