Exit Exams: From a Regulatory Perspective

BY NANCY SPECTOR, DNSC, RN, Director of Education, National Council of State Boards of Nursing
BY MARYANN ALEXANDER, PHD, RN, Chief Officer, Nursing Regulation, National Council of State Boards of Nursing

A significant role for most state boards of nursing, whose mission is to protect the public, is the approval of nursing education programs in their state. As part of this process, many of the state boards review their schools’ annual pass rates of first-time NCLEX-RN® candidates and compare these percentages to state regulations. Schools whose pass rates fall below the state standard risk losing the approval of their state board of nursing.

Use of Exit Examinations
Frequently, nursing programs administer standardized assessment examinations, which are designed for bench-marking and remediation, to increase the percentage of their students passing the NCLEX-RN. These are often referred to as exit or progression examinations. While exit examinations can be valuable assessment tools for all types of nursing programs, they must be used prudently. Using them to evaluate students’ readiness for taking the NCLEX-RN and to design individualized remediation programs for those who need them is a win-win situation for both the students and nursing program. Students are provided with the opportunity to further prepare for the NCLEX-RN, and the school often collects useful data for strengthening its curriculum.

However, these examinations are sometimes administered only at the end of a nursing program, with little or no structured remediation available for students. Students are required to achieve a certain score on the exit examination before the school will allow them to graduate and take the NCLEX-RN. Students who have successfully passed the classroom and clinical components of the nursing curriculum and were preparing to graduate may find themselves at a stalemate. They are given no other option than to take the exit examination repeatedly until they achieve the school’s designated passing score. The predicament is frustrating and may create financial problems for students by delaying them in seeking employment. When schools do not provide remediation or communicate clear plans to help students, the students often contact the state boards of nursing looking for answers or recourse.

Boards of nursing have made several recommendations to prevent this type of scenario from occurring.  A compre-hensive assessment program throughout the curriculum, with adequate remediation resources, is the foundation for preparing students to pass the NCLEX-RN. The objective of using standardized assessment examinations is to identify students who have gaps in their nursing knowledge so re-mediation can occur sooner, rather than later. Care must be taken to ensure that the exit examination selected is psy-chometrically sound. Standardized examinations that are integrated throughout the program provide valuable feed-back for students, as well as program administrators and faculty. Students become accustomed to taking standard-ized examinations, their strengths and learning needs can be assessed and intervention can be provided throughout the program. Standardized examinations can also provide faculty with information not only about how their students are doing, but also about how the students compare to other students in nursing programs across the country.

State boards of nursing suggest that nursing programs make careful decisions on the passing standards set for exit examinations. A passing standard that is set too high may prevent students who would normally pass the NCLEX-RN from graduating and taking it. The current shortage of nurses in the United States makes it imperative that students who have successfully completed a nursing program and are ready to practice be allowed to take the NCLEX-RN. The sooner they do so, the sooner they can become licensed and enter the workforce.

Problems with Exit Examinations
In an informal survey of the 60 boards of nursing about their experiences with exit examinations, 42 boards re-sponded. While many did not report problems with the exit examinations, 15 of those surveyed reported having some problems with exit examinations being used at the end of programs. One state’s pass rate monitoring policy includes a statement that exit examinations alone should not be used as a bar to graduation when all other program requirements have been met. Other states are currently monitoring the use of exit examinations.

While most boards have no statutory or regulatory re-quirements specifically for exit examinations, many have managed exit examination problems in various ways. Some boards of nursing have sent letters to the nursing programs explaining the board’s recommendations on the use of such examinations. Others have counseled students to use the institutional grievance process. Still others have investigated programs for lack of fair and ethical practices for students when exit examinations have unfairly inhibited program completion. Many states have rules or regulations that require the nursing programs to have written policies outlining the requirements for graduation and to imple-ment those policies as written. Therefore, in some states, using an exit examination without a written policy could be a violation of the state rules or regulations related to nursing education.

While many of the students who have difficulty passing a school’s exit examination have also had trouble in their clinical experiences and coursework, occasionally a board of nursing receives a complaint from a student who did not achieve the school’s passing score on the exit examina-tion but maintained an above-average grade point average (GPA) throughout the entire nursing program. Schools that use exit examinations should compare the data from these examinations to students’ GPA. If it is consistently noted that students with high or above-average GPAs are scoring low on the standardized examinations, the nursing program should question what is occurring and evaluate their expectations of students, the curriculum, their teaching and testing methods, and their grading system. Multiple students failing the exit examination may be evidence that the program’s curriculum needs to be reviewed.

Increasing Pass Rates
One of the most effective ways nursing schools can in-crease their NCLEX-RN scores is by encouraging students to take the examination as soon as possible after gradu-ation. In the NCLEX-RN Delay Pass Rate Study, the Na-tional Council of State Boards of Nursing (NCSBN) (2002) found that when students (RN population testing in 1998-2000) took the NCLEX-RN 0 to 26 days after graduation, the first-time pass rate was 89.2 percent; 27 to 39 days after grad-uation, the first-time pass rate was 86.1 percent; 40 to 62 days after graduation, the first-time pass rate was 81.1 percent; and 63 to 1,568 days after graduation, the first-time pass rate was 51 percent. Encouraging students to take the examination as soon as possible after graduation should be a focus of all nursing programs. Exit examinations that hold students back from taking the NCLEX-RN may also compound students’ prob-lems by preventing them from taking the NCLEX-RN when their chances are best to pass it.

Overall, educational programs are effectively prepar-ing students to pass the NCLEX-RN. Contrary to what is sometimes reported, NCLEX-RN pass rates are not in a downward trend. In fact, data from NCSBN (2006) re-veals an increase in pass rates from 2004 to 2005.

Summary
When programs do have problems with NCLEX-RN pass rates, the state boards of nursing often work with the program administrators and provide them with rea-sonable time to make changes. In the end, educators and regulators have the same goal: graduating safe and com-petent nurses in sufficient numbers to meet the needs of the public. NCSBN is committed to this goal and will continue to conduct research and disseminate information and data that will support the state boards of nursing and help nursing programs make innovative changes. We all share the common interest of promoting quality education for future nurses.

References
National Council of State Boards of Nursing. (2002). NCLEX research report: The NCLEX® delay pass rate study. Re-trieved June 13, 2006, from http://www.ncsbn.org/pdfs/RecentNCLEXResearch_Web_Testing017B02.pdf
National Council of State Boards of Nursing. (2006). NCLEX® examination pass rates. Retrieved June 13, 2006, from http://www.ncsbn.org/testing/psychometrics_nclexpassrates.asp

Reprinted with permission from the Journal of Nursing Education (online at www.journalofnursingeducation.com.