The Anxiety and Influence Factor of the Nurse Students in Different Levels before the NCLEX-RN

The examination anxiety has certain influence on the human individual activities and psychological behaviors, which plays a more important role on the students’ ability. Moderate examination anxiety is helpful to learning, while the severe anxiety generally affects and destroys the attention and logical thinking of the students to influence the academic score, which can even develop to anxious neurosis affecting the physical and mental health of teenagers.

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the exam designed to evaluate whether or not the applicant has acquired the necessary professional knowledge, technique and ability.

Most medical institutes only recruit nurses with certificates, which make the graduate nurse students to equal the passing of the nurse licensure examination and getting a job.

Starting from 2011, the Chinese NCLEX-RN is reformed with international standards of new exam content, exam questions, assessment methods and performance evaluation.

Because of the reform, the NCLEX-RN becomes harder correspondingly. Therefore, the licensure examination definitely increases the mental burden of nursing students, causing them to be anxious.

Furthermore, Chinese nursing students can be classified into secondary technique school, junior college and undergraduate school three levels so far. Hence, the present study is to investigate and analyze the anxious level and influence factors of the nursing students with different educational background before the national nurse licensure examination, in order to provide a scientific basis for the administrators and teachers in the education sectors.

In this cross-sectional study, the subjects were all the participants of NCLEX-RN on May 21 2011 in Xi’an, Shaanxi Province. After stratified sampling, 1527 nursing students were randomly chosen from six nursing school with different educational levels, including 658 secondary technique school nursing students, 782 junior college nursing students and 87 college nursing students.The Chinese version Test Anxiety Scale (TAS) was used to assess the anxious level of nursing students before the examination.

The scale was tested among 110 nursing students to show good reliability and validity (The derived stability is 0.79, the Cronbach’s alpha coefficient is 0.68, content validity index is 0.88).The influence factors from the aspects such as the nursing student himself/herself, family, school or reform situation were analyzed.

Finding shows that, among 1527 nursing students, 154(10.09%) cases have mild anxiety (less than 12), 688 (45.06%) with moderate anxiety (12–20) and 685 (44.86%) have severe anxiety (more than 20). The TAS score of students from junior college, secondary technique school and college are 19.85±6.42, 19.15±6.23 and 18.05±3.98 respectively, and the difference among them is significant(F=10.923, P=0.004).

This is in consistent with the percentage of severe anxiety for three fractions (junior college 46.80%, secondary technique school 44.83% and college 27.59%). Obviouslythe anxious level of the junior college students is the worst, and the secondary technique school students are highly anxious. For the nursing students from college, there are less people with severe anxiety.

The multiple linear regression result shows that, for students from junior college, 7 (out of 15) independent variables is determined as the influence factors leading to anxiety (P:0.000–0.042), for those from secondary technique school, 6 factors determined (P:0.000–0.022), and for those from college, 3(P:0.005–0.031).Two factors(“examination reform” and “others’ opinion”) are the collective, 3(“Worry to his/her future”, “Physical and psychological discomfort” and “Confidence”) are shared by those from junior college and secondary technique school. 1(“Previous academic record”) leads to anxiety from college students solely.

The NCLEX-RN is the only way for the nursing students to become national recognized nurses. The passing rate of examination is the verification of the educational quality of the school. Therefore, all countries attach great importance to it. The existing training on NCLEX-RN pays more attention on the ways of training than on the difference of educational level of the client. The present research suggests that, besides the knowledge on NCLEX-RN provided at different levels, the psychological remedial courses should also be strengthened according to education background.


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