Journal of Nursing Education

Research Briefs 

Determining Postgraduation Readiness to Take the NCLEX-RN®

Heidi E. Monroe, PhD, RN-BC, CAPA; Kathleen Dunemn, PhD, APRN, CNM

Abstract

Background:

This study examined the variables of gender, age, previous degree, first-generation college, type of nursing program, grade point average (GPA), amount of postgraduation recommended preparation completed, average score on recommended preparation examinations, the score on a postgraduation readiness examination, and the NCLEX-RN® outcome.

Method:

An exploratory field study approach was used to explore relationships among variables. The study was retrospective and longitudinal with quantitative data collected and analyzed and explored further by interviews.

Results:

A postgraduation readiness examination was found to accurately predict the NCLEX-RN outcome. Correlations were found between the readiness examination score and gender, first-generation college, GPA, amount of recommended preparation completed, and average score on recommended preparation tests. Anxiety was the common theme for the outliers.

Conclusion:

This study provided rich data about postgraduation readiness to take the NCLEX-RN examination and lays the groundwork for further research on postgraduation variables associated with NCLEX-RN success. [J Nurs Educ. 2020;59(2):101–106.]

Abstract

Background:

This study examined the variables of gender, age, previous degree, first-generation college, type of nursing program, grade point average (GPA), amount of postgraduation recommended preparation completed, average score on recommended preparation examinations, the score on a postgraduation readiness examination, and the NCLEX-RN® outcome.

Method:

An exploratory field study approach was used to explore relationships among variables. The study was retrospective and longitudinal with quantitative data collected and analyzed and explored further by interviews.

Results:

A postgraduation readiness examination was found to accurately predict the NCLEX-RN outcome. Correlations were found between the readiness examination score and gender, first-generation college, GPA, amount of recommended preparation completed, and average score on recommended preparation tests. Anxiety was the common theme for the outliers.

Conclusion:

This study provided rich data about postgraduation readiness to take the NCLEX-RN examination and lays the groundwork for further research on postgraduation variables associated with NCLEX-RN success. [J Nurs Educ. 2020;59(2):101–106.]

Passing the NCLEX-RN® on the first attempt is important. To the nursing graduate, failing the examination is often a traumatic experience and can have both psychological and financial effects. It is important to help reduce the current nursing shortage that the United States is experiencing and that is expected to intensify as Baby Boomers age and the need for health care grows and as a significant segment of the nursing workforce nears retirement age (American Association of Colleges of Nursing, 2014). It is also important to nursing programs as NCLEX-RN pass rates are considered by many to be the gold standard of nursing education program quality and success and poor NCLEX-RN pass rates can have an impact on nursing programs' accreditation, funding, and enrollment (Carrick, 2011; Commission on Collegiate Nursing Education, 2018; Giddens, 2009; Sayles & Shelton, 2005; Simon, McGinniss, & Krauss, 2013; Taylor, Loftin, & Reyes, 2014).

Due to the significance of candidates' outcomes on the NCLEX-RN, many studies have been conducted about it over the years. The literature reflects a wide array of variables used to predict NCLEX-RN success. Academic variables investigated include (a) college grade point average (GPA) and course grades (Bennett, Bormann, Lovan, & Cobb, 2016; Elkins, 2013; McCarthy, 2012; Romeo, 2013); (b) standardized test scores (Cooper, 2012; Elkins, 2013; Grossbach & Kuncel, 2011; Kehm, 2013; McCarthy, Harris, & Tracz, 2014; Serembus, 2016; Yeom, 2012); (c) critical thinking (Giddens & Gloeckner, 2005; Kaddoura, Flint, Van Dyke, Yang, & Chiang, 2017); and (d) preparation strategies (Cox-Davenport & Phelan, 2015; Hyland, 2012; Monroe & Schweizer, 2017; Pennington & Spurlock, 2010; Quinn, Smolinski, & Peters, 2018). Nonacademic variables investigated include pregraduation variables of student demographics (Kaddoura et al., 2017), test anxiety (Custer, 2018; Williams, 2010), and postgraduation variables of the time interval from graduation to NCLEX-RN test date (Woo, Wendt, & Liu, 2009), amount of time studying (Silva, 2014), employment (McFarquhar, 2006; Silva, 2014), and test anxiety (Silva, 2014). However, the findings from many of these studies are mixed. In addition, most of these studies examined factors prior to admission or during the nursing program. Few studies have examined postgraduation factors.

Since no in-program academic variables to accurately predict NCLEX-RN outcome have been identified, this study sought to examine both in-program and after-program or postgraduation factors associated with the NCLEX-RN outcome. The purpose of this study was twofold. The first aspect was to determine whether a score on a postgraduation examination—typically approximately 1 week before planning to take the NCLEX-RN—predicted passing the NCLEX-RN with 95% confidence and any relationships between several variables. The second aspect of the study was to explore the factors that the outliers identified as contributing to their outcome. The outliers included (a) candidates who met the benchmark score on the postgraduation readiness examination yet did not pass the NCLEX-RN or (b) candidates who scored 4% or more below the benchmark on the postgraduation readiness examination and passed the NCLEXRN.

Method

Design

This study used an exploratory field study design that had two phases. The first phase involved quantitative data collection and analysis, the results of which determined the participants in the second phase. An exploratory field study is one in which relationships are explored among variables that take place in the real world (not in a laboratory) and there is no manipulation of the variables (Remler & Van Ryzin, 2015). Such an approach was appropriate for the purpose of identifying variables associated with passing or failing the NCLEX-RN. The quantitative variables examined included gender, age, previous degree, being a first-generation college student, nursing program, end-of-program GPA, amount of completed recommended NCLEX-RN preparation, average score on recommended NCLEX-RN preparatory examinations, score on a postgraduation readiness examination, and NCLEX-RN outcome.

The recommended NCLEX-RN preparation for this study was a list of various tests from the review course vendor identified by the college's NCLEX-RN coordinator for graduates to complete after the NCLEX-RN review course. The postgraduation readiness examination used for this study was a computerized standardized examination offered by a standardized testing vendor in conjunction with their NCLEX-RN review course. The 180-question NCLEX-RN-style examination has both multiple choice and alternate style questions. Candidates are advised to take the examination in a quiet, distraction-free environment to simulate actual testing conditions approximately 4 to 7 days before their scheduled NCLEX-RN date. The vendor's data on this examination showed a statistically significant correlation at .26 (p = .00) between the score on this examination and the NCLEX-RN outcome indicating that as the readiness examination score increases, so does the likelihood of passing the NCLEX-RN examination. The vendor's statistics identified the examination score, or benchmark, associated with a 95% probability of passing the NCLEX-RN examination was 61.7%.

Setting

The setting for this study was a private, nonprofit health sciences college in the midwestern United States that has two prelicensure nursing programs (a traditional baccalaureate nursing [BSN] program and a 15-month BSN program). The college has a nursing faculty position of an NCLEX-RN coordinator who supports NCLEX-RN success within the prelicensure nursing curricula and assists graduates in preparing for the licensure examination.

Procedure for Data Collection

Institutional review board approval was obtained for this study. Data collected from the college were both nominal and ordinal and were deidentified or coded so that the researcher did not know the identity of any individual's data. Data were obtained from the college's registrar and dean of nursing. The registrar and dean of nursing determined codes for the graduates in the sample and each provided different parts of data for the study. Thus, no one knew the identity of the complete data set. The deidentified data obtained from the college's registrar included student age, gender, any previous degrees, status as a first-generation college student, nursing program (traditional or 15-month BSN), and end-of-nursing program GPA. The deidentified data obtained from the college's dean of nursing included graduates' score on the readiness examination, the amount of recommended NCLEX-RN preparation completed, and the graduates' outcome on the first attempt on the NCLEX-RN (which is public information). The researcher then entered all coded data into an Excel® spreadsheet and transferred it into SPSS® version 25 for analysis. Only data on graduates who took the NCLEX-RN were collected. Those who did not take the NCLEX-RN were excluded from the study. Because data in the first phase (quantitative) are data normally collected by the researcher in her role at the college, consent was not sought from these participants.

Consent was obtained from the participants involved in the second phase of this study. Data collection for the second phase involved face-to-face or telephone interviews using an interview script with primarily open-ended conversational questions, with the researcher acting as the tool for data collection. Interviews were used to supplement and more deeply explore data obtained in phase one.

Five in-person face-to-face interviews and two FaceTime® interviews were conducted. All participants were asked how long after taking the NCLEX-RN review course they took the NCLEX-RN, whether they were working while preparing for NCLEX-RN, and if so, what type of work and how many hours per week. Participants who had failed the NCLEX-RN were asked to describe their experience taking NCLEX-RN and what they thought contributed to their outcome on the examination. If participants mentioned anxiety, they were asked how they thought anxiety affected them. Participants who had scored below the benchmark score on the readiness examination yet passed the NCLEX-RN were asked to describe their experience taking the readiness examination and what they thought contributed to their outcome on that examination. They were also asked what they thought contributed to success on the NCLEX-RN and how they managed anxiety.

Description of Sample

All students who graduated from the prelicensure BSN programs between May 2016 and May 2018 were included in the sample for phase one (N = 284). All 284 graduates completed the NCLEX-RN review course provided the college's standardized testing vendor. The population of interest for the second phase of the study were the outliers from the first phase. There were 10 outliers in phase one, with an actual sample size of seven.

Data Analysis

SPSS version 25 software was used to analyze data in phase one. Several different statistical procedures were conducted to evaluate relationships between the dependent variable (first-attempt NCLEX-RN outcome) and independent variables (gender, age, previous degree, status as first-generation college student, type of nursing program, end-of-program GPA, amount of recommended NCLEX-RN preparation completed, the average score on the recommended NCLEX-RN preparation examinations, and postgraduation readiness examination score). Because there were few first-time failures in the sample (15 or 5% of the total 284 and 12 or 4.6% of the 257 who completed a postgraduation readiness examination), data were skewed. Therefore, nonparametric tests (Mann-Whitney U test and Spearman correlation coefficient) were conducted to evaluate relationships among variables.

Interviews in the second phase of the study were conducted by the researcher and recorded. All recordings were listened to at least twice to ensure accuracy in transcription. Data from interviews were analyzed by the researcher using a systematic procedure to synthesize themes from interviews into a description of the participants' experiences and then a composite description of the factors contributing to their NCLEX-RN outcome was constructed.

Results

Postgraduation Readiness Examination Score and NCLEX-RN Outcome

Because data did not fit the normal distribution, the nonparametric Mann-Whitney U test was used to determine whether a relationship existed between the score on a postgraduation readiness examination (ordinal variable) and the outcome on the NCLEX-RN (dichotomous variable). Two hundred fifty-seven of the 284 participants in phase one completed the postgraduation readiness examination. The median score on the postgraduation readiness examination for participants who passed the NCLEX-RN on their first attempt was 68% and 61% for those who failed. The p value for the Mann-Whitney U test was analyzed at .024, which is below the α level of .05. Thus, a significant relationship was found between scores on the postgraduation readiness examination and the outcome on the NCLEX-RN (Table 1).

Description of Sample for Phase 1

Table 1:

Description of Sample for Phase 1

Variables Associated With the Postgraduation Readiness Examination Score

Correlations between the variables of gender, age, previous degree, status as a first-generation college student, nursing program (traditional or 15-month), end-of-program GPA, amount of completed recommended NCLEX-RN preparation, and average score on recommended NCLEX-RN preparation examinations, and the score on a postgraduation readiness examination were explored. No statistically significant associations were found between student age, previous degree, or nursing program and scores on the postgraduation readiness examination (n = 257). Although a statistically significant relationship was found between first-generation college students and the score on the postgraduation readiness examination, it was a weak correlation (p = .043). This was not considered a strong enough correlation to make any changes until confirmed by a study with a larger and more diverse sample. The variables found to have a statistically significant relationship with the score on a post-graduation readiness examination, and thus the NCLEX-RN outcome, were gender, end-of-nursing program GPA, amount of recommended NCLEX-RN preparation completed, and the average score on the NCLEX-RN preparatory examination. The relationship between the dichotomous variable of gender and the score on a postgraduation readiness examination was that women scored higher on the examination than men (p = .0002). The relationships identified between the ordinal variables and the score on a postgraduation readiness examination were those with a higher end-of-nursing program GPA scored higher on the postgraduation readiness examination (Spearman correlation coefficient; p = .480; p = .000); those who completed more of the recommended NCLEX-RN preparation scored higher on the postgraduation readiness examination (Spearman correlation coefficient; p = .213; p = .001), and those with a higher average score on the NCLEX-RN preparatory examinations scored higher on the postgraduation readiness examination (Spearman correlation coefficient; p = .581; p = .000) (Table 1).

Factors Influencing Failing and Passing the NCLEX-RN

Although the score on a postgraduation readiness examination was found to be predictive of passing the NCLEX-RN, there were some outliers—those who met the benchmark score on a postgraduation examination yet did not pass the NCLEXRN examination, as well as those who scored 4% or more below the benchmark and passed the NCLEX-RN (Table 2).

Description of Sample for Phase 2

Table 2:

Description of Sample for Phase 2

After using a systematic procedure to synthesize themes from the interviews, the common theme identified among all seven participants was anxiety or nervousness. The four participants who had met the benchmark score on the postgraduation readiness examination yet did not pass the NCLEX-RN on the first attempt reported anxiety both prior to and during the NCLEX-RN. All four reported being distracted, either by movement and noises in their surroundings or by thoughts running through their heads, while taking the NCLEX-RN and were not able to focus on the questions. A few of these participants also reported the check-in process for the NCLEX-RN contributed to their anxiety.

The three participants who had scored below the benchmark on the postgraduation readiness examination and still passed the NCLEX-RN on the first attempt identified anxiety or nervousness while taking the postgraduation readiness examination and felt that it contributed to a lower score on their examination. All three participants reported having anxiety leading up to the NCLEX-RN; however, the difference between these participants and those who met the benchmark score and failed the NCLEX-RN was that their anxiety subsided while taking the NCLEX-RN. Thus, they were able to focus on the test questions. They reported that they were not distracted by their surroundings or thoughts running through their heads.

Conclusion

Although many studies attempting to identify predictors associated with NCLEX-RN success have been conducted over the years, the findings have been mixed and few have been proven reliable over time. In addition, most of these studies examined factors prior to admission or while students were in a nursing program—few examined postgraduation factors. The findings of this study identified a postgraduation readiness examination as a test that accurately predicted passing the NCLEX-RN. Subsequently, a correlation between the amount of recommended NCLEX-RN preparation completed and the average score on the recommended NCLEX-RN preparation examinations and the score on the postgraduation readiness examination was significant. Nursing programs should counsel graduates about these correlations and encourage completion of the recommended NCLEX-RN preparation, treating the postgraduation readiness examination as a practice NCLEX-RN, and using the results of the readiness examination to determine their readiness to take the NCLEX-RN. Nursing programs should also consider following up with students after graduation to inquire about their NCLEX-RN preparation and provide support and encouragement.

Because a significant relationship between end-of-nursing program GPA and women scoring significantly higher than men—such as on the score on the postgraduation readiness examination—nursing programs should conduct ongoing assessment of students' GPAs. Students with lower GPAs, particularly male students, could be identified as at risk and placed into a remediation program and provided with academic support (e.g., sessions on testing-taking strategies, mentoring, tutoring, and anxiety management).

Although a postgraduation readiness examination was found to be predictive of the NCLEX-RN outcome, there were some outliers. The common factor for these outliers was anxiety. While all outliers reported anxiety leading up to the NCLEXRN (some identified the check in process for the licensure examination as increasing their anxiety), the difference appeared to be that those whose anxiety subsided or was managed during the examination were able to focus on the questions. Whereas those who continued to have anxiety while taking the examination were distracted by movement or noises in the testing environment or by their thoughts, preventing them from being able to focus while taking the test.

This study provided rich data about determining postgraduation readiness to take the NCLEX-RN that is useful for both faculty and graduates. Sparse publicly available published data exist regarding postgraduation factors associated with NCLEXRN success, so the results of this study lay the groundwork for further research on this topic. Duplicating this study with a larger, more diverse sample that included participants from several different colleges and types of nursing programs and with a larger percentage of first-time NCLEX-RN failures could provide more generalizable results.

References

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  • McCarthy, M.A. (2012). Academic and nursing aptitude and the NCLEXRN in baccalaureate programs. Retrieved from https://pdfs.semantic-scholar.org/4f6a/e903f7ac20f81fb50fc08b794d9472612aeb.pdf
  • McCarthy, M.A., Harris, D. & Tracz, S.M. (2014). Academic and nursing aptitude and the NCLEX-RN in baccalaureate programs. Journal of Nursing Education, 53, 151–160. doi:10.3928/01484834-20140220-01 [CrossRef]
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  • Monroe, H.E. & Schweizer, A. ( 2017, July. ). NCLEX-RN success & preparation strategies: A national study. Poster presented at the 2017 Nurse Educators Conference in the Rockies. , Breckenridge, CO. .
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  • Serembus, J.F. (2016). Improving NCLEX first time pass rates: A comprehensive program approach. Journal of Nursing Regulation, 6(4), 38–44.
  • Silva, C.L. (2014). The lived experience of graduate nurses with multiple NLCEX-RN failure. Retrieved from https://unco.idm.oclc.org/login?url=https://search-proquest-com.unco.idm.oclc.org/docview/1639079558?accountid=12832
  • Simon, E.B., McGinniss, S.P. & Krauss, B.J. (2013). Predictor variables for NCLEX-RN readiness exam performance. Nursing Education Perspectives, 34, 18–24.
  • Taylor, H., Loftin, C. & Reyes, H. (2014). First-time NCLEX-RN pass rate: Measure of program quality or something else?Journal of Nursing Education, 53, 336–341 https://doi-org.unco.idm.oclc.org/10.3928/01484834-20140520-02
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  • Woo, A., Wendt, A. & Liu, W. (2009). NCLEX pass rates: An investigation into the effect of lag time and retake attempts. JONA's Healthcare Law, Ethics and Regulation, 11, 23–26.
  • Yeom, Y. (2012). An investigation of predictors of NCLEX-RN outcomes on the first-attempt among standardized tests. Retrieved from https://unco.idm.oclc.org/login?url=https://search-proquest-com.unco.idm.oclc.org/docview/1081743390?accountid=12832

Description of Sample for Phase 1

VariableValue
Sample size284a
NCLEX-RN® outcome, n
  Passed269 (94.7%)
  Failed15 (5.3%)
Gender, n
  Female257 (90.5%)
  Male27 (9.5%)
Previous degree, n
  Yes71 (25%)
  No213 (75%)
First-generation college student, n
  Yes110 (38.7%)
  No174 (61.3%)
Nursing program, n
  Traditional154 (54.2%)
  15 month30 (45.8%)
Age (years)
  Range21 to 56
  Mean24.5
  Median23
End-of-program grade point average
  Range2.36 to 4.0
  Mean3.35
  Median3.37
Amount of recommended NCLEX-RN preparation completed
  Range0% to 133.9%
  Mean79.9%
  Median84.2%
Average score on recommended NCLEX-RN preparation examinations
  Range46.4% to 71%
  Mean57.9%
  Median57.9%
Average score on the readiness examination
  Range53% to 88%
  Mean67.9%
  Median67%

Description of Sample for Phase 2

VariableMet Benchmark Score and Failed NCLEX-RN®Scored ≥ 4% Below Benchmark and Passed NCLEX-RN
Sample size, n (10 participants met criteria, 7 participated in the study)6 met the criteria, 4 interviewed4 met the criteria, 3 interviewed
Gender, n
  Female64
  Male00
Previous degree, n
  Yes02
  No62
First-generation college student, n
  Yes11
  No53
Nursing program, n
  Traditional42
  15-month22
Age (years)
  Range22 to 25
  Mean23.8
  Median24
End-of-program grade point average
  Range2.50 to 3.492.85 to 3.38
  Mean3.043.17
  Median3.113.23
Amount of recommended NCLEX-RN preparation completed
  Range50.7% to 110.5%73% to 111.3%
  Mean88.7%92%
  Median92.1%91.8%
Average on recommended NCLEX-RN preparatory examinations
  Range51% to 62.5%54.3% to 58.2%
  Mean55.1%55.6%
  Median53.5%54.9%
Average score on the readiness examination
  Range64% to 87%54% to 56%
  Mean72%55.3%
  Median67.5%55.5%
Authors

Dr. Monroe is Assistant Professor/NCLEX–RN Coordinator, Bellin College, Green Bay, Wisconsin; and Dr. Dunemn is Professor and Coordinator, Doctor of Nursing Practice Program, University of Northern Colorado, Greeley, Colorado.

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

Address correspondence to Heidi E. Monroe, PhD, RN-BC, CAPA, Assistant Professor/NCLEX-RN Coordinator, Bellin College, 3201 Eaton Rd., Green Bay, WI 54311; e-mail: heidi.monroe@bellincollege.edu.

Received: May 13, 2019
Accepted: November 04, 2019

10.3928/01484834-20200122-09

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