For-profit nursing schools associated with lower performance on nurse licensure test

A new study published today by researchers at the George Washington University Milken Institute School of Public Health (Milken Institute SPH) finds that for-profit ownership of nursing school programs is significantly associated with lower performance on a national nursing licensure exam than public and nonprofit programs.

The study found that graduates of for-profit nursing programs were more likely to fail the National Council Licensure Examination (NCLEX) on the first try compared to peers who had attended public or nonprofit schools. Students who fail can try again, but they cannot get an entry-level nursing job until they pass the test, said Patricia Pittman, PhD, the lead study author and a professor of health policy and management at Milken Institute SPH.

For this study, Pittman and her colleagues first tracked the number of U.S. nursing programs and graduates by ownership type from 2007 through 2016. The researchers found a 14-fold increase in the number of graduates from for-profit nursing school programs during the study period - and a five-fold jump in the total number of for-profit nursing programs.

Next, the team gathered data on first-time nursing exam pass rates for graduates and sorted them by degree and by ownership status during a five-year period from 2011 through 2015. Performance trends revealed wide variation within the for-profit sector, although, on average, pass rates among for-profit programs declined over the study period, while public and nonprofit programs' pass rates stayed about the same.

Descriptive analysis of five years of pooled data across the three degree types (Bachelor of Science in Nursing, Associate Degree in Nursing, and Practical Nurse) found that, on average, public programs had a first time pass rate of 88 percent, nonprofits 84 percent and for-profits 68 percent.

After controlling for school, program, socioeconomic factors and other indicators that can affect performance, for-profit ownership status was still a significant predictor of lower NCLEX pass rates.

The regression models indicate that for-profit nursing programs had pass rates that were 7 percentage points lower than public programs. Nonprofit programs also had lower pass rates than public programs, but the magnitude of the difference was smaller at 2 percent, the authors said.

"Many states and accreditation agencies consider an NCLEX pass rate of at least 80 percent as a minimum quality threshold for nursing programs," Pittman said. "Our study found that for-profit nursing programs were nearly twice as likely to have failed to meet that 80 percent threshold as compared to public programs."

This study used the NCLEX pass rates as a measure of a nursing school's quality, an imperfect yardstick to be sure, Pittman said. However, she adds that it is one of the few ways to gauge a nursing school's ability to prepare newly minted nurses for the demands of an entry-level job.

The findings suggest that nursing leaders and policymakers must take a hard look at the performance of all nursing programs, not just those in the for-profit sector. For example, Pittman said that not all states require accreditation at the nursing program level, and that accreditation could help ensure that all nursing schools meet a higher bar in performance standards.

In addition, states could also require nursing programs to publicly report their NCLEX pass rates, she said. Such disclosure could help prospective students size up the value of a nursing program regardless of its ownership status.

The study, "The Growth and Performance of Nursing Programs by Ownership Status," was published online January 15 in the Journal of Nursing Regulation.