Overcoming the NCLEX

Students interested in becoming nurses should know that two main categories of professional nurses work in the medical field in the United States: registered nurses (RN) and practical nurses (PN), also known as vocational nurses. Although these nurses may have similar job descriptions and work in some of the same settings, RNs generally command higher salaries than PNs. This is due to the fact that becoming an RN requires more advanced education and training. These two types of nursing also have different competency exams for licensure. To become an RN, you must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN), whereas individuals interested in becoming vocational or practical nurses must earn a passing score on the NCLEX-PN.

Sitting for the NCLEX is a necessary step to licensure for any prospective nurse. Earning a passing score demonstrates to state licensing boards and employers that a nursing candidate has a thorough understanding of the fundamentals of nursing, including ethics, patient care, and medical procedures. Completion of the exam and subsequent licensing qualifies a nurse for employment in a variety of medical settings, such as hospitals, doctors offices, medical clinics, nursing homes, hospices, and home health services.

NCLEX-RN vs. NCLEX-PN: What's the Difference?

Individuals can take two different versions of the NCLEX exam: the NCLEX-RN and the NCLEX-PN. The NCLEX-RN is designed for nursing students who wish to become licensed as registered nurses in their state. Alternatively, the NCLEX-PN is for students who want to become practical or vocational nurses. There is considerable overlap between the content of the two exams, although the NCLEX-PN is typically considered to be less difficult.

To become a registered nurse, you first need to earn a professional nursing degree. This can be done by completing a diploma program at a hospital, a two-year associate program in nursing, or a four-year bachelor of science in nursing program. A registered nurse who completes their educational program and licensing requirements may choose to further their education by earning a BSN or MSN after their RN certification is complete.

A practical or vocational nurse generally has less educational and training experience than a registered nurse. PNs usually complete a year-long program that culminates in a nursing certificate. Both registered nurses and practical nurses find employment in an array of settings, although their responsibilities differ. RNs generally do more critical thinking on the job, complete more advanced duties, and hold a higher level of responsibility. Additionally, PNs often report to RNs.

While both of these occupations continue to experience job growth, there is a higher demand for registered nurses because these professionals can carry out a greater variety of tasks.

Before Taking the NCLEX

Preparing for the NCLEX exam involves more than just reviewing the material learned in a nursing program. You must also go through an application and registration procedure that involves contacting your state nursing board/regulatory agency and the testing administrators to confirm your eligibility and schedule the exam. Additionally, you need to select a testing center and pay all of the fees associated with the administration of the exam. Finally, you should familiarize yourself with the day-of-examination procedures and be prepared to follow the test-taking protocol.

Application and Registration for the NCLEX

Before you can actually sit for the nursing exam, you must apply to the board of nursing or regulatory body responsible for certifying nurses in the area in which you plan to work. If this regulatory body finds you eligible to take the exam, you will be issued an Authorization to Test (ATT) by email. This ATT is valid for a certain period of time, as determined by your regulatory body; the average ATT period is 90 days. You must also register with Pearson VUE to take the NCLEX exam while your ATT is valid. Prospective nurses can register for the test online or by phone, although the online method is recommended due to the large number of calls fielded by the call center. Your registration with Pearson VUE is open for a period of 365 days.

Associated Testing Fees

The following table provides the fees test takers pay during the NCLEX registration process. Costs can be affected by whether you plan to work in the U.S. or Canada, whether you must pay an international scheduling fee, the exam type, and whether you change the regulatory board or exam language after registration. Additionally, each board of nursing or regulatory body sets its own licensing and registration fees.

Payment must be made using a credit, debit, or prepaid card. If you cancel your test fewer than 24 hours in advance, or if you do not keep your exam appointment, you forfeit the registration fee. In this case, you need to re-register and pay another exam fee. Registrants cannot have their NCLEX fees refunded. However, qualified veterans may be eligible for reimbursement of their testing fees.

NCLEX Fees & Payment

Fee Candidates Seeking U.S. Licensure Candidates Seeking Canadian Licensure/Registration
Registration fee $200 USD $360 CAD
Additional international scheduling fee (plus a value-added tax where applicable) $150 USD $150 CAD
Changing the board of nursing/regulatory body after registration fee $50 USD $50 CAD
Changing the exam type (RN/PN) after registration fee $50 USD N/A
Changing the exam language (English/French) after registration fee N/A $50 CAD
Licensure/registration fee Contact board of nursing Contact regulatory body

Finding a Testing Facility and Scheduling

Nursing students can schedule their NCLEX test online or by phone. Test taking centers can be found domestically and internationally. Candidates seeking licensure in the U.S. can contact domestic centers in the U.S., Guam, American Samoa, Northern Mariana Islands, and the U.S. Virgin Islands. Additionally, candidates seeking licensure in Canada can choose from domestic testing centers in Canadian provinces and territories, as well as the mainland U.S. Students located outside of the country seeking licensure in the U.S. may schedule their exam at one of the many available international test centers.

First-time test takers will be offered an exam date within 30 days of their attempt to schedule an appointment. Alternatively, repeat test takers will be given a date within 45 days of their attempt to schedule.

What to Do on Test Day

Test takers must follow a strict protocol with regard to what they need to bring and the rules they must follow when they take the NCLEX exam. The following information may help students prepare for the logistics of the exam and ensure that the process goes smoothly.

Bring identification

You must bring an acceptable form of identification with you to the testing center on the day of the exam. Acceptable forms of identification include a driver’s license, passport, state ID card, permanent residence card, and a military identification card. Although you do not need to bring your paper ATT to the exam, the first and last name on your ID card must match the name with which you registered and obtained the ATT.

Arrive early

You should plan to arrive at the designated testing center at least 30 minutes before your scheduled exam time. This gives you plenty of time to complete the check in procedures before the test begins.

Review candidate rules

You should review the testing rules before you arrive at the test center for your exam. You cannot bring any personal items, clothing accessories, study materials, or electronic devices into the exam room.

Dress comfortably

Dressing comfortably is important and can help minimize distractions during the exam. Clothing should be sufficiently warm and comfortable.

Provide your biometrics

During the check-in process at the testing center, you need to provide biometrics to verify your identity. These include a digital signature and a palm vein scan. Your photograph is also taken.

Taking the NCLEX

Students have a maximum of six hours to complete the NCLEX-RN exam and a maximum of five hours to complete the NCLEX-PN exam. This period includes time spent answering NCLEX questions and completing the pre-exam tutorial program as well as all scheduled breaks during testing.

Participants take the exam on a computer through a computer-adaptive form of testing. This means that, after each test question, the computer program reassesses the student’s ability. Subsequent NCLEX questions match the student’s competence level based on the accuracy of answers to previous questions. The difficulty level is intended to give the student a 50% chance of answering each question correctly.

Students taking the NCLEX-RN exam will see between 75 and 265 questions, while NCLEX-PN candidates answer between 85 and 205 questions; the number of questions depend on a test taker’s performance. If an individual is asked 75 questions, with the questions steadily becoming more difficult, this is a sign that they likely did very well on the test. Alternatively, if questions fail to get harder, a test taker is likely struggling to select the correct answers. Test questions come in the form of multiple-choice questions, fill-in-the-blanks, ordered responses, and/or hot spots. Students may also need to review tables, graphics, charts, sound, and/or video in order to answer questions.

Misconduct during the exam, such as cheating or failure to follow testing rules, may result in a candidate’s dismissal from the test center and forfeiture of any paid fees. In this case, your exam results may be withheld or canceled and your state regulatory board may decide to deny you licensure or prevent you from taking the exam again in the future.

NCLEX Exam Categories

The content of the NCLEX exam covers four categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity. Understanding these categories and their relative levels of representation on the exam can help nursing students plan their study strategies and improve their chances of passing.

Safe and effective care environment

This category contains subcategories of management of care and safety and infection control, responsible for 17-23% and 9-15% of the exam content, respectively. This section revolves around the protection of clients and healthcare personnel.

Health promotion and maintenance

This section makes up 6-12% of the exam. Questions ensure that nurses understand growth and development, prevention and detection of health issues, and strategies to help clients improve their overall health.

Psychosocial integrity

Questions related to psychosocial integrity make up 6-12% of the exam. This portion of the test includes material regarding the role that nurses play in promoting the mental, emotional, and social health of their clients. This is especially crucial in high-stress periods of life, such as when a client is experiencing an illness.

Physiological integrity

The physiological integrity portion of the exam is divided into subcategories of basic care and comfort (6-12% of the exam), pharmacological and parenteral therapies (12-18%), reduction of risk potential (9-15%), and physiological adaptation (11-17%). This category covers the promotion of client health and wellness.

Tips on Passing the NCLEX in One Attempt

Each exam experience is different and requires its own unique preparation. Understanding how to prepare and sit for the NCLEX exam can make your study sessions more effective and improve your chances of success. The following sections offer some study tips for the exam, as well as strategies that you can use while actually taking the test.

Tips on Studying for the Exam

  • Take the test early. If you schedule the exam right after your nursing program finishes, information will be fresher in your mind. This can help cut down on the time you would otherwise need to spend relearning forgotten material.
  • Critical thinking and memorization represent crucial test-taking skills. The NCLEX exam asks students to recall memorized information, such as symptoms, side effects, and normal lab values. Other questions require critical thinking to choose the most correct answer from several that seem right.
  • Familiarize yourself with the exam format. Knowing how the test is structured helps improve the efficacy of your study strategies.
  • Take practice tests. Practice tests help you learn how to avoid common pitfalls. This is a good strategy to avoid feeling confused or overwhelmed on test day.
  • Study effectively instead of cramming. Due to the wide amount of information covered in a nursing program, attempting to review or relearn all of this material in a short period just before the test is extremely difficult. Instead, give yourself enough time to absorb and retain the information.

Tips on Taking the Exam

  • Come prepared for the exam. Dress comfortably and make sure you have gotten enough sleep and eaten enough food; being distracted by hunger or drowsiness can adversely affect your test-taking ability.
  • Visualize the scenarios presented in exam questions. Draw upon the knowledge you have acquired over the course of your nursing program by imagining the situations presented by the test questions. This visualization exercise can help activate your memory.
  • Eliminate the false answers first. If you can immediately identify incorrect multiple choice answers, eliminate those and concentrate on the remaining options.

If You Don't Pass on the First Try

If you don’t pass the NCLEX exam on your first try, try not to get discouraged. It is likely that you will have at least three more chances to pass the test. If you fail the first time, you may take the test again but you must wait at least 45-90 days after your first attempt; the length of this waiting period depends on the regulations established by your state nursing board.

You can retake the test as many times during your 365-day eligibility period as your state nursing board allows. However, you must register with Pearson VUE and pay exam fees for each attempt. If you failed the exam the first time, contact your state board of nursing and let them know you plan to retake the test. Next, register for the exam with Pearson VUE and pay all of the associated fees. Once you have received your new ATT, schedule your new exam date through Pearson VUE.

After a failed exam attempt, you will be mailed an NCLEX Candidate Performance Report. This report identifies the areas of the exam where you scored poorly. Use this report to focus your studies so you can improve on your worst areas and increase the likelihood of earning a passing score on a subsequent attempt.

After Taking the NCLEX the Exam

After taking the NCLEX exam, you will need to wait about six weeks to get your test results from your state regulatory board. These will be sent to you in the mail. However, 48 U.S. states and territories participate in a “quick results” program. This program allows test takers to view their unofficial results just two business days after they completed the exam; individuals interested in this privilege must pay a fee of $7.95. However, these results do not authorize you to practice as a licensed or registered nurse. To earn that status, you must wait until you receive your official results. If your official exam results indicate that you successfully passed the exam, you qualify to begin practicing as a licensed or registered nurse in your state or region.

Nursing Licensure

Some states in the U.S. participate in a program called the Enhanced Nurse Licensure Compact (eNLC). The eNLC allows nurses licensed in one eNLC state to practice nursing in other eNLC states, without needing to obtain additional licensure. This program increases public access to qualified nurses while minimizing the red tape nurses must go through to practice healthcare in multiple locations over their careers. To determine whether or not the state or region you want to practice in participates in the eNLC program, visit this website.

Renewing Your Nursing License

Each state or region’s board of nursing establishes requirements for the renewal of nursing licenses. Some nursing boards require that nurses complete a certain number of continuing-education credits, practice hours, or various other activities to qualify for license renewal. A typical license is valid for 5-10 years, although this varies by area. Please check with your state’s board of nursing to verify requirements and deadlines for license renewal.

First Time NCLEX Pass Rates for 2017

NCSBN NCLEX Pass Rates - RN

NCSBN NCLEX Pass Rates - PN

NCLEX Practice Tests & More

Many nurses who successfully pass the NCLEX exam cite practice tests as the most important and effective study tool. Practice exams can help you get a feel for the structure and design of the exam and decrease the anxiety you might otherwise feel upon seeing a new test format. The list below contains some NCLEX practice tests and study resources that may prove beneficial as you prepare for the exam.

  • Kaplan Nursing: Kaplan Nursing’s NCLEX-RN Prep offers several study guide packages that include practice questions with explanations of answers, video content, and instruction in a classroom environment (either virtually or in a practical setting).
  • NCSBN’s Review for the NCLEX: The National Council of State Boards of Nursing provides NCLEX review materials that include practice questions, study guides, and reinforcement activities. Program cost varies based on the length of the program.
  • UWorld: UWorld is a valuable resource for students preparing for the NCLEX exams. Users can access practice questions with in-depth explanations, flash cards, and performance tracking to monitor their progress and focus future studying.
  • Khan Academy: Khan Academy offers free resources to students aiming for NCLEX mastery. Participants start the program by taking a preliminary test to identify the areas they need to focus on most. A program of study is then customized to suit an individual’s needs.