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

January 15, 2019

WASHINGTON, DC (Jan. 15, 2019) -- 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.

George Washington University

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal)

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to