NCLEX-RN Pass Rates and ADN Curriculum Models in NC

Introduction

In the years prior to 1997, the average pass rate for first-time test takers on the NCLEX-RN was 93%. Since 1997, the national average pass rate on the NCLEX-RN has declined to 83.8% (National Organization for Associate Degree Nursing, 2002). The pass rate for the state of North Carolina and many other states has also declined in recent years.

Community colleges are the primary educators of new registered nurses in the United States. In 1997, 701 community colleges awarded 41,258 associate degrees in nursing (National Center for Education Statistics, 1997). The combined ADN graduate pool constituted 60 percent of U.S. graduates who took the NCLEX-RN exam in 2000, and these graduates represent the largest group of nurses entering the profession (National Council of State Boards of Nursing, 2001). By comparison, baccalaureate programs graduated 37 percent of the total, and diploma or hospital-based educational programs graduated 3 percent (Teich et al.).

In addition to educating the majority of nurses entering the field, ADN programs provide important opportunities for mature students and students from minority communities. Community colleges are the institutions of choice for Hispanic, African American, and Native American individuals pursuing nursing careers. The American Association of Community Colleges (AACC) estimates that 57% of non-diploma African American nursing graduates were educated in associate-degree programs in 1997. Hispanic and Native American nursing graduates also received associate degrees at even higher percentages than African Americans. The AACC also reports that the comparative representation of each of these minority groups increased from 1995 to 2000 with respect to the overall associate-degree nursing population — this is especially true for African Americans, who made up 7.1 percent of all ADN graduates in 1995 and 12.6 percent in 2000. Hispanics constituted 4.2 percent in 1995 and 7.4 percent in 2000 (Teich et al.). Finally, community colleges educate most nursing professionals in rural areas: 73 percent of all nursing graduates in rural areas came from ADN programs (National Center for Education Statistics, 2000).

The following study investigates the factors that have contributed to a recent significant decline in the student pass rate on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) in the state of North Carolina. In addition, the study examines Associate Degree Nursing Curriculum Models and provides a brief discussion of the NCLEX-RN exam itself. It subsequently focuses on nursing curricula, workforce shortages, and worker dissatisfaction, reports the results of a literary review, describes the problem, and presents the study proposal.

About the NCLEX-RN

The National Council of State Boards of Nursing created the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The structure of the examination is based on an analysis of the entry-level performance of registered nurses. All graduates of nursing programs must pass the exam in order to practice as a Registered Nurse. The NCLEX-RN attempts to ensure minimum levels of safety on the part of the practicing nurse to the public (Houchin, 1994). Nursing programs are always apprehensive about their graduates' performance on the NCLEX-RN, and the results of the test are often interpreted as an indicator of program quality. The State Board of Nursing can deny approval of a program whose failing rate is considered too high.

Prior to 1994, the NCLEX-RN was a five-part pencil-and-paper test. In 1994, it evolved into a single computerized examination. Scoring is pass/fail, based not merely on the number of questions answered correctly but also on the level of difficulty of the questions answered correctly.

In 1997, the national passing rate for first-time test takers was 91%. In 1998, the National Council of State Boards of Nursing established a higher passing standard. As a result, the national passing rate for first-time candidates declined to 84%. There has been a significant drop in passing rates since 1994. It is also documented that repeat takers of the NCLEX-RN have a significantly reduced chance of successfully passing the test if they failed on their first attempt. With a decline in the number of first-time test takers passing the NCLEX-RN, the number of RNs entering the workforce is further reduced.

NCLEX-RN data also showed that passing rates for both ADN and baccalaureate-prepared candidates have dropped. A peer analysis of the Integrated Postsecondary Education Data System (IPEDS) revealed that the graduate pipeline is skewed by geographic location, with institutions in rural areas experiencing the largest decline in graduates, followed by large and small towns (National Center for Education Statistics, 1995, 2000).