The NCLEX-RN

Within the past two weeks Boston College nursing students have been joining us at work as part of their community rotation. Because student nurses in their fourth year are focused on the ultimate task of nursing school: passing the NCLEX-RN, I have recently been talking a lot about study tips, testing strategies and of course, my own experience with the NCLEX.

The NCLEX is a terrifying thing. Questions are asked in literally every category of nursing, even though no nurse will ever have to have quite such a broad span of knowledge once he or she starts work. This is, of course, because nursing school isn't actually a training to be a nurse so much as it's the training for the skills needed to learn to be a nurse. Once a nurse enters a specialty he or she draws upon this broad base of knowledge while going about the business of transitioning from a student to a professional. Medical/surgical, maternity, neonatal, pediatrics, mental health, and of course fundamentals (physical assessment, psychosocial development, general med or I.V administration, etc), it's all on there. And of course pharmacology, my exam weakness.

The day before my exam I did a "dry run" in the afternoon. I was staying at my family's house in W.Roxbury so I parked at Forest Hills and took the train to Downtown Crossing. I went to the building where the test would be held and even went inside. I made sure there was no way I could get lost or be late. Amy and Scott came with me and double checked my plans. I felt assured. I chose a comfortable and attractive outfit to wear and even made a mix CD full of pump-up music to listen to for the train ride. I was READY.

The morning of the test I drove to Jamaica Plain two hours early as planned. But I had neglected to take into account time of day during my dry run. There was no where to park. I kept my cool, having left time in the schedule for glitches. I drove to Green Street. No parking. As I waited to turn the corner a woman walking started screaming at me because "I know you were going to run that red light if I didn't stop you." (I wasn't.) Shaken by the unpleasant encounter, I drove to Centre Street. Nothing. I circled back around to the Park and Lock, which was full. I tried to squeeze my car in the corner, by the fence which the manager had allowed me to do in the past. But this time an angry man I had never seen approached my car yelling at the top of his lungs, "No! No No! You can NOT park there!" I tried to explain, "Sir, I really need to get downtown for this exam," but he just kept yelling. Back in the car I took a deep breath.
I had lost an entire hour so far, but still had a half hour margin to work with.

I found some on street parking with a two hour limit and decided I'd just eat the ticket. Considering that just signing up for the NCLEX-RN costs over $200 it was better than rescheduling. Congratulating myself on getting back on track, I parked with ease and grace. As I left the car I realized I had left my CD in the player. I had to turn the car back on to get it out. Trying not to get hit by oncoming traffic I extracted the CD and put it in my disc man. That was when I realized I had shut the door. With the keys in the car. And the car running.

I lost all composure and called my mother up on the brink of a compete melt down. She asked for the location of my car, told me to get on the train and not to think about it anymore. While I was in the test she found my spare keys and enlisted my aunt to drive her to the car. In case anyone was wondering, my mother is My Hero.

I arrived about 15 minutes early to the test and collected myself in the waiting room. The exam itself is a different length for every prospective nurse, but the total allotted time is six hours total. The test can be anywhere from 75 questions to 265 questions. It's a computer adaptive test (CAT). The questions get progressively harder as long as they are answered correctly. They get easier if you answer incorrectly but then get harder again as you begin to answer correctly. The machine shuts off at the point where you would stay above the minimum level of competency no matter how many more questions you got, or conversely, when no matter how many more questions you answered you could not rise above the minimum level of competency. Because of that, there is no way to know if you passed or failed based on when the computer shuts off.

Many nurses can tell you how many questions they had. I can not. They told us not to look at the numbers. I looked once, and it was past 75 and I started getting sick to my stomach, and I looked away. It felt as though over 70% of my exam was made up of obscure pharmacology questions about specific antidepressants having to do with whether or not a med should be taken with grapefruit juice and things of that nature.

When my machine shut off I was thankful and depressed. I walked outside, sat down on a brick wall amongst a flock of pigeons and began to cry. If only I hadn't had such a stressful morning, I thought, I wouldn't have failed.

Three days later I decided to make it official, and I checked the status of my exam online. The word "Pass," next to my name seemed impossible. I made a noise, "like an animal," according to my brother, who walked into the room, saw the screen and immediately began pounding me with a pillow and then his fist. "Do you know what you put us through?" he screamed, "we thought you actually failed. We felt so bad for you!" This attracted Mom's attention and she joined in the pummeling.

When I tell this story to the SNs at work the take aways are these:
-Plan as much as you can for how you want your day to go, but realize it still might not be perfect so leave room for error.
-Study as hard you want, but realize that at the end of four years, you know what you know.
- Everyone thinks they've failed. I haven't met anyone who thought he or she passed. The test is designed to make you feel horrible. Wait the three days out and be good to yourself. Your family and friends will appreciate it.