May 2, 2022

Florida Colleges Are Nation’s Worst on Nursing Exam Pass Rate

Florida Colleges Are Nation's Worst on Nursing Exam Pass Rate

While Florida governor Ron DeSantis promotes himself as a champion of education and economic opportunity, his state is lagging far behind every other state on a key measure of educational quality, social mobility, and public health standards: whether people who complete nursing school can then pass the NCLEX nurse licensing exam. In the first quarter of 2022, according to recently-released data, 51,052 people nationwide took the NCLEX registered nurse exam for the first time. 82.45% passed. But for people educated in nursing programs in Florida, the passage rate was only 67.41%: nearly a third of Florida nursing school graduates flunked the licensing exam. The next lowest state rate was Arkansas, at 75.63%. Most states had rates in the 80’s and 90’s.

Florida was in last place among states by even worse margins for 2021 and has posted poor results for years, through DeSantis’s term and that of his predecessor, Rick Scott, now a U.S. senator.

Florida also has the largest number of NCLEX test takers in recent years; in the most recent quarter it had 5,103 people — just after Texas and well ahead of other large states. So a large number of Floridians who have invested time, money, and dreams, as well as taxpayer-funded student aid, in Florida nursing schools are, for now, unable to join the profession. Instead, all they may have from their studies is thousands of dollars in student loan debt.

It may be that too many Florida schools are over-promising potential nursing students, in order to lure them into programs and collect their cash and federal aid, while failing to offer programs strong enough to help some of these students succeed.

Florida’s Commission for Independent Education (CIE), which is holding a regularly-scheduled meeting Tuesday, is the state agency tasked with overseeing independent colleges in the state. CIE has a full-time staff as well as a group of outside commissioners. Among CIE’s duties is the obligation to monitor NCLEX pass rates and require improvements for schools with low rates. There clearly is room for improvement on that score.

CIE’s long-time chair, Peter Crocitto, is listed on the CIE website as being affiliated with Southeastern College, a for-profit school that has campuses in Florida, North Carolina, and South Carolina and is owned by politically powerful Florida college baron Arthur Keiser and Keiser’s wife, Belinda. Crocitto is also the chief operating officer of the much larger Keiser University, a formerly for-profit school converted to non-profit on dubious terms by the Keisers and still run by them.

This year, the chairs of the House Veterans Affairs, House Education and Labor, and Senate Judiciary committees have called on the U.S. Department of Education to investigate Keiser University, which already has faced multiple law enforcement investigations alleging deceptive acts. But on NCLEX, the school is doing fairly well; last quarter its pass rates ranged from 64 percent to 100 percent and collectively exceeded state outcomes. However, the registered nurse NCLEX pass rates at the two reporting campuses of the Keisers’ other school, Southeastern, were just 43 and 33 percent: 16 out of 25 Southeastern students failed the test.

A long-time for-profit college industry executive told me what he thought Florida and its schools were doing wrong: “Approval to offer rigorous allied health programs which require passing a board exam allows these institutions to validate [themselves] as educational institutions.”  But too many Florida schools, this executive says, “have enrolled tremendous numbers” of students unlikely to succeed “and allowed them to complete their program without actually preparing them, losing valuable time while only gaining debt.” Because state and accreditor oversight is weak, “These school collect tuition for years before having the programs taken away.”

Nationwide, NCLEX preparation at the nation’s nursing schools may be worse than reported because some career schools have sought to weed out low performing students as they near completion and prevent them from graduating after paying several years of tuition, in order to render them ineligible to sit for the NCLEX exam, with the aim of keeping school pass rates from going lower.

The industry executive who spoke with me suggests that schools should be penalize by oversight bodies for poor NCLEX pass rates, just as some schools ultimately dump low-performing students: “Since students may only be on academic probation for two terms [before they are] dismissed, maybe these schools should receive the same amount of time.”

Barmak Nassirian, a leading higher education expert with the advocacy and research group Veterans Education Success, reflected for me on the context around Florida’s dismal NCLEX outcomes. “In multiple ways,” he said, “Florida serves as the poster child of how higher education — historically viewed as the realm of empirical facts and deep subject-matter expertise — is being politicized by elected officials who view it as their prerogative to substitute their opinions and preferences for the considered findings of the various disciplines. Historically, such preferences were limited to underfunding of public institutions and lax oversight of for-profits, which have thrived in the state because of its laissez-faire approach to regulatory oversight. Over the course of the past few years, however, political interference in Florida has crossed the line into hitherto sacrosanct matters of faculty appointments and fundamental academic practices of the state’s public universities. This mindset certainly threatens the reputation and the quality of higher education in Florida, as shoddy providers are allowed to flourish and as the state’s leading public institutions begin to be run as mere extensions of the Governor’s office, like the Department of Motor Vehicles.”

The communications office of Governor DeSantis did not respond to my request for comment. Neither did the Florida Board of Nursing, which licenses, monitors, and disciplines nurses in the state. A spokesperson for Keiser University did not respond to my questions or my request to speak with Peter Crocitto and Arthur Keiser. A spokesperson for the Florida Commission for Independent Education wrote back, just before the deadline I provided, “This has been sent to our commissioner’s office for response.”

UPDATE 05-03-22:

At the start of today’s meeting of the Florida Commission on Independent Education, the body’s executive director, Sam Ferguson, noted that Florida was last in the nation on NCLEX pass rates and said, “I think we made national news.” (Which was pretty charitable of him.) He added that Florida’s NCLEX performance “is not a distinction we ought to appreciate,” and he noted that several of the schools on CIE’s meeting agenda for the day “are on that list.” Commission members subsequently questioned Southeastern College officials about the school’s low NCLEX passage rate; they responded that the school had created a mediation plan and also was focused on recruiting “better qualified” students.

UPDATE 05-04-22:

Cassie Palelis, press secretary for the Florida Department of Education, emailed me today “to express our deep concern with your complete lack of understanding of the great work Florida’s college system has done to prepare our nursing workforce.” She added, “there is a vast difference when analyzing the nursing exam pass rates of state institutions versus private institutions. In 2020, district technical colleges had an 84% pass rate and Florida College System Institutions had an 89% pass rate. While not accredited private institutions had a pass rate of 49.72%.”

I do not dispute the solid NCLEX pass rate figures that Ms. Palelis provides for state-operated institutions back in 2020. But even including those scores, Florida remains last in the nation. In addition, state agencies — the Florida Commission for Independent Education, which is part of the state Department of Education, where Ms. Palelis works, and the Florida Board of Nursing — have oversight responsibilities over private nursing schools in that state, responsibilities that include protecting students from programs that enroll them and take their money but leave them unable to pass the NCLEX exam and thus practice as nurses. Moreover, the Florida private schools — which, contrary to Ms. Palelis’s note, are in fact accredited and also approved by the state Board of Nursing — report more NCLEX test-takers than Florida state schools.

UPDATE 05-16-22:

Governor DeSantis announced today that he had approved, according to a press release, “over $125 million for nursing education for the 2022 – 2023 Fiscal Year….”  $100 million of that funding is “to establish the Prepping Institutions, Programs, Employers, and Learners through Incentives for Nursing Education (PIPELINE) program to financially reward colleges and universities for their nursing education programs, based on student success.” The release quoted DeSantis as explaining, “We are investing in quality nursing education to increase the number of programs and jobs that prepare students for careers in nursing.”

I hope this initiative will include stronger oversight of schools that aggressively and deceptively recruit students into nursing programs that are not of sufficient quality to help them succeed — even if those schools are owned by influential Floridians.