Nursing graduates enter a complex healthcare system requiring they develop ever-expanding knowledge to provide safe practice. This researcher examined the effect of an intervention on the performance on comprehensive assessments by achievement level and degree status of graduating nursing students, and the relationship of these scores to the first-time pass rates on the National Council Licensure Examination-Registered Nurse (NCLEX-RN). The relationships between student grades obtained in previous nursing courses, graduates' perceptions of the effectiveness of the intervention and the impact of nonacademic factors also were explored.

Two versions of the Assessment Technology Institute (ATI) RN Comprehensive Predictor® were administered to graduating seniors in proctored environments before and after students attended a Pre-NCLEX Review course. After graduation, candidates took the NCLEX-RN; their pass-fail status was reported to the school by the state. An invitation letter and survey was sent to all graduates who took the NCLEX-RN. This survey obtained data about graduates' perception of the effect of the intervention and other factors on their performance on the assessments. Exam scores, demographic data, course grades were obtained from college records for students of one academic year.

The results obtained with a paired sample t-test for a sample of 116 revealed a significant increase between pretest and posttest scores (p<.000) for all subgroups; differences by achievement level and degree status were not significant. Regression analyses identified final grades in Growth and Development and Pharmacology as best predictors of pretest and posttest performance (R square = .497, .468, respectively). There was also a significant relationship between the posttest scores and NCLEX-RN outcomes (r=.334, p=.009). In this sample, 88.1% of graduates performed as predicted by the comprehensive assessments. Descriptive statistics were reported for survey responses.

The researcher provides a basis for evaluating the relationship between nursing education practices and licensure examination. Targeted preparation and measures to address at-risk students can promote success on NCLEX-RN. The findings have implications for review of instructional practice and examination preparation within nursing programs.