Research Article|Articles in Press

Retaining Graduate Nurses Who Experience NCLEX Failure: Recommendations for Supporting Retest Success

Published:December 20, 2022DOI:


      Current turbulent times in health care are exacerbated by a shortage of registered nurses (RNs), challenging nurse leaders to explore opportunities for improving RN retention. National Council Licensure Examination (NCLEX) pass rates are declining, and an upcoming change in the NCLEX-RN exam is likely to intensify that decline. On average, 18% of graduate nurses (GNs) fail on their first NCLEX-RN attempt, and less than 43% are successful on retest attempts. Therefore, the GN who fails on the first attempt is likely to not be retained for the RN position for which they were hired. A consideration in supporting the GN who fails to retest success is that the most prevalent demographic among GNs is Generation Z. Individuals in this generation display characteristics that impact their ability to negotiate the high-stakes NCLEX-RN exam. Based on experience coaching Generation Z GNs to NCLEX-RN success, the author provides recommendations for coaching to support NCLEX retest success. Nurse leaders in hospital settings are encouraged to consider adopting these recommendations to improve RN retention among GNs who experience NCLEX failure.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Nurse Leader
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Auerbach D.I.
        • Buerhaus P.I.
        • Staiger D.O.
        Will the RN workforce weather the retirement of the Baby Boomers?.
        Med Care. 2015; 53: 850-856
        • Berlin G.
        • Lapointe M.
        • Murphy M.
        • Wexler J.
        Assessing the lingering impact of COVID-19 on the nursing workforce.
        McKinsey & Company, May 11, 2022 (Available at:)
        • National Council of State Boards of Nursing
        NCSBN’s Environmental Scan COVID-19 and its impact on nursing and regulation.
        J Nurs Regul. 2021; 11: S1-S36
      1. NCSBN. NCLEX pass rates. 2022.
        (Available at:)
        • Dickison P.
        • Haerling K.A.
        • Lasater K.
        Integrating the National Council of State Boards of Nursing Clinical Judgment Model into nursing educational frameworks.
        J Nurs Educ. 2019; 58: 72-78
        • Mager D.
        • Beauvais A.
        • Kazer M.W.
        Surviving the NCLEX dip.
        Nurs Educ Perspect. 2017; 38: 283-285
        • Chicca J.
        • Shellenbarger T.
        Generation Z: Approaches and teaching-learning practices for nursing professional development practitioners.
        J Nurs Prof Dev. 2018; 34: 250-256
        • Smith-Trudeau P.
        Generation Z nurses have arrived, are you ready?.
        Vermont Nurse Connection. 2016; 19: 3
        • Williams C.A.
        Nurse educators meet your new students: Generation Z.
        Nurs Educ. 2019; 44: 59-60
        • American Psychological Association
        Stress in America: Generation Z. Stress in America Survey. 2018.
        (Available at:)
        • Mc Farquhar C.
        Lived experiences of failure on the National Council Licensure Examination - Registered Nurse (NCLEX-RN): perceptions of registered nurses.
        Int J Nurs Educ. 2014; 6: 10-14
        • Kasprovich T.
        • VandeVusse L.
        Registered nurses’ experiences of passing the NCLEX-RN after more than one attempt.
        J Nurs Educ. 2018; 57: 590-597
        • Banks J.
        • Onsomu E.O.
        • Hall S.
        • et al.
        Factors that predict NCLEX-RN success at a historically black college and university: a four-year retrospective study.
        J Nurs Prof Dev. 2022; 39: 177-186
        • Flowers M.
        • Olenick M.
        • Maltseva T.
        • Simon S.
        • Diez-Sampedro A.
        • Allen L.R.
        Academic factors predicting NCLEX-RN success.
        Nurs Educ Perspect. 2022; 43: 112-114
        • Schwarz K.A.
        Making the grade: help staff pass the NCLEX-RN.
        Nurs Manage. 2005; 36: 38-44
        • Spencer J.A.
        When new graduate nurses fail the NCLEX: what role can the hospital play?.
        J Nurs Staff Dev. 2006; 22: 187-189
        • Lutter S.L.
        • Thompson C.W.
        • Condon M.C.
        Tutoring for success: empowering graduate nurses after failure on the NCLEX-RN.
        J Nurs Educ. 2017; 56: 758-761


      Cheryl W. Thompson, DNP, RN, PHCNS-BC, is Professor (Retired) and Adjunct Faculty at York College of Pennsylvania in York, Pennsylvania. She can be reached at [email protected]