Enhanced nursing licensure exam to launch in April amid rising fail rates 

In line with the regulations imposed by the COVID-19 national health emergency for the past three years, hospitals across the U.S. made necessary changes to almost every aspect of their business. Now, as the health emergency is coming to an end in May, the industry is eyeing an unforeseen fallout from the pandemic. 

David Benton, PhD, CEO of the National Council of State Boards of Nursing, told Becker's, "Anecdotally, we are fairly certain that the pandemic has had an outsized impact on NCLEX pass rates over the past three years."

National Council Licensure Exam pass rates for U.S.-educated, first-time test takers have been steadily falling in the past few years, from 88.2 percent in 2019 to 82.5 percent in 2021, then down to an average pass rate of 80.9 percent in 2022, according to the NCSBN.

"Clinical placements were limited and sometimes eliminated from the curriculum, which reduced the ability of the students to consolidate learning as they were not able to apply theory in practice," Dr. Benton said. "Also, the education sector had to pivot to providing material via the internet, and not all students had the same access to such facilities."

This has resulted in some coinciding harsh realities: The nursing shortage looms large while, at the same time, nursing schools have to turn away students because they lack adequate nurse educators. And about 20 percent of those who did graduate from nursing school aren't passing the test that will allow them to enter the nursing profession.

Becker's asked Dr. Benton about rising NCLEX fail rates, the new version of the exam due out this spring and the importance of the Nursing Licensure Compact, which allows nurses to practice in multiple states, he hopes more states will enact into law.

Question: Since the start of the COVID-19 pandemic, NCLEX fail rates have been  increasing. Why? 

Dr. David Benton: Pass rates across a wide range of exams have decreased, and it is important to understand that there is no one single reason for why NCLEX pass rates may fluctuate — the examination of these trends requires a careful evaluation. 

To help best understand these trends, NCSBN is gathering evidence and researching the impact of the pandemic on nursing education, as well as tracking students' performance and assessing the effectiveness of new approaches to prepare students for the transition to the workforce. The research will be published in April in the Journal of Nursing Regulation. 

Q: Why is there a need for updates to the NCLEX and entrance exams? 

DB: NCSBN assesses the NCLEX every three years, and the test's goal is to assess new graduates' readiness and ability to provide a minimum standard of safe and competent patient care. 

As the population has aged and people often suffer from multiple conditions, NCSBN, as part of its assessments, found that the importance of clinical judgment is highly rated by newly licensed nurses, supervisors, facilities and educators. This research feedback data and the rising complexity of how and where care is delivered led NCSBN to research new NCLEX testing methods that can even more precisely measure knowledge and critical thinking skills for prospective nurses in today's evolved healthcare landscape. 

In April 2023, NCSBN will launch the Next Generation NCLEX (NGN), an enhancement of the current exam. At its core is the NCSBN Clinical Judgment Measurement Model, which is a framework for the valid measurement of clinical judgment and decision-making within the context of a standardized, high-stakes examination. 

Q: Why is the Nurse Licensure Compact a leading initiative of the NCSBN?

DB: NCSBN has been very successful in developing and promoting the Nurse Licensure Compact as a means of improving public safety and reducing burdens on nurses themselves. It also facilitates speedy mobility that allows nurses to respond quickly to disasters. Further, it makes it easier for military families who have nurses that need to move with their partner when deployed to a different state. 

There still are a few states that have not passed this legislation, and we are working with coalition partners to create a compact nation that is fit for the challenges of modern healthcare.

Q: What major trend are you most concerned about in the nursing industry? 

DB: At the top of the list must be the need to better plan the workforce for the future. Evolving delivery models, increased use of technology, changing demographics and repeated failures to get this right means that a new workforce model is needed. NCSBN is completing a new workforce study, which will be available in April, and will start by identifying the weaknesses in the current planning model and facilitating a future-oriented dialogue with key stakeholders. We will then propose solutions fit for the new highly mobile, digital age that we work in.

In terms of the workforce shortage and inadequacy of the current model, there are many things that are driving these problems. Sadly, there has been an increase in violence in the workplace as well as the phenomenal burdens and resultant stress and burnout of the past several years during the pandemic. Data systems are currently inadequate, and hence our organization is promoting the use of a unique identifier, the NCSBN ID, that will enable better healthcare workforce planning.

Q: Do you think there are any actionable public policy solutions to these issues? 

DB: We need to be far more focused on the use of evidence rather than political ideology. Learning from others should be something that we are proud of rather than worried about. 

The problems we face in America are not unique, and we can learn from other nations. We need to learn that finance, education, healthcare and so many other areas are not isolated islands but are interdependent components of a successful nation. 

Nurses need to step out of their comfort zone of working on health policy, and get active in designing policy that is coherent, increases access to services, prevents disease burden and increases life expectancy. This can be done by scaling existing solutions, working collaboratively and being prepared to learn from each other.

Q: What do you think the future of nursing is going to look like?

DB: Nursing's future is bright, it makes a difference to society, and as such it will continue to evolve as a central partner in achieving health as well as treating illness.

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