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Continuing Nursing Competency

Written by kimmel52 on November 11, 2008 – 11:38 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

For those student nurses who are about to graduate, their main priority is to pass the NCLEX-RN examination. The practice of nursing is regulated according to licensing authorities in each state jurisdiction.

Each jurisdiction must ensure that each nurse has the minimum competency to practice nursing in their state. In order to ensure such requirements, the National Council of State Boards of Nurses, Inc.

(NCSBN) has developed a comprehensive examination entitled, National Council Licensure Examination for Registered Nurses (NCLEX-RN). The NCLEX test plan occurs in several steps. The first step is to conduct a practice analysis. This is used to collect data on the practice of entry level nurses. By collecting this data the board can design NCLEX test questions that will be applicable to the majority of graduate nurses.

For instance, it has been found that the majority of new graduate nurses find work on medical/surgical units. The majority of the new graduates surveyed also indicated their primary responsibility was in the delivery of direct patient care. (1) Therefore, questions regarding the care of patients on medical/surgical units is pertinent and important for graduate nurses to know. Although some graduate nurses will tell you that they had more questions on psychiatric nursing or maternity nursing on the NCLEX, this is not the norm. Six thousand or more newly licensed registered nurses are asked about the frequency and priority of performing more than one hundred and fifty care activities. These activities are analyzed in relation to the impact on patient care, safety and client settings where they are performed. It is in this framework that NCLEX test questions are designed to be applicable in real world settings, thus requiring graduate nurses to be knowledgeable of such practices.

The second step in the NCLEX test plan is to develop a method to test behaviors regarding the content formed in step one. The NCLEX-RN, Test Plan, provides a focused summary of the concepts to be tested. It serves not only to delineate what content to cover and the method of presenting the test questions but also serves to assist in developing a study guide in preparing those who will take the test. The NCLEX assesses the graduate nurse’s knowledge of required skills to practice nursing safely and competently.

Beliefs about people and nursing underlie the NCLEX-RN test plan. People are finite beings with varying capacities to function in society. (2) Each person is a unique and special individual existing in a system that they exert some control over, such as their beliefs, social systems, family systems, health customs. It is in this underlying theory of each individuals beliefs that the nursing process guides in the intervention to promote psychological and physical wellness. Nursing is an art as much as it is a science, founded on a scientific body of knowledge that has been tested and proven effective in meeting the goals of each individual. The cognitive learning domain is a integral part of the NCLEX test plan. The use of Bloom’s taxonomy is the basis for writing and coding items (Bloom,e tal.,1956: Anderson & Krathwohl, 2001) Since the practice of nursing requires application or higher levels of cognitive ability, it becomes imperative to test graduate nurses complex and abstract reasoning.

The framework of Client Needs was selected for the NCLEX due to its all encompassing body of nursing knowledge that must be applied to successfully meet these needs. There are four distinct categories of Client Needs that are integrated into the exam, with two of the four categories subdivided to more adequately cover all subject matter. The categories are as follows:

A. Safe and Effective Care Environment
1. Management of Care
2. Safety and infection control

B. Promotion and Maintenance

C. Psychosocial Integrity

D. Physiological Integrity
1. Basic Care and Comfort
2. Pharmacological and Parenteral Therapies
3. Reduction of Risk Potential
4. Physiological Adaptation

Integrated concepts and processes are fundamental to the nursing practice and are applied to the various and categories of client needs.

These integrated concepts are as follows:
A. The nursing process- a scientific problem solving approach to client care that includes, assessment, analysis, planning, implementation and evaluation.

B. Caring- interaction between the nurse and client that provides for a nurturing, positive, and helpful environment whereby the client feels special and important knowing that the relationship that develops between themselves and the nurse will provide the needed assistance in their achieving a higher level of psychological and physical wellness.

C. Communication and Documentation- verbal and or nonverbal interactions between the nurse and client, significant others and multidisciplinary health teams. Validation either through written and or electronic entry which reflects that what has been done is documented and is within the scope of the nurses educational and licensure level as well as meeting the policies of the hospital or other client care environment.

D. Teaching-Learning- facilitating the acquirement of further knowledge which will lead to a more informed and skilled nurse with the application of the newly learned material.

The distribution of content and the percentage of test questions assigned to each Client Needs subcategory in the NCLEX test plan is based on the results of the Report of Finding from the 2005 RN Practice Analysis:
1. Zerwekh, JoAnn, Claborn, Jo Carol, (page95) 5th Edition, Co. 2003, Nursing Today Transition and Trends , Saunders, Philadelphia 2. Henry Ford Community College, Division of Nursing, NSG255 U-1 M-1.6, Co.2006 page 3-5, Dearborn, MI


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