Examining the relationships between NCLEX-RN performance and nursing student factors, including undergraduate nursing program performance: A systematic review

Abstract

The National Council Licensure Examination for Registered Nursing (NCLEX-RN) replaced the Canadian Registered Nursing Examination (CRNE) in January 2015 as part of the requirements for qualifying for registered nurse (RN) status in all but one Canadian province. This substantial change is likely to have a profound impact on Canadian undergraduate nursing degree programs practices.  This systematic review aims to examine the evidence describing the relationship between undergraduate nursing program performance and NCLEX-RN performance by registered nursing candidates as well as other factors contributing to NCLEX-RN success.  An initial search of CINAHL and Medline databases using key terms NCLEX and predict, publication dates between 1984-2015 revealed 46 articles of interest.  28 articles were examined for eligibility and 17 articles with clear evidence and descriptions were included.  Thematic groupings of academic, cognitive, individual factors and models for successes are presented.  The review showed academic factors are strong predictors for NCLEX-RN success.  Cognitive factors, particularly critical thinking skills, are correlated with NCLEX-RN success.  Stress and highly negative emotions inversely correlate with NCLEX-RN success. Speaking English as a first language showed high correlation with NCLEX success, while other non-academic factors such as age, gender and ethnicity showed varying results.  All these factors have implications for nursing programs’ practices and students. Research studies need to begin immediately, not only to define and predict factors for NCLEX-RN success within its new Canadian arena, but also to evaluate the outcomes of this exam at baseline and frequent intervals within this population. This will enhance nursing programs’ support of students’ success.