Qualifications for Licensure
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The basic qualification for licensure requires gradu- ation from an approved nursing program. In the United States, states may add additional require- ments, such as disclosures regarding health or med- ications that could affect practice. Most states require disclosure of criminal conviction.
Licensure by Examination A major accomplishment in the history of nursing licensure was the creation of the Bureau of State Boards of Nurse Examiners. The formation of this agency led to the development of an identical examination in all states. The original examination, called the State Board Test Pool Examination, was created by the testing department of the National League for Nursing. This was done through a collaborating contract with the state boards. Initially, each state determined its own passing score; however, the states did adopt a common passing score. The examination is called the NCLEX-RN and is used in all states and ter- ritories of the United States. This test is prepared and administered through a testing company, Pearson Professional Testing of Minnesota (Ellis & Hartley, 2004).
NCLEX-RN The NCLEX-RN is administered through com- puterized adaptive testing (CAT). Candidates must register to take the examination at an approved testing center in their area. Because of a large test bank, CAT permits a variety of questions to be administered to a group of candidates. Candidates taking the examination at the same time may not necessarily receive the same questions. Once a can- didate answers a question, the computer analyzes the response and then chooses an appropriate ques-
tion to ask next. If the question was answered cor- rectly, the following question may be more difficult; if the question was answered incorrectly, the next question may be easier.
In April 2013 the new test plan was imple- mented. Changes in the test plan were based on the Findings from the 2011 RN Practice Analysis: Linking the NCLEX Examination to Practice (NCSBN, 2012). The minimum number of questions any can- didate may receive is 75, and the maximum is 265. Although the maximum amount of time for taking the examination is 6 hours, candidates who do well or those who are not performing well may finish as soon as 1 hour. The test ends once the analysis of the examination clearly determines that the candi- date has successfully passed, has undoubtedly failed, has answered the maximum number of questions, or has reached the time limit (NCSBN, 2012). The computer scores the test at the time it is taken; however, candidates are not notified of their status at the time of completion. The infor mation first goes to the testing service, which in turn notifies the appropriate state board. The state board notifies the candidate of the examination results.
Nursing practice requires the application of knowledge, skills, and abilities (NCSBN, 2012). The items are written to reflect the levels of Bloom’s taxonomy and are organized around client needs to reflect the candidates’ ability to make nursing deci- sions regarding client care through application and analysis of information. The examination is orga- nized into four major client need categories. Two of these categories, safe and effective care and physi- ological needs, include subdivisions (NCSBN, 2012). Integrated processes incorporate “nursing process, caring, communication and documen- tation and teaching/learning” (NCSBN, 2012, p. 3). Table 3-2 summarizes the categories and subcategories.