Passing rates for the National Council Licensure Examination (NCLEX) dropped for the third year in a row, compounding a workforce shortage at a time when some nurses are retiring or seeking alternate work due to understaffing and stress from the COVID-19 pandemic.
From 2019 through 2022, NCLEX-RN pass rates dropped more than 8 percentage points-from 88.18% to 79.90% for all first-time U.S.-educated candidates. For all candidates, including internationally educated students, and repeat exam takers, the passing rate declined from 72.8% in 2019 to 63.39% in 2022. Pass rates dropped for first-time exam takers among both bachelor's and associate degree graduates: from 91.22% in 2019 to 82.32% in 2022 for those with baccalaureates and from 85.17% in 2019 to 77.91% in 2022 for those with associate degrees.
Scores among candidates in some states, such as Florida, were far worse, with less than two-thirds of U.S.-educated students passing on the first attempt. Other states, such as Maryland, saw pass rates around 80.83% for first-time U.S. candidates in 2022, which was a few tenths of a point above the national average. But Maryland still saw a decline of about 8 percentage points from its 2019 passing rate of 88.36%. A report from the Florida Center for Nursing blamed continued fallout from the COVID-19 pandemic for Florida candidates' poor results, though other factors were likely in play since Florida's pass rates were nearly 20 points lower than the national average.
Addressing the national decline in pass rates, Kenya Beard, former dean of nursing and health sciences at Nassau Community College in New York, cited the switch to remote learning in addition to the pandemic. "If anything, COVID made us realize how important clinical hours are," Beard told AJN.
According to results of a survey on the pandemic's impact on students' nursing education published in the September-October 2021 Nursing Outlook, many students struggled with emotional and mental health challenges, along with the inadequate hands-on training. At the same time, nearly two-thirds of respondents said the pandemic strengthened their resolve to become nurses. A larger study on the topic by the National Council of State Boards of Nursing (NCSBN) is ongoing.
The NCLEX exam did its job: eliminating candidates who are not yet ready to enter the workforce. The effect, however, was to reduce the number of students eligible to practice as nurses in a time of workforce shortage, according to Beard.
The NCSBN is holding firm on the requirements for a passing grade. Its board of directors voted last December to endorse the current standards for the NCLEX-RN and NCLEX-PN examinations, and incorporate them into the Next Generation NCLEX, due to launch in April. "The board determined that the current passing standard is appropriate as a measure of safe and effective entry-level nurse practice," the NCSBN said in a statement. The updated exam will also place greater emphasis on candidates' critical thinking skills and clinical analysis.
In the meantime, nursing schools are looking at how to better use simulation technology so that certain scenarios can be standardized, according to Beard. While she doesn't advocate "teaching to the test," Beard said nursing school leaders should familiarize themselves with the NCSBN blueprint to make sure there are no gaps in their curricula.-Liz Seegert