The lived experiences of diploma nurses who did not pass their professional licensing examination on the first attempt: A qualitative phenomenological study

In the world of healthcare, a license is more than a piece of paper; it is the legal key that unlocks the door to a career. For nurses, this key is earned by passing a rigorous professional exam that tests their knowledge of medicine, surgery, and patient care. In many countries, this exam acts as a final gatekeeper, ensuring that only those who are truly ready to care for the sick are allowed to enter the workforce. When a student passes, they join the ranks of professionals who save lives. When they fail, however, the consequences extend far beyond a simple grade on a report card. The failure blocks their entry into the hospital, delays their ability to earn a living, and often leaves them stranded in a state of limbo while their peers move forward. This gap between graduation and employment creates a unique kind of pressure, one that is felt deeply by the individual and ripples out to their families and communities.

A team of researchers in Ghana set out to understand what happens inside the minds and lives of nurses who face this specific hurdle. They focused on a group of diploma nurses who had graduated but failed their licensing exam on the very first try. While many studies look at what predicts a student's success or failure before they even take the test, this group wanted to hear the stories of those who had already failed and then had to find a way back. They asked these nurses to describe their feelings, the reasons they believed they failed, and the steps they took to eventually pass the exam on a second attempt. By listening closely to these personal accounts, the researchers hoped to uncover the hidden emotional and social costs of failure and identify the support systems that help people recover.

The study took place in the Sunyani municipality of Ghana, where ten nurses who had successfully passed their exam on a second try agreed to share their experiences. These individuals had all graduated from a local nursing college and were currently working in hospitals, having finally cleared the barrier that had once stopped them. The researchers conducted long, private conversations with each person, asking them to recount the days immediately following their failure and the months that followed. The goal was not to judge them or to find statistical patterns, but to understand the texture of their lived reality: the shame, the fear, the isolation, and the eventual path to redemption.

The stories that emerged were heavy with emotion. When the results were announced, the initial reaction for most was a profound shock. Many had expected to pass, or at least believed they had studied hard enough. Hearing that they had failed felt like a sudden, jarring break from reality. One nurse described checking the results and thinking it was a joke, unable to reconcile the news with their own sense of competence. This shock quickly gave way to a deep sadness. The failure was not just an academic setback; it was a personal crisis. Several participants described crying for days, locking themselves in their rooms, and feeling a crushing weight of disappointment. For some, the pain was so intense that they thought about ending their lives, finding the only reason to stay alive was the need to support their aging parents.

Beyond the internal turmoil, the failure tore at their social fabric. In a culture where community and family are central, being unable to join the workforce as a qualified nurse brought a heavy sense of shame. The nurses described withdrawing from their friends and neighbors, avoiding social gatherings, and even skipping church services to escape the questions and the pitying looks. They felt left behind, watching their classmates who had passed move into hospitals, start earning money, and plan their weddings, while they remained stuck at home. This feeling of stagnation was painful; they saw their lives pausing while everyone else's continued. Some even had to postpone their own wedding plans because their partners or families insisted they secure their license first. The social isolation was so severe that many chose to cut ties with the friends who had passed, finding it too painful to be around them, and instead sought comfort only among others who had also failed.

When the nurses looked back to understand why they had failed, they did not blame the system or the exam alone. Instead, they pointed to their own choices and the influence of those around them. Many admitted that they had prioritized recreation, such as football matches or socializing, over their study time. They acknowledged that they had not taken the exam seriously enough until it was too late. Others spoke of negative peer pressure, where friends distracted them or encouraged them to skip studying. One participant noted that a romantic relationship had consumed too much of their time. They realized that their failure was not a mystery, but the result of specific behaviors and a lack of focus during their preparation.

Despite the depth of their struggle, every single one of these nurses eventually found a way to pass the exam on their second try. Their success was not a solitary victory; it was built on a foundation of support. The most critical factor was their families. Parents and spouses provided not just financial help to pay for the re-examination fees, but also emotional encouragement that kept the nurses from giving up. Tutors and former teachers also played a vital role, offering guidance and reminding the candidates that they were capable. For many, faith was a powerful anchor. They turned to prayer and religious texts to manage their anxiety and find the strength to keep going. Finally, they changed how they studied. Instead of studying alone in isolation, they formed small groups with other nurses who were also preparing to retake the exam. These groups shared past questions, discussed difficult topics, and held each other accountable, creating a collaborative environment that helped them master the material.

The researchers concluded that the journey from failure to success is a complex emotional and social process. It is not enough to simply study harder; the psychological toll of failure requires a supportive network to overcome. The study suggests that nursing schools and health institutions need to do more than just teach the curriculum. They must create programs that support students who fail, offering counseling and structured guidance to help them navigate the shame and isolation that often follow a failed exam. By understanding the human side of this experience, institutions can help more nurses cross the finish line, ensuring that the healthcare system gains the skilled professionals it needs. The story of these nurses is a reminder that while failure can be a devastating event, it is not the end of the road, provided there is a path of support to walk back onto.