HYBRID EVENT: You can participate in person at Boston, Massachusetts, USA or Virtually from your home or work.

7th Edition of Nursing World Conference

October 16-18, 2023 | Boston, Massachusetts, USA

October 16 -18, 2023 | Boston, Massachusetts, USA
NWC 2023

James Montegrico

Speaker at  Nursing World Conference 2023 - James Montegrico
University of North Carolina at Charlotte, United States
Title : Factors influencing National Council Licensure Examination–Registered Nurses (NCLEX-RN) outcomes of internationally educated nurses


Background: The United States’ (U.S.) nursing shortage attracted internationally educated nurses (IENs) from 187 countries and territories to migrate to the U.S. The National Council Licensure Examination–Registered Nurses (NCLEX-RN) is required to practice nursing in the U.S. From 2002 to 2021, a total of 285,094 IENs took the NCLEX-RN but more than half failed on first attempt (52.7%, n=150,244). Philippine educated nurses (PEN) comprised more than half of IENs in the U.S. nursing workforce. Only 45.8% of 177,730 NCLEX-RN applicants from the Philippines from 2002 to 2021 passed the exam on first attempt. Published studies investigating IEN NCLEX-RN performance are very limited. English language proficiency, support system, previous health care employment, familiarity with the NCLEX-RN, and differences in nursing education and practice were known to influence IENs’ NCLEX-RN outcomes. However, other relevant factors were not investigated. This study addressed this gap in the literature.

Aim:  This study determined the association between academic, initial nursing licensure, and employment factors on PEN NCLEX-RN passing on first attempt. It compared the characteristics of PEN who passed and failed the NCLEX-RN on first attempt to understand factors associated with successful NCLEX-RN outcomes.    

Methods: A retrospective correlation research design was used to determine the association between the research variables. A literature-based survey-questionnaire was developed for data collection. Two PhD-prepared nurses who are familiar with U.S. and Philippine nursing education performed content validity of the instrument. Participants were recruited through online nursing groups. The web-based survey was administered through Qualtrics. G*power analysis required 128 participants to produce an effect size of 0.30, power of 0.80, and 0.05 statistical significance. A total of 328 participants started the survey but only 140 completed (42.7% completion rate). Data analysis was done on R4.2. Descriptive statistics compared the characteristics of PEN who passed and failed the NCLEX-RN on first attempt. Chi square and Fisher’s exact test were used to determine the association between academic, licensure, and employment factors on PEN NCLEX-RN passing at first attempt. The Institutional Review Board of the University of North Carolina at Charlotte approved the study.

Results: Majority of the participants passed NCLEX-RN at first attempt (79.5%). Those who passed the NCLEX-RN at first attempt were mostly males (86%), single (83.1%), younger (mean age=27.9 years), graduated from public schools (89.5%), has graduate nursing degree (95.2%), and nursing was their first career choice (80.7%) compared to those who did not pass the NCLEX-RN at first attempt. Further, majority of those who passed the NCLEX-RN at first attempt passed their national nurse licensure examination at first attempt (82.8%), enrolled in a review center (83.3%), reviewed for four to six months (87.2%), were not employed while preparing for the NCLEX-RN (84.4%). For those who were employed, majority were employed full-time (80%), worked in a nursing job (83.5%), and employed in a non-hospital based setting (93.8%). However, only initial nursing licensure [Fisher’s p=.001] and nursing workplace [Fisher’s p=.026] were significantly associated with PEN NCLEX-RN passing on first attempt.

Conclusion: PEN have unique contextual academic and employment factors that are significantly associated with IEN NCLEX-RN outcomes. Passing the national nursing licensure examination at first attempt and selecting an appropriate nursing workplace may increase IEN chances of passing the NCLEX-RN. Identifying these factors are crucial in designing context-specific interventions, and to a broader scale, educational and regulatory policies to help IEN improve individual NCLEX-RN passing and country NCLEX-RN first-time pass rates.   

Audience Take Away Notes:

  • Research on internationally educated nurses (IENs) in general, and in particular their NCLEX-RN experiences and performance, is very limited. This presentation presents the magnitude of the problem (i.e., high failure rate) about IEN NCLEX-RN performance.  
  • Exploring an understudied but relevant area in international nursing education and workforce is essential in developing strategies to increase internationally educated nurses chances of passing the NCLEX-RN and improve country NCLEX-RN first-time pass rates.
  • Results of this study may help international nurse educators identify factors influencing NCLEX-RN outcomes that are relevant to their country’s educational and practice settings. Contextual-specific interventions can be designed based on these identified factors.
  • The understudied area of international nursing education and workforce calls for potential research collaboration among international nurse education researchers.


Dr. James Montegrico is an Assistant Professor and the Academic Success Coordinator at the University of North Carolina at Charlotte–School of Nursing. He earned his PhD from the University of North Carolina at Greensboro (USA), Master of Science in Nursing from Saint Paul University Philippines, and Bachelor Science of Nursing from the University of Santo Tomas (Philippines). He has a 30-year experience as a nurse, including 25 years as an educator in the associate, bachelor, masters, and doctoral levels of nursing education. His research interests include nursing education and nursing workforce, with special focus on internationally educated nurses and measurement of educational outcomes. Dr. Montegrico has several publications on his area of research and has presented his research at various local, regional, national, and international conferences. He is also an HIV/AIDS researcher, with research focus on improving HIV/AIDS knowledge, attitudes, and behaviors in adolescence and young adults and reducing stigma and discrimination among people living with HIV (PLHIV).