From the latest US nursing workforce report from the Health Research Services Administration in the US, this striking graph should get more attention. The plunging pass rates of internationally educated nurses (IEN) on the NCLEX-RN exam have big implications for global health workforce policy. The first thing you need to know is that the National Council of State Boards of Nursing (NCSBN) changed the format and content of the NCLEX-RN exam in 2008. The test designers added new testing methods that better validate the actual knowledge, skills, and abilities of internationally educated candidates. This also occurred during growing global outcry of high income countries contributing to "brain drain" in low and middle-income countries. The impact of the change on internationally educated nurses is clear and has reduced the number of viable candidates who would be eligible for practice in the US. At the same time, NCSBN data also show that the overall numbers of IENs
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