Florida ranks last in the pass rate of the national licensure exam for nurses. (FS Productions/Getty Images)
Florida is racing against time to avert a projected shortage of 60,000 nurses by 2035, and the national licensure exam is a big obstacle to that mission.
Although the state saw the most first-time testers in 2024, it also posted the worst pass rate in the country on the National Council Licensure Examination (NCLEX).
Floridians trying to earn a registered nurse license scored six percentage points below the national average of 91.16% and those trying to become practical nurses scored eight points below the 88.38% national average, according to the annual report from the Florida Center for Nursing.
“This is unacceptable and it’s why we’re here today,” Republican Rep. Kaylee Tuck of Lake Placid said of the test scores during a Feb. 19 meeting of the House Health Professions and Programs Subcommittee she chairs. Tuck noted the importance of the pass rate against the Florida Hospital Association’s estimate that the state could see a shortage of nearly 60,000 nurses in 10 years when the demand is expected to be more than 370,000.
Lawmakers sought answers from nursing school administrators ahead of the start of the legislative session on March 4.
Private for-profit schools perform poorly
The 2024 scores were the highest in a decade, and most of the change has come from an improvement by the private, for-profit nursing schools, which offer 60% of all nursing programs in Florida, according to FCN’s report.
NCLEX data show that since 2020 private, for-profit schools have improved their pass rates by more than 30 percentage points in programs preparing people to become registered nurses. However, students in these programs have pass rates as much as 10 percentage points lower than those in public and private nonprofit schools.
An analysis by the Florida Department of Health presented to lawmakers pointed to the for-profit sector’s performance. The Florida Board of Nursing has placed 71 RN and PN for-profit programs on probation during the past five years, compared to 30 public and private nonprofits. The board places programs on probation when their pass rates lag more than 10 percentage points behind the national average for two years in a row.
Pedro De Guzman, president of for-profit HCI College in West Palm Beach, argued against the state’s focus on the first-time pass rate and said raising qualifications for applicants too much would lead to fewer students enrolling.
“Everybody’s focused on this pass rate because we’re at the bottom, and Florida doesn’t want to be at the bottom of anything unless it’s a golf score,” De Guzman told lawmakers during the House subcommittee panel.
He said HCI has averaged a 94% pass rate in the past four years.
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Harsher consequences for failing programs
One lawmaker who wants to place greater emphasis on the NCLEX pass rate is Republican Sen. Gayle Harrell of Stuart. She filed a bill, SB 526, on Feb. 6 requiring the board to place programs on probation if they don’t meet the standard in one year instead of two. Programs whose directors don’t submit improvement plans within six months after their probation period starts would shutter under the bill.
Harrell wants to require failing schools to pay for students’ remedial programs to retake the exam.
“What do we as state appropriators, as state legislators who write the laws and the requirements, what can we do to improve that and make us not last but first?” Harrell asked a panel of nursing school administrators during the Feb. 12 Senate Appropriations Committee on Higher Education.
Administrators asked lawmakers in both chambers for continued investments in grants to help fund student scholarships, purchase equipment, and bolster faculty recruitment. As part of the Live Healthy Act, which then-Senate President Kathleen Passidomo spearheaded last year, the state put $5 million toward grants for nursing schools. Only programs with at least a 75% NCLEX pass rate can apply for the money.
Students’ diverse backgrounds
Administrators pointed out the diversity of nursing students in the state, both in age and cultural background, as a possible explanation. De Guzman and Audria Denker, “chief experience officer” with the for-profit Galen College of Nursing, said its average student is 31 years old. Galen College operates four campuses in Florida with a pass rate of 94% for RNs and 96% for PNs, Denker said.
“Life is hitting them in the face,” De Guzman said. “They’ve got kids to take care of, they’ve got jobs. In the ideal nursing world, your directors of nursing would love your nursing students to be 18, 19 years old, be at home with mom and dad, not have to work, and just focus their entire 24/7 on becoming a nurse. And I admire that goal. It’s not realistic, and that’s not what’s happening in Florida.”
Kimberly Fenstermacher, Palm Beach Atlantic University’s dean of nursing, told House members that students’ preparedness for college-level science and math courses had dwindled since the COVID-19 pandemic. The university is a private, nonprofit institution.
“If anything is going to deter a student from progression in the nursing program, it is going to be failure of chemistry, microbiology, anatomy, physiology, and math,” Fenstermacher, who has been a nursing educator for 15 years, said.
West Palm Beach Democratic Rep. Jervontae Edmonds asked administrators on Feb. 19 whether they would consider offering their curricula in another language.
The College of Nursing at the University of Florida is looking to offer a course in medical Spanish, said Dean Shakira Henderson. HCI would only offer classes in Spanish if the NCLEX were also offered in the language, De Guzman said.
Republican Sen. Ana Maria Rodriguez, who is from Miami, filed a resolution, SR 672, on Feb. 12 requesting that the National Council of State Boards of Nursing administer the exam in Spanish.
Those who wait to take the NCLEX have lower pass rates
Florida students who took the NCLEX a month after graduating had the highest pass rate, 94.32%. Others who took the test last year had graduated years earlier.
Patricia Gagliano, Dean of Nursing at Indian River State College, and John Monda, director of the Lorenzo Walker Technical College in Collier County, wanted lawmakers to limit how many months after graduation students can take the exam.
“Students can come one, two, three, four, five, six, seven years after they’ve completed our programs and go take the exam,” Monda told senators on Feb. 12. “It just doesn’t seem like a scientific approach that we’re setting ourselves up for success for demonstrating what the students have learned.”
More than 800 students took the exam more than a year after finishing their programs and their pass rate dwindled to 48.61%, according to the FCN report.
“We tend to want to put a quick band-aid on something and say we did something, but then there are all these other holes in the boat or cracks in the foundation where the house can’t stand,” said Parkland Democratic Rep. Christine Hunschofsky, who brought up the middle schoolers’ decline in math and reading scores.
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