For the past 15 years, the number of graduates from registered nursing programs from all types of institutional settings has dramatically increased, with the largest growth observed in the for-profit sector. But now, a new study has found students who have completed this type of nursing program are less likely to pass their licensure exam, which is mandatory for an individual who wishes to work as a registered nurse.

Compared to public and nonprofit programs, for-profit ownership of nursing school programs was significantly associated with lower performance on a national nursing licensure exam. In addition, the study authors found that the graduates of these programs were more likely to fail the National Council Licensure Examination (NCLEX) on their first try than graduates from public or nonprofit schools. According to the National Council of State Boards of Nursing (NCSBN), students who fail can retake the test and are permitted to take the NCLEX eight times a year, but no more than once in any 45-day period. However, new graduates cannot be hired for a nursing job unless they pass the test.

 Many states and accreditation agencies consider an NCLEX pass rate of at least 80% as a minimum quality threshold for nursing programs,” said lead author Patricia Pittman, Ph.D., a professor of health policy and management at the George Washington University Milken Institute School of Public Health. 

“Our study found that for-profit nursing programs were nearly twice as likely to have failed to meet that 80% threshold as compared to public programs”, she said in a statement. To track the number of programs and graduates by the type of ownership, Dr. Pittman and her colleagues looked at ten years of data (2007-2016) obtained from the Integrated Postsecondary Education Data System (IPEDS). They also used data from 2011-2015 from state boards of nursing to assess first-time NCLEX pass rates by degree.

They found that there were 301 for-profit nursing programs in the United States in 2016, which was five times the number from 2007 (n = 60). While the total number of for-profit programs is still lower than public and nonprofit programs, this increase represents a growth rate of 402% in ten years.

By 2016, graduates of for-profit nursing education programs made up 14.2% of all nursing school graduates, up from 1.7% in 2007. During this same period, the percentage of students graduating from nonprofit programs remained relatively flat, while the number of graduates from public programs declined from 74.6% to 61.7%. 

The authors looked at the first-time nursing exam pass rates for graduates and assessed them according to degree and ownership status from 2011 through 2015. While there was an extensive range in performance trends within the for-profit group, pass rates declined during the five-year study period, while those for public and nonprofit programs remained essentially the same. Pooled data from the types of degree programs (Bachelor of Science in Nursing, Associate Degree in Nursing, and Practical Nurse) showed that, on average, graduates from public programs had a first-time pass rate of 88%, nonprofits 84% percent and for-profits 68%. Even after controlling for confounders such as the school, program type, demographic and socioeconomic factors, for-profit ownership status remained a significant predictor of lower NCLEX pass rates.

Dr. Pittman and colleagues note that the “topic of education regulation will likely be hotly debated in the coming years.” It is important that regulators, educators, and scholars engage in conversation about what factors drive the performance of nursing programs, but “ultimately, it the responsibility of the profession to either assist, or restrict, programs that have subpar pass rates, and to provide prospective students with information about the value of specific nursing programs.”

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