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The real world versus the NCLEX

This isn't Friday Night Fights

A student recently wanted to know how to “switch” her thoughts from the “mindset of the real world versus [the] NCLEX”. When I read this, all I could think about was the improbable matchups on The Late Show’s “Friday Night Fights” skits, with Marvel villain Thanos versus Santa Claus or Mr. Peanut versus Tony the Tiger.

But seriously, there is no competition between the NCLEX and the real world… because the NCLEX is the real world.

NCLEX is real world

Did you know that NCLEX questions originate from information gathered from new nurses who are working in clinical practice? This 3-part process helps ensure its connection to real-world nursing:

  1. Nursing experts from various specialties and practice settings meet to create a list of tasks entry-level nurses perform on the job.
  2. A questionnaire is developed and sent to new nurses across the country. These new nurses report:
    • How often they perform the tasks identified by the nursing experts.

    • How important the activity is to client safety and/or the treatment of complications.

  3. Using the results, nursing educators create new questions and review older questions, ensuring that all NCLEX questions reflect current entry-level practice.

NCLEX isn't just for a perfect world

I have read a number of nurse blogs saying that the NCLEX world is a perfect world where all the equipment you need actually works and there are no staffing problems while you care for one client at a time.

Yet, don't all the imperfections in real life practice point to the need for standards that take us through situations calmly and cooly? NCLEX points us towards:

Competent Nursing - Determining if you have the (minimal) competencies needed to perform safely and effectively as a newly licensed, entry-level nurse.

Logical Nursing - Thinking systematically by reading a problem and then using nursing knowledge to focus on what's important and arrive at a solution.

Orderly Nursing - Working through a complex situation (like someone taking the NCLEX) will help you create some semblance of order while functioning safely and effectively in a disorderly world.

And that, my friends, is reality...

Want to help dispel this myth? Whenever you hear someone complain that the exam isn't real world, gently remind him or her that the NCLEX is...

  • Evidence-based.
  • Relevant to current nursing practice.
  • Reflective of what new nurses are expected to know... in the real world.

Whether there is enough help, or equipment is working properly, or you have 10 (or more) clients to care for, you will always be expected to do what's safe and effective... or in other words, what's best for the client.

And that's reality.

Now it's your turn

Still not convinced that NCLEX isn't the real world? Write to me and tell me why.

  • When I took an in class review for NCLEX, the instructor, who had written actual NCLEX questions at one point, told us, "NCLEX is based on the asusmption that you have unlimited staff in the hall waiting to assist you, an supply closet stocked with every piece of equipment known to medical science, and an order already present for anything you could possibly need. Where is this hospital, I want to apply there! It sounds pretty unrealistic to me.

  • @mbulger: You are responsible for the care clients receive and you are accountable for your own practice.  Regardless of what's going on on the unit, you must always follow policy and procedure, as well as the standards of nursing practice - no shortcuts or workarounds, because these are accidents waiting to happen.

    If the unit is chronically understaffed (according to policy), then you must speak up (following the chain of command). Inadequate staffing is a safety issue and results in poor outcomes for clients, which should be a primary concern for all staff and the facility.  You can read more about pending federal regulation about nurse staffing on the ANA website: www.nursingworld.org/.../State-StaffingPlansRatios.

    If the linen cart is always empty on pm/night shift, you must speak up (actually, this would be a great QI project.)

    Be proactive and don't make excuses. Always protect your license - you worked too hard to get it!!