What it's like to be a Millenurse?



What is it like being a nurse in this millennium? Amidst all the negative connotations of the job and its salary, nurses from different places strive for career-development aiming for a better professional condition, gearing towards making a difference. It is not foreign that nurses go abroad to fulfil these aspirations — one of the most common destinations is the United States.

The National Council of the State Board of Nursing (NCSBN) spearheads the registration, and examination for qualifying as a Registered Nurse in the United States through the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The NCLEX-RN test plan is reviewed and approved every three years using multiple resources including the recent practice analysis of registered nurses (RNs), and expert opinions of the NCLEX Examination Committee (NEC), NCSBN content staff, and boards of nursing/regulatory bodies. The most recent update was this 1st of April 2019.

In the latest update: a.) overall format was retained; b.) minor edits for currency and clarification; c.) minimal changes to the entry-level nursing activity statements; and d.) no change to the NCLEX client need content distribution percentages.

The Examination focuses generally on Safe Nursing Practice and is sub-divided into the following categories:

Management of Care                                                     20%

Safety and Infection Control                                        12%

Health Promotion and Maintenance                        9%

Psychosocial Integrity                                                     9%

Basic Care and Comfort                                                 9%

Pharmacological and Parenteral Therapies            15%

Reduction of Risk Potential                                          12%

Physiological Adaptation                                               14%

The NCLEX uses Computerized Adaptive Testing (CAT) which aims to produce exam results that are more precise and efficient, using fewer items by targeting items to the candidate’s ability. The algorithm estimates the ability of the candidate in relation to the passing standard. Every time the candidate answers an item, the computer re-estimates the candidate’s ability. With each additional answered item, the ability estimate becomes more precise. Though it is important to be knowledgeable of the objective part of the test, it is equally beneficial to know the question types and prepare one’s self on test-taking strategies. Many items on the NCLEX are multiple-choice, however other item formats exist. Items are scored as either correct or incorrect – there is no partial credit. All item types may include multimedia, such as charts, tables, graphics, and audio.

The classic Multiple-Choice type is straight up question, choices, then choose the best answer among the given choices. Don’t be deceived because entries would seem to be right, but there’s ONLY ONE correct answer.

The dreaded Multiple Response otherwise known as SATA (select all that apply) is a type of item wherein you are presented with a question and a list of options and asked to select all the options that apply. Before the update, candidates are reassured that there is at least two correct options, but according to NCSBN 2017, multiple response items may require a candidate to select a SINGLE correct response, have more than one correct response, or require ALL responses to be correct regardless of the number of possible responses. 

Fill-in-the-blank are usually used for calculation which requires the candidate to type in number/s in a mathematical problem – drug calculation perhaps.

Hot Spots ask candidates to identify one or more area/s on a picture or graphic.

Chart/ Exhibit is where the candidate will be presented with a problem and ill need to read the information in the chart/ exhibit to answer the problem.

Ordered Response items require the candidate to rank order or move options to provide the correct answer.

The candidate is provided with headphones for Audio item formats and may also be presented with Graphic options, and they will be required to select the appropriate option that applies.

Keywords are in BOLD which are used to help the candidate analyse questions better. Examples are best, most, essential, first, priority, immediately, highest, initial, next, refute, increased, decreased, and support.

“The Millennial Nurses”, as most call us, are individuals brave enough to go out of the comfort zone and explore the greater picture for self-improvement through career-development. Good luck, future USRNs!


National Council of State Boards of Nursing, Inc. (2012). NCSBN Model Act. Chicago: Author.

National Council of State Boards of Nursing, Inc. (2019). NCSBN NCLEX® Examination Candidate

National Council of State Boards of Nursing, Inc. (2018). 2017 RN Practice Analysis: Linking the

          NCLEX-RN® Examination to Practice.

National Council of State Boards of Nursing, Inc. (2018). Report of Findings from the 2017 RN

          Nursing Knowledge Survey.