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In January 2023, we reported on the reasons why nursing test pass rates fell in 2020 and 2021. In this report, we follow up on what has happened since.

During the first 2 years of the COVID-19 pandemic, the share of candidates who passed the national licensure test to work as a registered nurse fell sharply, from 88.2% to 82.5%, for first-time U.S.-educated candidates, with a smaller decline -- from 72.8% to 68.9% -- for all candidates, including internationally educated and repeat test-takers.

In 2022, pass rates continued to drop, averaging 79.9% (8 percentage points lower than in 2019) for first-time U.S.-educated candidates, and 63.4% for all candidates, the lowest point in the last decade.

In 2023, to most experts' surprise, that spiral appears to be turning around.

Things Are Looking Up

The reason for this reversal depends on whom you ask. Test developers have argued that rates improved due to radical transparency and massive outreach to stakeholders, while some online critics have suggested the test simply got easier. Other nurse educators agreed that the increased transparency and outreach impacted rates, but worry those same measures exacerbated a culture of "teaching to the test."

Understanding trends in test pass rates also requires context.

The National Council of State Boards of Nursing (NCSBN) produces the test that aspiring nurses take to gain licensure: the National Council Licensure Examination (NCLEX). This test uses computerized adaptive testing, which means each test-taker gets virtually a different exam, the difficulty of which changes based on the response given.

Every 3 years, the NCSBN assesses the pass rates for the test and determines whether the current passing standard is appropriate. If the NCSBN's board of directors decides that the level of clinical judgment required of nurses in practice has increased, it can vote to raise the passing standard.

In December 2022, the NCSBN's board voted to keep the current passing standard on the NCLEX through March 31, 2026. Months later, on April 1, the NCSBN launched the Next Generation NCLEX (NGN), a new version of the NCLEX that aims to more effectively measure test-takers' clinical judgment.

Anytime a new test is introduced, pass rates tend to dip by a few percentage points in the first two to three quarters, explained Philip Dickison, PhD, RN, CEO of the NCSBN. He said he was naturally a bit concerned about a new test compounding the "drastic drop in the ability curve" seen during the pandemic, "but it was still the right thing to do."

Keith Rischer, PhD, RN, a nurse educator and owner of KeithRN, a nursing education company, recalled that the last major change to the NCLEX occurred when the passing standard was raised by 0.16 percentage points in 2012. Pass rates fell more than 7 percentage points -- from 90.34% for first-time candidates to 83.04% -- in a single year.

While the NCSBN kept the same passing standard in 2022, the stronger emphasis on clinical judgment and the "unique six-question case studies" in the NGN was predicted to increase the difficulty of the test in some respects.

"There was an anticipation that this was going to be another precipitous decline in NCLEX pass rates," Rischer said.

Post-Pandemic Rebound

However, that wasn't what happened. Instead, preliminary data showed a jump in pass rates, from 79.9% in 2022 to 88.6% in 2023, for all first-time U.S.-educated candidates. Importantly, the 2023 data exclude the fourth quarter of the calendar year, which typically has the lowest pass rate, experts noted.

Still, Dickison said he was "pretty amazed" at the speed of the recovery. Some viewed the change as a "huge increase," but he stressed that rates were starting from a low baseline following a 3-year period when other variables, namely pandemic-related disruptions, impacted pass rates.

"What I think you're seeing ... is that we have rebounded to pre-pandemic ability levels in our measurements," he said.

Dickison credits the rebound to NCSBN's decision to let educators, regulators, and -- controversially -- preparatory groups "under the hood" of the new test for several years before the NGN actually launched.

"The idea was to be as transparent as possible to all stakeholders," Dickison said. This meant leveraging opportunities at conferences and during webinars, and sharing what to expect of the new test -- from case studies and measurement models -- in newsletters. Dickison also credited educators for the big role they played in helping prepare students.

Rayna Letourneau, PhD, RN, executive director of the Florida Center for Nursing, said that while some nurse educators have noted the test has gotten "too easy," she suggested that perhaps the NGN is simply "a more logical way to measure what nursing students are being taught."

Similarly, she attributes the rise in pass rates to the focus on increased resources and preparation of candidates, including the implementation of "student success" coaching programs.

Teaching to the Test?

Rischer seemed to have a different view, pointing out that the NGN offers partial credit for certain "select-all-that-apply" multiple-choice questions. He said that he believes the real reason for improved pass rates is a shift in nursing education, though he added that his hypothesis is, at this point, "conjecture."

"What we have in the nursing literature for over almost 50 years ... is this widening gap between how nursing is taught in the university and college settings and how it's actually practiced at the bedside," he said. "We're not preparing our graduates for real-world practice realities."

Rischer said he grew even more concerned when he learned from online discussions that some professors were using NGN trial items to teach first-semester students.

"That's called teaching to the test," he argued. Instead of teaching students "alternative multiple-choice items, we need to be teaching our students the open-ended thinking of clinical practice."

For example, for a patient who had an appendectomy, Rischer said the appropriate steps are to take vital signs and conduct a head-to-toe assessment.

"There is not a 'select-all-that apply' multiple-choice item on your forehead that I could say, 'You know what? This is the correct answer,'" he added, noting that the NCSBN "is part of the problem." Currently, the primary mechanism that state nursing boards use to measure a program's performance is their first-time pass rate on the NCLEX, which only "reinforc[es] this unhealthy culture of teaching to the test."

The end result of that, as studies have shown, is that "currently less than 10% [of new nurses] have what practice partners would say is entry-level clinical judgment competency," Rischer said, citing a 2021 study. "Complications develop when a nurse doesn't notice or recognize what's most important until it's too late. So ... clinical judgment competency is a big deal. And teaching to the test ... isn't going to solve that."

He said one solution is to move away from first-time test-taker metrics and potentially allow students to take the test twice and then average their score.

Another, more dramatic, change would be to include a skills test or what Rischer calls "demonstrable competencies" for essential skills involved in clinical decision making, which could be evaluated by an "objective observer."

"It will take more time. It will take more money, but this is something that we can and should be doing," he said.

'Not the Only Measurement'

For his part, Dickison noted that the NGN, like any exam, has limitations.

While it "measures your cognitive and your thinking ability, our test does not measure the affective domain, doesn't measure character," he said. For example, the test cannot assess a "less-than-acceptable social interaction" a student has with a professor, nor does the test know which student is always late to class.

"If they don't show up to class on time every day, that might be a [sign] that they're not going to show up to a patient when they need to," Dickison explained. "That's why you have a regulatory system. That's why we have an education [system] ... these all have to work together. If you don't pass the NCLEX, you don't go to work, but it is not the only measurement that tells us we have a good nurse."

Pretty much every new TV and projector has the ability to decode HDR, or high dynamic range, video. In most cases, HDR content looks better than non-HDR material, though an individual display's ability to deal with the extra data can vary greatly. 

However, there isn't just one HDR format. There are a number, including Dolby Vision, HDR10, HLG and a couple of others. Few displays can decode them all, but all can decode the basic HDR formatting that all HDR content includes. Streaming services like Netflix and Amazon Prime Video, along with 4K Blu-ray discs, can also support multiple formats, though often they only have one or two. 

The good news is, this isn't a format war. All HDR displays can watch all HDR content. However, some of the formats have additional features that can be used by compatible displays for an even better image. Knowing what each of the formats does, and what to look for on your own TV, can be very helpful. Here's everything you need to know

The basics

In CNET's TV and projector reviews, both the capabilities of the TV itself and the way HDR is used in the movie or TV show have a greater impact on image quality than the specific HDR format. Which is to say, just because a display can read a "better" HDR format, doesn't mean that display will look better than one that can't read that format. Here's a tour of the HDR landscape as it stands today.

• It's not a full-fledged "format war," it's more like a slap fight.
• Multiple HDR formats can exist in a single TV.
• Everything supports HDR10, but many TVs and sources will also have at least one of the other formats.
• One format might look "better" than another on paper, but in the real world the biggest factors are the TV's overall performance and the content itself.

Most new TVs have the ability to display HDR content, which has more detail in the bright and dark areas of the image, for a greater "dynamic range" compared to non-HDR content (i.e. pretty much everything you've ever watched). Older content is now referred to as "SDR," or standard dynamic range. HDR content on an HDR TV can look far more punchy and vibrant than traditional content.

Read more: How HDR Works

Just having an HDR TV isn't enough. You have to watch specific HDR content. Without HDR content, your HDR TV doesn't really know what to do with itself. Sure, it will look good, and maybe even artificially expand SDR content for perhaps a slight improvement. But to get the most out of your HDR TV, you need real HDR content. Thankfully, there's now a lot of it out there. Chances are your favorite new programs are available in HDR.

HDR10

• Supported by everything.
• Better image quality potential than SDR, but perhaps not as good as HDR10 Plus or Dolby Vision.
• Static metadata.

HDR10 is as close to a standard as we've got. It's free to use for manufacturers, so it's available everywhere. Every HDR TV can decode it, every HDR streamer can stream it. Pretty much all HDR content has an HDR10 version, in some cases along with a more "advanced" HDR format like Dolby Vision, which we'll discuss in a moment.  

HDR10's issue, if you can call it that, is that it has "static" metadata. This means that there's one HDR "look" for the entire movie or show. This is certainly better than SDR content, but it doesn't allow for, say, a really bright scene to look its absolute best, nor a dark scene its best, within the same movie. This one-size-fits-all aspect of static metadata is fine, but doesn't let the content nor the TV live up to its full potential. You need dynamic metadata for that, which most of the other formats have. 

Static metadata is sort of like if a football team all had to wear the same sized shirt. Maybe it looks good on the quarterback, and OK on the big linebacker and the diminutive kicker, but surely they'd all look better with a shirt in their own size.

HDR10 isn't backward-compatible with SDR TVs, so it's no good for broadcast. You'll find it available with streaming content and on 4K Blu-ray.

HDR10 Plus

• Championed by Samsung.
• Not widely supported.
• Dynamic metadata.
• Potentially better image than vanilla HDR10.

As you probably figured from the name, HDR10 Plus is like HDR10… but plus. The "plus" in this case is dynamic metadata, improving on HDR10's static version. This means that on a per-scene -- or even per-image -- basis, the content can provide the TV with all the information it needs to look its absolute best.

The catch is… this is a Samsung format. It's pushing it hard, and despite promising no licensing fees (so anyone can use it basically for free), this is a bit of a stumbling block. Hard to imagine a world where LG willingly supports a fledgling format backed by Samsung. Other TV companies have probably been hesitant to back it for the same reason. Yes, consumer electronics is as petty as junior high.

Right now -- beyond Samsung -- Panasonic, TCL, and Hisense are the biggest display brands supporting the format in the US. On the content side, there's Amazon, Hulu, Paramount Plus, Apple TV Plus and Google. It's unlikely HDR10 Plus will ever become the standard dynamic metadata HDR format, but it does deliver companies an alternative to the licensing fees of Dolby Vision.

Read more: What is HDR10 Plus?

Dolby Vision

• Widely supported.
• Potentially the best image quality of all the formats.
• Less content than stock HDR10.

Dolby Vision, like HDR10 Plus, can have dynamic metadata. Streaming services like Netflix, Amazon, Vudu and Apple TV Plus support it, and you can find it on some 4K Blu-rays. Aspects of Dolby Vision, like how it handles dynamic metadata and color, are optional for HDR formatting in the upcoming NextGenTV, aka ATSC 3.0. 

The issue with DV is that companies have to pay Dolby to use it. On the plus side to that, Dolby will then show them how to make their TVs look best when showing DV content. So for some companies, this is an easy way to get their TVs to look better than perhaps they would on their own. For larger companies (like certain Korean companies that begin with S), they don't need such assistance and would rather dump money into their own HDR format, thank you very much.

After HDR10, this is the most popular HDR format, but that doesn't mean it's universal. Samsung is the biggest holdout, for reasons mentioned above. Some companies might only offer Dolby Vision support on certain models. Generally speaking, if a company doesn't support Dolby Vision, they likely support HDR10 Plus, though some companies support both. There is far less Dolby Vision content than there is vanilla HDR10 content. Not a huge issue, but something to keep in mind.

HLG

• From BBC and NHK.
• Free to use.
• Broadcast friendly.

Hybrid Log Gamma was created by Britain's BBC and Japan's NHK. Unlike the formats we've discussed so far, it's actually backward-compatible with SDR TVs. One signal that works on both older TVs and newer is a huge deal for broadcasters. Though as you can imagine, it's not without drawbacks. Mainly, that's in terms of picture quality. Like HDR10, HLG is likely better than SDR, but perhaps not quite the picture quality of the other HDR formats. It's part of the upcoming ATSC 3.0 standard.

There's already wide TV support. Content is still in the early stages, however. If you can get the BBC's iPlayer (whether you're in the UK or using a VPN), that service has HLG support. DirecTV and YouTube also support HLG, but there's just not a lot of content so far. Since it's free, and fills an important niche, expect to see more HLG in the future. Some phones can record HDR via HLG, which you can playback on HLG-compatible displays.

For more info, and why it's so different from other methods, check out our explainer on hybrid log gamma.

Advanced HDR by Technicolor (SL-HDR1, 2 and 3)

• Not widely supported.
• Each "flavor" has its own niche.
• Potentially useful, but we shall see.

Technicolor's Advanced HDR comes in multiple flavors: SL-HDR1 is similar to HLG, in that it's fully backward-compatible with SDR TVs, allowing for one signal to rule them all; SL-HDR2 has dynamic metadata like HDR10 Plus and Dolby Vision; SL-HDR3 uses HLG as a base, but adds dynamic metadata.

Content is limited to some NextGenTV broadcasts. It's unlikely it will get wide acceptance among streaming companies. 

Read more: What is Advanced HDR by Technicolor?

There can be only one. Or three. Or maybe five

A few things here are pretty easy to guess. HDR10 is the de facto base format. Nothing is likely to change that. Dolby Vision, with its wide industry support, especially on the content side, is likely to remain the "step-up" format. HDR10 Plus has increased in acceptance since its launch and is now a viable alternative to Dolby Vision.

NextGenTV continues its slow rollout, and it remains to be seen how much HDR content we'll get with over the air content, though both HLG and Advanced HDR are viable options. 

In reality the long-term outlook is, to be honest, one of universal playback and irrelevant content format. Do you care if your TV is showing Dolby Vision or HDR10 Plus, as long as it looks as good as possible and just like the other format? Since a TV's HDR performance is almost entirely based on its physical hardware, as long as the content looks good and can be shown properly, its specific format "language" doesn't matter. Well, it doesn't matter as long as your TV can speak it. 

As well as covering TV and other display tech, Geoff does photo tours of things like cool museums and locations around the world, including nuclear submarines, massive aircraft carriers, medieval castles, epic 10,000-mile road trips, and more. Check out Tech Treks for all his tours and adventures.

He wrote a bestselling sci-fi novel about city-size submarines, and also Budget Travel for Dummies. You can follow him on Instagram and YouTube.

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