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May 22, 2013
So that is actually a tricky question. Have you let your license lapse? Or do you still have a current RN/PN license?
If you have kept at least one state license current, then you probably don’t need to ever retake the NCLEX. If, however you have not had a RN/PN license in the last couple of years, then the answer might be yes. Might be is the operative word.
It depends on the state that you want to work in. Each state board of nursing has passed regulating laws as to how long ago you must have worked in nursing or passed the NCLEX in order to “apply by endorsement”. Essentially most boards require that you
have practiced x number of hours in at least the last four year as an RN/PN, otherwise they might require you to take the NCLEX again. However, some boards do allow you to complete a refresher course or practicum instead of reexamination.
Example 1: The Georgia Board of Nursing currently requires that you must have practiced 500 documented hours in the last four years to reinstate a RN/PN license. If you don’t than they don’t make you retest – they require you to do a reentry program in
order to be issued a license but just retaking the NCLEX is not an option.
Example 2: The South Carolina Board of Nursing currently requires that you must have either completed a refresher course or completion of the NCLEX if you have let your license lapse over 5 years. They do not have a set number of hours that you are
required to work within that 5 years – just that you have “demonstrated competency”.
The best thing to do is to go to the board of nursing website for the state you want to be licensed in and look for their “application by endorsement” if you have already passed the NCLEX. Laws are dynamic and might change so that would be the most current
If you do decide to retake the NCLEX to get your license reinstated – you are up against a challenge. I think you can become successful at passing the NCLEX. You have an advantage that you have life experience, have passed before, and have worked as a
nurse. A disadvantage is that you likely completed your RN/PN program at least 5 years ago if not more. Unfortunately, the NCLEX is revised every 3 years. Your educational program prepared you for the NCLEX-RN/PN of the past, not the one of the
present. So you will have to study extra hard to get your nursing knowledge to the current state.
Continue efforts to review all content. Most successful test takers take multiple practice exams and review many many questions prior to their exam.
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The NCLEX will also be given in Canada, hey?
Posted on May 17, 2013 by Nurse Amy
So back in 2011, the NCLEX-RN was selected by 10 Canadian nursing bodies to be used in Canada for a licensing requirement. This is going to be implemented in 2015. It takes several years to implement because NCSBN has to conduct practice surveys to
assess nursing practice in Canada, develop questions, test questions among candidates, and translate questions into French for French-speakers.
Sufficient research was done by the NCSBN in Ontario and British Columbia that showed that entry-level practice characteristics among the US, BC, and Ontario were similar enough to feasibly use one test. However, this is only the NCLEX-RN. For LPNs,
the Canadian Practical Nurse Registration Exam will remain the same.
Is there going to be a Canada NCLEX and an American NCLEX?
The answer to that question is no. There will be one NCLEX-RN. However, the NCLEX-RN administered in Canada will be offered in French or English.
One of the main testing strategies that allows NCSBN to do this is something called “differential item functioning” (DIF). When the NCSBN tests their NCLEX questions among candidates, the DIF scores show if there is a difference based on where the person
went to school. DIF is already used to make sure a nurse in California wouldn’t have a different answer than a nurse in Maryland for example. This will be applied as well, that a nurse in Canada won’t have a different answer than a nurse in the US. If there were
a difference when the candidates answer, than that question would be thrown out and not used in the NCLEX.
What about healthcare system content?
So, the NCLEX tests nursing competence and critical thinking – not knowledge of the US healthcare system or Canadian healthcare system. They might give you information about a healthcare system and then ask the candidate to apply it to a given situation and
critically think of its consequence.
How will they adapt it to French?
The translation process is very rigorous as to be expected. First, the questions will be translated by a Canadian French expert. Then an NCSBN appointed Translation Panel will review the items. This panel will consist of 3 nurses proficient in French and English
who will review the items for accuracy and context. Then the French questions will be tested in a pool of applicants and tested for bias using DIF. Finally, the approved questions will be used as an NCLEX test.
So, if someone passes the NCLEX in Canada, then can they apply for licensure in the US? Potentially yes. You must look at the specific state board of nursing that you want to apply to. But if a test taker in Canada met all the board’s requirements such as
graduation from an approved program, English language proficiency, background checks, work VISA, and passage of the NCLEX then a US license could be issued.
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Medication Practice NCLEX Question
May 17, 2013
One thing that I would reassure you as you take the NCLEX is to develop a couple of test-taking strategies. I’ll talk about a few and then we will apply it in a question.
1.Read the whole question. Do not read the first sentence and then answer it. NCLEX writers love to feed you too much information to distract you.
2.While you are reading the question – ask yourself what is the answer before looking at the written multiple choice answers. If you can think of the answer in your head, then look down and try to find it. Chances are – you know it.
3.After you have read the question, ask yourself what is the question? You will be amazed at how this will help you clarify what they are REALLY asking for.
4.Eliminate all the incorrect answers. Remember a 50% change of guessing right between two answers is still better than a 25% chance between four.
5.Look for the distractor. Multiple choice test writers love to throw in an answer to distract you from the real answer. It sounds right, but it’s not.
6.Choose “the best” answer. A professor once told me, remember that on the NCLEX you are in “the perfect hospital with all the time in the world”. It is not testing you on how to nurse under stressful conditions when one of your staff called out sick and your
IT department just declared a “downtime”.
So this is a very popular type of pharmacology question to throw on a nursing test.
You are caring for a 52 year old woman with a penicillin allergy. She reports that when exposed to the drug she suffers shortness of breath and facial swelling. She has been diagnosed with community-acquired pneumonia. If she were prescribed which drug
would you want to hold administration until clarifying with the ordering provider?
1.Vancocin (Vancomycin) 250mg IV Q 8 hours for 10 days.
2.Teflaro (Ceftaroline) 600mg IV Q 12 hours for 5 days
3.Z pack (azithromycin) 500mg day 1 then 250mg for 4 days by mouth
4.Zosyn (amoxicillin clavulanate) 2000mg/125mg by mouth Q12 hours for 10 days.
Let us work through the answer together.
First – what are they asking? They could be asking are the drugs, dosages correct. But the gist of the question is – which one shouldn’t be given to someone with a penicillin allergy?
Eliminate – if you can, eliminate any incorrect answers.
Look for the distractor – so the author of this question through in several. It is common for students to think that the -cin ending of drug means it is in the –cillin family. They sound similar. You are stressed. They put Vancomycin as the first answer. You might
read quickly and pick it and move on. Vancomycin is an “other antimicrobial” and is not in the pencillin family.
Similarly, azithromycin has the –cin prefix. However, it is a macrolide and is often given to those with penicillin allergies.
Teflaro (Ceftaroline) is the distractor for nursing students good at pharmacology. It is a cephalosporin. Most cephalosporins shouldn’t necessarily be given to persons that show hypersensitivity to PCN. However, since it is a fifth generation cephalosporin, it is
okay to be given. First through fourth generations are not.
Finally, they leave the really penicillinase for the last answer. It is the correct one.
Also, they might have confused you by throwing in dosages. All the dosages are accurate, but it just adds to the information in the question and might confuse you or lead you off track. Think of the extra info as “red herrings”. Focus on the primary question at
hand and you will do well!
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Triaging in an NCLEX Question
April 25, 2013
So, back to the meat of the NCLEX – questions! It is likely that you will see a cardiac triage question on the NCLEX as chest pain accounts for over 6 million visits to the Emergency Departments (ED) in the US annually, making it one of the most common
complaints (McCaig, 2003). This is definitely a protocol in most EDs and one that you should be comfortable with triaging and managing proactively within your nursing scope of practice and judgment.
So a case then,
A 57 year old African American male presents to your Emergency Department at 2200 complaining of chest pain that began at dinner and has lasted for over two hours. He has a prior history of hypertension for which he is on lisinopril 40mg PO daily and he
smokes 1/2 pack a day. He weighs 240 lbs and is 5’6”. He is accompanied by his worried wife and his occupation is a business executive. He did try to take two Tums at dinner but it didn’t relieve his chest pain. His pain is an 8/10 and is radiating up his
sternum. It is intermittent and activity makes it worse. He was brought directly back into your ED bay and his vital signs are 170/90, heart rate of 98, respirations 27, 97% pulse oximetry on room air, and temperature of 98.9 degrees F.
The first things you would do for this patient would include:
A. Put him on a cardiac monitor, place on 2 liters of oxygen and draw a set of cardiac enzymes and a BNP before continuing.
B. Put him on a cardiac monitor, place an IV, do a history and physical exam, give an appropriate dose of aspirin, obtain an EKG and chest x-ray, and place on 2 liters of oxygen.
C. Put him on a cardiac monitor, place an IV, do a history and physical exam, give an appropriate dose of aspirin, obtain an EKG, and place on 2 liters of oxygen.
D. Call a code while placing him on a cardiac monitor and 2 liters of oxygen
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Remember that in chest pain patients – your first priority will be to help gather subjective and objective data to diagnose or rule out life-threatening causes. These include acute coronary syndrome, aortic dissection, pulmonary embolism, tension pneumothorax,
pericardial tamponade, and mediastinitis. Then you will move on to secondary significant but not typically fatal diagnoses.
(A) is a good answer however includes lab draws that should wait until the initial work up rules out STEMI or aortic dissection.
(B) is the best answer based on a stable cardiac pain algorithm as described in current literature. Many protocols are written in the ED to allow nurses to use their judgment and follow a protocol when seeing chest pain patients. As this is a stable patient, these
things are important in the algorithm of differential diagnoses and ruling out potentially life-threatening events.
(C) is a good answer but lacks the chest x-ray. This may seem extraneous, but a radiograph helps diagnose tension pneumothorax, pulmonary embolism, and pericardial tamponade.
(D) this would be appropriate in an unstable chest pain patient but his vital signs, while altered are essentially stable.
So the NCLEX loves to ask questions like this. They are looking for the best answer. But they love to mix answers with good answers and usually at least one distracting answer that competes well with the best answer and tempts you to choose it.
One test-taking strategy is to use the process of elimination to cut down 4 answers to at least 2 best choices and then choose between them if you are unsure. A 50% chance is better than a 25% chance of guessing.
Before you eliminate any answers, read the question and ask yourself “what are they really asking?”. In this case it is what is the priority nursing interventions for a cardiac pain patient? Then read through every answer before starting to eliminate.
After you read through the answers restate the question ” Are these the priority nurse interventions…then read (A)”. Your answer should be no, these are good but not the priority. Repeat that process with the other answers and try to eliminate 2.
In this case, it should be pretty clear that (A) is secondary and (D) is not correct because he is stable. When you get down to choose between (B) and (C) it is essentially coming down to your knowledge of how important a chest x-ray is in ruling out differential
diagnoses of chest pain. But hey, you have a 50/50 chance if you didn’t know and chances are you know.
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The NCLEX and Moving Between States – An Easy Guide
April 22, 2013
Congratulations! You are nearing or are done with nursing school and many people take that opportunity to seek out a new home in a different state then they went to school in for a variety of reasons. But this can bring up some obvious questions such as …
If I took the NCLEX here and move there, do I need to retake it?
Is my nursing license still valid? If not, what do I need to do?
If my primary residence is here, can I take the NCLEX in the new state I am planning on moving to?
NCLEX is National
So let me put your mind at ease a little – the NCLEX is a national exam and is valid in any state you want to practice in. It does not vary from state to state. RNs in Georgia take the same NCLEX as RNs in Nevada for example. However, there are a couple of
hoops you need to jump through in order to get initial licensure and move.
License is by State
Essentially, although RNs and PNs take a national NCLEX exam – they do not have a national license. They have to get a state license in any state they wish to practice in by applying to each board individually. It is pretty straightforward once you have your
initial license, but it can get confusing because each state does it a little differently.
This allows each state to regulate their RNs and PNs as well as you must abide by a state nursing practice act of the state you practice in. The scope can be slightly different and you must take the responsibility to read up on your practice act and know it for
Figure Out If You are Eligible for that State
Deep breath…let’s go. So first things first – after you graduate, in order to sit for the NCLEX you have to get an initial license. You can get this in the state you are going to move to (if the board of that state allows it) or the state that you went to your nursing
school in. If you are in college, you might be a permanent resident of another state that you want a license in – residency doesn’t matter where you take the NCLEX or where you get licensed. But you MUST read the board’s requirements and see what they
are. Each state is unique and has different guidelines and requirements. It is obviously outside the scope of this blog to review each state but if you have a specific question, you may email me.
It may be quicker to sit for examination in the state that you went to school and receive a license by examination in that state. Then you can apply for a license by endorsement in the state you want to move to – but then you would have to pay for two licenses.
Go to the state’s nursing board website and look for the “Nurse by Examination Requirements”. The first time you get a license it is “By Examination”. When you have a license and you want to apply for a license in another state than it is “By Endorsement”. If
you look at the Florida Board of Nursing website their requirement detail that you can attend a Florida eligible nursing school, a military school, an international school, or another state’s nursing school if they have an NCLEX code by NCSBN and qualify to be
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licensed by examination in Florida.
When you apply to a board of nursing look at their requirements carefully. If you are applying to a state that is not the same state that your nursing school is in, you often must submit an affidavit of graduation. Make sure you keep copies of EVERYTHING and
mail it certified to them. If you are moving – make sure you put a stable address on your application where you can receive the mail they send back. It can take varying amounts of time for your board to review your application – so submit it well in advance of
your target test date.
Once a board deems you eligible to test then they will give you a testing window – most are about 90 days that you have to take the test by after receiving the letter (so read the fine print and don’t take forever!). Each board’s testing window is a different
It doesn’t matter where you physically take the NCLEX.
The NCLEX is a national exam and you may take it at any qualified testing center in the nation or at several international exam centers. If you want to be licensed in Arizona, you do not have to take the NCLEX in Arizona. You could take the NCLEX in Boston
and the score would be communicated to the Arizona board of nursing if that is the board you applied too. Make sure you search for test centers around where you want to take the test. A busy metro area might not have the test date you want – but if you are
willing to drive to the next town, they might have a good opening for you.
What if I wasn’t eligible to license by examination in the state I want to work in? or What if I need a license in a different state now?
Okay, so maybe plans changed and you need a license in a different state now. This is called “licensure by endorsement”.
To start this process, you have to do two things – apply to the new state’s board of nursing through their licensure by endorsement process. And typically you have to pay to have your license verified by Nursys.
Nursys is a national online database that verifies licenses for employers, the public, and nursing boards.
But essentially, it is about a 10 minute process to go in online and pay a small fee ($30) to send verification of your license to one or multiple states.
If your state’s nursing board doesn’t participate in Nursys then often you have to get them to fill out an affidavit and mail it to the state’s nursing board you are applying to.
Whether or not the state has Nursys does not affect where you take the NCLEX. It doesn’t matter if you move from a non-Nursys to a Nursys or a Nursys state to another Nursys state or a Nursys state to a non-Nursys state. Your NCLEX result is valid in
every state of the nation. Moving in these instances just changes how your license is verified and the steps you have to take. It takes a little longer to verify a license from a non-Nursys state because you have to contact that state nursing board directly to send an
endorsement to the new state you are applying too.
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What is the Nurse Licensure Compact?
The other thing you should know about is the Nurse Licensure Compact (NLC). The NLC is states that have agreed if a nurse has a license in one of the participating states, then they will honor it and it streamlines the process to work in another compact state.
For example, if you have a license in South Carolina and wanted to move to Colorado, then you could work in Colorado with your SC license for up to 30 days while your license got approved and issued by Colorado. You still must apply for licensure in
Colorado but the process is a little less strenuous then if you moved from a non-compact state.
It doesn’t matter if you are moving from NLC to non-NLC or non-NLC to NLC to take the NCLEX. The NCLEX is valid in every state. What changes is the endorsement process and how long it takes to get issued a license in the new state. Here is a good
Can I have various active licenses in different states
Yes. You can have 50 state nursing licenses if you wanted to. It would be a lot of paperwork! But essentially, you also have to keep up with fees and continuing education for any state. A lot of people keep active licenses in at least 2 states. This allows you to
travel nurse in another state or some people keep it if they think there is a possibility they might need to move. For example, a friend of mine has elderly parents in Florida but she lives in Texas. She has kept a license in Florida in case she needs to quickly
relocate to help her parents. This would allow her the option of getting a quick temporary nurse position there and relocating easily. Some people that live in a town on a state line get two licenses so they have more job options. Lake Tahoe is a good example of
a city that might have employers in two different states.
Under what scenario would I ever have to retake the NCLEX and do this again?
So typically for any state to renew a nursing license they require a certain number of practice hours. These can typically be paid or voluntary. If you don’t meet those practice hours requirement to be competent then to keep a nursing license you may have to
retake the NCLEX to show you know enough to care for patients safely.
The other situation is if you let your license lapse and didn’t work for a couple of years as a nurse but then decided to go back to it, reinstate your license and start working again. Depending on how long it is since you have had a license, that state might require
you to take the NCLEX again. Some states also have an option where you can take a refresher course instead of retaking the NCLEX – it just depends on the state. For example, in South Carolina if it has been over 5 years since you have held a nursing license
you can take a refresher course or the NCLEX. If it has been less than 5 years then you can show that you have had 30 hours of continuing education, maintained a certification, got another nursing degree, or completed a refresher course.
Always check the board of nursing for the state you want to move to. There can be unique rules and qualifications. Sometimes states require specific continuing education (CE) requirements that you have to take online (e.g. New York requires a sexual abuse
course). Most nursing schools include all these unique items in your curriculum for the state they are in. My Florida nursing school included the hour of CE on HIV/AIDS for example one day in class and gave us certificates to submit for the Florida board of
Some states require other options to show you know their practice act. In Texas, all nurses must take a separate state board called the “Texas nursing jurisprudence examination”. This is an online exam that you can take from home that makes sure you have
reviewed and are competent on the specific nursing practice act in Texas.
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The Major Difference Between the RN and PN NCLEX Test Plans.
April 9, 2013
As I reviewed in a previous blog, the RN and PN NCLEX tests have the same categories with one difference – in the care subcategory, which falls underneath “Safe Effective Care Environment”. They also have unique percentages devoted to the categories,
altering the distribution of the content questions. We can go into that more in a future blog.
The care subcategory of the RN test is called “Management of Care” and is 17-23% of the questions. The care subcategory of the PN test is called “Coordinated Care” and is 13-19% of the questions. This subcategory is obviously important on either test
since it can make up 1/5th of the exam showing the important role nurses have in patient care!
What’s the difference you ask? Valid question…let us explore. So what the NCSBN does is every 3 years they survey LPNs/VNs for the PN test and RNs for the RN test. They then compile a very comprehensive practice analysis of what RNs and LPNs do
and make the NCLEXs accordingly. So content will vary as laws modify to change practice for LPN/VNs and RNs.
So a brief view is that the RN “Management of Care” subcategory includes content that tests case management and patient teaching such as discharge care. These are distinctive to the NCLEX-RN. Meanwhile, the PN “Coordinated Care” subcategory tests
participation in case management and patient teaching.
The major legal difference between RNs and LPNs is that RNs can diagnose human responses, develop plans of care for patients, screen patients that might be at risk, care for complex/unstable patients, and conduct patient teaching/discharging/admitting. LPNs,
however, usually care for more stable patients under the supervision of an RN and participate in collecting important data that can lead to diagnosis and case management. Their role is participatory when it comes to plans of care (Connecticut League for Nursing,
2013). Caveat: since every state’s practice act is different, the details can vary by state.
All in all, the categories are more similar than divergent. The types of things that you might see in this section on both tests include the following list: advance directives, advocacy, client rights, interdisciplinary collaboration, information security, management
concepts, continuity of care, priorities, ethics, informed consent, information technology, legal responsibilities, quality improvement, and the referral process.
So, what does this look like when you are sitting in front of the NCLEX?
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A question to an RN might look like this:
A 42 year-old male patient is admitted to your medical surgical unit at a community hospital in the month of May. He has a history of Type 2 Diabetes Mellitus and End Stage Renal Disease. During your admission, you screen and recommend which of the
following immunizations for him.
1.Influenza live nasal spray
3.Influenza attenuated (dead) SQ injection
Answer and Rationale: The correct answer is B – the Pneumococcal vaccination. Per Center for Disease Control (CDC) guidelines, this is recommended for any patient with chronic diabetes or kidney disease. Influenza vaccines are given during the flu season,
which is September – March. The HPV vaccine is currently recommended for patients under age 26.
A similar yet different question might be asked to a PN test taker:
You are ordered to give a 42 year-old male patient that has Type 2 Diabetes Mellitus and End Stage Renal Disease a Pneumococcal vaccination during his stay on your hospital medical surgical unit. When you go to give the vaccination, he mentions that he might
have gotten it about 6 years ago but cannot remember and doesn’t have any documentation. Should you still give it and why?
1.No. If he already got the vaccine, then he doesn’t need it again
2.Yes. A patient needs the vaccine every 5 years.
3.No. The scope of practice for PNs does not include SQ injections
4.Yes. If a patient is unsure, the CDC recommends vaccinating, as there is little potential harm but much potential benefit.
Answer and Rationale: The correct answer is D. According to the CDC, a patient recommended for the pneumococcal vaccination should receive it if it is unknown or unclear whether or not they are previously vaccinated. A is not correct because the patient
does not know if he received it. B is not the best answer because an at-risk patient needs the vaccine once and in some rare cases twice. C is erroneous because the scope of practice for PNs does include SQ injections.
What’s the difference? The RN question involves screening and developing a plan of care for a vaccination. Many hospitals have protocols that a RN can follow and they can actually order the vaccine after a screen. LPNs are not able to do this with their
scope of practice in most states because it involves developing a plan of care. However, once ordered, an LPN can give a vaccination and use follow appropriate pharmacological guidelines to administer it.
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What’s the Worst That Could Happen If You Fail?
March 14, 2013
So we all learned how to treat patients with high anxiety while we were in psych class. Ask them “what’s the worst thing that will happen” if their anxiety or fears were to manifest into reality. Sometimes reality is not as bad as it seems. Typically, then the patient
can see how they could deal with that and part of their anxiety, their fear of the unknown, subsides.
So be a kind nurse to yourself and ask, “What’s the worst thing that will happen if I fail the NCLEX?”. The answer is simple: you will retake it and be better prepared next time, but you will have to pay for it again. I know that you may want to pass NOW and
it may throw a wrench in your plans to work or move, but that is not the end of the world. It may be the edge, but not the end.
If you don’t pass for some reason you will get a candidate report that shows your weaknesses and strengths. This can help guide your studying for the next try. Typically boards of nursing require that you wait 45-90 days in between exams. Check with your
board to find out its rules.
Your school’s program will find out. Schools receive passing rates so they can report them to incoming graduates and to the higher education powers. So remember that, your school wants you to pass – it makes them look good too. If you feel weak going into
the exam, see what resources they might have available to help strengthen you. And if you don’t pass an exam, see what resources they might have available to help you the second time. Nursing schools are invested in their graduates’ success.
Your friends might find out, that is really up to you. The reality of not passing is that there is about an 80% pass rate of US educated nurses to the exam. That means that 20% do not pass. That’s 1 in every 5 people that take it. You would not be alone.
If you do have to retake it, please seek out testing preparation to help you be successful. Students I have mentored have used services, one-on-one tutoring, and professors to help them develop a testing plan. Only about 50% of people that retake the exam
pass – so it is really important to go into it prepared the second time.
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My Testing Story
March 14, 2013
I remember the day I went to take the NCLEX. Two years of hard work and study all culminating in one exam. The sterile testing environment seemed like an appropriate place to start a career in healthcare. Was I nervous, of course! Becoming a nurse meant
a lot to me and I think I would have been worried if I would not have had butterflies.
A mentor had told me to make sure I did not put myself in a situation that created more anxiety – such as being late or not being able to find the testing center. It may sound silly but I read the directions several times and printed out two hard copies. I double-
checked that I had multiple forms of identification with me in case I lost one. My test was scheduled in a city two hours away from my home, so I traveled the night before so I knew I would be there, driving past the test center when I entered the city. My
friends and I went to a funny movie the night before and laughed – releasing all the stress I had built up. In short, I made sure my T’s were crossed and my I’s dotted.
The test itself was pretty straightforward. Testing centers all have rules about what you can take in with you, which is pretty much nothing except for your ID. I only got 75 questions and then left. Once the exam started, I realized that I knew many of the “right”
answers not from nursing lectures but from the clinical experience I had had in school. I was very thankful for all my preceptors when I left that day, feeling pretty good about my effort.
Then the wait began. Testing results took a little longer back then and I had not paid for any extra service to get results quicker. My friends from school and I would check online everyday at the nursing board’s website to see if our names had shown up with
licenses. At least that way we got it quicker then the mail. Much celebration ensued when I finally saw that number after my name. I was finally a nurse!
You will get through this part of your journey as well.