Second, there are Associate Degrees in Nursing (ADN) programs that also require two years of full-time study. In addition to the nursing curriculum, they require general education courses to obtain an ADN. Third, there are Baccalaureate of Science in Nursing (BSN) programs that mandate four years of full time study. The BSN programs are university based programs and require general education courses in addition to the nursing classes. After the nursing program is successfully completed, the candidate is eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX or NCLEX-RN).
Since it was first administered in July of 1982 , the NCLEX has undergone many changes. It started as a two-day paper-and-pencil exam that tested each specialty area, such as medical, surgical, pediatrics, mental health, and women's health, separately. Next, the exam format was changed so that the specialties were blended together. However, it still was a two-day paper-and-pencil test. The most recent change occurred in 1994. At that time, the test was extended into a Computer-Adaptive Test (CAT) version. It is now given on computer and lasts an average of 3 to 4 hours. The CAT version has presented new challenges for nursing school graduates and faculty.
Nursing graduaNursing graduates must be successful on NCLEX in order to practice nursing. There are three major reasons for higher education administrators and educators to be concerned about failure on NCLEX. A lower regional, state or national failure rate has an impact on the health care profession for two reasons: it decreases the number of graduates available to the workforce, and it increases the amount of time until the graduate is licensed and can actually contribute to the workforce and the profession .
The second reason is that lower pass rates reflect poorly on the nursing program at institutions of higher education and may ultimately mean budgetary cutbacks or program closure and waning nursing student enrollments. Students often choose programs accredited by the National League for Nursing  and programs with a reputation for high NCLEX pass rates. Nursing education programs in some USA states were reported to have a pass rate of at least 92.5% of the national average (National Board of Examiners for Registered Professional Nurses, 1999) during the period of 1991 to 2000.
Faculty may experience frustration and concerns about the reputation of their programs based on licensure exam success or failure . This has motivated faculty to identify factors related to the program, teaching or students contributing to NCLEX success or failure. A third reason for studying factors predicting NCLEX performance is the impact of failure on the self-esteem of the graduate and the implications for decreased professional self-confidence [2, 5] described feelings experienced by graduates who failed the NCLEX as anger, shame and despair.
A review of the literature over the past 20 years reveals many studies relating to performance of graduates on the NCLEX. These studies fall into two categories: student characteristics and performance on the licensure examination and