Critics have raised concerns around the NCLEX test and the rate at which students are passing the exam, but chief nursing officers told Becker's there are reasons for the improved scores.
In April, the National Council of State Boards of Nursing launched its Next Generation NCLEX. The new test is designed to more precisely measure nurses' clinical judgment and critical thinking skills. In the second quarter of testing, the organization saw an increase in the number of registered nurses and licensed vocational nurses who passed the exam, going from a 70.42% pass rate in 2022 to 81.44% in 2023.
The reasons for the increase in passing students are highly debated. Test developers said the rates improved due to radical transparency and outreach. Nurse educators said increased resources and preparation, including student success coaching programs, helped as well. Critics, meanwhile, have said the exam got easier and that too many educators are "teaching to the test."
A 2021 study showed that fewer than 10% of new nurses have entry-level clinical judgment competency, according to practice partners, and some critics worry the test may be partially to blame, specifically its focus on closed questions.
"The biggest change [to the NCLEX] was adding clinical judgment items," Phil Dickinson, PhD, RN, CEO of the National Council of State Boards of Nursing, told Becker's. "And more importantly, scenarios and case studies were added. These questions are a progression of patient care that nurses are responsible for, not just a single moment but through holistic journey. These case studies reflect a lot better how we actually work and think. For leaders, one of the takeaways is that these new individuals have been successfully measured around processes, outcomes of clinical judgment — an added benefit we didn't have before. It took us 10 years to get here."
Becker's asked five chief nursing executives their view on the increasing pass rates and if there was any difference in the nurses entering the field:
Regina Foley, PhD, RN. Executive Vice President, Chief Nurse Executive and Chief Clinical Transformation and Integration Officer at Hackensack Meridian Health (Edison, N.J.): Because of the pandemic, we have nurses who were predominantly remote and didn't have the benefit of many clinicals as they historically had. However, they learned a lot more because they were virtual and couldn't be in a clinical setting more.
The nursing workforce, I think, has stepped up even harder because we knew we needed to. I think nursing schools did a great job adapting to be hybrid or virtual. We partner with several schools and we thankfully had strong NCLEX results pre-pandemic, and they have maintained their strength through today.
Julia Mason, DNP, RN. Chief Inpatient Nursing Officer at MetroHealth (Cleveland): The new NCLEX is better. It's more focused on critical thinking rather than memorization. The only thing, and this is anecdotal, is it feels like there is more hesitancy for new nurses in being comfortable around patients. In clinicals, new nurses get used to communicating with patients, doing a bath, getting a patient out of bed and those really basic skills. In new nurses, I see some hesitancy and they want help doing some things I would expect them to be more comfortable with. I think it goes back to how students were prepared during the pandemic. Students were virtual and the side-by-side parallel learning wasn't happening inside the hospital. Upcoming nurses did not get the chance to work on interdisciplinary teams or really learn to care for people. I am optimistic that these students are getting back into the actual acute care environment, and I don't have big concerns.
Tiffany Murdock, DNP, RN. Senior Vice President and System Chief Nursing Officer at Ochsner Health (New Orleans): I believe the rise in pass rates can be attributed to our improved approach in educating and mentoring nursing students post-pandemic. The nursing school curriculum plays a crucial role, and there has been a notable shift away from virtual education towards hands-on bedside training. The NCLEX undergoes thorough review, ensuring its content remains relevant to the educational needs of our future nurses. It's essential to recognize that the NCLEX is just one measure of a new nurse's success. Health systems bear a significant responsibility in providing ample opportunities for bedside education with preceptors, shaping a nurse's career.
Jacqueline Pester-Babcock, MSN, RN. Region II Chief Nursing Officer at Prime Healthcare (Ontario, Calif.): Many factors contribute to the high pass rate with the NCLEX exam. Many schools now offer and, in many cases, require the completion of an NCLEX prep course before taking the NCLEX exam. This process alone can result in an improved pass rate. I have no concerns regarding the increase in the pass rate of the NCLEX but more of a concern about the new graduate's skill and ability to practice nursing in a safe manner.
The pandemic altered traditional teaching methods and, in many circumstances, limited clinical practice time. As a result, new graduate nurses have experienced an increase in virtual learning versus hands-on learning. As the CNO, it is my responsibility to ensure patients receive safe, quality care. To make certain new graduates have the orientation required, the entire nursing team along with the education team have come together to support the new graduate nurse and support a successful journey. Our job as educators and mentors is not done, as the passing standard is the minimum level of ability required for safe and effective entry-level nursing practice. Nurses need many more learning opportunities and mentorship as they transition from newly licensed nurses into the complex care setting.
Veronica Scott-Fulton, DNP. Chief Nurse Executive at Bon Secours Mercy Health (Cincinnati): We have a notable influx of recent graduates coming into our care settings, and we are delighted to witness their intelligence, community dedication and compassionate spirit. These nurses not only bring a sense of optimism to the workplace but also exhibit a commendable approach of asking critical questions to gain a deep understanding of processes, procedures and care directives. We recognize that these qualities are indispensable for a thriving nursing career, and we remain confident in their capabilities, regardless of fluctuations in NCLEX pass rates.