The global nursing shortage continues, further increasing the demand for nurses who have passed the NCLEX RN or PN. The latest NCLEX RN (Table 1) results have shown a significant increase (44%) in the number of Internationally Educated Registered Nurses (IEN) passing the exam in 2023. This increase should encourage IENs that their knowledge and clinical judgment are meeting the standard established by nursing in the United States (U.S.). A successful NCLEX result will provide more opportunities for nurses wishing to migrate and become licensed in the U.S.
Table 1: Comparison of total number of IEN taking the NCLEX exam in 2023 vs. 2022
| RN | 2022 | 2023 |
| 1st Time IEN | 35,074 | 65,966 |
| Repeat IEN | 28,762 | 48,008 |
| Total | 63,836 | 113,974 |
Next Generation Nursing (NGN) – Clinical Judgment Case Studies
It is important to note there was a change to the test on April 1, 2023. This new test incorporated the Next Generation Nursing (NGN) item types within both nursing exams. The NGN uses case studies to measure a candidate’s ability to apply clinical judgment to make the correct care decisions. This measurement takes place using innovative item types that have been continually evaluated and refined since 2013. All items continue to be delivered through a Computer Adaptive Test (CAT) interface that targets the candidate’s ability based on their individual answers to the test items. This provides a precise pass/fail outcome for the candidate and assures the public that only safe and competent nurses are joining the workforce.
Comparing U.S. Candidates to IEN Candidates
Table 2 compares the U.S. candidates to the IEN candidates. The April 2023 exam had a large proportion of first-time U.S. educated candidates, since many of the repeat candidates (100% increase in volume) took the test in January, potentially to avoid the implementation of the new test design (NGN). Historically, the April exam tends to have highest pass rates, and we see this exemplified in 2023. An additional assumption for the higher rates could be that this exam is more realistic to nursing practice. Another hypothesis could be that faculty and candidates’ preparation increased in anticipation of the test change.
Table 2: Comparison of the total number of test takers in 2023 by quarter.
| Registered Nurse 2023 | Jan-Mar | Apr – June | July – Sept | Oct – Dec | 2023 Total |
| 1st Time U.S. educated | 80.48 | 94.32 | 90.69 | 88.63 | 88.56 |
| 1st IEN | 39.86 | 57.69 | 58.37 | 60.4 | 52.6 |
| Repeat U.S. educated | 40.66 | 62.15 | 56.61 | 55.81 | 51.15 |
| Repeat IEN | 28.85 | 51.33 | 50.03 | 48.06 | 42.35 |
| Practical Nurse 2023 | Jan-Mar | Apr – June | July – Sept | Oct – Dec | 2023 Total |
| 1st Time U.S. educated | 79.56 | 90.07 | 90.65 | 87.59 | 86.67 |
| Repeat U.S. educated | 37.83 | 49.88 | 43.11 | 44.89 | 42.84 |
| 1st Time IEN | 47.45 | 63.64 | 50.57 | 58.333 | 54.03 |
| Repeat IEN | 25.87 | 33 | 29.17 | 31.36 | 29.13 |
| NOTE: Test change April 1 |
The Future Looks Bright for NGN and IEN
There continues to be a shortage of nurses, which was further detailed last March, as the International Council of Nurses (ICN) published a report that highlighted the critical global nursing workforce situation and warned that it is projected to get worse. International nurses have long desired to migrate to the U.S. for work, and if the results of the April 2023 NCLEX are a trend of what’s to come, there will be more NCLEX qualified IENs that can come to the U.S. The new test, which includes NGN cases studies, seems better suited for IENs, testing their clinical judgment and nursing knowledge. If this trend continues, and more IENs are able to obtain licensure, it will mean that more nurses will have the opportunity to apply for jobs in the U.S, and help overcome the nursing shortage.
At International Education Evalutions, our goal is to empower dreams and improve the lives of people through the recognicaton of foreign educational achvement. We are excited to see these results and look forward to helping nurses fulfill their dreams.
