HealthSeptember 20, 2017

Breaking down the NCLEX® test plan for curricular guidance

by Diana L. Rupert, PhD, RN, CNE

Every nursing program's curriculum provides the foundation for nursing education. Each curriculum establishes a framework by which students systematically learn content and layer nursing skills and reasoning skills applicable to clinical scenarios. A challenge for administrators, faculty, and students alike, however, is that there is no one universal approach to designing curriculum. Educational programs differ in their content progression, as well as in the classes required for students to complete them successfully.

Many potential nursing students question how every candidate can take and successfully pass the same licensure examination despite each student attending educational programs with different approaches to curricula, alternating styles, and varied durations. This is one reason the nursing licensure examination (NCLEX) is so important. The NCLEX tests students on core information applied to nursing situations, to ensure that each graduate who passes the examination and receives a nursing license, regardless of where he or she studied nursing, is a competent entry-level practitioner. The National Council of State Boards of Nursing (NCSBN) conducts a practice analysis every three years to establish this core content (targeted specifically for registered nursing [RN] or practical/vocational nursing [PN] programs), which in turn influences the structure and content of the NCLEX-RN and NCLEX-PN, respectively. The current NCLEX-RN test plan is in effect until March 31, 2019, and the current NCLEX-PN test plan is in effect until March 31, 2020. Differences between these test plans are related to scope of practice. It is highly recommended that faculty and students alike access the NCSBN Website (www.ncsbn.org) to become familiar with the specific NCLEX test plans and to stay abreast of news and updates about NCLEX.

As many nursing administrators would attest, a nursing program's NCLEX pass rate carries great significance. A pass rate at or above state and national averages can be influential when prospective students compare the characteristics and advantages of one program over another. Whenever a program's pass rate drops or a program is placed on probationary status for any reason, the program's administration and faculty must scrutinize its curricular structure and content. Once that step is completed, they also must review content delivery strategies and student clinical opportunities. The information presented here focuses on the core content of a nursing program and how it is aligned (or not) with the NCLEX test plan. The content will be obtained from the definition of the Client Needs category, nursing Activity Statements, and detailed content examples as identified on the NCLEX test plan.

The NCLEX test plan is systematically organized under four broad categories, some of which are also broken into smaller subcategories (Client Needs), and then into the smallest and most detailed level, which are called Activity Statements. Sometimes, students wish the broader NCLEX Client Needs were more specific. Educators, however, can take the various topics, place them in the curriculum, and expand on them throughout the program. Some topics (e.g., therapeutic communication, alteration in body systems, pharmacology) must be addressed as threads throughout the curriculum, because students apply the related content in a variety of clinical situations.

One way for a nursing program to ensure that each content area is covered in the curriculum is to assign topic areas to faculty and have the faculty document in which nursing course the topic is housed and how the topic is addressed. An example is below.

CONTENT CATEGORY: Safe and Effective Care Environment

SUBCATEGORY: Safety and Infection Control

“Protecting clients and health care personnel from health and environmental hazards”

Related Content and Activity Statements Nursing Course How Presented Student Assignment Curricular Concern
Accident/Error/Injury Prevention Fundies-Unit 2 Lecture  Clinical-H&P, Med Benchmark
*Allergies assessment/intervention

MS-Assessment 

Pharm-Unit 1

 

Admin 

Unit 2 Exam 

 
*Knowledge of safety procedures Fundies-Basic Skills Skills Lab  Practicum Benchmark
*Factors influencing accident/injury

Fundies-Basic Ckills

Unit 1 MS-Thread

Skills Lab

Unit exams

Clinical conference

Practicum

Benchmark
*Client deficits impeding safety

Fundies-Sensory

Unit MS-CVA Unit 

Geriatric sim,

Skills videos,

Lecture

Simulation prep

Review skills

videos

Did not meet
*Treatments impeding safety

Pharm-Opioid Unit

Fundies-Skills

MS-Hot/cold, IV

Lecture

Skills lab

PCA pump

Care plan

Benchmark
*Correct use of infant/child car seats

OB-Unit 2

Pediatrics-Clinical

Orientation

Guest speaker

State website

N/A
Benchmark
*Seizure precautions

Pediatrics-Unit 7

MS-Unit 5

Pediatric simulation
Case study
Benchmark

Consider the last column, which is labeled “Curricular Concern." The intent here is to highlight a curriculum topic for which students scored below the benchmark, which might be established based on grades, use of formative tools like Lippincott PassPoint or Lippincott CoursePoint, other resources such as standardized testing, or a combination of these methods. Or a nursing program can obtain from the NCSBN scored reports on their graduates” performance on the NCLEX and use the data there to inform the “Curricular Concern" column. The benefit of involving the faculty is increasing faculty knowledge of the curriculum, stressing their curricular responsibility, and increasing their acceptance and embrace of the curricular process. If present, the curriculum committee may be in charge of the process.

Mapping the nursing curriculum to ensure alignment with the NCLEX test plan requires knowledge of the curriculum and thoughtful student assignments. This is a time-consuming process. Once completed, however, this document can be used as an example of curriculum review to meet accreditation standards. In addition, it provides justification that the curriculum has strategically met the key topics. Furthermore, if students continue to be unsuccessful on the NCLEX, reviewing the rigor of test items may be needed.

In conclusion, a strong curriculum proves to be invaluable to the educational process. Both students and faculty need to be aware of the NCLEX test plan and how it applies to and aligns with the curriculum. Many programs actually introduce the NCLEX test plan to students within the first nursing course to stress the importance of all nursing content, from the first nursing course to the last.

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