The associate degree nursing program offered at a privately owned, regionally accredited career college in central Virginia was placed under conditional approval by the Virginia Board of Nursing (VBON) due to low NCLEX[R]-RN pass rates and nine other violations of regulation. The lack of VBON approval for the nursing program resulted in the inability to obtain national accreditation. The problem underlying this study is NCLEX[R] pass rates below the national average which endanger the sustainability of the educational pathway for the nursing student. The purpose of this retrospective exploratory single case study utilizing document analysis of a proprietary nursing program was to identify the strategies utilized to improve the program outcomes to align with VBON approval and national accreditation standards. The sources of data were archived documents including national accreditation candidacy applications, acceptance of candidacy from accreditor, program initial self-study documents, systematic plans of evaluation, accreditation evaluation reports, and program responses to accreditation evaluation reports and letters of accreditation. Data analysis utilized NVivo[R]-12 software. The findings of this study are important for other pre-licensure practical nursing, pre-licensure registered nursing, and RN to BSN nursing programs as they work to be successful in achieving state board of nursing approval and national accreditation. The research may provide strategies utilized in accreditation and improvement of nursing program outcomes to other nursing schools with NCLEX[R] pass rates below the national average. Implications for nursing education practitioners and leaders include creating nursing programs that explicitly follow board of nursing regulation and accrediting body standards for the educational pathway. [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.]