Determining the “hardest” nursing exam is subjective, as difficulty varies by candidate background, preparation, and exam format. However, based on pass rates, content depth, and expert consensus, the CGFNS Qualifying Exam often ranks as the toughest for many aspiring nurses, particularly international ones. Here’s a breakdown to help you understand why.
Key Nursing Exams and Their Challenges
Nursing licensure exams ensure safe practice, but they differ in scope and rigor:
- NCLEX-RN (National Council Licensure Examination for Registered Nurses): This U.S.-based exam is the gold standard for RN licensure worldwide (used in 50+ countries). It’s computerized adaptive testing (CAT), with 75–145 questions lasting up to 5 hours. It tests critical thinking via real-world scenarios in areas like pharmacology, pediatrics, and mental health. The 2024 global first-time pass rate is ~79% for U.S.-educated candidates, dropping to 68–82% overall (including repeats and internationals). Its adaptive nature makes it feel unpredictable—questions get harder if you’re performing well.
- CGFNS Qualifying Exam (Commission on Graduates of Foreign Nursing Schools): Required for foreign-educated nurses (FENs) seeking U.S. licensure in states like New York or Texas. It includes a credentials review, English proficiency test, and a 3-hour, 165-question exam mirroring NCLEX content but tailored to bridge international education gaps. Historically, FEN pass rates on similar licensure tests hovered at 15–20%, though recent data is sparse; many report it as harder than NCLEX due to cultural/language barriers and lower preparation resources. Only ~30–50% pass on the first try, per anecdotal reports.
- Other Contenders:
- CCRN (Critical Care Registered Nurse): A U.S. specialty certification for ICU nurses, requiring 1,750 hours of experience. Pass rate: ~70–80%, but it’s deeper in advanced topics like organ failure protocols—often called “harder than NCLEX” by experienced RNs.
- NMC Test of Competence (UK): For overseas nurses, with a pass rate of ~50–60%; emphasizes OSCEs (practical simulations).
- OSCEs (Objective Structured Clinical Examinations): Used in Canada/Australia; hands-on skills testing with ~80% pass rates but high anxiety due to performance pressure.
Why CGFNS Tops the List
For FENs (who make up 15% of U.S. nurses), CGFNS is a gatekeeper before NCLEX, combining evaluation, language hurdles, and content mastery. Lower pass rates reflect systemic challenges like differing curricula abroad. NCLEX, while grueling, benefits from standardized U.S. training.
Tips to Tackle Any Exam
- Prepare Strategically: Use resources like UWorld or Kaplan for practice questions; focus on application over memorization.
- Build Stamina: Simulate test conditions with timed mocks.
- Seek Support: Join study groups or hire tutors for weak areas like prioritization.
- Mindset Matters: High-stakes pressure amplifies difficulty—practice self-care to reduce anxiety.
Ultimately, “hardest” depends on your context: entry-level? NCLEX. International? CGFNS. Specialty? CCRN. With dedication, any is conquerable. Consult your board for specifics.