Addressing the nursing shortage remains an important public health concern in the United States (Janiszewski Goodin, 2003). Although, many policies have been suggested to promote retention and reduce attrition in nursing schools (Kubec, 2017; Roa et al., 2011; Schrum, 2015), the significant failure rate in the NCLEX-RN remains a challenge (National Council of State Boards of Nursing, 2021; Carr, 2011; Roa et al., 2011), which delays the early recruitment of new graduates to compensate for the growing shortage of nurses. According to the National Council of State Boards of Nursing (NCSBN), the annual first-time pass rate of US-educated Baccalaureate Degree students was more than 90% during the period of 2017-2020. In 2021 and 2022, the pass rate dropped to 86.06% and 82.32% respectively (National Council of State Boards of Nursing, 2021, 2022.) This lower pass rate places a psychosocial burden onto students, and failure in NCLEX-RN has significant time and financial implications on the candidates, guardians, nursing programs, and healthcare organizations among other nursing stakeholders (Carr, 2011; Roa et al., 2011).

In an effort to ensure that students are better prepared for NCLEX-RN, nursing schools have adopted the use of a variety of computerized testing modules such as the Health Education Systems, Inc. (HESI) to assess the readiness of students to appear for NCLEX-RN as well as for benchmarking for remediation. Previous studies have demonstrated that a high HESI test score is predictive of success in the NCLEX-RN (Langford & Young, 2013; Lauchner et al., 1999; Nibert et al., 2008; Shah et al., 2022) . Schools of nursing are opting to use standardized exams, by Health Education Systems, Inc (HESI), despite concerns among some stakeholders about its utility (Nibert et al., 2008; Randolph, 2017; Spurlock & Hanks, 2004).

Nursing programs which utilize the HESI have a similar stream of information about their students. This stream or pipeline starts with the individual course grades, then intermediate assessments on HESI specialty exams, a final HESI exit exam, and then the NCLEX-RN exam. This pipeline of information is meant to inform the staff and faculty about a student's progression toward RN licensure. The HESI exit test helps nursing programs to quickly identify students at risk of failure for early remediation interventions and strategies to assist such students (Langford & Young, 2013; Nibert et al., 2008; Shah et al., 2022) . Previous studies have demonstrated that HESI specialty examination scores are associated with the HESI exit scores (Johnson et al., 2017). These specialty HESI exams expose students to standardized testing early in the curriculum and facilitate early identification of at-risk students which enables the nursing schools to intervene and provide special attention and intervention to these students as they progress through the nursing program (Zweighaft, 2013). Therefore, it is a priority to determine which factors contribute to student success on these HESI specialty exams. One factor likely associated with HESI specialty exams, and earliest in the pipeline of information are the students’ individual course grades. However, there is paucity of literature on how students’ individual grades in undergraduate prelicensure courses are associated with their HESI specialty examination scores. By establishing which relationships exist we can enact new data driven policies to aid the progression of students in our programs. Therefore, the goal of this study was to determine how students’ individual grades in undergraduate prelicensure courses are associated with their fundamentals, medical-surgical, and pharmacology raw HESI scores.