There has been a shortage of registered nurses in the United States for more than a decade, and an aging population is increasing this problem. This study was prompted by the number of associate degree nursing graduates at a Midwestern community college failing the NCLEX-RN licensure exam, which is required for employment. The purpose of this study was to explore associate degree graduate nurses' views of the effectiveness of classroom and clinical training on NCLEX-RN exam performance. Guided by the conceptual framework of Bigg's students' approaches to learning, which maintains deep learning is associated with achievement of learning outcomes, this qualitative case study investigated ways to improve success on the licensure exam. The central research questions examined the perceptions of what nursing school experiences contributed to NCLEX-RN success or failure. Semistructured interviews with 5 recent graduates who have been successful and 5 who failed the exam were conducted to gather the data. Triangulation and member checking were used to improve the quality of the data. The student perceptions were coded to identify emerging themes. The following themes that impact NCLEX performance were identified: extreme anxiety, fear of failure, faculty student relationships, and approach to learning. The findings revealed the need for additional faculty training in curriculum and instruction, reducing stress and building self-confidence. Based upon these findings, faculty were encouraged to participate in a 3-day professional development activity designed to improve their skills in preparing students to take the nursing examination. Possible social changes can benefit healthcare institutions, nursing graduates, and community by expanding the nursing workforce. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]