Why Are So Many Would-Be Nurses Failing Their Exams?

The U.S. is in desperate need of more nurses. Interest in the profession remains high, but every year thousands of would-be nurses fail their test requirements, depriving the workforce of potentially valuable staffers. Registered and practical nurses have to pass the National Council Licensure Exam (NCLEX) to practice anywhere in the country, but the pipeline of new talent appears to be broken.

The problem is most acute in the state of Florida, where fewer than two-thirds of nursing students failed to pass the exam in 2021, the lowest passing rate in the U.S. Florida’s pass rate is more than 17 points lower than the national average, according to a new report from the Florida Center for Nursing, based at the University of South Florida.

But not all nursing programs in Florida are to blame. Most of the state’s non-profit, public and community colleges have pass rates at or above the national average. But the state’s for-profit and private colleges have pass rates below 50%, dragging down the average.

The crisis is being felt up and down the state, according to Florida Hospital Association CEO Mary Mayhew, where one in five nurse positions remain vacant.

If this trend continues, hospitals are projected to be short by 59,100 nurses by 2035, according to a 2021 study from the Florida Hospital Association and Safety Net Hospital Alliance of Florida.

The state is producing more licensed nursing graduates than ever before. More than 12,400 new registered and practical nurses passed the NCLEX in 2021, marking a 30% increase over the last five years, but it’s still not enough to meet demand.

Gov. Ron DeSantis recently approved a $125 million spending package to increase nursing education in the state, but schools are having trouble putting those funds to good use. As the number of students increases, the passing rate drops. In 2021, Florida lost some 6,800 potential registered nurses and 1,400 potential practical nurses who took and failed the national exam.

Would-be nurses can retake the exam but the data shows that few take the test more than once and the chances of them passing gets even worse with each try.

Without a higher pass rate, “you’re going to see hospital units closing, wait times are going to get longer, elective surgeries are going to take longer to schedule and in general care is going to get worse,” said Rayna Letourneau, an assistant professor of nursing at USF and executive director of the Florida Center for Nursing. “When we look at the state as a whole it looks really bad, but you have to hone in to see the patterns.”

The majority of the problem seems to be concentrated in the southern part of the state. A recent report from the Florida Board of Nursing shows that more than half of all operating nursing programs in the state are for-profit.

Willa Fuller, executive director of the Florida Nurses Association, said there are some for-profit schools that provide a quality education but most of them can’t compete with nonprofits and public institutions. Fuller said she’s not sure why these schools are having so much trouble producing qualified nurses. “The research hasn’t been done and any statement at this point is just speculation. But we need to identify the best practices at high-performing schools and make those the norm across the state.”

She suspects the school’s business practices may be at odds with its responsibility to provide a quality education.

“When the business model is the driving force behind opening so many schools,” she said, “you need to ensure that standards are kept in place and focus on graduating well-educated nurses.”

The number of nursing schools has increased dramatically over the last few years. The Board of Nursing approved 231 programs between 2010 and 2013, more than doubling the number of nursing schools in the state.

But many of these institutions do not have the resources to meet the board’s requirements. Fuller encourages prospective nurses to find accredited institutions to ensure they will graduate with the skills they need to find work. Accredited programs can be harder to get into or have long waiting lists, she noted. But she encourages prospective students to be patient and do their homework.

“Nursing is hard. It’s life and death every day and you have to be prepared,” Fuller said. “And you need to know your (school) will train you right.”