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Systemic Racism in Nursing Education and Accreditation

Additional resources and citations for the Nightingale Education Group's American Academy of Nursing 2023 Health Policy Conference poster.

View Full Poster Here

Research Brief​: NCLEX-RN® Pass Rates as a Measure Of Program Quality

View Hanover Research Brief

Dive Into the Data

Navigate the dashboard below by clicking the tabs at the bottom.

History of First-Time Pass Rate (FTPR)

Prior to the NCLEX-RN®, state licensure exams were administered twice a year at predetermined locations (by state), requiring the tester to travel for a two-day paper-based exam. 

If a candidate did not pass on the first attempt, they could not retest shortly thereafter. This contributed to long gaps to licensure and employment, thus necessitating public policy and accreditation standards requiring high FTPR.

As a result, nursing schools developed practices to ensure that their graduates could pass state licensure exams on the first attempt. These practices disproportionately favor middle-high income white females. 

The need for these policies has been eliminated with the introduction of computerized NCLEX-RN® in 1994. However, the public policies and accreditation standards and resulting educational practices remained, thus perpetuating non-diversification of the nursing profession to this day.

NCLEX-RN® Pass Rate Metrics Vary by State

The variability among NCLEX-RN® pass rate standards set by state licensing boards (AKA boards of nursing) demonstrates the inadequacy of FTPR as a measure of program quality. Notable variability exists in percentage, timeframe, and calculation methods. There are at least 27 variations of NCLEX-RN® pass rate standards across the United States.

Percentages range from fixed to variable numbers fluctuating in relation to national averages such as 75% in Illinois and 80% in Massachusetts vs. 90% of the national average in Maryland and Montana.

Timeframe calculations vary considerably from simple annual calculations to averages over specific timeframes. Connecticut requires 80% FTPR annually. Colorado requires 75% FTPR quarterly, removing approval from programs falling below 75% for eight consecutive quarters. North Carolina requires 95% of the national average FTPR averaged over five years. Washington requires 80% first-time annually for four out of five consecutive years.

A few states provide multiple options to meet their standards. Oregon requires either 75% rolling 12 months FTPR or 90% overall pass rate for the same period. Wyoming requires both annual FTPR and multi-year overall options.

At least three states (Utah, Vermont, and Alabama) defer some or all programmatic oversight, including NCLEX-RN® pass rates, to national nursing programmatic accreditors. Pass rate standards vary by accrediting body, with at least one accreditor providing multiple options for pass rate standard compliance (CCNE accreditation standards, IV-C).

State 2023 FTPR Nurse Practice Act Defers to accreditors?
Alabama Compliance with accrediting standards ALABAMA BOARD OF NURSING ( No
Alaska 80% FT cumulative annual Alaska Board of Nursing ( No
Arizona 80% FT^ annual (within 12 mo) Arizona ( No
Arkansas 75% Arkansas ( No
California 75% FT annual California ( No
Colorado 75% FT quarter Colorado ( No
Connecticut 80% FT annual Connecticut ( No
Delaware 80% unclear 3 consecutive years Delaware ( No
Florida passage rate for first-time test takers which is not more than 10 percentage points lower than the average passage rate during the same calendar year for graduates of comparable degree programs  Florida ( No - but programs are deemed approved if board doesn't reply
Georgia 80% FT^ annual (within 12 mo) Georgia GAC No
Hawaii No mention of pass rate in statutes or rules, other than a requirement that pass rates be included on the annual report. Annual report asks for narratives if FTPR is below national average. Hawaii No
Idaho 80% FT annual Idaho ( No
Illinois 75% FT annual Illinois ( No
Indiana 1SD FT 3 consecutive years Indiana No
Iowa 95%NA FT calendar year Iowa No
Kansas 80% FT annual Kansas( No
Kentucky Avg of 80% FT for 3 consecutive yrs Kentucky More info
Louisiana 80% FT annual Louisiana No
Maine 80% FT annual Laws and Rules/Chapters: Maine State Board of Nursing No
Maryland 90%NA FT annual Maryland ( No, but accreditation is a big part of approval
Massachussets 80% FT annual Massachussets No
Michigan 80% FT annual Michigan No
Minnesota >75% FT annual Minnesota No
Mississippi Avg of 80% FT for 3 consecutive yrs    
Missouri 80% FT annual Missouri No
Montana 90%NA FT annual Montana ( No
Nebraska 80% per year or 3-year avg consistent with NA Nebraska No
Nevada 80% FT annual Nevada ( No
New Hampshire NCSBN FT annual   No
New Jersey 75% overall annual New Jersey ( No
New Mexico 80% FT annual New Mexico( No
New York Need clarification    
North Carolina 95%NA 3 year average FT North Carolina No
North Dakota 80% FT annual North Dakota No
Ohio 95%NA FT annual Ohio No
Oklahoma 90%NA FT Oklahoma No
Oregon 75% FT most recent 12-month period OR 90% overall most recent 12-month period Oregon No
Pennsylvania 80% FT annual Pennsylvania No
Rhode Island 80% FT annual Rhode Island No
South Carolina 95%NA FT annual South Carolina No - but programs can submit accreditor reports instead of BON survey
South Dakota 75% FT annual South Dakota No
Tennessee 85% FT annual Tennessee No
Texas 80% FT annual Texas No
Utah None   Yes
Vermont Compliance with accrediting standards Vermont No
Virgina 80% FT 4 quarters Virginia No
Washington 80% FT annual (after noncompliance for 4 out of 5 consecutive years, approval may be withdrawn) Washington Like Maryland
Washington, D.C. 80% FT annual Washington D.C. No
West Virginia 100%NA all West Virginia No
Wisconsin 80% all annual Wisconsin No
Wyoming 80% unclear annually OR the 3 most recent years in at least one of the following: 80% or greater for all FT, or 80% or greater overall, or at or avove national mean Wyoming No

Knowledge-to-Action Process Framework

Knowledge to action Framework

Nightingale College Implemented the Knowledge-to-Action Process Framework 


  1. Identify Problem: Nightingale College identified that expanding nursing diversity could be addressed in the educational pipeline. 
  2. Adapt: Nightingale College adapted knowledge to use in local context: its learner population was more representative of the population at large. Nightingale College sought a new educational approach to serve the learner population. 
  3. Identify barrier: Accreditation bodies and Boards of Nursing (BON) that rely on NCLEX-RN® First-Time Pass Rate (FTPR) as a metric of educational quality.
  4. Interventions: Nightingale College moved to a concept-based curriculum, remote skills acquisition model, use of VR, and wrap around learner support services to educate and support a diverse learner population. Thus, students learn independently with continued educational support.
  5. Monitor: Ongoing
  6. Evaluate: Ongoing
  7. Sustain: Ongoing

Nightingale College Wraparound Learner Support Services Address Structural Bias

Nightingale College serves historically marginalized populations through its educational philosophy and services:

  • Employs admission standards that do not exclude based on academic history 
  • Ensures learners understand the educational process and commitment
  • Provides wraparound services required to bridge the educational achievement gap 
    • Academic success plans
    • Navigating the College and its internal functions 
    • Study skills and academic resources 
    • Referrals for tutoring and APA resources 
    • Time management and study schedules 
    • Learner status and enrollment changes 
    • Program plans and schedules 
    • Traversing life barriers (work, family, etc.) 
    • Coaching throughout NCLEX-RN® exams

Concept-Based Curriculum

  • Concept-based Nursing Curriculum Nursing concepts (Giddens) are threaded throughout the curriculum
  • Concepts are repeated in several courses and exemplars are customized to the course-specific content
  • Learning Delivery Model that allows for access in any setting​
  • Remote Skills Acquisition Model​
  • Up to 50% use of virtual simulations for clinical experiences as consistent with program approval

Learning Concept model


  • Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursingat the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press (US); 2011. PMID: 24983041.
  • Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine Report The Future of Nursing: Leading Change, Advancing Health; Institute of Medicine; National Academies of Sciences, Engineering, and Medicine. Assessing Progress on the Institute of Medicine Report The Future of Nursing. Altman SH, Butler AS, Shern L, editors. Washington (DC): National Academies Press (US); 2016 Feb 22. PMID: 27010049.
  • National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Flaubert JL, Le Menestrel S, Williams DR, Wakefield MK, editors. Washington (DC): National Academies Press (US); 2021 May 11. PMID: 34524769.
  • National Commission to Address Racism in Nursing, Report Series, 2022.  
  • Taylor H, Loftin C, Reyes H. First-time NCLEX-RN® pass rate: Measure of Program Quality or Something Else? Nurs Educ. 2014 Jun;53(6):336-41. doi: 10.3928/01484834-20140520-02. Epub 2014 May 20. PMID: 24855991.
  • Hanover Research Brief – NCLEX Pass Rates
  • Stephen Foreman, The accuracy of state NCLEX-RN®© passing standards for nursing programs, Nurse Education Today,Volume 52,2017,Pages 81-86, ISSN 02606917,
  • Knowledge to Action Framework: Models and Frameworks for Implementing Evidence-Based Practice: Linking Evidence to Action, Rycroft-Malone & Bucknall, May 2010  Chapter 10 – The Knowledge to Action framework, Graham and Tetroe
  • Giddens, J. (2013). Concepts for nursing practice. St. Louis, Mo.: Mosby/Elsevier​

CCNE Standards for Accreditation of Baccalaureate and Graduate Nursing Program: 

View CCNE Here

Demographics Data:

View Journal of Nursing

View Census

American Academy of Nursing DEI Statement:

View AAN

Pew Research Center:

Pew Research


  • NCLEX-RN®: National Council Licensure Examination-RN 
  • FTPR: First Time Pass Rate 
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