By Debra Wood, RN, contributor
Some nursing educators have expressed concern that the
National Council Licensure Examination (NCLEX) is not keeping up with
evidence-based practice and are recommending the test switch from technical to
“why” questions.
“NCLEX questions, by the nature of how people prepare them,
are seven years behind practice,” said Mary C. Gebhardt, Ph.D., RN, CRRN, an
associate professor at the Byrdine F. Lewis School of Nursing at Georgia State
University, in Atlanta.
Gebhardt explained that it takes about three to five years to
write and edit a new textbook or review book and every question must have
citations. Meanwhile new best practices surface. She gave as an example an NCLEX
question about assessing for return of gastric mobility after abdominal surgery.
In the past, nurses listened five minutes for bowel sounds in each quadrant.
Now, passing gas or having a bowel movement is considered a better indicator of
peristalsis. She found NCLEX review books still show the correct answer to be
listening for bowel sounds.
“When we teach them in class, we can say the new gold standard
is this, but according to the NCLEX questions in review books, it’s this,”
Gebhardt said. “The quickest way to lose [students’] respect is saying, this is
what we teach you, but this is what you need to know. They will turn you off
right away.”
Anne Wendt, Ph.D., RN, CAE, director of the NCLEX Examinations
Department at the National Council of State Boards of Nursing (NCSBN), defends
the process. NCSBN develops the test and recruits current practitioners to write
and review test questions, which are then validated in the most recent
textbooks, journals and guidelines.
“Even if there is a time lag between the time that new
guidelines are established and when that information is incorporated into
textbooks, the guidelines themselves can be used to validate the items allowing
for inclusion of practice changes,” Wendt said. “Additionally, when there is an
established change in practice, all of the NCLEX items are checked to ensure
that the correct answers are still correct.”
Gebhardt; Barbara Clifford, MNEd, RN,C, a faculty member at
West Penn Allegheny Health System Citizens School of Nursing, in New Kensington,
Pennsylvania; and Teresa Bates, MSN, RN, a clinical instructor at the Byrdine F.
Lewis School of Nursing, expressed their concerns in an October 2006 editorial
in the American Journal of Nursing. They advocate changing the NCLEX to
ask about the concept, rather than inquiring about a specific skill, which would
stimulate students’ critical thinking.
“It wouldn’t be outdated,” Gebhardt said. “If you ask for the
technique, it’s going to be outdated every time something new comes along or new
equipment comes along.”
Wendt responded that the NCLEX already asks “why” questions.
“Most of the items on the NCLEX are written to address higher
order thinking,” Wendt said.
Gebhardt said experienced nurses may need to mentor students
if the focus switches. As it is, students learning the latest best practices
often run into difficulty on their first jobs, as practicing nurses may not know
the about latest data or guidelines. If the student corrects the experienced
colleague, it creates friction.
“Experienced nurses need to take them where they are at and
bring them where they want them to go and not place judgment on the quality of
their education,” Gebhardt said. “Students may have been taught at an
institution teaching to the exams. That’s not the student’s fault.”
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