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Original Research

A Comparative Study of the Nurse Licensure Exam Systems between the United States and South Korea

Chanyeong Kwak1, Soon-Nyoung Yun2, Shin-Jeong Kim1
Korean Journal of Adult Nursing 2013;25(6):622-632.
Published online: December 18, 2012

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Corresponding author: Kwak, Chanyeong College of Nursing, Hallym University, 1 Hallimdaehak-gil, Chuncheon 200-702, Korea. Tel: +82-10-2248-3570, Fax: +82-33-248-2734, E-mail: chanyeong@hallym.ac.kr

© 2012 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was conducted to compare the nurse licensure examination system in Korea with that of the United States (US).
  • Methods
    Focus interviews with the administrative staff of the National Council of State Boards of Nursing (NCSBN) were held. two areas were explored in the interviews: the item development process and the general administrative operating procedures.
  • Results
    NCLEX-RN items are designed for entry-level practice. The items are subjected to a series of 12 steps including a item writing panel, a content and editorial review, a sensitivity panel, a pre-test, a Differential item functioning panel and a committee review. NCSBN is responsible for the test for registered nurses and one for practical nurses. In contrast the Korean National Health Personnel Licensing Board (KNHPLB) is responsible for nursing is and 21 other health related licensure. Another difference is that in Korea there is no consistent and specialized staff to develop question items. Items are developed by educators who are not active nurses (this last statemtne is not a finding but a point of view usually not given in findings.).
  • Conclusion
    Korean nurses form the largest group of health related job categories and the most direct to health care consumers. Therefore, the nursing licensure exam should be acknowledged as the most influential licensure exam in health care services. We recommend a nursing specialized licensing institution to be established with active nurse'participation in item development process to reflect clinical practice into licensure exam.
  • Key Words: Nursing licensure
Figure 1.
Process of item development.
kjan-25-622f1.jpg
Figure 2.
Item development process in Korea. Retrieved from the report of the National Health Personnel Licensing Board (2010).
kjan-25-622f2.jpg
Table 1.
Interview Contents (N=5)
Subject Interviewees Contents
NCBSN organization The director and the department chair of NCSBN ․ Who make a test plan initially?
․ How to select categories of the test and devide each category proportionally?
․ How to preform practice analyses?
․ What are the required qualification for each panel and committee?
․ What is the education and experience background for a judge on the panel?
․ How collect practice items?
․ Information about the item selection process?
․ What are the standards applied to the item selection?
․ Who and how to collect entry-level and general practices that are essential basic knowledge?
․ Information about item development process: content review, item writing, editing, reviewing sensitivity and legal aspects
․ How to predict item difficulty?
․ How to decide pass and fail?
․ Information about pre-test
․ Process about item revision and elimination
NCLEX-RN item contents Item developer and clinician ․ How to become a representative of each state?
․ Information about item formats, contents, and alternate formats, review process, and monitoring examinations
․ How to analyze general and entry-level practice across nation-wide?
․ How to determine if difference in group performance is relevant to nursing practice and/or plausible?
Table 2.
Comparison of U.S. and Korea Nurse Licensure System
Categories U.S. Korea
Institution ․ NCLEX examinations are developed and owned by the NCSBN, non-profit organization, that manages examinations for registered and practice nurses only. ․ The National Health Personnel Licensing Board (NHPLB) manages nurses' licensing examination including 21 other health related licensure examination.
․ NCLEX is administered by the Pearson VUE in their network of Pearson Professional Centers
Board of directors ․ NCSBN Delegate Assembly consists of 60 members from the boards of nursing in the 50 U.S. states and it's territories. ․ Board members of the NHPLB consist of presidents of 21 other health related jobs who are in charge of 2 years usually.
․ The director of NCSBN is in charge for 4~8 years. ․ The director of NHPLB is in charge for 2~4 years.
Test Item ․ Safe and effective care environment ․ Adult, maternity, pediatric, psychologic, community, and fundamental nursing
․ Health promotion and maintenance ․ Nursing management
․ Psychosocial integrity ․ Legal scope of practice
․ Physiological integrity
Types of question ․ Multiple response items ․ Multiple response items only
․ Fill-in blank items
․ Hot spot items
․ Chart/exhibit format
․ Drag-and-drop items
․ Audio item format
․ Graphic format
Convenience of testing ․ After receiving an authorization for testing from the Board of Nursing, a examinee can request a preferred date and time of testing at a preferred location. ․ The paper-pencil exam is offered annually. Candidate should take it the at the designated date, time, and place
․ If fail, the exam can be retaken anytime. The number of times a examinee can retake the exam is varied by States. ․ If fail, a candidate should wait for one year to retake the exam.
Efficiency of the test ․ The NCLEX uses CAT system for maximum efficiency of the exam process. (high ability people few few easy items and low ability people get few difficulty items) ․ Every examinee should solve 330 questions.
․ It re-estimated the examinee's ability after every answer.
․ The numer of items an examinee receives on their test depends upon their ability (minimum 75 to maximum 265 items)
Relevance to nursing practice ․ Actively working nurses are initial item developers ․ Nursing professors who teach students at the university level and do not participate in nursing practice are the item developer and reviewer.
Item review process items through three process year-round : ․ Clinical nurses and educators together review ․ There is no official review process.
․ 1) Item review panel that reviews for job relatedness, accuracy, currency, and entry-level.
․ 2) Editorial review that checks for clarity, grammar, punctuation, spelling
․ 3) Sensitivity panel that reviews ethnocentrism and elitism, stereotypes, underlying assumptions, tone of language, inappropriate terminology.
Item difficulty ․ All newly developed items undergo pre-testing prior to becoming operational. Through the pre-testing process, items are calibrated for item difficulty. This known item difficulty allow NCSBN to estimate a candidate's ability. ․ There is no pre-testing process. Each item contains an equal level of difficulty
  • Emory J.. 2013;Standardized mastery content assessments for predicting NCLEX-RN outcomes. Nurse Education. 38(2.
  • Jacobs P., Koehn M. L.. 2006;Implementing a standardized testing program: preparing students for the NCLEX-RN. Journal of Professional Nursing. 22(6):373-379.
  • Kim J. J., Kang H. S., Park S. A., Song J. H., Lee S. J., Lee J. S., et al. 2002;Standards of item development for the Korean national nurse's license examination. Korean Association of Medical Journal Editors.
  • Kim J. J., Lee H. R., Song J. H., Lee S. J., Kang H. S., Park S. A., et al. 2004;Development of the basic core test items of national nurse's license examination. Journal of Educational Evaluation for Health Professions. 1(1):27-36.
  • Kim M. S., Song H. J., Kim B. H.. 2000;A study on the development of test items standard of national nurse's license examination National Health Personnel Licensing Examination Board Report..
  • Lee H. R., Kim J. J., Lee S. J., Park H. R., Lee I. S., Kim H. J., et al. 2005;A study of the validity of the Korean nurses' licensing examination. Journal of Educational Evaluational for Health Professions. 2(1):31-42.
  • McGahee J.. 2009;How to read and really use an item analysis. Nurse Educator. 34(4):166-171.
  • Oh G. S.. 2006;A study of globalization for Korean nurse license examination Institution of Health Policy in Yonsei University, Seoul..
  • Smith J. E., Crawford L. H.. 2002;The link between entry-level RN practice and the NCLEX-RN (R) examination. Nurse Education. 27(3):109-112.
  • Song R. Y., Shin S. J., Suh Y. O., Shin S. R., Park Y. H., Kang Y. H., et al. 2011;The future direction of learning objectives and national nurse's licensing examination in adult health nursing. Korean Journal of Adult Nursing. 23(5):503-513.
  • Spanier A.. 1988;Issues. National Council of State Boards of Nursing. 9(2):1-2. , 6-8.
  • Yoon S. N.. 2005;How to cope with international migration among nurses. Report from the health policy forum. Department of Health and Social Welfare 37-42.

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      A Comparative Study of the Nurse Licensure Exam Systems between the United States and South Korea
      Korean J Adult Nurs. 2013;25(6):622-632.   Published online December 31, 2013
      DOI: https://doi.org/10.7475/kjan.2013.25.6.622
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      A Comparative Study of the Nurse Licensure Exam Systems between the United States and South Korea
      Korean J Adult Nurs. 2013;25(6):622-632.   Published online December 31, 2013
      DOI: https://doi.org/10.7475/kjan.2013.25.6.622
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      A Comparative Study of the Nurse Licensure Exam Systems between the United States and South Korea
      Image Image
      Figure 1. Process of item development.
      Figure 2. Item development process in Korea. Retrieved from the report of the National Health Personnel Licensing Board (2010).

      Figure 1.

      Figure 2.

      A Comparative Study of the Nurse Licensure Exam Systems between the United States and South Korea

      Interview Contents (N=5)

      Subject Interviewees Contents
      NCBSN organization The director and the department chair of NCSBN ․ Who make a test plan initially?
      ․ How to select categories of the test and devide each category proportionally?
      ․ How to preform practice analyses?
      ․ What are the required qualification for each panel and committee?
      ․ What is the education and experience background for a judge on the panel?
      ․ How collect practice items?
      ․ Information about the item selection process?
      ․ What are the standards applied to the item selection?
      ․ Who and how to collect entry-level and general practices that are essential basic knowledge?
      ․ Information about item development process: content review, item writing, editing, reviewing sensitivity and legal aspects
      ․ How to predict item difficulty?
      ․ How to decide pass and fail?
      ․ Information about pre-test
      ․ Process about item revision and elimination
      NCLEX-RN item contents Item developer and clinician ․ How to become a representative of each state?
      ․ Information about item formats, contents, and alternate formats, review process, and monitoring examinations
      ․ How to analyze general and entry-level practice across nation-wide?
      ․ How to determine if difference in group performance is relevant to nursing practice and/or plausible?

      Comparison of U.S. and Korea Nurse Licensure System

      Categories U.S. Korea
      Institution ․ NCLEX examinations are developed and owned by the NCSBN, non-profit organization, that manages examinations for registered and practice nurses only. ․ The National Health Personnel Licensing Board (NHPLB) manages nurses' licensing examination including 21 other health related licensure examination.
      ․ NCLEX is administered by the Pearson VUE in their network of Pearson Professional Centers
      Board of directors ․ NCSBN Delegate Assembly consists of 60 members from the boards of nursing in the 50 U.S. states and it's territories. ․ Board members of the NHPLB consist of presidents of 21 other health related jobs who are in charge of 2 years usually.
      ․ The director of NCSBN is in charge for 4~8 years. ․ The director of NHPLB is in charge for 2~4 years.
      Test Item ․ Safe and effective care environment ․ Adult, maternity, pediatric, psychologic, community, and fundamental nursing
      ․ Health promotion and maintenance ․ Nursing management
      ․ Psychosocial integrity ․ Legal scope of practice
      ․ Physiological integrity
      Types of question ․ Multiple response items ․ Multiple response items only
      ․ Fill-in blank items
      ․ Hot spot items
      ․ Chart/exhibit format
      ․ Drag-and-drop items
      ․ Audio item format
      ․ Graphic format
      Convenience of testing ․ After receiving an authorization for testing from the Board of Nursing, a examinee can request a preferred date and time of testing at a preferred location. ․ The paper-pencil exam is offered annually. Candidate should take it the at the designated date, time, and place
      ․ If fail, the exam can be retaken anytime. The number of times a examinee can retake the exam is varied by States. ․ If fail, a candidate should wait for one year to retake the exam.
      Efficiency of the test ․ The NCLEX uses CAT system for maximum efficiency of the exam process. (high ability people few few easy items and low ability people get few difficulty items) ․ Every examinee should solve 330 questions.
      ․ It re-estimated the examinee's ability after every answer.
      ․ The numer of items an examinee receives on their test depends upon their ability (minimum 75 to maximum 265 items)
      Relevance to nursing practice ․ Actively working nurses are initial item developers ․ Nursing professors who teach students at the university level and do not participate in nursing practice are the item developer and reviewer.
      Item review process items through three process year-round : ․ Clinical nurses and educators together review ․ There is no official review process.
      ․ 1) Item review panel that reviews for job relatedness, accuracy, currency, and entry-level.
      ․ 2) Editorial review that checks for clarity, grammar, punctuation, spelling
      ․ 3) Sensitivity panel that reviews ethnocentrism and elitism, stereotypes, underlying assumptions, tone of language, inappropriate terminology.
      Item difficulty ․ All newly developed items undergo pre-testing prior to becoming operational. Through the pre-testing process, items are calibrated for item difficulty. This known item difficulty allow NCSBN to estimate a candidate's ability. ․ There is no pre-testing process. Each item contains an equal level of difficulty
      Table 1. Interview Contents (N=5)

      Table 2. Comparison of U.S. and Korea Nurse Licensure System

      Table 1.

      Table 2.

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