How are NCLEX
®
Questions Written?
The NCLEX
®
Test Development Processes
Roseann Colosimo, PhD, MSN, RN University of Nevada Las Vegas
Catherine Dearman, RN, PhD University of West Florida
Conflict of Interest and Disclosures
Neither the planners or presenters indicated that they have any
real or perceived vested interest that relate to this presentation.
Learning Objectives
Conference attendees will be able to:
§ Describe the process used to develop and maintain the currency and accuracy of the NCLEX
§ Understand the Practice Analysis as a basis for NCLEX item development
§ Identify the item development process and regulatory oversight
§ Dispel some of the common myths associated with the NCLEX
Presentation Outline
§ History of the NCLEX®
§ Overview of the NCLEX Development Process
§ Entry-Level Nursing Practice Analysis
§ NCLEX Test Plan
§ Item Development and Regulatory Oversight
§ NCLEX True or False
Brief History of U.S. Nursing Licensure Testing
§ 1941: The State Board Test Pool Examination (SBTPE) was administered in four U.S. states, with the National League for Nursing (NLN) serving as the test service.
§ 1950: All 48 U.S. states and Washington DC adopted the SBTPE as the jurisdictional licensure examination.
§ 1978: NCSBN® was established and served as the test developer of SBTPE.
§ 1982: The NCSBN Board of Directors (BOD) officially changed the name of the examination to the National Council Licensure Examination (NCLEX).
§ 1986: The NCSBN BOD began the investigation of computerized adaptive testing (CAT).
Overview of the NCLEX
®Development Process
NCLEX
®Development Cycle
Practice Analysis: Entry-Level Nursing
Scope of Practice
Develop the NCLEX®Test Plan
Item Writing
Item Review
Item Bias and Fairness Review Boards of Nursing
Regulatory Review New Items Pretest
Administer the Operational
What is a Practice Analysis?
§ A large scale survey of job incumbents on activities that are performed on the job.
§ For the development of NCLEX, newly licensed nurses are surveyed on current entry-level nursing practice.
§ The results are used to guide content distribution of the client need categories on the NCLEX and its test plan.
Practice Analysis Methodology
§ RN and PN/LVN entry-level practice analyses are conducted separately using the same methodology.
§ All RN and PN practice analysis methodology is reviewed by three external experts prior to survey data collection.
§ A panel of 9 to 15 nurse subject matter experts develops a comprehensive list of entry-level RN or PN activity statements.
§ The comprehensive list of nursing activity statements forms the basis of the practice analysis survey.
Sample and Respondents
§ The practice analysis survey sample reflects the population of RN or NCLEX-PN candidates.
§ Sampling follows entry-level nurse distribution across the U.S.
§ Percentage of respondents by states was also similar to the nursing representation across the U.S.
§ Each practice analysis survey is sent to 12000 entry-level nurses at the appropriate licensure level. The response rates for RN and PN practice analyses are approximately 20% and 15%, respectively.
NCLEX
®Test Plan
NCLEX
®Test Plan
§ Basic Test Plan
― Available in September prior to the effective year
― Provides basic information and updated client needs category percentages
§ Detailed Test Plan
― Available in December prior to the effective year ― Sample Items for all client need categories
― Item Writer/Item Reviewer/Nurse Educator Version ― Candidate Version
NCLEX
®Detailed Test Plan
§ Three important purposes
1. Guide candidates preparing for the exam
2. Direction for item development 3. Facilitate classification of exam
Item Development and Regulatory Oversight
Item Writers
§
Qualified nurse volunteers
§
Actively teaching entry-level nursing students
§
Create items (test questions) based on the current NCLEX Test Plan
§
Have not participated in other nursing licensure exam or preparatory exam
Item Reviewers
§
Qualified nurse volunteers
§
Actively working with entry-level nurses providing care to clients
§
Review test items for accuracy, currency and entry-level appropriateness
§
Have not participated in other nursing licensure exam or preparatory exam
Item Bias and Fairness Reviews
§
All items are reviewed to ensure the exclusion of sensitive, unintentional biased
language.
§
Items are edited to remove words or phrases which may affect exam
Item Bias Reviews Criteria
§ Stereotypes
§ Inflammatory material
§ Language
Oversight Committee Review
§
NCLEX Examination Committee (NEC)
―
Comprised of nurse regulators in various jurisdictions
―
Develops and maintains NCLEX policies
―
Reviews and approves all NCLEX items before use in scoring
―
Review recommendations from all NCLEX review committees and
Boards of Nursing Regulatory Review
§
Conducted biannually
§
Review criteria
―
Entry-level appropriateness
―
Nurse practice act congruency
True or False? #1
Recent changes in nursing practice are not tested on the NCLEX. It
takes a while for the NCLEX to incorporate changes in practice…
False!
§ Each NCLEX item undergoes a number of review processes to ensure currency
― Practice Analysis
― Item Review
― NCLEX Examination Committee
― Board of Nursing/Regulatory Body Review
― Ongoing item pool maintenance
§ Immediate changes are reflected in an Item Pool Search to uncover items with outdated content.
True or False? #2
The computer randomly selects students for an exam with the maximum
number of questions.
False!
§ All NCLEX-RN or NCLEX-PN exams administered match the respective test plan percentages.
§ Pass/Fail determinations are not made until the approved NCLEX Test Plan has been met.
§ Items are only administered as they are needed to determine candidate’s competence. Unnecessary item exposures may pose security threats to the exam.
True or False? #3
The NCLEX is more difficult for candidates who speak English as a second
language.
False!
§ The language used in an NCLEX item is consistent with verbiage an entry-level nurse is expected to know.
§ NCLEX readability is initially established at the start of item development and is frequently reviewed to ensure it remains intact.
§ NCLEX-RN no higher than 1300 Lexiles ― e.g., David Copperfield (1340 Lexiles) § NCLEX-PN no higher 1200 Lexiles
True or False? #4
The computer will continue to choose questions on a content topic
previously answered incorrectly.
False!
§ The computer is programmed to select items based on test plan content areas and item difficulty.
§ All NCLEX exams administered match the test plan percentages.
True or False? #5
The NCLEX contains questions outside of the entry-level nursing scope of
practice.
False!
§ The NCLEX Test Plan is based on the analysis of entry-level practice as outlined in the triennial NCLEX Practice Analysis.
§ In other words, the NCLEX is built on the current practice of entry-level nurses within the context of the nursing scope of practice—the allowable duties in nursing.
NCLEX
®Resources Online
§ NCLEX Candidate Bulletin (www.ncsbn.org/1213.htm)
― This resource serves as your guide from before to after the NCLEX, including important contact information, details on how to register, the NCLEX Candidate Rules and results processing.
§ NCLEX-RN and NCLEX-PN Test Plans & Detailed Test Plans (www.ncsbn.org/1287.htm)
― Learn more about the content and scope of the NCLEX by reviewing the basic and detailed versions of the NCLEX Test Plans.
§ RN & LPN/VN Practice Analyses (www.ncsbn.org/1235.htm)
― Discover the triennial studies that provide the basis for the NCLEX-RN and NCLEX-PN Test Plans.
Online Resources (Continued)
§ NCLEX Using CAT Video (www.ncsbn.org/1216.htm)
― Familiarize yourself and your students with how computerized adaptive testing (CAT) works.
§ NCSBN Portal (portal.ncsbn.org/)
― Register for the NCLEX and sign into your account for scheduling and Quick Results.
§ NCLEX Tutorial (www.pearsonvue.com/nclex)
― Experience the same tutorial that NCLEX candidates take at the beginning of their exam, including a look at the different item formats that they might see on their exam.
Online Resources (Continued)
§ NCLEX Frequently Asked Questions (www.ncsbn.org/1201.htm)
― Find answers to your questions about the NCLEX, including questions from candidates and/or about exam development, psychometrics, alternate item formats and more.
§ Like us on Facebook and Follow us on Twitter!
(www.facebook.com/NCSBNNCLEX, www.twitter.com/NCLEXInfo)
― Receive NCLEX information, news and updates, and ask any questions you may have about the NCLEX program.
How Nevada Improved!
Nevada
36
Skinny on real Nevada
37
A few facts
§ We have lovely Communities, schools , Churches, great Parks
§ Shrimp consumption is Nevada is 60,000 pounds per day higher than rest of country combined
§ Only state to posses a complete skeleton (55 feet) of an Ichthyosaur (extinct marine reptile)
§ 150 couples get married everyday in Las Vegas
Nevada Health – 38 up from 45
38
Healthy People 2020 – land of disparities and access issues § Low per capita public health funding
§ Low rate of high school graduation
§ 17% of adults smoke
§ 25% adults Obese
§ Children in poverty 24%
§ Increased our immunization compliance to 67%
Education Consultant 2006- 2015
39
Nevada State Board of Nursing
13 RN programs
3 LVN
35,000 registered nurses
Large area, 2 major cities Las Vegas , Reno
800 practical nurses
Nevada response
40
§ Nevada Regulations requires an 80% full year pass rate for all schools of nursing for first time takers.
§ 2007 Nevada was 46 out of 56 states and territories.
§ Deans and Directors were demanding a different measure be used but agreed other measures would be more labor intensive for them ( not a good option)
§ Nevada State Board of Nursing upheld 80% first time test taker full year score as required.
Nevada Nursing School Approval categories
41
§ Provisional - New schools have 2 years after first class graduates to achieve Nursing
programmatic accreditation and 80% first time full year pass rate.
NSBN has granted extensions to schools make good progress but has accepted “teach out plans from schools unable to achieve”
§ Fully approved schools need to maintain nursing programmatic accreditation and 80%
first time taker full year pass rate.
§ If below 80% one year submit plan, if below two years conditional status and must have survey and consultant help.
Precipitating Factors
42
Some not all
§ Lack of understanding of NCLEX- negative attitude
§ Many Faculty have Nurse Practitioner background
§ Many part time adjunct faculty teaching clinical
§ Double number of nursing schools in 7 years with increased growth
§ Faculty shortage ( better black dealer and bartender schools)
§ Competition for clinical practice settings
Nevada
43
Explosive growth in home sales before crash
§ Ripe for explosion of technical schools moving into teaching nursing
― Increasing population
― Always ranking 46-48 in numbers of nurses per 100,000 citizens ― Building hospitals
― Technical schools already existed for massage, medical assisting and criminal justice programs
The NCLEX Story
44
year NCLEX pass rate- NV NCLEX pass rate -National Number –RN
Schools 2007 81.18 85.50 4/9 below 80% 2009 83.95 88.42 2/11 below 80% 2011 90.04 87.41 1/12 below 80% 2012 94.23 90.34 0/12 below 80% 2013 84.98 83.04 5/14 below 80% 2014 88.87 81.78 3/12 below 80% 2015 84.53
Perspective for 2015 - totals
45 § Candidates. 2015 Total § RN 229,459 (69.87%) § RN First time 166,523 (81.78%) § Repeat 62,936 (38.36%) § U.S.-Educated 206,170 (75.15%) § Internationally Educated 23,289 (23.11%)Nevada Action Plan
46
§ Regional workshops by NCSBN
§ Highly encourage test item development classes for faculty
§ Faculty development
§ NSBN communicates test plan changes and dates
Regional workshops
47
§ NCSBN Workshops
― Dispel myths Who has high scores Associate degree programs or BSN??
- Explain development of exam
- Explain how many of your peers are involved - Explain how your faculty can participate
- Focus on test plan
Test Item Development
48
§ Help faculty to think critically
§ Not just rely on test item banks
Faculty development
49
§ Clinical Faculty workshops – NSBN facilitated
§ Learning theories – Flipped classroom
― Engage the student
§ Classroom control
― Command of classroom
§ Students – wide range
― 40 years ago everyone was white ,female and 19
― Today 19- 60 , every ethnic group, 10 %male and rising,
Communication
50
§ Nudge faculty meeting to discuss NCLEX
NSBN
51
Anecdotal experience -Nevada
52
§ Schools that fail have
― 1. leadership not experienced in nursing education
― 2. Admission criteria that do not support national research ― 3. Faculty who maybe excellent clinicians but not educators ― 4. Lack local faculty control over curriculum
Fully approved schools
53
§ Proof in pudding
― Maintained an above 90% PASS RATE IN 2013 AFTER INCREASE IN PASSING SCORE ― The systematic program evaluation of curriculum
NSBN – Collaboration , Collaboration
54
§ Positive feedback to faculty Deans and Directors at Meetings
§ Positive meetings and constant collaboration
§ Board paid initial cost to of computer program to do clinical scheduling releasing more faculty to teach
