Wishing For A Cheat Sheet

Early this morning I took what was perhaps the hardest and most frightening test of my life. At 8:00am, I arrived at a plain-looking office building on the other side of Columbus to take the NCLEX, also known as the licensing exam that is the final step to adding those little “RN” initials after my name.

I read through the introductory materials the receptionist handed me, then had my ID checked, was fingerprinted and photographed, stored my purse, contents of my pockets (yes, I had to turn out my pockets) and watch (no watch allowed) in a locker, and stood at the door waiting to take my test. I was then fingerprinted again at the door, had my ID checked again, and was then seated at my computer workstation, where video cameras tracked my every move and microphones recorded every sound. If I wasn’t nervous before, I certainly was after all of that.

Truthfully, I was nervous. Despite studying for it here and there, I felt completely unprepared for this exam. It’s an incredible amount of material to know all at once, and while I had planned out a study schedule over several weeks, life got in the way and very little scheduled studying happened. My hands trembled as I clicked through the tutorial.

For those who aren’t nurses, here’s how the test works: it’s a computerized adaptive test, meaning it changes based on how you answer each question. The first question is a mid-level question in difficulty. If you answer it correctly, it gives you a harder question next; if you miss it, you’ll get an easier or equal difficulty question. It continues to track the level of competency you’re at with each question, until it reaches a point where it is certain, with 95% accuracy, that you are either at a minimum level of competency to be a nurse, or will not reach that level by the end of the test.

There are 265 questions maximum, but the test can shut off anywhere after the minimum of 75 questions. In other words, the test keeps going until it knows for sure if you’re passing or failing. (A few unlucky ones get randomly selected to take the entire test, even if they’ve achieved competency early on, for control purposes.)

From the very beginning, I felt I was in over my head. The questions seemed to pick apart my knowledge and focus on all of my weak points. Medications I didn’t know appeared before me, with no hints as to what the med was for. I was asked several questions where I had to choose the patient I would assign highest priority to, when each answer seemed just as high a priority as the next.

And I had several of the “alternate style questions” – essentially questions that aren’t your typical multiple choice, choose one answer type – and several of those were the “choose all that apply” questions. I hate those questions. If you miss one of the correct answers, you miss the entire question.

Where are the medication math questions? I wondered. I’m really good at math! As the question numbers gradually creeped up, I started to panic, realizing I was answering without being sure on more questions than I felt comfortable with. I got closer to the magic #75, and I silently tried to will the computer to keep giving me more questions so I had a better chance to show my competency. I know I can prove I’m a good nurse, just let me keep answering questions and get to the ones I really know!

Then it happened. I answered question #75, and the screen blinked and turned blue. After a few seconds of wondering if I somehow summoned the Blue Screen of Death, the grey background appeared again, with the words, “Congratulations! You’ve finished the NCLEX!”

NOOOOOOOOOO!!!!

I sat there unsure of what to do next. There’s no way I did well enough to warrant the shut-off at 75 questions. But I also couldn’t face the possibility that I bombed the test so badly that it determined me a complete failure at only 75 questions. The trembling in my hands appeared again as I answered the demographic exit survey questions and meekly raised my hand to call the testing assistant into the room to let me leave. I felt sick as I gathered up my belonging and walked to my car.

Just to add to the suspense, I won’t know my results for a day or two. So instead I sit here and replay the test in my head, wondering if I will keep my job if I failed. If I do fail, I can retake the test in 45 days, but they might not want to wait that long for me.

I’m normally a fairly laid-back person. But I’m a nervous wreck right now. The Board of Nursing should run ads on their license check web page – they’d be making a fortune from my refresh rate right now.