Clinical Nurse Specialist Shares Advice For Nursing Students Preparing for the NCLEX

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Preparing for the NCLEX can be a stressful and scary experience. At Confident Voices, we thought it would be helpful to all nursing students out there, especially those who will be taking the NCLEX in the near future, to share some advice and insights from someone who is very experienced in preparing students for the NCLEX. We were so excited to get a chance to interview Deborah King, Ph.D., MS, RN to do just that!  She has some awesome suggestions!

Tell us about yourself, including your education, career background, and approach to NCLEX tutoring?

I am a Master’s prepared Clinical Nurse Specialist and hold a Ph.D. in Human Services Psychology from The University of Maryland. I have over 35 years of clinical nursing practice, teaching, and tutoring experience. I have a Nursing tutor profile at Wyzant, through which and elsewhere I have worked with countless nursing students from a diversity of backgrounds, with a variety of learning styles, including challenges with test anxiety, learning disabilities, language challenges, or adult learners who are returning to school or changing careers.

Many of my students have done quite well in their nursing programs, but don’t “test well” or know how to study effectively for this exam—which can be intimidating for even the strongest student. This is a common pattern, and by effectively building a toolbox of NCLEX strategies, this pattern can be successfully broken—leading to NCLEX success. The psychology of approaching this exam, and building one’s confidence, are key to passing NCLEX, and I use my background in psychology to focus on these in every tutoring session in some way.

Most importantly, I have a passion for teaching, a love for nursing and human services, and a genuine commitment to supporting the success of every student I work with. Tutoring is my own personal vehicle for mentoring the nursing professionals of tomorrow into a profession to which they will make their own, unique and much-needed contributions.   

Why did you decide to choose your career path and areas of study?

Like many of the students I work with, I chose to enter nursing to make a difference in the lives of others. Helping patients and families through some of the most challenging times in their lives was what I envisioned I would be doing as a nurse, and many years later, my nursing practice has allowed me to do just that—which has been very fulfilling for me.

My mother was a nurse, and from a very young age, I witnessed the satisfaction and fulfillment she experienced as a nurse, by providing compassion and expertise to those she cared for. This was a tremendous inspiration for me. I chose to become a nurse educator to share this inspiration with others, and to support each student to success in achieving their goals. This benefits not only the student, but ultimately the patient, and the profession of nursing as a whole. If you feel called to make a real difference, nursing provides endless opportunities for doing just that.

What do you love about nursing?

The variety of roles and settings nurses can work in is almost endless—which is one of the things I love most about nursing. There is something for everyone, and something new to learn each and every day. The opportunities for professional growth are abundant, especially in our rapidly-changing healthcare environment, and lifelong learning provides ongoing stimulation and growth. Each day brings new challenges, as does being a part of an industry that is continually evolving and changing in order to enrich the lives of others–but the rewards are well worth it.

Nursing has allowed me to travel and to work with patients from many different cultures and regions, and to be involved in their lived experience—which has been extremely enriching both personally and professionally. As a nurse, I have been able to practice my own core values of compassion, integrity, and commitment in my professional life, as I have in my personal life. Nursing has allowed me to do what I love, and to love what I do.

Why should a student considering a degree and career in nursing?

The unique variety of knowledge, skills, and expertise that nurses possess provides a multitude of career choices—and an endless menu of options. Nurses are increasingly in high demand in a variety of settings including the hospital, community, school, research, or business settings—as well as many others.

A variety of nursing roles allow nurses to work very flexible schedules, to work from home, or to become entrepreneurs—-in order to build a work-life balance for themselves and their families in today’s high-demand, fast-paced lifestyle. Nurses have significant earning power, which can be increased even more by working in travel nursing, advanced practice nursing roles, specialty areas, or in independent practice as nurse practitioners, nurse midwives, or nurse anesthetists.

Advanced nursing degrees can bring further opportunities for things like student loan forgiveness, becoming commissioned into the armed forces, or improved salary and benefit packages. Being a part of a profession that has a long and honorable history, as well as one that is consistently rated as the most trustworthy by consumers, provides the opportunity to not only make a good living—but to make a good life—by helping others.

In your experience, do most students struggle with the NCLEX exam? Why?

A large number of students struggle with the NCLEX in some way, simply because they do not know how to effectively prepare for the exam. This increases their anxiety and fear about succeeding in their chosen career path after many years of study—which often does a good job at preparing them for nursing, but not always for the NCLEX.

In my experience, although students face many obstacles when preparing for this exam, not knowing how to effectively prepare is at the top of the list—which leads to unnecessary struggle for many students.  Effective preparation is unique to every unique student, based on their areas of strength and challenge, their learning style, and academic history. Most students who take a “one size fits all” approach to NCLEX also struggle because the exam, by its nature, it not a “one size fits all” exam.

Computerized Adaptive Testing (CAT) is individualized to each student’s performance, and is new to most students preparing for NCLEX—which calls for preparation that is as individualized as the exam is. This is the biggest missing link for many students, who feel defeated after using many common review programs and products that may provide good content—but do not help them learn how to use these resources to most effectively prepare for this challenging exam.

What is a common struggle that all NCLEX students face?

A common struggle faced by all NCLEX students is the challenge of strengthening their critical thinking skills. The NCLEX is not so much an exam about what you know, as one of how you use and apply what you know—and mostly about how you think. Many students are well-prepared to answer questions at levels of the learning hierarchy which call for identification, recall, and understanding of content, but struggle with the levels involving application, analysis, and synthesis of content—which require critical thinking skills. In order to pass NCLEX, students must be able to consistently answer questions that are above the passing standard—all of which require problem solving, prioritizing, evaluating the evidence, and decision making. Knowledge of content alone will not help students to master critical thinking skills, which most students struggle with in some way. It takes a different type of approach than those that led to success for many students in nursing school. Strengthening critical thinking involves practicing—more than traditional ways of “studying”—-with an emphasis on prioritizing, decision making, and problem solving.

What are the two or three most important concepts for a student to understand going into the NCLEX exam?

  • One of the most important concepts to understand for the NCLEX exam is how Computerized Adaptive Testing (CAT) works. Since the NCLEX is a CAT exam, each time you answer a question, the computer assesses and re-estimates your ability, based on the difficulty level of the previous questions you took, and the answers you provided.  This results in a different sequence of questions for every student, and questions that become more challenging as the exam proceeds. This causes many students to panic during the exam, if they do not understand that this is how CAT works—or if they are spending valuable time and focus trying to figure out how or why they are getting a certain question, or level of difficulty. Panic can be a recipe for disaster on NCLEX!  Remember that your own sense of what is a “hard” or an “easy” question is relative to your own ability, so don’t spend valuable time or energy trying to assess this. Focus on what you can control: one question at a time. The computer will do the rest.

 

  • You can pass the RN NCLEX with anywhere from 75-265 questions, and the PN NCLEX with anywhere from 85-205 questions. You can pass if you run out of time, or if you answer the minimum or maximum number of questions—or any number in between! So, no matter what, keep going—and give every question your best shot. There is nothing magical about passing the exam with the minimum number of questions—the average student does not do this. The magic comes with passing the exam, no matter how many questions you take. Hang in there, and don’t get discouraged by the question numbers or difficulty levels. Many of my students leave the exam absolutely convinced that they failed—when, in fact, they passed—by giving each question their best effort during the exam, and not giving up if they feared they were failing. Remember, you have no real way of knowing whether you are passing or failing during the exam itself, so just keep doing your best until the computer shuts off!

 

  • “Priority” questions are how many critical thinking questions present themselves on NCLEX, and you will see a lot of them—so expect them to make a frequent appearance. You will see a lot of them not because you have gotten a lot of them wrong earlier in the exam (this is one of the common “NCLEX Myths” that I hear) but simply because this is the way the exam is designed. Answering these correctly is key to passing NCLEX, so this is the most important type of question to practice for the exam, and to build skill in. Priority questions will ask you to identify what is “most important,” “the best initial response,” “who should be seen first,” or to identify “the first” or “best” nursing action.  Many—if not all—of the answer options may seem to be “correct”—or at least to have some degree of truth in them—which is exactly why these are critical thinking—and challenging questions. They are asking you to solve a problem, which will be a daily occurrence in nursing. Once you have passed NCLEX, you will be caring for patients that have multiple problems and complex needs, and you will need to identify priorities for their care. Understanding the concept of priority setting—and building skill in answering these questions correctly— is one of the most essential ingredients in success on NCLEX. This is where a good tutor can be much more valuable than a textbook!

What are your top tips or pieces of advice for students preparing for the NCLEX exam?

Remember to visit the National Council of State Boards of Nursing (NCSBN) website to review as much as you can about the exam, including the candidate test bulletin and test plan, what to do before the exam, details and tips for exam day, frequently asked questions, exam changes, and next steps after the exam is complete. The website contains a wealth of information that provides essential information that is most often not contained in any review book or NCLEX prep course, and that can act as an “NCLEX myth-buster” for the many myths and misconceptions out there about the exam. Knowing exactly what to expect reduces anxiety so that there are no surprises on test day.
Practicing the use of effective test-taking strategies during repeated practice with critical thinking level questions is far more valuable than studying content alone. “Practicing” more than “studying” is essential, and the application of strategies can help direct you to the best answer choice(s) even if the content is not as familiar to you as you would like it to be. Make strategies a focus of your NCLEX study plan, and build a “strategy” toolbox that you can use mentally on exam day. This can work wonders with confidence, anxiety management, and focus during the exam. Practicing questions, critical thinking, and test-taking strategies provide the best combination of methods to prepare for the NCLEX.
Don’t take your exam before you are prepared, and don’t “exam cram!”  After spending countless hours studying in your nursing program—and successfully completing it—it is understandable that you want to be done, and out in the world of nursing practice. But don’t give in to the temptation to sit for the exam too quickly, and if you are thinking about cramming, think again. One of the popular “NCLEX Myths” that I hear frequently is that if you do not test as soon after finishing your nursing program as possible, that you will forget so much so quickly—that your chances of passing the exam will be dramatically reduced.  While it is true that refreshing content areas that you might not have reviewed since you first studied them earlier in your nursing program can be very helpful, it is not true that testing as early as possible will dramatically increase your chances of passing. In fact, your chances of passing will only be dramatically increased by careful preparation and practice, which will take time—which will be a wise investment. Cramming to meet an early testing deadline will only increase your anxiety and decrease your ability to remember, think, and problem solve. Scores on practice exams, confidence levels, and the guidance of a good tutor can all help you to determine when you are ready to test, which is different for every student. I work with students every day who have been out of their basic nursing programs for quite a long time—some even years—and they succeed on NCLEX with the right preparation approach for them.

Anything else you would like to tell students reading?

You will never know everything there is to possibly know before you sit for NCLEX—and the great news is that you don’t have to in order to pass the exam. Take the pressure off yourself by preparing according to the NCSBN test plan, and practicing critical thinking and test taking strategies. Instead of dreading this final hurdle before you are able to practice the career you have waited so long for, spend your time building skill and confidence, and reminding yourself that you did not get to this point by accident. You earned your right to be a NCLEX candidate by hard work, skill, and persistence—which is exactly what will lead you to NCLEX success. You can do this. You have done much harder things already!

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