Who Will Pass and Who Will Fail? That is the Question. Should It Be?

The nursing education literature is full of research (of varying qualities) on predicting NCLEX-RN® passing and failure by nursing students. It has been a dominant topic in the literature since a national test became available. It seems that nearly every month, in one nursing education publication or another, there is some new report on predicting NCLEX-RN outcomes, programs to help students "at-risk" of failure on the NCLEX-RN, or about remediation of low-scoring students on some academic skill set.

What effect does this preoccupation by nursing faculty have on addressing other problems in nursing education? Most of the studies and reports put out on this topic focus on student-level variables. GPA. Test scores. Test anxiety. Course failures.

What about curriculum evaluation? There isn't much about that. If students get to the end of an academic program and are unprepared for the licensure exam, is that a student problem, or is that a curricular problem? Students don't pass themselves. Faculty pass students on to the next course. So, what are students to think when they get to the end of a program yet are un(der)prepared to take the NCLEX-RN? Is it really their fault? I think not. In the age of public school accountability, it is not only students who pay, but also faculty when student performance is sub-par. In nursing education, however, it is much easier to shift the burden to students and make the issue one of student preparation, rather than one of the systems and processes that get students to the end of their programs, un(der)prepared, in the first place.

Calibration is key. Curricula must be calibrated to the test. This does not mean that one cannot teach more than is on the test (NCLEX-RN), but you certainly cannot teach less than is on the test and expect graduates to pass. The NCLEX-RN blueprint changes periodically, and every 2-3 years it seems the passing standard on the NCLEX-RN is raised (the test becomes more difficult to "pass"). Do faculty stay on top of these changes and re-calibrate their curricula to meet the dynamic nature of the licensure exam? If the passing standard increased periodically, are nursing education curricula adjusted accordingly in difficulty level? This could be part of the seemingly omnipresent problem of NCLEX-RN pass rates.

I won't discuss whether or not the NCLEX-RN should drive nursing education (at least at the pre-licensure level) like it does. It truly does, no questions asked. If it was announced tomorrow that the NCSBN was changing the content of the licensure exam to include a significant focus on genetic therapies for developmental disorders, schools would be compelled to increase or add this content to their current curricula. What I think is happening is that less distinct changes, such as a .07 logit increase in the passing standard, are not being followed by schools as closely as they should be. True, the national pass rate doesn't "plummet" when the passing standard is changed, but NCLEX pass rates seem to be a nagging problem for schools, and this could reflect the underlying, always dynamic nature of the test graduates take to become licensed. This idea is not to forsake issues of quality and consistency in curricula themselves, but it is a reasonable proposition, given the gravity of the data present on the problem.