The academic strength of grade school and high school students is an influential factor in the ability of nursing programs to prepare new nurses who will meet current and projected healthcare system needs.

Patty Knecht, PhD, RN, ANEF, chief nursing officer for Ascend Learning and ATI Nursing Education, recently sounded a national alarm bell on this issue. In an opinion piece published in the journal Women in Higher Education, Dr. Knecht raised awareness about declining test scores among girls. Because the majority of nurses are women, this trend is concerning for the nursing workforce.

Access the editorial on the Women in Higher Education website (subscription or purchase required) or see the full text below:

Sinking Test Scores Among Girls Could Have Wide-Ranging Implications for America’s Healthcare System

Close your eyes and picture a nurse. Who do you see? 

Chances are, you’re imagining a strong and compassionate woman. This is understandable, as the Bureau of Labor Statistics estimates that 9 in 10 registered nurses, nursing assistants, and licensed practical nurses are women. For years, nursing schools have worked hard to recruit more young men and other underrepresented groups into the field to build a diverse workforce — this good work is important and surely must continue. 

However, with statistics showing girls’ test scores dropping precipitously during the pandemic (read more at bit.ly/4clxNNU), there is cause for concern — not just for individual students who need help catching up but also for America’s healthcare system as a whole. Given what we know about the rigors of nursing school, any drop in students’ academic preparedness will make it much harder for them to develop the skills and earn the grades they need to follow their nursing dreams.  

The U.S. is already facing a serious shortage of nurses — meaning we need to educate and train even more new nurses just to keep up with growing turnover and retirement rates. The problem will only get worse as the demand for nurses is growing faster (according to the Bureau of Labor Statistics at bit.ly/3Ehr1w3) than the national average of other professions. To help strengthen the pipeline, policymakers must create policies that help students succeed in the classroom, pass their licensure exams, and enter the workforce with the necessary confidence and knowledge to care for everyone, from new babies in the NICU to grandparents in hospice. Importantly, we must also ensure new graduates remain in the workforce past their first year and build lifelong careers as nurses. By pursuing policies with measurable outcomes grounded in empirical evidence, we can ensure any funds allocated are well-spent to help solve this crisis.  

Nursing is a rewarding career path, a source of financial stability, and a pillar of the community as the nation’s most trusted profession for over 20 years, according to Gallup (bit.ly/42pd6ME). However, becoming a nurse is no easy feat. If students don’t develop a strong background in STEM fields, solid reading comprehension skills, good communication techniques, and reliable study habits, it will be extremely difficult for them to succeed in nursing school.

A lack of academic preparedness was the top reason cited by students who chose to forgo applying to nursing school after taking the required Test of Essential Academic Skills (TEAS) exam, according to a national survey conducted by ATI Nursing Education. And even among students who applied and were accepted to nursing school, there is growing recognition that more support is needed. According to ATI's November 2024 Nurse Educator Satisfaction Survey, academic preparedness is the number one concern that faculty members have about their students. You can read more from the TEAS survey at bit.ly/4jky7iR.

If left to its current trajectory, this trend could have wide-ranging effects. Not only could it potentially lower enrollment, but a lack of academic preparedness could lead to more dropouts and delays in graduating—a lose-lose for everyone. At the end of the day, the results are the same: fewer nurses entering the profession than are needed to fill the growing gaps in the workforce.

So, what can policymakers do? Helping create and expand support systems that ensure students can excel in the classroom is a good first step. 

Following sharp learning loss during the pandemic, we saw the U.S. Department of Education make a $190 billion investment in elementary and secondary schools, as well as various states invest billions to boost student outcomes. As many of these funds begin to expire, it’s imperative that federal, state, and local policymakers act now to make sustainable, outcomes-based investments to better prepare our nation’s youngest learners. Specifically, these investments should be targeted towards remedial courses for students—like girls—who are falling behind, boosting faculty recruitment and retention, and technology support tools, among other solutions. 

 It’s also important that policymakers invest in students once they’re in nursing school to help reduce first-year attrition. Transitioning to college can be challenging, especially for students struggling to keep up with their rigorous coursework. By taking early action and supporting students, America’s nursing programs can improve their essential knowledge, strengthen their study skills, support their wellbeing, and better retain students without adding any unnecessary additional burden on faculty. (For more on course correction studies, check out bit.ly/3E0Lrtj.)

 Sinking test scores are troubling, but they need not spell doom for America’s students who dream of a career in healthcare. As efforts to diversify the nursing workforce continue, we must also keep its foundation strong and ensure girls are not falling behind in school. With increased academic support, all students stand to benefit and succeed academically and professionally. At the end of the day, all of society will benefit when we help these students grow and graduate into practice-ready nurses. 

 Patty Knecht, PhD, RN, ANEF, is the chief nursing officer of Ascend Learning. ATI is an Ascend Learning brand.