Canadian NCLEX-RN outcomes: A two-year cross-sectional exploratory study in Ontario

Abstract

Background/Objective: In January 2015, 10 of 12 registered nurse regulators in Canada began using the National Council Licensure Exam for Registered Nursing (NCLEX-RN) as the entry-to-practice examination. We examine the NCLEX-RN performance of BScN graduates from three sites of one program across the first 2 years of its use. We aim to investigate the relationship between undergraduate academic performance and NCLEX-RN performance, and to determine predictors of success and/or failure on the exam.

Methods: A total of 215 graduates who wrote the 2015 or 2016 NCLEX-RN participated in the study. Course grades, final program percentage grade and GPAs, and students’ time to complete the program are examined against pass/fail performance on the NCLEX-RN. Student’s t test and Chi Square tests are used for comparative analysis. Logistic regression identified the odds ratio and associated 95% confidence interval for each one-unit increase in GPAs as a predictor of success.

Results: Overall, 141 of 215 (66%) graduates passed NCLEX-RN and 74 (34%) failed, with no significant difference between the two years. Time to complete the program is significantly lower (p = .002) and graduating GPA is significantly higher (p < .001) among those who passed the NCLEX-RN compared to those who failed. With one exception, all course grades are significantly higher for students who passed, compared to those who failed. The odds of passing the NCLEX-RN increase by 10 (95% CI 4.5, 22.6) for each one-point increase in GPA. At a GPA of 4.0, zero failures on NCLEX-RN are observed.

Conclusions: To our knowledge, this is the first Canadian systematic institutional based study examining the relationship between NCLEX-RN performance and academic factors. The study concludes high academic performance remains a strong predictor for NCLEX-RN success. Future, preferably multicenter larger studies, could further the understanding of the performance on this exam in Canada and support practices enhancing students’ success on the NCLEX-RN.