By the time a repeat test-taker found their way to tootRN, they’d usually already been told what was wrong with them.
They’d failed once, sometimes twice. (I worked with students who’d failed as many as ten times before they found me — though most found their way to me after just one or two attempts.) They’d bought the question banks. They’d done thousands of practice questions. They’d tried the big-name prep tools. And somewhere along the way, someone had handed them an explanation for why they kept failing: You just need to do more questions. You’re an anxious test-taker. You need to memorize the high-yield topics.
So that’s what they’d do. More questions. More flashcards. More high-yield cram sheets. And they’d fail again — now more convinced than ever that something was fundamentally wrong with them.
Here’s what I found, over and over: the explanation they’d been given was almost always wrong.
The anxiety that wasn’t anxiety
Let’s start with anxiety, because it’s the one I heard most.
Plenty of my students told me they were anxious test-takers. For some, the anxiety was real and worth taking seriously. But for many more, when I dug into it, the “anxiety” didn’t behave like anxiety. It behaved like something else wearing anxiety’s clothes.
I’d ask a student to walk me through what they felt when they sat down with a question. Often what they described wasn’t fear — it was a kind of fog. A blankness. A not-knowing-where-to-start. And when I pressed on it, what surfaced underneath wasn’t anxiety at all. It was a lack of confidence. Are you sure it’s anxiety — or do you just not have a word yet for not feeling confident? Because that’s a different problem with a different fix.
And the lack of confidence had a source: they didn’t actually know how to approach the question in front of them. Of course you feel something like panic when you don’t have a method. The feeling was real. The label was wrong. And calling it “anxiety” sent these students toward solutions that weren’t wrong, exactly, but weren’t the right ones for what they were actually facing — breathing exercises, test-taking-strategy videos, more questions to “desensitize” themselves. Those are real tools, and they help real problems. They just weren’t the tools these students needed, because the problem underneath wasn’t emotional. It was cognitive.
What was actually going on
So what was the real problem?
The clearest pattern I saw: students rushed. They’d read a question and jump straight at the answer choices before they’d really digested what was being asked. They were trying to recognize the question — to match it against something they’d memorized — instead of reasoning through it.
What they weren’t doing was thinking like a nurse detective.
A nurse detective slows down. They read the question and ask: what is actually going on with this patient? What is this question really asking me to do? They reason forward — if I do that, then this will happen. If the patient is presenting this way, then the priority is that. They use the information in front of them to predict outcomes, not to trigger a memorized response.
That’s critical thinking. And it’s the exact skill the Next Generation NCLEX was built to measure. The exam isn’t asking do you remember this fact? It’s asking can you reason through this situation the way a safe nurse would at the bedside? This isn’t only my read of it. The NGN was deliberately redesigned to measure clinical judgment — applying concepts to patient scenarios, prioritizing, making safe decisions — rather than factual recall.³ The path to the answer matters as much as the knowledge behind it.⁴ A student trained to recognize and recall — rather than analyze and predict — walks into that exam fundamentally mismatched to what it’s testing. More practice questions don’t fix that mismatch. They just give the student more reps at the wrong skill.
The lightbulb
When I worked with a student on this, the change usually wasn’t gradual. It was a lightbulb.
Once they stopped trying to recognize the answer and started treating the question like a puzzle — slowing down, gathering the pieces, asking what each one meant, predicting what would happen next — something clicked. They could see the big picture instead of grasping at fragments. They could predict outcomes instead of guessing. The questions stopped feeling like traps and started feeling like problems they actually knew how to solve.
I watched students go from defeated to capable in the span of a few sessions. Not because they learned new content — but because they finally learned how to use the content they already had.
Why this should matter to anyone running a program
Here’s the part that goes beyond the individual student.
This wasn’t a rare profile. It was the most common one I saw — and the national numbers suggest these students are anything but a fringe case. In 2025, first-time U.S.-educated candidates passed the NCLEX-RN at 86.7%; repeat U.S.-educated test-takers passed at just 52.7%.¹ And the gap isn’t a recent blip — across 2018 to 2025, the first-time rate has run nearly double the repeat rate.² Repeat test-takers are a large, persistent population, and the explanations they’re handed for why they keep failing deserve far more scrutiny than they get.
Student after student, the same root cause: they had spent nursing school cramming bits and pieces of information into their heads, and they had never been given the chance to connect the dots. They’d accumulated an enormous amount of knowledge. What they’d never been taught was how to build on it, apply it, and analyze it — how to actually do something with all of it.
Sit with what that means. If the most common reason students fail the NCLEX repeatedly is that they were never taught to connect knowledge to action — then repeat test-takers aren’t fundamentally a testing problem. They’re a curriculum signal.
A student who can’t build on, apply, and analyze information didn’t develop that gap at the testing center. They developed it across two to four years of a program that — usually without anyone intending it — rewarded accumulation over application. They were assessed on whether they’d absorbed the pieces, not on whether they could assemble them. Then they sat for an exam that only cares about assembly.
Treating the symptom at the latest possible moment
This is why I get uneasy when programs treat repeat test-takers as a problem to be fixed at the end — more questions, a boot camp before the exam, a high-yield review the month before students sit. That’s treating the symptom at the latest possible moment, when the gap was built in years earlier.
The programs that produce fewer repeat test-takers aren’t the ones with the best end-stage remediation. They’re the ones that build the thinking in from the beginning — that teach students to reason like a nurse detective from the first semester, that assess application and not just recall along the way, that treat “connect the dots” as a skill to develop deliberately rather than something students are simply expected to absorb on their own.
That’s harder than bolting on a remediation module. It means looking at how content is taught across the whole curriculum, not just how students are prepped at the end. But it’s the difference between manufacturing repeat test-takers and graduating nurses who were ready all along.
They were never broken
I think about the students I worked with who’d failed five, eight, ten times. Some of them did have real knowledge deficits — genuine gaps in foundational content that we had to rebuild before anything else could click, and I won’t pretend that work is quick or that it isn’t a real struggle. Time compounds it, too: content fades with distance from graduation, and pass probability is meaningfully higher for candidates who test within weeks of finishing school rather than months or years later.⁵ But far more often, the knowledge was already there. What was missing was the one thing nobody had taught them: how to think with it. Once they learned that, they passed — often on the very next attempt.
They were never broken. They were never “bad test-takers.” They were capable people who’d been taught to memorize when they needed to be taught to think.
The exam already changed to reflect that. The question is whether our programs will.
If you’re looking at your program’s repeat test-taker numbers and wondering whether the problem is really where you’ve been told it is — that’s a lot of what I do. You can start a conversation here.
References
- Kaplan Test Prep, NCLEX Pass Rates 2026: What You Need to Know (2026). 2025 first-time U.S.-educated (86.7%) vs. repeat U.S.-educated (52.7%) NCLEX-RN pass rates, per NCSBN data. https://www.kaptest.com/study/nclex/nclex-pass-rates-what-you-need-to-know/
- Blueprint Prep, The NCLEX Pass Rate is Decreasing: What to Know for 2026 (2026), citing NCSBN. First-time vs. U.S.-educated repeat pass-rate comparison, 2018–2025. https://blog.blueprintprep.com/nursing/what-is-the-nclex-pass-rate/
- UWorld Nursing, NCLEX Passing Score & Scoring Guide (2026). The NGN’s emphasis on clinical judgment and application over memorization. https://nursing.uworld.com/nclex/passing-score-and-scoring-guide/
- Sulcus Learning, What Is the NCLEX Pass Rate? 2026 Update (2026). The path to and timing of the answer as critical as the underlying knowledge. https://sulcuslearning.com/blogs/what-is-the-nclex-passing-rate/
- OpenExamPrep, NCLEX Pass Rate 2026: Why It Dropped to 87% RN (2026). Pass probability higher when testing soon after graduation; knowledge decay over time. https://open-exam-prep.com/blog/nclex-pass-rate-2026