Journal of Nursing Education

Major Article 

Registered Nurses' Experiences of Passing the NCLEX-RN After More Than One Attempt

Tammy Kasprovich, PhD, RN, CEN; Leona VandeVusse, PhD, CNM, FACNM

Abstract

Background:

In the past decade, little research has been conducted regarding individuals' stories about not initially being successful on the National Council Licensure Examination for Registered Nurses. An unsuccessful licensure examination attempt may affect the individual personally and profoundly in ways that could influence their future success.

Method:

Individual in-depth interviews were conducted once with 15 RNs who were initially unsuccessful on the licensure examination and subsequently passed. Data analyses were conducted using both manual and electronic coding through thematic identification. Rigor was ensured by meeting quality criteria for qualitative research.

Results:

Four themes were identified: (a) Pressures all Around, (b) the Stigma of Being Unsuccessful, (c) Correcting the Problems, and (d) Ultimate Triumph in Discovery.

Conclusion:

Following their initial unsuccessful National Council Licen-sure Examination for Registered Nurses results, participants were deeply affected, but after accepting help from family, friends, nursing instructors, and managers, they were able to move forward, change their approaches, and become RNs. [J Nurs Educ. 2018;57(10):590–597.]

Abstract

Background:

In the past decade, little research has been conducted regarding individuals' stories about not initially being successful on the National Council Licensure Examination for Registered Nurses. An unsuccessful licensure examination attempt may affect the individual personally and profoundly in ways that could influence their future success.

Method:

Individual in-depth interviews were conducted once with 15 RNs who were initially unsuccessful on the licensure examination and subsequently passed. Data analyses were conducted using both manual and electronic coding through thematic identification. Rigor was ensured by meeting quality criteria for qualitative research.

Results:

Four themes were identified: (a) Pressures all Around, (b) the Stigma of Being Unsuccessful, (c) Correcting the Problems, and (d) Ultimate Triumph in Discovery.

Conclusion:

Following their initial unsuccessful National Council Licen-sure Examination for Registered Nurses results, participants were deeply affected, but after accepting help from family, friends, nursing instructors, and managers, they were able to move forward, change their approaches, and become RNs. [J Nurs Educ. 2018;57(10):590–597.]

Graduate nurses continue to struggle with successfully passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN). According to the National Council State Boards of Nursing (2018), approximately 10% to 18% of new graduate nurses are unsuccessful on their first attempt. When graduate nurses are unsuccessful on the NCLEX-RN, they are then denied the opportunity to work as RNs. According to the American Association of Colleges of Nursing (2017), the national nursing shortage is expected to exceed 1.09 million RNs by 2024. The profession of nursing needs graduate nurses to be successful on the NCLEX-RN to alleviate the nursing shortage more rapidly and to grow their numbers. The purpose of this study was to describe the experiences of RNs who were not initially successful on the NCLEX-RN, then subsequently passed.

Prior to 2004, only three published qualitative studies had focused on graduate nurses who failed the NCLEX-RN and their experiences related to this failure (Griffiths, Papastrat, Czekanski, & Hagan, 2004; Poorman & Webb, 2000; Vance & Davidhizar, 1997). Recently, after a decade-long gap in the literature, three more studies had surfaced on the experiences of graduate nurses who had reportedly failed the NCLEX-RN. Two dissertators have conducted research studies on the topic (Atemafac, 2014; Silva, 2014), and McFarquhar published a research study (2014) from her dissertation (2006) that focused on the lived experiences of RNs and the factors that led to their successes after multiple attempts on the NCLEX-RN. Additionally, a research study was conducted to explore the experience of graduate nurses who began to take the NCLEX-RN for entry into Canadian nursing practice in 2015 (McGillis Hall, Lalonde, & Kashin, 2016). The researchers interviewed graduate nurses who were successful and unsuccessful on the examination. Further details about these research studies will be used for comparison in the discussion section of this article.

The bulk of the literature on NCLEX-RN results has been quantitative and reported academic predictors, demographic data, interventions, and the use of commercial tests to prepare new graduates for the examination. However, most of these research studies have been conducted in single nursing institutions, which makes it difficult to generalize the findings. Authors have attempted to predict NCLEX-RN success and failure but have been better able to predict success than failure.

Method

An exploratory, descriptive, narrative method design was used for this study. Institutional review board approval was obtained from the researchers' university prior to conducting the research study (T.K., L.V.).

Setting and Sample

Participants were recruited from two midwestern states, primarily by word of mouth. Initially, the researcher discussed the study outside health care delivery facilities to colleagues, friends, acquaintances, and anyone else who might know RNs who were not successful on the NCLEX-RN. Attempts were made to recruit participants from local chapters of minority-affiliated nursing organizations to enhance diversity of the sample, but without successful recruitment. Fifteen participants met the inclusion criteria and prior to being interviewed, an informed consent was signed by each participant. Inclusion criteria included:

  • Adults who are least 18 years of age.
  • Current RNs who were not initially successful on the NCLEX-RN, then subsequently passed within the past 3 years to facilitate recall after any number of unsuccessful attempts prior to receiving an RN license.
  • Proficiency in speaking and reading English.

Exclusion criteria included:

  • Individuals who had not taken the NCLEX-RN.
  • Those who lacked proficiency in English that would prevent informed consent or completion of the interview.

Procedure

Fourteen of the participants agreed to be interviewed at coffee shops and one participant chose a private office space. The researcher conducted all 15 interviews using a semistructured interview guide to allow the participants to talk openly. The overall research question was, “What do RNs report about their experiences of not initially being successful on the NCLEX-RN, then subsequently passing?” Throughout the interview, the researcher prompted or asked questions to clarify what the participant was saying often by requesting further explanations of particular phrases to enhance understanding of unique meanings. The interviews ranged from 25 to 108 minutes in length; each participant determined the length of the interview by telling his or her story. After each interview and a brief demographic questionnaire were completed, the participant was given a gift card incentive of $25. Interviews were audio-recorded and transcribed by a professional transcriptionist, then the researcher listened and edited the recordings to ensure they were transcribed verbatim and all identifiers were removed. Data were managed both manually and electronically using NVivo 10™ qualitative data analysis software.

Data Analysis and Rigor

The researcher used continual reflection about the data analysis processes and ensured trustworthiness of the data, as described below. Using these strategies, participants' stories were reconstructed in a meaningful, comprehensive manner. Data were analyzed using Braun's and Clarke's (2006) six phases of thematic analysis coding. The six steps included (a) familiarizing yourself with your data by rereading, (b) generating initial codes, (c) searching for themes, (d) reviewing themes, (e) defining and naming them, and (f) producing the report. The researcher decided to manually code each transcript line by line and used different color pens to identify commonalities and then initial codes. After identifying initial codes, the researcher used NVivo 10™ to electronically code the data. During the third phase, the researcher began to identify the relationships between the codes, themes, and subthemes (Braun & Clarke, 2006). The fourth phase involved reviewing themes, which was done by checking them against coded excerpts and the entire data set. The second level of the fourth phase included consideration of the validity of individual themes in relation to all the data. The researcher reviewed all the previous data excerpts that were placed under each theme and subtheme and identified those data excerpts that fit best. If the datum excerpt did not fit, then the researcher reworked where it might best be placed for explanatory power. The fifth phase involved defining and naming each theme, which the researcher did by analyzing and reevaluating all the excerpts under each theme, organizing them in a coherent manner, and renaming or redefining any to improve clarity. In this phase, the researcher ensured that the report provided sufficient evidence about how the data represented each theme. The final phase was reporting the overall story (Braun & Clarke, 2006).

Trustworthiness of the data was ensured throughout the analysis by meeting the quality criteria for qualitative research, such as open-ended interviewing, using field notes, careful auditing, and describing the demographics of the participants in the study. First, the researcher developed trust during each interview through active listening to develop rapport with the participant and by clarifying the statements made, which resulted in trustworthy data that accurately expressed participants' experiences. Second, the researcher created an audit trail identifying her biases, opinions, hunches, analytic ideas, insights, and key words in a reflexive journal and recorded these after each interview and during data analysis. Third, credibility and confirmability were established by using three coders who read through the same three transcripts, followed by the researcher interviewing each coder separately for additional insights. Fourth, the researcher completed field notes regarding the procedures and processes applied during analysis by recording and reviewing them in her reflexive journal. Finally, transferability in qualitative research is the extent to which the findings can be applied to other groups of individuals (Petty, Thomson, & Stew, 2012). The researcher had each of the participants fill out a demographic questionnaire to aid in understanding facts about the participants to transfer their insights to other groups taking high-stakes examinations. Ultimately, by using multiple strategies, the researcher was able to ensure trustworthiness of the study.

Findings

Fifteen RNs completed the study. The mean age of the participants was 26.8 years old, with the majority (75%) of the participants in their 20s when they first took the NCLEX-RN. Thirteen of the participants were women and two were men. Regarding race and ethnicity, two participants self-identified as Asian, two as Hispanic or Latino, and 11 as White. Two of the participants had Bachelor's degrees in fields other than nursing, but also had Associate nursing degrees. The remaining 13 graduated from Bachelor of Science in Nursing programs. Ten (two thirds) of approximately the 15 participants took the NCLEX-RN twice before successfully passing. Four (one quarter) of the participants took the NCLEX-RN three times before successfully passing, and one participant took the examination more than three times. Five (one third) of the participants who took the NCLEX-RN more than twice described either being poor standardized test takers or anxious during the unsuccessful NCLEX-RN attempts.

Four main themes were identified: (a) Pressures All Around, (b) the Stigma of Being Unsuccessful, (c) Correcting the Problems, and (d) Ultimate Triumph in Discovery. Each theme is described below, and example quotations from participants are provided.

Theme 1: Pressures All Around

The first theme, Pressures All Around, reflected how all 15 participants responded regarding having internal and external pressures prior to and/or during the NCLEX-RN on the first attempt (Table 1). Two subthemes emerged: (a) internal pressures, and (b) external pressures. The subtheme internal pressures included all 15 participants' own thoughts about their knowledge base, abilities, confidence, self-esteem, and anxiety levels prior to and/or during the NCLEX-RN. More than half (n = 8, 53%) participants described how they continued to question their preparedness, felt easily distracted, lost focus, and second-guessed themselves during the examination. The subtheme external pressures referred to factors that the participants reported had affected them the first time they took the NCLEX-RN and learned they were not initially successful. Two (13%) of the participants stated that they already had RN positions while working as graduate nurses, which put extra pressure on them. In addition, three (20%) of the participants believed that having former nursing school classmates who took the examination and posted their success about their first attempts on social media resulted in increased stress for those who waited to take the NCLEX-RN. The participants indicated that they were not surprised when they were not initially successful due to the reported internal and external pressures they felt prior to and/or during their initial NCLEX-RN attempts.

Pressures All Around

Table 1:

Pressures All Around

Theme 2: The Stigma of Being Unsuccessful

The second theme, The Stigma of Being Unsuccessful, addressed how all 15 participants reported feeling stigmatized after not initially being successful on the NCLEX-RN (Table 2). Four subthemes were identified: (a) personal beliefs, (b) don't ask, don't tell, (c) negative personal reactions, and (d) negative interactions. In the first subtheme, personal beliefs, 11 (73%) of the participants wanted to maintain their privacy and were concerned when not initially being successful on the NCLEX-RN about being judged by colleagues or patients. In the second subtheme, don't ask, don't tell, two (13%) of the participants who were working in health care after not initially being successful chose not to tell patients their NCLEX-RN results. Participants reported that they were worried the patients would think they were incompetent nurses. Within the third subtheme, negative personal reactions, all 15 participants expressed their thoughts and emotions after receiving the notification that they were not initially successful on the NCLEX-RN. Participants described feeling “heartbroken,” “devastated,” “frustrated,” and “like a failure.” Participants commented that they questioned whether they should be RNs or choose other careers. All of them chose to stay in nursing and retake the NCLEX-RN. In the fourth subtheme, negative interactions, three (20%) of the participants perceived that others were being rude to them because of their initial NCLEX-RN results.

The Stigma of Being Unsuccessful

Table 2:

The Stigma of Being Unsuccessful

Theme 3: Correcting the Problems

The third theme, Correcting the Problems, reflected the processes all 15 participants went through to prepare to retake the NCLEX-RN (Table 3). Three subthemes were identified: (a) preparing, (b) seeking support, and (c) changing to positive self-talk. In the first subtheme, preparing, eight (53%) of the participants talked about the different NCLEX-RN books, CDs, and commercial preparation tests they used to help them prepare for retakes. In addition, 12 (80%) of the participants reported using different test-taking strategies to help them be successful on the NCLEX-RN. The strategies the participants referred to were (a) look for key words, (b) do not add any information into the question, (c) eliminate incorrect answers, (d) use clues to help you select answer, and (e) pick apart the question. Within the second subtheme, seeking support, all 15 participants had decided to seek support from immediate family, close friends, nursing instructors, and nurse managers after not initially being successful on NCLEX-RN. The participants talked about how important support from others, with whom they felt close, helped them prepare to retake the NCLEX-RN. The third subtheme, changing to positive self-talk, represented the participants' internal thoughts reflecting on their knowledge, abilities, and self-esteem levels. Prior to and during the NCLEX-RN retakes, 14 (93%) of the participants continually reassured themselves that they knew the content and were smart enough to pass the examination. In addition, the participants reported that they needed to give themselves pep talks to increase their confidence levels if they wanted to be successful on the current examination.

Correcting the Problems

Table 3:

Correcting the Problems

Theme 4: Ultimate Triumph in Discovery

The final theme, Ultimate Triumph in Discovery, represented how all 15 participants described their emotions after successfully passing the examination overcame the stigma of being unsuccessful and provided words of wisdom to those individuals who were getting ready to take NCLEX-RN (Table 4). Four subthemes were identified: (a) the emotional journey, (b) surpassing the stigma, (c) no regrets, and (d) words of wisdom. In the first subtheme, the emotional journey: strong positive reactions to success on the NCLEX-RN, all 15 participants provided thoughts and feelings as they transitioned from being unsuccessful to passing. Initially, participants spoke about how they were devastated and embarrassed when they were not successful, but they were able to emotionally move forward to retake the examination. The second subtheme, surpassing the stigma, represented how eight (53%) of the participants were able to move beyond the shame by talking openly with others about taking the NCLEX-RN more than once. In the third subtheme, no regrets, 11 (73%) of the participants reflected on how they overcame the challenge of not initially being successful on the NCLEX-RN and expressed that this had become a valuable learning experience for them. The fourth subtheme, words of wisdom, represented the knowledge gained from taking the examination more than once. Nearly half (n = 7, 47%) of the participants expressed feeling compelled to offer advice to other individuals taking the NCLEX-RN. In the end, the participants commented that they had no regrets and are better people and nurses because of their challenges and experiences.

Ultimate Triumph in Discovery

Table 4:

Ultimate Triumph in Discovery

The participants passionately spoke about their thoughts, reactions, and emotions related to taking the NCLEX-RN more than once. Participants reported pressures all around prior to taking the NCLEX-RN for the first time and identified a stigma after initially being unsuccessful. The participants chose to correct the problems and prepared to retake the NCLEX-RN; ultimately, they reflected on how they improved their coping with challenges by taking the NCLEX-RN more than once and being successful.

Discussion

In past decades, there has been a small amount of qualitative research conducted regarding individuals' stories about not initially being successful on the NCLEX-RN. Due to the paucity of literature on the topic, this study explored RNs' experiences related to not initially being successful on the NCLEX-RN, then subsequently passing. Participants spoke about the pressures they experienced prior to and/or during the NCLEX-RN that they believed prevented them from being successful on their first attempts. In prior studies, varied authors reported similar results to those described here. Eight (89%) of nine of Eddy's and Epeneter's (2002) participants who were unsuccessful stated that they were distracted, compared with only three (30%) of 10 participants who were successful on the NCLEX-RN. McFarquhar (2006, 2014) found that 13 (72%) of 18 participants were distracted during the NCLEX-RN, reporting being overly anxious, lacking concentration, and/or doubting themselves, which they believed contributed to their lack of success on the NCLEX-RN (McFarquhar, 2006, 2014).

Participants in this study stated that accepting RN positions prior to taking the NCLEX-RN was stressful on them. Two other studies reported that participants who had accepted RN employment prior to taking the examination stated that these commitments contributed to them not initially being successful on the NCLEX-RN (Atemafac, 2014; Griffiths et al., 2004). Atemafac (2014) discovered that 13 (76.5%) of 17 participants stated their current RN employment distracted their attention from studying for the licensure examination. Griffiths et al. (2004) reported that participants had commented that being employed as RNs prevented them from being successful on the NCLEX-RN; however, the authors did not provide the number of participants who had made this connection.

Due to the self-perceived stigma with being unsuccessful on the NCLEX-RN, participants wanted to maintain their privacy because they were concerned about being judged negatively by colleagues and patients. No prior studies reported a stigma with being unsuccessful on the licensure examination. However, McFarquhar (2006, 2014) found that nine (50%) of 18 participants described inducing a self-imposed social isolation after not initially being successful on the NCLEX-RN. The participants choose to speak with immediate family members and close friends but did not want to share their initial results with colleagues.

Participants in this study spoke about their own negative personal reactions experienced when they were not initially successful on the NCLEX-RN. The participants used a variety of terms to describe their emotional reactions, such as “devastated,” “frustrated,” “disappointed,” “defeated,” “crushed,” and “heartbroken.” Several qualitative studies reported similar results (Atemafac 2014; McFarquhar, 2006, 2014; Silva 2014). Atemafac (2014) discovered that 16 (94.1%) of 17 participants stated that they were depressed after not being successful on the licensure examination. Silva (2014) reported that six (67%) of nine participants expressed that they were “devastated,” “disappointed,” and “irritated” after multiple attempts of not being successful on the licensure examination.

Similarly, McFarquhar (2006, 2014) found that participants who were not initially successful on the NCLEX-RN displayed a temporary decrease in their psychological and sociological well-being. The participants stated that they were “disappointed” (n = 13, 65%) and “depressed” (n =5, 27.8%) after finding out they were not successful on the licensure examination. However, according to McFarquhar (2006, 2014), some participants stated they experienced disappointment and depression for a few days, whereas other participants experienced these feelings for several months before coming to terms with their initial results.

In this study, participants questioned their depth of knowledge in relation to content, stating they knew they needed to focus on the content prior to retaking the NCLEX-RN. Atemafac (2014) and McFarquhar (2006, 2014) reported similar findings from their participants; 14 (82%) of 17, and all 18 (100%) of the participants were focused on reviewing content-based learning, respectively. In this study, the changes made in the participants' approaches reportedly increased their understanding of the content and their confidence levels, which helped them successfully pass the licensure examination on subsequent attempts.

The participants in this study commented that practicing NCLEX-RN style questions helped build their confidence levels prior to retaking the examination. The number of questions they reported practicing daily ranged between 25 and 200 questions. These findings were similar in two studies (Eddy & Epeneter, 2002; McFarquhar, 2006, 2014). McFarquhar (2006, 2014) reported participants indicating that focusing on NCLEX-RN questions helped them to be successful on their retakes. Eddy and Epeneter (2002) interviewed participants who were initially successful and those who failed the NCLEX-RN. Those participants who were initially successful reported practicing thousands of questions prior to taking the examination.

Participants in this study invested in different commercial preparation courses prior to retaking the licensure examination. Participants commented that they felt more prepared to retake the NCLEX-RN given the completion of these additional commercial preparation courses. This finding was similar in several studies (Atemafac, 2014; Griffiths et al., 2004; McFarquhar, 2006, 2014). Atemafac (2014) found that all 17 participants took commercial preparation courses for tutoring purposes prior to retaking the NCLEX-RN, and the participants stated these courses boosted their confidence levels. Additionally, Griffiths et al. (2004) reported that participants stated their confidence increased after taking commercial preparation courses, although the number of participants who stated they took commercial preparation courses was not identified. McFarquhar (2006, 2014) found that three of the 18 (11%) of the participants took commercial preparation courses to prepare them to retake the NCLEX-RN. However, the author did not report whether these courses were beneficial.

The participants in this study used test-taking strategies to help them understand how to answer NCLEX-RN-style questions. McFarquhar (2006, 2014) reported that participants commented they were not initially successful on the NCLEX-RN because they lacked test-taking strategies. On the contrary, Eddy and Epeneter (2002) reported that all 19 participants stated that nothing prepared them to answer critical thinking and prioritization questions. In contrast, the participants in this study stated that learning and applying test-taking strategies fostered their NCLEX-RN success when retaking the examination.

After not initially being successful on the NCLEX-RN, participants in this study sought support from immediate family. They commented on how important it was for them to have the support of their families. McFarquhar (2006, 2014) found similar results, with nine (50%) of 18 participants stating they were motivated by their families to retake the NCLEX-RN. However, three studies had different findings (Atemafac, 2014; Poorman & Webb, 2000; Silva, 2014). Atemafac (2014) reported that the participants did not feel their spouses were supportive of them after not successfully passing the NCLEX-RN. Additionally, Silva (2014) and Poorman and Webb (2000) reported that their participants did not feel supported by their families in general, although they did not specify whether their spouses were supportive.

In this study, participants felt it was important for them to be able to rely on close friends after not initially being successful on the NCLEX-RN. Participants appreciated the advice their close friends gave them prior to retaking the licensure examination. McFarquhar (2006, 2014) had similar results, with nine (50%) of 18 participants openly sharing with their friends that they had been unsuccessful on the examination. Additionally, Atemafac's (2014) participants stated they believed that they would be successful when they retook the examination because of the support they received from their friends.

Participants in this study decided to reach out to their nursing instructors for guidance and support. After meeting with their nursing instructors, these participants stated that they were more confident in their abilities to be successful in the future. Griffiths et al. (2004) and McFarquhar (2006, 2014), reported similar findings; their participants sought assistance to prepare to retake the NCLEX-RN. Atemafac (2014) and Silva (2014) reported different findings from their participants. Atemafac (2014) stated that seven (41%) of the 17 participants did not receive any support from their school of nursing after graduation. Silva (2014) reported that three (33.3%) of nine participants were not offered additional support from their schools of nursing.

After not initially being successful on the NCLEX-RN, the participants in this study realized they had to change their negative internal thoughts to positive self-talk. Participants repeatedly reassured themselves they were smart enough, which helped them be successful on retakes. Silvestri (2010) found that individuals who had higher self-efficacy expectations prior to taking the NCLEX-RN for the first time successfully passed. McFarquhar (2006, 2014) reported that 13 (72.2%) of 18 participants continually reflected on what they learned from their past experiences, which helped them to be successful. Other authors identified different ways participants mentally prepared to retake the NCLEX-RN, such as prayer (Johnson, 2009; McFarquhar, 2006, 2014) and visualizing being successful (Poorman & Webb, 2000). In general, research conducted on how individuals mentally prepare to take or retake the NCLEX-RN is lacking in the current literature; this is worthy of further study.

Participants in this study gave themselves pep talks during the NCLEX-RN on retakes. The pep talks consisted of “you can do this,” “let's focus on the questions,” and “just keep going, you'll be fine”; McFarquhar (2006, 2014) and Eddy and Epeneter (2002) reported similar results. McFarquhar (2006, 2014) found that two (11.1%) of 18 participants told themselves “you can do it” and to “relax” during subsequent NCLEX-RN attempts.

All participants in this study shared how they surpassed the stigma of being unsuccessful and wanted to offer words of wisdom to those individuals who are preparing to take the examination. There were only three research studies that interviewed RNs after successfully passing the licensure examination (Eddy & Epeneter, 2002; McFarquhar, 2006, 2014; McGillis Hall et al., 2016). However, the authors of those studies did not report participants' thoughts, reactions, or emotions after successfully passing, so it was difficult to make comparisons.

Recommendations

Graduate nurses need guidance on how to properly prepare to take or retake the NCLEX-RN. The focus of conversation to promote success can include proper preparation, repeated practicing of NCLEX-RN-style questions, applying test-taking strategies, and using positive self-talk and other means to lessen stress (e.g., prayer, visualization). In this study, the participants stated that they were not initially successful because they lacked preparation, test-taking strategies, and/or ways to reduce stress during their initial attempts, such as positive self-talk.

To help ease the stigma related to being unsuccessful, it would be beneficial for educators and nurse mangers to offer verbal support and encouragement and to reinforce the importance of successfully passing and the fact that it can be done. This support can help graduate nurses feel like they are not alone. In this study, when participants talked with immediate family, close friends, nursing instructors, and nurse managers, their confidence levels increased and they were motivated to retake the NCLEX-RN.

Conclusion

Participants who were not initially successful on the NCLEX-RN then subsequently passed were personally and psychologically affected. However, after seeking support and correcting the problems they identified, they were able to move forward and retake the NCLEX-RN to become successful on subsequent attempts. The nursing profession needs RNs who were not initially successful but persisted until they were because they have encountered a major challenge, altered their approaches, and achieved success. They showed resilience by retaking the NCLEX-RN until they were successful, without expressing bitterness but by finding new strengths within themselves. Participants claimed they are “better nurses” because of not initially being successful on the licensure examination; they stated they can now better empathize with client difficulties and challenges and assist in problem solving.

References

  • American Association of Colleges of Nursing. (2017). Fact sheet: Nursing shortage. Retrieved from http://www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-Shortage-Factsheet-2017.pdf
  • Atemafac, J. (2014). Consequences for nursing graduates of failing the National Council Licensure Examination (NCLEX) (Doctoral dissertation). Retrieved from http://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=1173&context=dissertations
  • Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. doi:10.1191/1478088706qp063oa [CrossRef]
  • Eddy, L.L. & Epeneter, B.J. (2002). The NCLEX-RN experience: Qualitative interviews with graduates of a baccalaureate nursing program. Journal of Nursing Education, 41, 273–278.
  • Griffiths, M.J., Papastrat, K., Czekanski, K. & Hagan, K. (2004). The lived experience of NCLEX failure. Journal of Nursing Education, 43, 322–325.
  • Johnson, A.N. (2009). NCLEX-RN success with boot camp. Nursing Education Perspectives, 30, 328–329.
  • McFarquhar, C.V. (2006). Registered nurses' perception of factors leading to success on multiple attempts on the National Council Licensure Examination—Registered Nurse (NCLEX-RN) (Unpublished doctoral dissertation). Walden University, MN.
  • McFarquhar, C.V. (2014). Lived experiences of failure on the National Council Licensure Examination—Registered Nurse (NCLEX-RN): Perceptions of registered nurses. International Journal of Nursing Education, 6, 10–14. doi:10.5958/j.0974-9357.6.1.003 [CrossRef]
  • McGillis Hall, L., Lalonde, M. & Kashin, J. (2016). People are failing! Something needs to be done: Canadian students' experience with NCLEX-RN. Nurse Education Today, 46, 43–49. doi:10.1016/j.nedt.2016.08.022 [CrossRef]
  • National Council State Boards of Nursing. (2018). Exam statistics and publications. Retrieved from https://www.ncsbn.org/534.htm
  • Petty, N.J., Thomson, O.P. & Stew, G. (2012). Ready for a paradigm shift? Part 2: Introducing qualitative methodologies and methods. Manual Therapy, 17, 378–384. doi:10.1016/j.math.2012.03.004 [CrossRef]
  • Poorman, S.G. & Webb, C.A. (2000). Preparing to retake the NCLEX-RN: The experience of graduates who fail. Nurse Educator, 25, 175–180. doi:10.1097/00006223-200007000-00013 [CrossRef]
  • Silva, C.L. (2014). The lived experience of graduate nurses with multiple NCLEX-RN failure (Doctoral dissertation). Retrieved from http://knowledge.library.iup.edu/cgi/viewcontent.cgi?article=1121&context=etd
  • Silvestri, L.A. (2010). Self-efficacy and the predictors for NCLEX-RN success for baccalaureate nursing students (Doctoral dissertation). Retrieved from http://digitalscholarship.unlv.edu/thesesdissertations/231/
  • Vance, A. & Davidhizar, R. (1997). Strategies to assist students to be successful the next time around on the NCLEX-RN. Journal of Nursing Education, 36, 190–192.

Pressures All Around

SubthemeCategoryExemplar
Internal pressuresPrior to taking the NCLEX-RN“I just knew. Again intuition, I knew I did enough. I shouldn't say I did enough, I knew I did exactly what everyone told me I needed to do, and I knew I was prepared that way, but there was something in the back of my mind saying, ‘It's not time yet. You're not ready.’”
During the NCLEX-RN“During the test I thought I was doing pretty well, and all of a sudden, I was expecting 75 questions, I kept on looking at that number at the top and finally it comes to 75 questions and I was like, okay, maybe 100 or 115, and all of a sudden it gets to that, didn't happen. I started getting so sick of the test I just started clicking because I was just so over it. I wanted it done, I didn't care if I passed or failed at that point because I was so anxious and I was even angry at the time too.”
External pressuresRN positions“I think part of the problem was I had a lot riding on this…. My job was one of the things that was contingent on it. That's also when I was working a lot too, as a graduate nurse.”
Family members“They'd be like, ‘Yay, you're graduating.’ I'm like, ‘Yeah,’ they're like, ‘So you're getting a job right away?’ I'm like, ‘I still have to take the NCLEX, it's kind of a big deal.’ I'm kind of an anxious test taker, so that didn't help. I tell them that and then the next question I got forever from every single person, ‘When are you gonna take it? When are you gonna take it?’ I felt a lot of pressure to take it, which is why I don't think I was successful the first time, I didn't do it when I was ready. I just did it to get it done with.”
Nursing school colleagues passing the NCLEX-RN“I know because I'd be on a trip—we took a trip right after school. While we were there I had a friend tell me ‘Oh I passed.’ It didn't ruin my vacation, obviously I was happy for her, but at the same time it was like, ugh. It was the fact that you're seeing people do it, now you have to do it. You need to go at it as much as you can, so I think right off the bat I was kind of under the gun because I was seeing everybody else pass, and that added stress and pressure and thinking about it too much every day. That was a problem.”
The effect of social media“Yes, but in a way, I think this time I was more like pressured because everyone knew in my class when my day was. Everyone was getting jobs and posting on Facebook® ‘Here's my ID card as an RN.’ I'm happy for them but as a person you feel left out, behind.”

The Stigma of Being Unsuccessful

SubthemeCategoryExemplar
Personal beliefsMaintain privacy“I think I still haven't come to complete terms about being able to tell people because I feel there's just a negative aspect to it. ‘Maybe she isn't that good of a nurse because she couldn't pass the NCLEX the first time’. I still feel like there's still negativity around it. Really haven't admitted to it to people. I only told one person in my family that I wasn't successful still.”
Concerns about being judged“How they were gonna judge me. I'm a failure, that kind of thing. Everyone sharing how good they did and I'm the only one the shares how bad I am, how are they gonna see me?”
Don't ask, don't tellDon't tell the patients“I was worried they would think I would be a bad nurse, or I was dumb that I couldn't pass two times.”
Keeping a secret“A lot of times people would ask me where I'm working. I'd say a hospital and they would ask, ‘You got a nursing position?’ I was like, ‘I did have a nursing position.’ I would kind of brush over it and not really tell them I'm no longer a nurse. I just didn't say anything.”
Negative personal reactions“So I did not pass and I was kind of like a train wreck for a few days, I didn't want to do anything, I was mad at the world. Didn't want to try again. I was frustrated and devastated, because I am not used to failing. I don't always pass with flying colors but I passed and got through it. Failing the important milestone, the [NCLEX-RN] was a big one for me.”
Negative interactions“There was one doctor in particular who said to me, ‘You're just not smart enough, just try harder.’ That was kind of hurtful. It was something I didn't expect from that doctor. But, it happened…for them to say that I just need to try harder? ‘Why would I not try hard?’ That was my response.”

Correcting the Problems

SubthemeCategoryExemplar
PreparingStudying content“Content. I knew the strategy. It was just the content I was iffy on. I just started thinking like a nurse. I was just like—it all comes down to safety. What is the safest here? When you think like a nurse, you take the test right. Yeah, I started thinking like a nurse and I passed.”
Practicing NCLEX-RN questions“I had three different books actually, just to give different questions and all that. I would read the questions and I would do like a hundred a day, and it helped a lot. Just I had to remember not to rush through the questions….”
Taking commercial preparation courses“The third time it was. I felt—I don't know why, but after Kaplan I felt so much more prepared…. I did nothing but Kaplan. I did their pre-coursework, questions, and all the questions they did during the webinars. I did questions and tests afterwards, which were fabulous. You got 75, then 150, then 265. I did all of them.”
Revising test-taking strategies“I learned how to read the question and then go back and pick apart the question…. It told me key words to look for, kind of how the NCLEX class did. Underlined the words you were actually looking for, eliminating two out of the three answers. Elimination.”
Seeking supportImmediate family“After a couple days, then I told my parents. They were really supportive about it and didn't make it a huge deal, ‘Just take it a second time around and you'll be fine.’ At least I had that support system.
Close friends“My one friend who helped me. She had passed the first time and she helped me through a lot of it too…. She kind of told me to not put so much pressure on myself. She's like, ‘It's okay. Don't let the test define you' because she knew that's what I was doing and she just tried to talk me off the ledge I guess, for me, trying to give up and all that stuff.”
Nursing instructors“Obviously, what I was doing was not working. I tried to change things up, I did things differently, but obviously I needed to do something else. There wasn't anything else other than coming to my instructor. I hate to say it that way but it's true. Then coming to my instructor and getting help. It was one of the hardest things I think I've done. It was almost harder coming to talk to my instructor than [to] take the NCLEX, not because I found my instructor unapproachable, [but because] I was so embarrassed at that point.”
Nurse managers“Especially when people like my manager on my floor…would send me e-mails like, ‘I'm sorry to hear about the news, but I want to tell you what kind of person I think you are and how proud we are to know that you work for us and you're not giving up and you're still bound and determined to take the NCLEX-RN again as many times as it takes.’”
Changing to positive self-talkPreparing mentally for subsequent attempts“The morning of, I sat in my car outside the place and ate a banana, and just remind myself I could do this, and I'm smart enough to do this, I worked really hard for this, just focusing on breathing and calming myself down. Just trying to stay as relaxed as I could.”
Giving own pep talks during subsequent attempts“The second time I went in there, I kept trying to give myself pep talks and stopped saying you couldn't do this, you can do this, you can pass and be successful; don't worry about anyone else that is in there.”

Ultimate Triumph in Discovery

SubthemeCategoryExemplar
The emotional journeyPowerful positive reactions to success“I was elated. I was jumping around. I was hugging my family, I was really excited. It was more so just the relief of stress. Oh my goodness, I never have to have that feeling ever again. That's what I was most excited about. Never having to be stressed out about it again.”
Surpassing the stigmaPaying it forward“Passing my experience on to newer [graduates who] have to go through this experience in about a month or two months. Passing my experience on to them and then letting them know ‘You'll be fine, don't worry about it, do your questions and work hard.’ I think it's kind of helping me get through this experience.”
Talking openly“Now I know people [who] have failed, and I think by sharing just not passing, then that would give them like ‘Hey I'm not alone, she failed too, this is what she did.’ Keep going to pass. If I could do it over, I would definitely have shared like my experience and maybe that's why I went through it, I don't know.”
No regretsI am stronger person“I just kind of look at the bigger picture and realize it's made me a stronger person and a better person, better nurse. Of course I wouldn't be a nurse if I didn't pass it. It just made me a stronger person and more confident in myself.”
I am confident“No, I mean it gives me a confidence boost knowing I can get through something like that and I didn't give up. It was a good experience. I'm not sad that I failed the first time now, and I'm not upset about that.”
I am a better nurse“I think it's made me into a better nurse in general because I can handle emergent situations differently and don't freak out like the other nurses.”
Words of wisdomIt's about strategy“I told them, ‘Be confident in what you know…. Trust yourself; trust what your teachers have instructed you. Read the questions twice, and eliminate the most obvious answers. Once those are eliminated then read the question and then answer it and just be prepared.’”
Enjoy life“Don't focus your studies as your life. You have to have a life outside of studying too. You have to have some fun. You're going to be so stressed and so tense if you take the exam, you won't do as well. My biggest advice is mix pleasure along with your studying; you can't make studying your life. It shouldn't be.”
Authors

Dr. Kasprovich is Interim Associate Dean of Post Licensure Programs, College of Nursing, Columbia College of Nursing, Glendale, and Dr. VandeVusse is Associate Professor Emerita and Director, Nursing Work-force Diversity Grant, College of Nursing, Marquette University, Milwaukee, Wisconsin.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Tammy Kasprovich, PhD, RN, CEN, Interim Associate Dean of Post Licensure Programs, College of Nursing, Columbia College of Nursing, 4425 N. Port Washington Road, Glendale, WI 53212; e-mail: tkasprov@ccon.edu.

Received: November 18, 2017
Accepted: April 12, 2018

10.3928/01484834-20180921-04

Sign up to receive

Journal E-contents