As enrollment at for-profit nursing programs rises, their graduates are more likely to fail their licensing examinations on the first try compared with peers who attended public or not-for-profit schools, according to a new study.
Researchers at George Washington University’s Milken Institute School of Public Health conducted a comparative analysis of more than 13,000 nursing school degree programs across 41 states and the District of Columbia; the study found students who graduated from for-profit nursing school programs from 2011 to 2015 had a higher average fail rate the first time they took the National Council Licensure Examination compared with students from public school programs.
Students from not-for-profit nursing school programs also had lower rates of passing the licensing exam the first time compared with public-school nursing students. But the study found the disparity was much wider among for-profit students, who had an average first-time pass rate of 68% across all degrees, including bachelor’s degrees in nursing, associate’s degrees in nursing and practical nurse programs. By comparison, the average pass rates among not-for-profits were 84% and 88% among students in public nursing programs.
First-time pass rates for for-profit nursing school programs declined over time. From 2011 to 2015, rates fell from 83% to 67% among bachelor-degree graduates, 74% to 58% among associate students, and from 76% to 68% for practical nurse graduates.
“This is an issue that should rise to the top of nursing leadership’s attention,” said study lead author Patricia Pittman, professor of health policy and management at the Milken Institute. “I think that the policies that they implement should not be targeting for-profits necessarily—they should be applied to any kind of nursing program—but there’s clearly some very low performers that are slipping through the cracks.”
The study did not examine contributing factors for why nursing school ownership was a predictor of exam pass rates. Pittman said it could be related to the for-profit nursing education sector’s rapid growth in the past decade.
The number of for-profit nursing programs in the U.S. rose by more than 400% from 2007 to 2016, from 60 to 301, according to the study, while the number of students at such institutions increased by more than 1,300%, from 2,100 to more than 29,000. During the same period, public nursing programs increased by 11%, while the number of not-for-profit programs grew by 21%. Public nursing school enrollment grew by 39% from 2007 to 2016, while enrollment in not-for-profit programs rose by 78%.
“These schools have grown very quickly, and often times when schools grow quickly you have to hire faculty that may not be as high quality as faculty that you hire if you were just maintaining the level of admissions or just growing slowly,” Pittman said.
Another possible explanation could be the wide variation in nursing regulations in each state. Some have no accreditation requirements for nursing school programs to operate. Pittman recommended states agree to a more uniform standard that requires nursing schools not to fall below a first-time exam pass rate of 85%.
“If the regulatory policies in the states that are lagging were raised to the states that are doing well, we could do a lot to resolve this problem,” Pittman said.
Pittman said making school exam pass rates public might help to hold schools more accountable for performance while allowing prospective students to make more informed choices about the quality of programs.
The study’s findings suggest that a significant share of each year’s nursing school graduates are delayed from entering the workforce because they fail their licensing exams on the first attempt.
Pittman said it was likely such a scenario was helping to further exacerbate the national nursing shortage. Figures from the U.S. Bureau of Labor Statistics project there will be a need for more than 1 million additional nurses by 2024 due to industry growth and to replace nurses leaving the field.
“There’s no question this is delaying a segment of the graduating class from being able to get into practice,” Pittman said. “That is likely going to be distributed unequally throughout the country. It would be interesting to see where there are pockets of low-performing programs and see how that has affected the local market.”