Letters to the Editor
Article Outline
To the editor:
Most nurses understand that the purpose of the National Nursing Licensure Examination (NCLEX®) is to assess a candidate’s ability to provide safe, effective nursing care upon entry into practice in the United States and its territories. In order to qualify to take the NCLEX examination, nursing candidates must graduate from a Board of Nursing-approved nursing program.1 The overarching principle behind requiring nurses to graduate from an approved nursing program and pass an entry-level examination is to ensure that the newly licensed nurse is safe to practice so that the public will be protected.
The processes that are used to determine the content of the NCLEX examinations are legally defensible and based on sound psychometric principles. In terms of legal defensibility, the Equal Employment Opportunity Commission Guidelines require evidence that tests are related to the work to be performed on the job.2 In addition, testing and measurement industry experts from the American Educational Research Association (AERA), American Psychological Association (APA), and the National Council on Measurement in Education (NCME) have developed standards for testing, the Standards for Educational and Psychological Testing, which specify that evidence to support the validity of an examination should be based on those “elements, knowledge, skills, abilities, or other personal characteristics” which are necessary for the job.3 Furthermore, The Council on Licensure Enforcement and Regulation (CLEAR) specifies that empirical data should be collected from job incumbents by asking what they do on the job and how important each task is in relation to safe practice.4
One of the methods that provide empirical evidence about the knowledge, skills and abilities needed to perform a job is through a job or practice analysis. A practice analysis provides a detailed description of those activities that the nurse performs on the job. The results of the practice analysis are then used to develop a test plan using empirical data obtained from job incumbents about the frequency with which they perform nursing activities and the importance of those activities for client safety. Both the 2004 NCLEX-RN® Test Plan and the 2007 NCLEX-RN® Test Plan were reviewed and approved by the National Council of State Boards of Nursing (NCSBN) member boards, which are comprised of nurses from a variety of practice settings and specialty areas, including nursing educators.5, 6 In addition, nursing educators and nursing service providers have routinely contributed to the development of the NCLEX examination by service on expert panels.
A practice analysis is not intended to (nor should it) describe past practice or foretell future practice. The National Council of State Boards (NCSBN) of Nursing conducts practice analyses at least every 3 years in order to ensure that the examination is based on current nursing practice. A practice analysis should not describe nursing practice beyond the knowledge, skills and abilities needed to be safe upon entry into practice. There are other mechanisms, such as certification examinations, whereby a nurse can demonstrate post-entry-level nursing expertise. Moreover, a practice analysis that establishes the validity of the NCLEX should describe nursing practice in the US and its territories—not physician practice or nursing practice worldwide.
The NCLEX examination is testing the essential knowledge, skills and abilities to be a safe nursing practitioner at the entry-level, as it should. A licensure examination, regardless of the profession, should not be used to drive practice or education.
The most recent Institute of Medicine (IOM) report, A Bridge to Quality, points out problems with the preparation of our current healthcare professionals and our current health care system and recommends broad changes.7 In light of the IOM recommendations, a more productive use of nursing educators’ efforts may be to work together with practice and regulation to continue to educate high quality nurses who are prepared in the core competencies specified in the IOM report. The nursing profession should not be divided by specialty interests but should focus on providing high quality nursing care.
References
- Crawford L. Profiles of Member Boards. National Council of State Boards of Nursing; 2002.
- . In: Licensure Testing: Purposes, Procedures, and Practices: Buros-Nebraska series on Measurement and Testing: Legal and Professional Bases for Licensure Testing. Lincoln, NE: Buros Institute of Mental Measurements; 1995;p. 33–58
- . The Joint Standards for Educational and Psychological Testing. Washington, DC: APA; 1999;
- . Development, Administration, Scoring and Reporting of Credentialing Examinations: Recommendations for Board Members. (2nd ed). Lexington, KY: The Council on Licensure, Enforcement and Regulation; 2004;
- NCLEX-RN® Examination: Test Plan for the National Licensure Examination for Registered Nurses (2004). National Council of State Boards of Nursing; 2003.
- 2007 NCLEX-RN® Test Plan. National Council of State Boards of Nursing; 2006.
- . Health Professions Education: A Bridge to Quality. Washington, DC: The National Academies Press; 2003;
PII: S0029-6554(06)00214-4
doi:10.1016/j.outlook.2006.07.002
© 2006 Mosby, Inc. All rights reserved.
