A Retrospective Review of NCLEX Candidates’ Testing Behavior: Examining the Relationship Between Repeat Testing, Time-to-Test, and Discipline

Background

Concerns about the competence of repeat NCLEX test takers have persisted, resulting in a patchwork of regulatory policies that limit the number of test attempts or the conditions under which a candidate can retest in certain U.S. jurisdictions.

Purpose

To examine possible corrolaries between repeat test-taker status and future practice discipline and to investigate the relationship between time-to-test and repeat testing.

Methods

Data were collected on nearly a quarter of a million registered nurse (RN) and practical nurse (PN) NCLEX candidates who passed the examination between 2013 and 2017. Multivariable generalized estimating equation models were used to assess the likelihood of discipline (0, 1) and the need for repeat testing (0, 1). Propensity score matching was employed to address initial group imbalance on all available covariates for models assessing discipline.

Results

The rate of discipline among the RN (1.0%, n = 2,029) and PN (1.8%, n = 749) samples was low. After applying propensity score matching, repeat test-taker status was found to be weakly aligned with practice discipline for RNs (p = .047) but was not correlated for PNs (p = .13). In contrast, adjusting for sex, race, ethnicity, and age, RN candidates who delayed taking the test for 60 days were 5% more likely to need to retake the NCLEX (p < .001). For PN candidates, a delay of 90 days was associated with a 9% increase in the likelihood of needing to retake the NCLEX (p < .001).

Conclusion

Empirical evidence supports the comparable safety profile of single– and multi–test-taker groups, underscoring the need to revaluate restrictions that limit the conditions under which candidates can retest. Furthermore, ongoing outreach to nursing programs to emphasize the importance of prompt NCLEX testing and the possible deleterious effects of delays, by even a few months, is important.