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Little information is available regarding the consequences of new nursing graduates who fail the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The purpose of this study was to understand how these graduates could successfully pass this examination in subsequent attempts. Guided by Fisher's personal change model, the key research questions addressed the consequences of failing the NCLEX-RN exam and the actions the new graduate took after failing it. A phenomenological design was employed with a purposive sample of 17 new nursing graduates in the metropolitan area who had failed the NCLEX-RN. An inductive approach using a constant comparison, content analysis was used to analyze data. NVivo software was used to assist in identifying and clustering codes to form a thematic label. Emergent themes were extracted and then triangulated with those themes emerging from each respondent's interview. Results of the study indicated that students who failed the NCLEX-RN exam were depressed, isolated, and financially strained as they continued to pay their student loans during their unemployment. The findings indicated that schools of nursing seldom offer support for graduates who do not pass the exam. This finding informed the development of an NCLEX-RN preparation course to aid students to pass the NCLEX-RN exam, either on their first attempt or after failing the exam. Positive social change may occur as nursing school program directors and faculty use the results of the study to modify curriculum and develop strategies to ensure higher NCLEX-RN success rates.

Health care professionals and nurse educators are concerned about increasing percentage of first time test takers failing the NCLEX-RN exam. The purpose of this retrospective study was to examine predictive accuracy of the Assessment Technologies Institute (ATI) RN Comprehensive Predictor for passing or failing the NCLEX-RN exam in a cohort of nursing students (N = 195). South Eastern Technical College in South Carolina is in jeopardy of losing accreditation for their nursing program because of the low percentage of first time test takers failing. The college's pass rate on the NCLEX-RN exam has been below the national and state averages for the last 2 years. Guided by Bloom's taxonomy and Knowles' andragogical model of learning as the theoretical mainstay, factors that predict success with the NCLEX-RN exam for first time test takers were examined. Inferential and descriptive statistics were used to determine if a relationship existed between NCLEX-RN scores and the independent variables. A Pearson r correlation test was conducted to address whether the ATI Comprehensive Predictor accurately predict student success with the NCLEX-RN exam on first attempt. Multiple regression was employed to test for a significant relationship between prenursing GPA, final GPA, age, gender, and ATI predictor scores. Regression analysis results showed ATI Predictor scores to significantly predict student success with the NCLEX-RN exam on first attempt. Based on findings, a Structured Learning Assistance program was proposed to assist in preparing students for NCLEX-RN success. Positive social change occurs within the community, nursing programs, and health care by increased NCLEX-RN pass rates enhancing the number of nurses entering into health care.

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) first-time pass rate for an associate degree in nursing (ADN) program was below the national mean, presenting a problem for graduates who failed the NCLEX-RN and could not enter the workforce as registered nurses. Knowles's assumptions of adult learning, Ebbinghaus's forgetting curve, and Zull's neuroscience research served as the theoretical frameworks for this study. The purpose of this study was to identify which academic and time-lapse variables predict the graduate's first-time passage for the NCLEX-RN. Archived academic records and NCLEX-RN results for all 786 graduates from one ADN program who took the NCLEX-RN for the first time in 2015 were reviewed. Binary logistic regression analysis of the data identified multiple academic and one time lag factor as significant predictors for first-time NCLEX-RN passage. Key results included positive relationships between academic variables (prerequisite grade point average [GPA], nursing GPA, cumulative GPA, final course grade in 1 medical surgical course) and NCLEX-RN passage. An inverse relationship was shown between NCLEX-RN pass and the number of nursing component failures and time lag between clinical capstone completion and first NCLEX-RN attempt. Results informed a policy recommendation to provide timely intervention and resources for students at risk, with a goal of promoting success on the first attempt of the NCLEX-RN. Increasing the numbers of graduates who successfully complete the NCLEX-RN on the first attempt and promptly join the nursing workforce will demonstrate positive social change by mitigating the nursing shortage, which promotes safe patient care.

Nurse educators make decisions regarding the inclusion or exclusion of non-nursing courses in a curriculum. The current literature lacks research regarding which courses have the most impact on first-time nursing licensing examination pass-rates. The purpose of this quasi-experimental study was to investigate if there is a specific combination of courses that enhance first-time licensing examination pass-rates, using 161 randomly selected accredited associate degree nursing programs. General systems theory applied to nursing education was the framework for the study. ANOVA and independent t-tests were used to address the questions of non-nursing courses or discipline-specific set of non-nursing courses' impact on first-time licensure pass-rates. The ANOVA and independent t-tests analyses did not yield any significant non-nursing courses or discipline-specific sets of non-nursing courses. The findings indicate that non-nursing courses are not a significant subsystem in nursing education when the sole outcome used is NCLEX-RN pass-rates. Nursing faculty can use the results of this study as evidence that the inclusion or exclusion of one non-nursing course over another will likely not be detrimental to their program. This study can lead to positive social change through increasing the evidence-based knowledge from which faculty can base their curriculum.

This applied dissertation paper introduced a program evaluation of a secure laptop-based testing (SLBT) program, which was implemented from 2009 to 2014 in an undergraduate nursing program at a private institution in the southeastern region of the United States (US). Computerized testing is an old topic in the educational research field, but the instructor-made, laptop-based secure testing that utilizes learning management systems (LMS) for undergraduate nursing programs is a fairly new topic in the US. Traditionally, testing has been administered with paper and pencil in the undergraduate nursing programs in the US for security reasons. Recently, with different robust LMSs, together with availability of affordable laptops, SLBT has become a reality on many campuses. The undergraduate nursing program at the Adventist University of Health Sciences (ADU) began to implement the SLBT program in 2009, which allowed students to use their newly purchased laptops to take secure quizzes and tests in their classrooms. After nearly five years' SLBT program implementation, a formative evaluation was conducted to seek constructive feedback from students, faculty, and technology support personnel to improve the program. Evaluation data show that, overall, students believed the SLBT program help them get hands-on experience of taking exams on the computer and get them prepared for their National Council Licensure Examination for Registered Nurses (NCLEX-RN) which is also computerized. Students, however, had a lot of concerns on laptop glitches and campus wireless network glitches they experienced during testing. Faculty and technology support personnel, on the other hand, were very satisfied with the SLBT program. Another goal of this evaluation study was to determine if students' first-time passing rate of NCLEX-RN has been improved significantly after the implementation of the SLBT program. NCLEX-RN first-time passing rate data were analyzed using the Chi-Square test and it revealed that there was no significant association between the two types of testing method (paper-and-pencil testing and the secure laptop-based testing) and whether or not students would pass NCLEX-RN the first time X2(1) = 3.53, p > .05. Based on the odds ratio, however, the odds of students passed NCLEX-RN the first time were 1.37 times higher if they were taught with the SLBT testing method than if taught with the traditional paper-and-pencil testing method in nursing school.