Throughout the past decade, the aging population and nursing shortage have caused a significant surge in the demand for nurses in all health care settings across the globe. From 2021–2031, the Registered Nursing (RN) workforce is expected to grow by 6% (). One of the fastest methods to address this shortage is implementing an Accelerated Bachelor of Science in Nursing (ABSN) program (). Tracing back to 1971, accelerated nursing degree programs were launched with the ability for students to complete the program within 12 to 18 months to ameliorate the nursing shortage emergency (). According to the AACN (), an estimated 28,580 students were enrolled in 321 accelerated baccalaureate programs in 2022. Nursing schools worldwide continue to increase the number of ABSN graduates, providing quality patient care and increasing diversity in age, ethnicity, and experience to the nursing profession.
Although ABSN programs have become prevalent in nursing, nursing educators still strive to ensure the quality of ABSN students' admissions and their successful passing of the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) on their first attempt. The NCLEX-RN is a national licensure examination for nursing graduates to successfully pass and be licensed as RNs in the United States and Canada. Because this is the main licensure examination for undergraduate nurses, success in passing the NCLEX-RN is imperative for all nursing students to enter the nursing workforce as RNs. Thus, passing the NCLEX-RN examination on the first attempt is considered a significant accomplishment for students and demonstrates their preparedness to join the nursing workforce, boosts their confidence, and provides a sense of validation for the hard work they have put into their nursing education (). On the other hand, failing the NCLEX-RN examination may cause an array of mental health and practical issues, such as social stigma, feelings of loss and embarrassment, low self-esteem, and financial concerns ().
For health care organizations, employers often view passing the NCLEX-RN examination on the first attempt as an indicator of a nurse's readiness for the job, with the ability to provide safe and effective patient care (). Nursing programs also are expected to meet the NCLEX-RN first-time pass threshold set by the National Council State Boards of Nursing (NCSBN). Failure to meet this threshold can result in these nursing programs being placed on probation, with the risk of the program being closed unless remediation measures are implemented to achieve the first-time NCLEX-RN passing rate threshold (; ). As a result, passing the NCLEX-RN examination on the first attempt is critical for the students themselves, health care organizations, and nursing programs. Therefore, a profile of ABSN students includes: (1) a minimum preadmission grade point average (GPA) between 3.0 and 3.5; (2) obtaining a grade of C or higher in prerequisite courses such as Microbiology, Anatomy and Physiology I and II, and Statistics; and (3) taking the Graduate Record Examination (GRE®), which some nursing schools require, are all factors that have been considered when accepting students into an ABSN program ().
Research conducted on ABSN programs and ABSN students' NCLEX-RN pass rate has not been well-documented in the literature, and more studies are needed to examine the associations between admission requirements and NCLEX-RN first-time success rate among ABSN students (; ; ). Previous studies have reported first-attempt NCLEX-RN pass rates range from 76.7% to 94% among ABSN students (; ; ). These studies showed that improving the passing rates among ABSN students is important for evaluating the program's success and future development needs. During the past two decades, most studies primarily explored predictors associated with passing the NCLEX-RN at the conclusion of traditional 4-year BSN nursing programs (; ; ). These predictors included academic variables such as standardized tests scores (SAT® or ACT®); students' performance in courses (e.g., cumulative GPA and the number of grades C or below in nursing courses); and students' scores on standardized nursing assessment tests, namely Health Education Systems (HESI) (; ), Assessment Technologies Institute (ATI) (; ), and Kaplan ().
In addition to academic variables, studies also examined nonacademic variables, such as age, gender, ethnicity, primary language, and critical thinking (; ). However, few studies examined factors associated with ABSN programs' NCLEX pass rate and admission criteria. In addition, students enrolled in ABSN programs often are older and have previous academic records compared with traditional BSN students admitted either directly after high school or transferred from community colleges. Thus, ABSN students might have different NCLEX-RN pass rate predictors than traditional BSN students.
An earlier study by Kaddoura and colleagues () revealed that speaking English as a second or additional language, cumulative GPA, proportion of grades ≤ C, and the HESI® Exit Exam scores were all significant predictors of first-time NCLEX-RN pass rate among graduate students. Abbott et al. () also explored predictors of ABSN students' success on the NCLEX-RN and found that students who had a higher GPA in certain senior courses (e.g., complex care course) and did well on their HESI pre-RN assessment were more likely to pass the NCLEX-RN on their first attempt. In addition, ABSN students whose first degree was in science performed better on their first NCLEX-RN attempt than those with a nonscience degree (). A study by Penprase and Harris () on an ABSN program indicated students' performance on the standardized exit examination (e.g., HESI) was significantly associated with their performance on the NCLEX-RN. They also reported that a psychology course grade, which showed students' critical thinking, was also associated with a higher pass rate on the NCLEX-RN (). Moreover, the Kaplan Diagnostic Test, which replaced the HESI pre-RN assessment in the study, also was a significant predictor of NCLEX-RN first-time pass. However, this has rarely been investigated as a potential predictor, especially among ABSN students ().
In addition, a study by Bowie and Carr () reported ABSN students who had above-average GRE quantitative scores were more likely to pass the NCLEX-RN on the first time. However, few studies examined the influence of ABSN students' GRE scores (verbal reasoning and quantitative separately or cumulatively) on NCLEX-RN passing rate. Because GRE verbal reasoning tests assess students' critical thinking and reasoning skills across a wide range of situations, it may be imperative to explore whether ABSN students' GRE scores will affect the NCLEX-RN first-time passing rate (). Therefore, this study aimed to explore factors that may predict ABSN students' success in passing the NCLEX-RN examination on the first attempt, including comprehensive academic and nonacademic factors.
Method
Design
This study used a descriptive, retrospective design to: (1) compare the mean difference of GRE scores at admission and GPA at graduation between ABSN students who passed the NCLEX-RN the first time and those who did not; and (2) examine factors that predict first-time NCLEX-RN success among ABSN students.
Sample and Setting
The sample included 591 nursing students who graduated from an accelerated prelicensure baccalaureate program at one University in Southwestern Pennsylvania between 2008 and 2019. Before the 2016 Fall term, GRE scores were needed for admission consideration among ABSN applicants. After 2016, GRE scores no longer were an admission requirement; nonetheless, students admitted to the ABSN program had to take the GRE test before starting the program. The analysis includes the Kaplan Diagnostic and Comprehensive Test scores, which were introduced in the 2016 academic year to improve the NCLEX-RN passing rate. Thus, the Kaplan test scores were only available in the last 3 years of the study. The study was approved by the University's Institutional Review Board.
Measures
The following nine components were collected as potential predictors of first-time NCLEX-RN success: (a) age at admission; (b) cumulative GPA at graduation based on a 4-point scale; (c) GRE verbal reasoning score at admission (range, 130 to 170); (d) GRE quantitative score at admission (range, 130 to 170); (e) whether the student was admitted with GRE scores; (f) Kaplan Diagnostic Test score percentile; (g) Kaplan Comprehensive Test score percentile; (h) whether the student met the Kaplan Diagnostic Test threshold (≥65%); and (i) whether the student met the Kaplan Comprehensive Test threshold (≥61%).
Concerning the Kaplan Diagnostic and Comprehensive Tests, the Kaplan Diagnostic Test is administered at the beginning of the last term of the completion of the ABSN program. The Kaplan Diagnostic Test aimed to identify students' strengths and weaknesses in certain nursing content areas, such as pharmacology or medical-surgical care. It also can help prepare students to take the Kaplan Comprehensive Test and subsequent NCLEX-RN examination. In the school's Kaplan Diagnostic Test, ABSN students were expected to score ≥65%, which indicates a 94.1% probability of passing the NCLEX-RN on the first attempt. Remediation measures were applied if students failed to pass the threshold (≥65%). Students were automatically assigned cases and follow-up items expected to enhance their performance on the Kaplan Comprehensive and NCLEX-RN examinations. The Kaplan Comprehensive Test, which is administered near the end of the ABSN program, consists of 180 multiple-choice questions that should be completed within 3 hours in a setting similar to that observed for the NCLEX-RN examination. For the school's Kaplan Comprehensive Test, ABSN students were expected to score ≥61%, which increases their chances of passing the NCLEX-RN examination on the first attempt by more than 94.8%. These threshold cut points align with the literature, which indicates students who score ≥60% on their Kaplan tests are more likely to pass the NCLEX-RN examination on their first attempt (). In the current study, Kaplan test thresholds (values of Kaplan test threshold) were used to identify students who passed the Kaplan tests. Information on NCLEX-RN pass or failure results was collected based on the quarterly reports for every graduate from the State Board of Nursing.
Data Collection
Data for this study were retrieved from two sources: (1) the existing school of nursing database system; and (2) the university's student data warehouse. The school of nursing's system analyst was tasked with gathering the data and de-identifying the records to ensure confidentiality.
Statistical Analysis
Data were analyzed using SPSS® version 25. Descriptive statistics were calculated for each academic year and were presented either as mean and SD for continuous variables (e.g., age at admission, cumulative grade point average [CGPA] at graduation, GRE scores, and Kaplan Diagnostic and Comprehensive Test scores' percentile) or frequencies and percentages for categorical variables (e.g., whether ABSN students were admitted with a GRE score and whether they met the Kaplan Diagnostic and Comprehensive Tests threshold). For continuous variables, Mann–Whitney tests were used to examine the differences between ABSN students who passed the NCLEX-RN the first time and those who did not. For categorical variables, the chi-square test and Fisher's exact test were used to examine the difference in NCLEX-RN first-time pass between ABSN students admitted with and without GRE scores, and between students who met or did not meet the Kaplan Diagnostic and Comprehensive Tests threshold.
Two logistic regression models were created to identify potential predictors of NCLEX-RN first-time pass rate (NCLEX-RN FTPR). The first logistic model consisted of the entire sample (n = 591) and included age at admission, CGPA at graduation, GRE scores, and whether GRE scores were required at admission as independent variables and NCLEX-RN FTPR as a dependent variable. Because Kaplan test findings were only available in the previous 3 years of the study (n = 205), the second model was limited to the last 3 years, and percentiles of Kaplan test scores were added as independent variables to the other previously mentioned independent variables. To select the best model, a stepwise logistic regression was performed, where predictors remained at the significance level of .05 and were removed from the model at a significance level of .1. For descriptive statistics and comparative analyses, the findings for both continuous (percentiles of Kaplan tests scores) and categorical (dichotomous variable using cut percentiles for meeting thresholds) Kaplan tests were reported. However, in the second logistic regression model, only Kaplan test score percentiles (continuous variable) were included to avoid redundancy.
Results
Descriptive Statistics
The study participants included 591 ABSN students who graduated between August 2008 and August 2019. Table A (available in the online version of this article) shows the descriptive statistics of the total study population. The mean age of students at admission was approximately 27 years (SD = 5.7). The average CGPA at graduation for the entire sample was 3.5 (SD = 0.3). The total sample mean GRE verbal reasoning and quantitative scores were 153.8 (SD = 6.5) and 151.1 (SD = 5.5), respectively. For the last three academic years (2016–2019), 34 (16%) students met the Kaplan Diagnostic Test threshold, and 96 (45.1%) students met the Kaplan Comprehensive Test threshold. The mean percentile of the Kaplan Diagnostic Test was 59.3 (SD = 5.6), and the mean percentile of the Kaplan Comprehensive Test was 60.0 (SD = 6.9).
For the entire sample, 90% (n = 532) of the students passed the NCLEX-RN on their first attempt. Students who passed the NCLEX-RN on the first time had significantly higher CGPA at graduation, GRE verbal reasoning and quantitative scores, and percentiles of Kaplan Diagnostic and Comprehensive Test scores compared with those who did not (Table B; available in the online version of this article). NCLEX-RN FTPR was not significantly different between ABSN students admitted with GRE scores and those who were not (Table 1). All of the students who met either the Kaplan Diagnostic Test or the Kaplan Comprehensive Test threshold passed the NCLEX-RN on their first attempt (Table 2).
NCLEX-RN First-Time Pass Rate Predictors
The first logistic regression models for the entire study (n = 591) are presented in Table 3. For an adjusted logistic model, GRE requirement for admission, age at admission, GRE verbal reasoning and quantitative scores, and CGPA at graduation were entered as predictive variables, and NCLEX-RN FTPR was entered as an outcome variable. The value of Nagelkerke R2 for this model was .34; the model had a satisfactory goodness of fit (Hosmer-Lemeshow p = .63). In this logistic regression model, both GRE verbal reasoning score (OR = 1.16, p < .001) and CGPA at graduation (OR = 41.64, p < .001) were significant predictors of NCLEX-RN pass on the first attempt. However, GRE as a requirement for ABSN admission, age at admission, and GRE quantitative score were not. To select the best model, a backward stepwise logistic regression was performed with the same data, in which a predictor was entered into the model at the significance level of .05 and was removed from the model at a significance level of .1. Similar to the adjusted logistic model, the backward stepwise regression model also revealed GRE verbal reasoning scores (OR = 1.15, p < .001) and CGPA at graduation (OR = 38.07, p < .001) were significant predictors of NCLEX-RN FTPR. For the stepwise model, the Nagelkerke R2 was 0.33 and had a satisfactory goodness of fit (Hosmer-Lemeshow P = 0.38).
For the second logistic regression models, which were limited to the last 3 years (n = 205), Kaplan Diagnostic and Comprehensive Tests percentiles were added as additional predictors (Table 4). In the adjusted model, the Kaplan Diagnostic Test percentile (OR = 1.25, p = .004) and Kaplan Comprehensive Test percentile (OR = 1.15, p = .040) were significant predictors of NCLEX-RN FTPR. In contrast, GRE as a requirement for ABSN admission, age at admission, CGPA at graduation, and GRE verbal reasoning and quantitative scores were not significant predictors. Properties of this model (Nagelkerke R2 = 0.59 and Hosmer-Lemeshow p = .96) indicated satisfactory predictive power and goodness of fit with the study data. A backward stepwise logistic regression also was conducted. The significance level of predictor entry and removal was the same as the ones used in the first model. CGPA at graduation (OR = 17.8, p = .038), GRE verbal reasoning scores (OR = 1.13, p = .015), Kaplan Diagnostic Test percentile (OR = 1.24, p = .004), and Kaplan Comprehensive Test percentile (OR = 1.14, p = .043) were significant predictors. Properties of this model (Nagelkerke R2 = 0.58 and Hosmer-Lemeshow p = .70) also indicated satisfactory predictive power and goodness of fit with the study data.
Discussion
The current study aimed to explore academic (CGPA at graduation, GRE scores, GRE as a requirement for ABSN admission, and Kaplan percentile scores) and nonacademic (age at admission) indicators associated with first-time NCLEX-RN pass rates among ABSN students. GRE verbal reasoning scores and CGPA at graduation were identified as the two main predictors for passing the NCLEX-RN on the first attempt for ABSN program students. Kaplan Diagnostic percentile and Kaplan Comprehensive percentile were also significant predictors of passing the NCLEX-RN examination on the first attempt.
The findings of this study aligned with previous studies that indicated CGPA and Kaplan Diagnostic Test were significant predictors of ABSN students' NCELX-RN passing rate (; ). CGPA is considered an important indicator in evaluating students' ability to comprehend and apply nursing knowledge in examinations. Because the ABSN is regarded as a fast-paced degree, it can be a challenging program for students whose first degree is not related to a health care degree or for students who do not have health-related experience. Thus, CGPA can be important in predicting whether ABSN students will pass the NCLEX-RN on their first attempt. As a result, the current study's findings indicate the ABSN program requires students with a higher CGPA on admission compared with other more traditional nursing programs. These results align with previous studies that demonstrated academic performance in the form of cumulative GPA is associated with students' success (; ).
The majority of the nursing schools in the U.S. assess students' readiness for the NCLEX-RN via standardized exit tests similar to the Kaplan Diagnostic Test. The Kaplan test is a frequently used test based on the most current NCLEX-RN tests and often is administrated in a computer-based environment simulating that of the actual NCLEX-RN testing environment. Using the Kaplan Diagnostic Test exposes ABSN students to questions similar to those included on the NCLEX-RN examination, with the opportunity to receive immediate feedback. The effectiveness of the Kaplan Diagnostic Test in promoting NCLEX-RN first-time pass has been documented previously in many traditional BSN nursing programs (; ; ). In addition, studies conducted on ABSN programs showed standardized exit examination scores (HESI and ATI) were significantly associated with NCLEX-RN FTPR (; ). The results of the current study on Kaplan test scores (Kaplan Diagnostic and Comprehensive) of ABSN students supports previous findings. In addition, using the Kaplan tests can either motivate students who did well on the test to continue or serve as a wake-up call for ABSN students who failed the test to study harder to pass their NCLEX-RN examination.
The current study also found GRE reasoning verbal scores to be a significant predictor of first-time NCLEX-RN pass among ABSN students. This may be attributed to the fact that GRE reasoning verbal scores often assess students' critical thinking, logical reasoning, and clinical judgment (). Thus, it is not surprising that ABSN students who scored high on their GRE verbal reasoning are more likely to pass the NCLEX-RN examination on their first attempt.
This study is one of the few studies comprehensively evaluating the ABSN program's academic and nonacademic indicators of first-time NCLEX-RN pass. The finding of this study can shed light on future curriculum planning and admission criteria for ABSN programs. Some educators may argue that focusing on ABSN academic performance might not completely reflect students' ability to pass the NCLEXRN examination (; ). Therefore, some educators recommend applying a more holistic approach in the admission process to improve student diversity (). However, the holistic approach might be more applicable in general programs, such as BSN and Doctor of Nursing Practice (DNP) programs, which provide students with more time for examination preparation and clinical training. Although academic indicators have been shown to be significant predictors of passing the NCLEX-RN examination on the first attempt, Zerwic and colleagues () emphasized the importance of considering other factors, such as attributes and experiences (e.g., having an underprivileged background, experiencing financial crisis, and having a chronic mental or physical illness) that can contribute to the student's learning and subsequent quality of care they provide to patients. Thus, such factors may be considered for ABSN program admission on a case-by-case basis.
Limitations
The current study has three main limitations. First, this study includes only one sample from a single institution, which limits the generalizability of the findings to other nursing schools. Second, the dataset used in the analysis was incomplete due to the limited availability of data. For example, the study dataset only included 3 years of Kaplan Diagnostic and Comprehensive Test scores; this also may limit generalizability and applicability of the findings to other ABSN programs. Third, to ensure students' anonymity, the current study was only able to include age as a nonacademic factor. Other nonacademic factors, such as gender, ethnicity, primary language, and family and work commitment should be explored in future studies.
Future Implications
Additional studies should explore how the use of GRE examinations, especially GRE verbal reasoning and other similar admission examinations, as an admission criterion for ABSN programs influence NCLEX-RN first-time pass rates. In addition, future studies should consider examining whether the use of standardized exit examinations, such as Kaplan, HESI, or ATI, improve NCLEX-RN pass rates among ABSN students.
Conclusion
The findings of this study indicate GRE verbal reasoning score, CGPA at graduation, and Kaplan test scores are important predictors of ABSN students' first-time NCLEXRN pass rate. Although the GRE might not be an admission requirement for all ABSN programs, the study findings revealed it might be a significant predictor for passing the NCLEX-RN on the first time among ABSN students. Thus, further investigation may be warranted to explore whether GRE verbal reasoning scores or similar admission examinations should be recommended as an admission criterion for ABSN programs. Moreover, standardized exit examinations also can be beneficial in exposing ABSN students to types of questions that are similar to NCLEX-RN questions with similar settings. In addition, standardized exit examinations can allow ABSN students to gauge their performance level by receiving immediate feedback and making changes to their learning strategies to improve their performance level before taking the actual NCLEX-RN examination. This can help promote the development of necessary knowledge and skills sets needed to succeed in passing the NCLEX-RN on the first attempt (). Nursing programs also can play a critical role in providing more support for ABSN students by having peer tutorial fellows or graduate teaching assistants offer additional classes for ABSN students struggling with their studies. In addition, faculty members can schedule office hours to help students who need further academic support.
The authors thank School of Nursing system data analyst Elena Panaitescu for assistance in gathering the data and deidentifying the records, and Katelyn Kocis for reviewing the manuscript.
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