Nursing Education and Success In NCLEX
What Is NCLEX Success
NCLEX success is passing the National Council Licensure Examination. There are two National Council Licensure Examinations, the NCLEX-RN and the NCLEX-PN”. The NCLEX-RN is for graduates of entry-level registered nursing (RN) programs and the NCLEX-PN is for graduates of practical nursing programs. Each test is designed to protect the public by assessing the competencies of new nursing graduates and whether they can perform safely and effectively in their respective roles.
The National Council of State Boards of Nursing (NCSBN) publicly reports data on first-time, repeat, US, and internationally educated test takers (NCSBN, 2013), Data on NCLEX success are also reported to its member boards and nursing programs.
Application of NCLEX
NCLEX success has a number of important applications, including determining eligibility for licensure. NCLEX is considered a high-stakes examination because
(a) failure has serious consequences for test takers
(b) low pass rates have serious consequences for nursing programs
(c) clear distinctions exist between passing and failing
(d) test takers invest considerable personnel and financial resources (Sullivan, 2014)
NCLEX success provides information for:
(a) hiring decisions
(b) internal program evaluation
(c) evaluation of external program effectiveness
(d) school comparisons made. by potential applicants
(e) new graduates preparing to enter the workforce
History of NCLEX Examination In Nursing Education
The NCLEX pass rates for US educated first time test takers for the RN examination aver aged 57.89% 90.34%, and 80.50% for 2011, 2012, and 2013, respectively (NCSBN, 2013). For the PN examination, pass rates for US-educated first-time test takers were 84.83%, 84.23%, and 84.63% for 2011, 2012, and 2013, respectively (NCSBN, 2013). Some nursing board jurisdictions have provisions for allowing new graduates to practice with a temporary permit; no jurisdiction allows practice after notification of a candidate's failure on the NCLEX.
In the few jurisdictions that have temporary permits, their use has been limited as employers of new graduates are increasingly reluctant to invest time and resources in orienting new graduates until they have successfully passed the NCLEX-RN or NCLEX-PN.Nurse educators have made numerous efforts to improve and maintain NCLEX success rates. These include efforts focused on identifying factors predictive of NCLEX success in order to make programmatic improvements and identify strategies to assist students at risk.
Studies examining predictors of NCLEX success have most commonly been conducted within a single school or school system; most have been focused on baccalaureate programs A meta-analysis of nursing school admission and program measures of 31 samples (N7,159) indicates that admission tests (SAT and ACT), and pre-admission grade-point average (GPA) are predictors, GPA and grades earned during the second year were the strongest predictors (Grossbach & Kuncel, 2011).
These findings are similar to that of an earlier meta-analysis indicating that grades in nursing and science courses were the strongest predictors of NCLEX success; Parental education and age were the strongest demographic predictors (Campbell & Dickson, 1996) For associate degree programs, pre-admission GPA, as well as grades in the sciences and psychology, are strong predictors (Yin & Burger, 2003). For practical nursing students, positive predictors are nursing GPA and science test scores (Ostrye, 2001).
Nursing programs spend considerable resources to improve the NCLEX success of their graduates. However, comprehensive reviews of intervention studies designed to improve NCLEX success rates indicate that identifying specific causes of improvements has been difficult, with most studies being descriptive in nature (DiBartolo & Seldomridge, 2005, Pennington & Spurlock, 2011 Reports of efforts to improve the NCLEX success of minority graduates has been limited (Sutherland, Hamilton, & Goodman, 2007).
Common strategies to improve NCLEX success have been the use of review courses, study materials, and standardized examinations designed to assist students and recent graduates in success on the NCLEX. The standardized test industry for NCLEX preparation has experienced considerable growth in the last 15 years. These tests are used at the completion of major content areas of a program as well as a predictor of NCLEX success at or near the conclusion of a program.
The Health Education Systems, Inc (HESI), Kaplan Nursing, and ATIT Nursing Education are major providers of standardized tests predicting the likelihood of NCLEX success, HESI has published the results of its validation studies in the literature (Zweighaft, 2013), whereas data about other standardized tests are generally made available to schools purchasing various test preparation products.
The use of standardized tests as predictors of NCLEX success has led to a proliferation of curricular policies designed to improve the NCLEX success of first-time test takers. A number of RN programs, and to a lesser extent PN programs, have instituted policies that require students to pass a standardized exit examination as a pre-requisite to graduation from a program, or as a prerequisite for the program's approval of a graduate's candidacy for the licensure examination, or for progression within a program (National League for Nursing INLNI, 2012).
This practice has come under criticism because standardized tests may be able to predict which students will pass the NCLEX, but they are not as reliable in predicting who will fail the NCLEX (Yeom, 2013). In response to this issue, the NLN has developed Fair Testing Guidelines to provide faculty in nursing programs with guidance in the use of tests and evaluative procedures for high-stakes testing with regard to the selection of appropriate tests, informing test takers, test administration and scoring, and reporting/interpretation of results, as well as recommendations for achieving a fair-testing environment (NLN, nd).
Program NCLEX success is closely monitored externally by boards of nursing as well as accreditation agencies. For example, schools with NCLEX success rates of less than 80% for three consecutive years may be placed upon provisional approval, requiring a detailed plan for improvement. This potentially jeopardizes the ability of the school to continue to operate, as well as receive initial or continuing accreditation. These, in turn, may jeopardize the ability of the school to recruit qualified candidates, which then may further impact the NCLEX success rate.
Potential applicants may be aware of the need to request information about a school's NCLEX success rate, but may be less familiar with the need to learn about attrition rates, progression policies, and high stakes exit examination requirements. NCLEX success rates provide information about the number of new nurses educated in the United States and internationally who are eligible to enter the workforce as well as valuable trend data. However, it does not provide specifics of employment (type of setting or role, full or part time, etc.), since hiring typically occurs after the achievement of NCLEX success.
Success In NCLEX
Predictors of NCLEX success for the RN examination have been well established for baccalaureate programs and are somewhat similar for associate degree and practical nursing programs. With one in five or six NCLEX US-educated candidates unable to pass the NCLEX on the first attempt, and with only about half the repeat US-educated NCLEX-RN and a little more than a third of NCLEX-PN test takers passing on subsequent attempts (NCSBN, 2013), additional efforts should be made to address the needs of students who have invested considerable resources of time and money without success.
While NCLEX success is important as a program outcome, NCLEX success rates need to be placed in the context of a program's attrition rate, progression policies, and use of high stakes exit examinations Increased emphasis needs should be placed on examination of factors related to NCLEX success for minority students. High quality, large scale multi site studies are needed on interventions designed to increase NCLEX success to identify interventions that have the most value.
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