A comparison of RN licensure test plans: the United States and China with implications for the Chinese nursing licensure exam

The purpose of this paper was to compare test plans between the National Council Licensure Examination-Registered Nurse (NCLEX-RN) in the United States and the National Nursing Licensure Examination (NNLE) in China, to discuss the influence of passing standards and critical thinking in the test plans on candidates and nursing education, and to provide implications to improve the NNLE test plan.Methods After reading the 2019 NCLEX-RN test plan and the 2019 NNLE test plan, a side-by-side comparison was done to evaluate both test plans.Results In the NCLEX-RN test plan, a periodical RN practice analysis provides fundamental principles for the development of test content based on the Client Needs framework. Item writing and coding is guided by the theory of Bloom’s taxonomy. The passing standard for the NCLEX-RN is based on a criterion-referenced method to assess candidates’ competencies as newly licensed nurses. In the NNLE test plan, test content comprises primary nursing tasks, nursing knowledge, and knowledge of common diseases. The standard score, a norm-referenced method, is used as the passing standard. The NNLE test plan does not present information concerning principles used in the development of test content, and the guidance related to item writing and coding.Conclusion The NCLEX-RN provides systematic and evidence-based procedures to determine and evaluate test content and passing standards as compared with the NNLE. The standard score used in the NNLE disadvantages candidates of secondary nursing education. The lack of principles to guide item writing and coding in the NNLE fails to foster students’ critical thinking. To improve the NNLE test plan, further research should be conducted to improve test content, item writing, and examination evaluation methods.