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NCLEX Pass Rates Are Falling and Hospitals Are Feeling the Impact
How simulation can help close the gap between education and practice readiness
The nursing workforce is under pressure. Hospitals are navigating persistent staffing challenges, rising costs, and shifting quality benchmarks, all while trying to onboard new nurses who may not be fully prepared for the realities of clinical care. At the same time, recent data confirms a downward trend in NCLEX pass rates, raising concerns about readiness at the point of entry.
As these challenges intersect, one question becomes clear: how can healthcare organizations better support new nurses, protect care quality, and maintain workforce stability? Simulation offers a strategic way forward, but only when it’s aligned with real needs and used with clear purpose.
The Data: NCLEX Pass Rates Are Slipping
In Q1 2025, just 71.6% of first-time U.S.-educated nursing candidates passed the NCLEX, down from 79.1% during the same period the year prior, according to Becker’s Hospital Review’s analysis of NCSBN data. The decline marks the second consecutive year of falling pass rates since the launch of the Next Generation NCLEX in 2023.
While these numbers alone are concerning, they don’t exist in isolation. Simultaneously, hospitals have seen a drop in five-star ratings from the Centers for Medicare & Medicaid Services (CMS) and continued challenges with nurse turnover. Fewer new nurses passing the NCLEX means a smaller pipeline, slower onboarding, and higher demand on the existing workforce. For hospitals already facing pressure on margins and staffing, this is not a small shift — it’s a growing operational risk.
Hospitals Are Already Feeling the Strain
Lower pass rates translate to fewer graduates eligible for licensure, limiting hiring pools in a moment when demand remains high. When new hires are less prepared, onboarding takes longer, often requiring more time from experienced nurses who are already stretched thin.
These downstream effects are visible in higher orientation costs, inconsistent unit performance, and in some cases, reduced patient satisfaction. Nurse managers report concerns about safety and quality when new hires are placed into high-acuity environments without the confidence or clinical judgment required.
Even hospitals with strong academic partnerships are noticing gaps. This is not a question of motivation or intent — it’s about changing expectations, limited resources, and the need for better preparation before day one.
What’s Causing the Readiness Gap?
Several converging challenges are contributing to the readiness gap, affecting both test performance and clinical confidence:
- Changes to the NCLEX: The newer exam format places greater weight on clinical judgment, decision-making, and prioritization; areas that may not be fully supported in all curricula.
- Clinical Site Access: Many students are graduating with fewer in-person clinical hours due to capacity limits and shifting hospital policies.
- Ongoing Faculty Shortages: Programs continue to face difficulty recruiting and retaining qualified nursing instructors, limiting opportunities for close supervision and skill development.
- Pandemic Residual Effects: The disruption caused by COVID-19 still lingers in some programs, especially those that pivoted away from in-person experiences for extended periods.
Together, these issues have created a learning environment where students may graduate with strong theoretical knowledge but less experience applying it in real-time clinical scenarios.
How Simulation Can Help — When It’s Used Strategically
Simulation has long been a part of healthcare education, but its role is evolving. When thoughtfully integrated, simulation doesn’t just check a competency box — it builds clinical reasoning, supports consistent practice, and creates a safer space to develop confidence.
Simulation can be leveraged in strategic ways to address today’s readiness challenges. This includes:
- Focusing on high-impact scenarios that align with common points of failure for new nurses — such as prioritization, rapid deterioration, or escalation.
- Supporting facilitators with training solutions to ensure simulation is delivered consistently and evaluated effectively.
- Bridging the gap between education and practice by aligning academic simulations with the realities of acute and critical care.
- Providing structure to orientation programs, helping clinical educators measure and track the development of key skills in new hires.
The key isn’t more simulation. It’s using simulation strategically – grounded in data, tied to outcomes, and designed to meet specific gaps in both technical skills and clinical decision-making.
What Comes Next: Preparing for the Moments That Matter Most
The readiness gap isn’t just a challenge for schools, it’s a system-wide concern impacting patient care, workforce stability, and financial performance. As hospitals continue to feel the effects of fluctuating NCLEX pass rates and extended onboarding timelines, the urgency to act is growing.
Simulation will play a larger role in addressing this gap. Not by replacing traditional learning, but by strengthening it. The future of simulation lies in its ability to bring learning closer to real care environments: sharper decision-making, faster recognition, better teamwork, and safer outcomes.
To get there, organizations will need to move beyond ad hoc use and adopt more intentional, data-driven simulation strategies — built around the realities new nurses face on the floor.
At Elevate Healthcare, we’re helping healthcare leaders design simulation programs that don’t just prepare nurses to pass exams, but to succeed in practice.
“The key is to just start. Start targeted, start focused, and grow from early wins,” shares Stacie Wood, Chief Nursing Officer at Elevate Healthcare.
It’s not about doing more. It’s about doing what works, where it counts.
Watch the full interview with Stacie Wood to hear her perspective on NCLEX trends, nurse readiness, and how hospitals can stay ahead of the curve