Title : Factors influencing National Council Licensure Examination–Registered Nurses (NCLEX-RN) outcomes of internationally educated nurses
Abstract:
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.
