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Early 1900s
First bill passed in the U.S. that allowed nurses to register with the state of North Carolina. Many other states followed suit. Nurses were required to graduate from an approved school, and pass both a practical and written examination to become registered. High school graduation was not a prerequisite for attending nursing school. Unregistered nurses were allowed to practice, but could not use the term 'registered nurse'. -
Mandatory Licensure
By 1923, all 48 states had some sort of legislation regarding nursing licensure.
These requirements were regulated by the states, so requirements varied greatly.
Nurses hoped that increasing these requirements would improve the quality of care being provided to patients. -
Mandatory Licensure Practice Act
New York was the first state to pass a mandatory licensure act, although it was not enforced until 1947 due to the nursing shortage attributed to WWII.
This legislation differentiated between registered and practical nurses.
It was the first of it's kind to describe the scope of practice for nurses.
Made practicing without a nursing license illegal. -
NLNE's National Committee on Nursing Tests
The National League of Nursing Education (NLNE) created the state board test pool examination (SBTPE) to ensure efficiency in testing and licensure of nurses. -
Nationwide Adoption of SBTPE
Nursing became the first profession to adopt a nationwide licensing examination, with all states adopting the SBTPE by 1950. Each state created its own passing criteria. -
American Nurses Association (ANA)
The ANA took over management of the SBTPE, which now consisted of a total of 720 questions divided into 4 sections. Grading based on normative reference began, which penalized candidates for guessing. Final scores were calculated by subtracting the number of incorrect answers from the number of correct answers. -
National Council of State Boards of Nursing Inception
The National Council of State Boards of Nursing (NCSBN) was created and charged with managing nursing licensure. Each state would have representatives on the NCSBN, which gave them some say in regards to nursing licensure. NCSBN continues to manage exam administration and licensure to this day. -
National Council Licensure Examination (NCLEX)
NCSBN changed the focus of licensure exams from a medical focus to a nursing focus, and questions were reduced from 720 to 480. The name of the exam changed to NCLEX-RN, and questions focused on the nursing process and utilized Bloom's taxonomy to assess application and analysis abilities of the candidates. These types of questions continue to be utilized on the NCLEX-RN examination. -
Updates and Changes
By 1988, the number of questions included on the NCLEX-RN exam was decreased to 370, with 70 of those questions being validator items that didn't count towards the final score of the exam.
Research indicated 'client needs' as an important assessment area, which was then added to the exam.
Results were now reported as pass/fail, rather than an overall score. -
Computerized Adaptive Testing (CAT)
Nursing became the first profession to utilize CAT. These exams are interactive and adaptive...based on the candidate's performance. CAT is offered year-round, at proctoring agencies around the country. This practice remains in place today. NCLEX pass rates are reported and new requirements are put into place for accreditation of schools of nursing. Schools with low pass rates risk consequences from state boards of nursing. -
Next Generation NCLEX
Currently, the NCSBN is in the process of creating the Next Generation NCLEX (NGN). This NCLEX examination will assess clinical judgment in new and innovative ways. NGN will be administered for the first time in April 2023.
