Nursing Examination Move Charges Dropped in Current Years. Why?

The share of candidates who go the licensure examination to work as a registered nurse has considerably dropped in recent times, and the Nationwide Council of State Boards of Nursing (NCSBN) — the regulator tasked with overseeing the exams — has no plans to make it any simpler.

Most main nurse teachers say that is a great factor. “Each as a nurse, but in addition as a possible affected person, I would like nurses to be extremely certified,” mentioned Linda Aiken, PhD, RN, founding director of the Middle for Well being Outcomes and Coverage Analysis on the College of Pennsylvania Faculty of Nursing in Philadelphia. “I do not assume anyone within the public is focused on reducing requirements for nurses,” particularly not after seeing the function that nurses performed through the COVID-19 pandemic.

Falling Move Charges

The proportion of U.S.-educated candidates taking the Nationwide Council Licensure Examination for registered nurses (NCLEX-RN) for the primary time and passing fell from 88.2% in 2019 to 82.5% in 2021, whereas the go price for all candidates (together with internationally educated and repeat candidates) fell from 72.8% to 68.9%.

Move charges continued to say no in 2022, with an average pass rate of 80.9% for all first-time U.S.-educated candidates, and a price of 66.6% for all candidates, primarily based on a dataset that excludes the fourth quarter of the yr.

Of observe, sure states’ go charges are markedly decrease than others. Florida ranked the bottom within the nation for first-time go charges amongst U.S.-educated candidates in 2020 and 2021, with a price practically 18 proportion factors beneath the nationwide common.

Wyoming and New York had the second and third lowest go charges in 2020, whereas New York and Ohio had the second and third lowest charges in 2021. Nonetheless, the hole between the nationwide common and every of those states has been at most 5 to six proportion factors — far narrower than the margin between nationwide go charges and Florida’s price.

The Pandemic’s Impression

Practically each supply that MedPage Right now spoke to for this story, together with the NCSBN, agreed that the pandemic has had an outsized influence on NCLEX go charges over the previous 3 years, along with different components. “Scientific placements had been restricted and generally eradicated from the curriculum” due to COVID-19, mentioned Daybreak Kappel, director of selling and communications for the NCSBN.

The choice to droop medical rotations for 1000’s of scholars at New York hospitals and different well being amenities in March 2020 had a “devastating” influence on nursing schooling, an official from New York State’s Training Division instructed MedPage Right now in an electronic mail. Many amenities did not have sufficient private protecting tools to guard college students, and others had been proscribing the variety of individuals on campus to forestall transmission of the virus, the official mentioned.

Given the total yr and a half with out medical rotations, “it isn’t stunning that the go charges on the nurse licensing examinations have declined,” the official added.

For nursing college students, ending medical rotations meant they weren’t ready to enter hospitals and obtain the hands-on expertise that they normally would have. This led to many nurses receiving the majority of their medical coaching via simulation, defined Lori Hart, PhD, APRN, govt director of the Wyoming State Board of Nursing. Whereas analysis helps substituting as much as half of conventional medical hours with high-quality medical simulation, there’s “a draw back” when 100% of a scholar’s medical coaching is simulated, Hart famous.

The second change was the “fast pivot” to on-line schooling, mentioned Maria Flores-Harris, DNP, MSN, BSN, RN, former govt director of nursing for Kaplan Check Prep in New York Metropolis, who has since began her personal consulting enterprise, Tutorial Companions Consulting. On-line schooling has its place, she added, however neither college students nor school had been ready for such a speedy transition. “And so throughout that point … college students weren’t engaged. They weren’t doing the work.”

The NCSBN launched a study of dozens of nursing education sites throughout the nation to higher perceive the pandemic’s results on nursing schooling, in addition to to trace college students’ efficiency and assess the effectiveness of recent approaches to making ready college students for the transition to the workforce, Kappel instructed MedPage Right now. That report is slated for launch in April.

Different Challenges: Much less Oversight, School Turnover, Management Adjustments

Wyoming had the second lowest go price within the nation in 2020. However in 2021, Wyoming’s go price for first-time U.S.-educated candidates bounced again and outpaced the nationwide common, although by solely a hair (83.1% vs 82.5%). Other than the pandemic itself, Hart attributed the state’s decrease go charges to challenges discovering and retaining certified school to serve within the least populated state within the nation. The truth that school salaries are decrease in rural areas additionally does not assist, she mentioned.

To assist handle the scenario, Wyoming is presently leveraging details about “warning indicators” — together with school turnover, management modifications, and new program standing — gleaned from a 2020 NCSBN research within the Journal of Nursing Regulation, to flag issues earlier than they worsen.

Based on the research authors, “frequent director turnover resulted in important statistical variations within the NCLEX go charges and variations in program approval standing.”

Hart famous that, in Wyoming, packages that haven’t met the 80% first-time go price are given a “plan of correction.”

MedPage Right now additionally contacted the boards of nursing for New York and Ohio — two of the states with the bottom NCLEX-RN go charges for first-time U.S.-educated candidates in 2021. New York’s Division of Training mentioned solely that whereas the urgency across the pandemic has decreased, there are nonetheless challenges and it “continues to work to help [New York state] nursing colleges and be certain that nursing college students are ready for protected entry-level observe.” A spokesperson for the Ohio Board of Nursing didn’t touch upon the explanations for the decline in go charges.

Do NCLEX Move Charges Matter?

Each state has its personal nursing board and each units its personal necessities with regard to the NCLEX, defined Flores-Harris. Some states need each program to have a go price equal to or above the nationwide go price, different states say a faculty should be inside 5 proportion factors, and nonetheless different states require 10 proportion factors.

“However for those who’re on the lookout for a standard denominator, it’s that nationwide NCLEX go price that everyone is and utilizing because the benchmark,” Flores-Harris mentioned.

In a 2020 editorial printed in Instructing and Studying in Nursing, Marsal Stoll, EdD, MSN, RN, CEO of the Accreditation Fee for Training in Nursing (ACEN), famous that “the overwhelming majority of nurse educators help using first-time licensure go charges as an vital end result measure reflective of program high quality,” citing what had been at the moment “current revisions to the ACEN requirements and standards.”

However NCLEX go charges aren’t the total image, Flores-Harris mentioned. “If a faculty is bragging that they’ve 100% NCLEX go charges, however solely 30% of their college students are getting via this system, is that actually a lot to brag about?”

Different methods to evaluate a faculty’s efficiency embody commencement charges, attrition charges, and the employment price of its college students (though, given the present demand for nurses, Flores-Harris mentioned she doubted any graduate would have problem discovering a job).

Approval by the state’s board of nursing or accreditation by an accrediting group are also thought to be measures of high quality. “Accreditation actually seems on the full program [including having qualified faculty, an appropriate curriculum and testing] and when you will have a stamp … of accreditation, that does imply that you have met extra rigorous requirements than simply an permitted program via the Board of Nursing,” mentioned Flores-Harris.

Retaining Passing Requirements

The NCSBN routinely evaluates go charges for the NCLEX each 3 years. The council conducts what is named a observe evaluation — sending surveys to employers, educators, and 1000’s of nursing college students — that features questions on newly graduated nurses’ duties, together with how frequent these duties are, how vital they’re, and whether or not they require medical judgment, Flores-Harris defined. That info is used to find out whether or not the present take a look at questions are nonetheless related or must be extra rigorous, she added.

If the NCSBN believes that the medical judgment mandatory for what nurses are doing has elevated for the reason that final time they raised the passing commonplace, then they’ll increase it once more. In the event that they really feel the passing commonplace is “at a enough degree that … if a candidate passes this examination, they’re protected to observe as a nurse,” then they keep the present commonplace, Flores-Harris mentioned.

Final month, the NCSBN’s Board of Administrators held a vote and “decided that the present passing commonplace is suitable as a measure of protected and efficient entry-level nurse observe,” mentioned Jay Douglas, MSM, RN, the board’s president, who can be govt director of the Virginia Board of Nursing, in a press release. The council determined to uphold passing requirements for each the NCLEX-RN and the NCLEX-PN, the examination for licensed sensible nurses.

Individually, for the previous few years, the NCSBN has been updating the unique NCLEX and as a replacement plans to supply the Subsequent Era NCLEX (NGN) primarily based on “a recognition that medical judgment underpins nearly the whole lot nurses do,” Kappel mentioned, including that the NGN goals to “extra successfully measure” medical judgment of scholars taking the examination.

Based on Flores-Harris, one of many largest modifications with the NGN is the inclusion of case research, for which college students are proven a affected person’s digital chart and requested questions concerning the affected person. The NGN is anticipated to launch on April 1.