A group of 25 people were caught forging transcripts from shuttered south Florida nursing schools. They were using the forged transcripts in a scheme to show eligibility to sit for nursing licensing exams.

I’m torn on this. If the exam were a valid measure of the knowledge and skills of the nursing profession, then why does it matter whether or not you went to a nursing school? Alternatively, if passing grades in the school were a reliable indicator of proficiency, then why have a licensing exam?

This is simply a continuation of our licensing discussion. The transcript is a certification- the school is certifying that you are proficient. With that being the case, why require an exam? Are you saying that the school’s certification isn’t reliable? Or is it the exam that isn’t reliable?

Or is this simply a money making scheme that allows colleges, testing centers, and the state to rake in thousands of dollars from each nursing candidate?

There are nursing schools that charge upwards of $50,000 for an associate’s in nursing. Many nursing programs have completion rates that are below 50 percent. That is, less than half of the nursing students who begin the program actually complete it. On top of that, less than 60 percent of those who complete nursing programs in south Florida actually pass their certification exams. That means less than a third of students who begin nursing education in south Florida wind up becoming nurses.

My own nursing school had a 45 percent completion rate and a 90 percent exam pass rate. That works out to about 40 percent, and doesn’t include those students who began the prerequisites but were never admitted to the school.

That’s why there is such a nursing shortage. For every 100 students who begin the nursing pipeline, only about 25 of them actually become nurses.

Categories: economics


differ · January 26, 2023 at 8:53 am

Someone I know recently graduated from nursing school and just sat the NCLEX exam. She graduated near the top of her class and has done well on practice tests, but described the actual NCLEX as completely unrelated to anything she’d learned in her classes and during externships and hospital placements and unlike any of the pracitce exams.
She said it was full of ambiguous questions about soft-skills and obscure situations, and in her opinion not a valid test of what she’s learned over the past few years.
Plus the cost…$200 to set up an account to take the test, $50 for background check, $60 for fingerprinting and $200 (I think) to actually sit the exam.
It really is a gate-keeping exercise.

    Divemedic · January 26, 2023 at 9:00 am

    Funny you should say that. I found the opposite to be true. I struggled with the school exams and found them to be difficult and ambiguous. Standard exams like NCLEX and HESI were easier. The correct answers just seemed obvious to me.
    Of course, I had to constantly hear from instructors about how I would not be a good nurse until I learned not to think like a paramedic. I disagree. I think being a medic makes me better as a nurse.

      grumpy · January 26, 2023 at 10:07 pm

      LOL…..my advanced med-sure instructor stated in front of the class (end of semester) – “I pray to God I never have another paramedic in my class”

      I routinely asked for “clarification” – this is where everything is (anatomy)? “yes”. This is how it’s working (physiology)? “yes”. How did you come to that conclusion?? “It’s the way we do things”. OI!!!!

      Differ · January 27, 2023 at 7:44 am

      She passed the test…..much relief.

    Aesop · January 31, 2023 at 12:55 am

    It’s gate-keeping because failure IRL can mean you kill people:


    Buttercup should suck it up.

    Hot Tip:
    The practice of nursing in the real world is full of ambiguous questions about soft skills and obscure situations.

    Pro Tip: Patients don’t have “A-B-C-D” tattooed on their chests. Life is an essay exam, not multiple choice. Know your stuff. There’s no room for “fake it ’till you make it” in healthcare.

    And the current NCLEX, in place since the mid 1990s, distills a question pool of thousands of questions down to an assemblage that is just as predictive of professional mastery as the former 14-hour Battan Death March over two days (8 hours on a Saturday, and 6 more on Sunday) of filling in bubbles with a #2 pencil used to be.
    They tested the last class requiring applicants to undergo both testing methodologies side-by-side, and found a negligible difference in pass/fail rates between the two methods. Ask me how I know.

    People who can’t pass the NCLEX shouldn’t be nurses, and invariably it’s their shoddy school curriculum that failed them (guesstimated 80%, versus just lazy or lunkheads 20%).

    As the bloghost has noted, there are schools of nursing all over the country that have initial testing pass rates in the mid 50%s. Having graduated from a school with a rate in the high 90%s, IMHO the diploma mills should be burned to the ground, and their instructors stripped of their teaching credentials for a minimum of 10 years. If not horsewhipped out of town.

    This isn’t locksmithing or muffler repair.

      Divemedic · January 31, 2023 at 5:46 am

      I would put forward a different theory: ANY difficult test would suffice. It isn’t nursing skill that makes the difference, but intelligence.
      Smart people pass tests. Smart people make good nurses. The people who are good at one thing requiring problem solving and intelligence will be good at many such things.
      An IQ test would be just as good at predicting nursing performance.
      The problem I have with testing is this: there are so many free passes and accommodations given, that the test then becomes worthless. Ever meet a nurse and think to yourself “How did THAT dumbass become a nurse?”
      Yeah, me too.

        Aesop · January 31, 2023 at 4:14 pm

        Yeah, your greater point is true, (and the “accommodations” for stupid people are criminal), but there’s an obvious counter-argument that if you’re going to test at all, it should be questions related to your actual field of practice, rather than random IQ questions.
        I have met stupid nurses (and doctors, techs, vets, dentists, lawyers, etc.). Pretty much every day of my life. (“Some people are still alive only because it’s illegal to kill them” applies in spades there.)
        But I could count the number of smart people I have met who couldn’t score 80% on a standard test on my thumbs, lifetime.

        Going back to the OP, I don’t know how FL works, but in CA, you can challenge to take the NCLEX without jumping through the hoop of actual nursing school, but it requires some amount of actual healthcare experience, like being an LVN or paramedic with clinical hours under your belt.
        If you have A + B and pass C, you get to be an RN.

        But fraud, as in all bonded professions, is an absolute bar to further progress.
        Anyone who’d fake a transcript might fake a chart, or steal narcotics.

        Falsus in uno, falsus in omnibus applies. Always.

          Aesop · January 31, 2023 at 4:27 pm

          And if we’re going to start giving IQ tests (which isn’t a bad idea), the first people tested and screened out should be nursing instructors.
          Some of the absolute dumbest dumbasses I’ve ever met in nursing were the ones flailing around as professors of nursing. (Proving yet again that “Those who can, do; those who cannot do, teach.”)
          The second batch of tests should be required for nursing school applicants.
          Grades and diversity beans be damned: if you can’t pull 110 or better on a standard IQ test, you get shitcanned from the applicant pool, and re-directed into something less difficult. And no more than 2 tries in any 10-year period.
          They could jump it earlier, and require that score to even register for any college, and weed out a lot of people from things they’ll never be able to perform in. Including college itself.
          As Mike Rowe has noted, the world needs ditch diggers, and there are a lot of high-paying jobs for average-bright people willing to work hard and/or get dirty.

          This is one place where the You’re-A-Peons get it right: boot your 10th-grade (equivalent) aptitude/placement scores, and you’re going vo-tech, not university.

          The Lake Wobegone American education model, where “everyone is above average” is a shambling disasterpiece. 75% of the people I met in my years the state college and university system should never have gotten in the door. Including the instructors.

neomunitor · January 26, 2023 at 8:59 am

I’m a retired registered professional engineer, and my wife is a retired CRNA, so familiar with the whole effed up scam of education/registration/continuing education. You are not wrong to point out the issues, but I can definitely say that there are people who should not be practicing in the professions. So the only conclusion I can come to is that the existing systems are nowhere near 100% at anything except making money for schools, registration boards, and their buddies who do the continuing education scam.
My guess is that much of the certification is driven by politicians and lawyers, who would want something to wave in front of the public and jurors when something goes wrong.
The free market approach would be to just let the insurance companies handle this, but they are driven by the lawyers, who want that cushion of certification. In the old days, you got your reputation by hiring on with a reputable firm and putting in some time, and that became your true validation of competence.

TechieDude · January 26, 2023 at 9:08 am

Back in the day (1979, to be exact) my sister took her RN boards and passed, having gone to the local community college for her associates in nursing, which cost peanuts.

Being a cancer survivor, I can’t tell you how many times I’ve had to deal with flat out incompetent and uncaring nurses. Even now, if I go to a downtown appointment I know I’ll be treated with indifference, as if they are going out of their way to deal with me. I’ve noticed a pattern though – vibrants are worse, and men are the best. Every time they can’t get an IV going, they grab a dude who comes in and does it in a minute.

There is no bigger certification ratwheel scam than IT. I should know, i’ve done technical training and certification for nearly 20 years. It’s purpose in the original company I worked for, before mergers and buyouts, was as a gatekeeping tool. You couldn’t get support unless you were certified. What it did was to allow us to function with a smaller support staff, and forced the customers to work with their dealer for minor issues. All technical training ever gives you is some sort of literacy in the product, and knowlege of where to find help (docs or support) when you need it.

MCChuck · January 26, 2023 at 10:06 am

“For every 100 students who begin the nursing pipeline, only about 25 of them actually become nurses.”

That’s a feature, not a bug. Nobody really wants everybody who contemplates going to nursing school actually becoming a nurse who cares for real, living people in need of competent care.

Let’s do the math. Half of all (white) people are of below average intelligence. Keeping in mind that average intelligence isn’t all that bright, do we really want them in nursing? Of those remaining, perhaps half have the commitment, drive, aptitude, and emotional stability to become good nurses. So about one in four completing the program and eventually becoming practicing nurses sounds about right to me.

Note that this has nothing to do with the validity of the process or the scam of most licensing and certification processes.

    Divemedic · January 26, 2023 at 10:39 am

    Yeah. I would agree with you, except there is no guarantee that the people who are being eliminated are of low intelligence, nor is there a guarantee that those who are passing are any better than those who don’t.
    That’s my point- the process is not designed to produce better nurses, simply fewer ones.
    To illustrate my point, a future post will talk about accommodations.

Sporky Boogs · January 26, 2023 at 2:01 pm

A niece went to the big Marxist EDU for nursing and she learned coding for insurance companies after being forced to take the not-a-vax and coming down with the Wu Flu several times.
Good thing it is Desantisland West Berlin or the test would be done away with entirely in the spirit of egalitarian equity.
Eventually healthcare will have a shortage of quality people and the same groups who work the nursing homes will be over represented.

FeralFerret · January 26, 2023 at 3:39 pm

My step-daughter is a nurse. I hate to think what it cost her since she has her Masters. I know her student loan payments are pretty high.

She now teaches nursing while still working at least one shift a week at her local hospital. She tries to reach in a manner that makes it easier for the student to learn, but her boss is so entrenched in the status quo that my step-daughters teaching contract will likely not be renewed even though her student reviews and her results are well above normal. The system does not want anyone rocking the boat, as I’m sure you understand.

Paulb · January 26, 2023 at 3:57 pm

I do like that my industry, the merchant marine, still has a pathway to advancement through experience and testing as an alterative to having to get a BS in engineering or marine transportation at a maritime college. I already went and paid for a BS and master’s in my original career path. I wasn’t going to play pretend military academy for 4 years and live in a dorm room with college-age children. Luckily, the merchant marine allows for certain numbers of days at sea and testing for assorted jobs to qualify people to sit for the engineers or deck officer’s license exams.
I can say without a bit of doubt that the Coast Guard’s merchant marine examination process is far more challenging than anything I ever went through in college or grad school, a combination of practical and theoretical knowledge.

Skeptic · January 27, 2023 at 9:37 am

I read the article, DM. I also read your post about accommodations – which is scary as hell.

In this particular instance, the tipoff is that no names of those charged are given, nor are any pictures published. That tells me that these are vibrants of one stripe or another, and we’ve certainly seen our share of exam fraud in vibrant communities, at all levels from K-12 through Ph.D programs.

EN2 SS · January 28, 2023 at 9:32 pm

At this rate of “equity”, Witch Doctors will soon make a dramatic comeback into play.

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