Academic Support Program for
Baccalaureate Nursing Students at West Chester University
©2000 Charlotte Harrison Mackey, MSN, RN
History of Concern
The National Council Licensing Examination for Registered Nurses (NCLEX-RN) is a standardized test, which all graduates of nursing programs must pass in order to practice as a Registered Nurse. The NCLEX-RN is the test, which attempts to ensure minimum levels of safety on the part of the practicing nurse to the public (Houchin, 1994). Graduation from a program of nursing, whether it is diploma, associate degree or baccalaureate degree, does not guarantee a passing this examination.
All nursing programs are concerned about their graduates' performance on NCLEXRN. The public and nursing community often interprets NCLEX-RN results as an indicator or the nursing program's quality. The State Board of Nursing can deny approval of a program for a failing rate which they consider too high. Additionally, a high failure rate on NCLEX-RN often affects the way accrediting agencies view a program.
Over the past twenty years the NCLEX-RN examination has undergone many changes. It has evolved from a five-part pencil and paper test to a single computerized examination in 1994. The scoring for the examination is pass/fail based not just on the number of questions answered correctly, but the level of difficulty. In order for a candidate to pass the examination, they must answer 5 percent of the more difficult questions correctly. The candidate cannot skip a question or go back to change an answer. If a question is answered incorrectly, the level of difficulty becomes easier and the candidate must then answer a larger quantity of questions correctly. The minimum number of questions is 75 (6 are actual questions and 15 are pilot questions). The maximum number of questions is 265 with a five-hour time limit (National Council of State Boards of Nursing, 1999). The level of difficulty of correct responses determines the number of questions a candidate answers. All candidates take the test independently at a time set between themselves and a Sylvan Learning Center.
Prior to 1988, the passing rate for first time test takers was 91%. In 1989, the National Council of State Boards of Nursing established a higher passing standard. The passing rate for first-time candidates then dropped to 84%. There has been a significant drop in passing rates for NCLEX- RN's since 1994. Table I demonstrates that the passing rate has decreased for first-time candidates seven percent. Once a candidate takes the test and is not successful, their chance of passing the second time decreases significantly (Brown, 1987). The figures for 1999 demonstrate that repeat takers of the NCLEX-RN only have a 4 percent chance of being successful once they fail the first time (National Council of State Boards of Nursing, 1999). The figures represented in Table I are combined totals for diploma, associate degree and baccalaureate degree programs.
Source: National Council of State Boards of Nursing, 1999.
NCLEX-RN Passing Rates
First time candidates
Based on these numbers, the goal is to have the candidate pass the examination the first time. A lot of research has been conducted to determine variables that will predict performance on the NCLEX-RN exam in order to identify at-risk students. A popular predictor is the Mosby Assess Test. This is a standardized test which is often given senior year (Alexander & Brophy, 1997). Most schools of nursing administer this test late in the senior year to enable students to have all the knowledge necessary to be successful. However, for an at-risk student, it often does not allow the student time enough to remediate in areas where they are deficient. Most nursing students sit for the NCLEXRN within 3 months after graduation. The research has shown that nursing theory courses are an accurate predictor of success on the NCLEX-RN.
Depending on the curriculum, a nursing course may come as early as the end of sophomore year. A study conducted by Barkley, Rhodes and Dufour (1988) demonstrated that the risk of failing NCLEX-RN increases with the number of C's or lower in any nursing course. Several studies with baccalaureate students have been done attempting to identify optimal timing for intervening with at risk students. Both studies showed that the junior year was optimal time, and some students could be identified as early as end of the sophomore year (Alexander & Brophy, 1997; Heupel, 1994). These studies also demonstrated that in addition to academic variables, test anxiety and self-predicted NCLEX scores should be considered (O'Connor & Bevil, 1996; Wall, Miller & Widerquist, 1993).
A study conducted at Valparaiso University College of Nursing in 1995 had identified that transfer students were at greater risk of failing the NCLEX An intervention program was developed for the at-risk students. These at-risk students were placed in two groups. A pre-test/post-test design was used. The experimental group receiving the intervention program had a statistically significant improvement in their score on a National League for Nursing computerized test over the group who did not receive any supportive intervention (Stevens, 1996).
This proposal will be presented to the Curriculum and Procedure Committee (CAPQ of the University in the fall 2. This committee is composed of tenured faculty who are voted by their peers to be on this committee. There is equal representation from all schools throughout the university. The larger schools have more representatives on the committee. The Department of Nursing has one representative on the committee. Because the majority of representatives are not familiar with nursing curriculum or NCLEX-RN examination, a more thorough background of the issue will need to be presented as rationale for the course proposal. Background of Issue Over the past eight years at West Chester University (WCU) passing rates for NCLEX-RN have improved. However, eight years ago the passing rate had dropped to 66 percent. Although some intervention has been done, passing rates currently are barely 81%.
In an attempt to raise the passing rate, the Department of Nursing instituted several measures. During a unit test review in all nursing courses, students complete the Loma Linda Objective Exam Analysis Worksheet (Figure 1). The student completes this worksheet as the test is reviewed. The student indicates the item they have missed and then checks the appropriate box for the reason why they believe they missed the question. There is also a space for analysis results. The Loma Linda Worksheet is a duplicate form, the student keeps the original and the Department keeps the copy.
In addition, a policy was adopted which was included in the student handbook which stated that "students who receive 75 in a nursing test will be obliged to attend an academic support session." (Undergraduate Student Handbook, 1999-2). This session was offered free of charge to the students. It involved a 9 minute meeting four times a semester. Faculty volunteered to conduct these workshops without any release time or compensation. Some problems exist with this approach to academic support for students. Student attendance is inconsistent, despite the fact that the policy is in the student handbook. Students do not interpret "obliged" as "mandatory." No communication between different levels of faculty occurs to let the faculty presenting the workshop knows what students they should expect to attend. It is also extremely difficult to find a time convenient to all students. Many students work after class or have other classes throughout the day. Therefore, faculty was offering multiple sessions to meet the needs of the students who were not able to attend the scheduled session. Facultv involved in the academic support program estimate that they are spending a minimum of six hours of time presenting the workshops per semester and another six to ten to prepare for the workshop without any release time or compensation. Faculty provided any materials or workbooks to students. No data was collected on whether the workshops actually did improve test perfortnance.
This proposal is for a one-credit course to be offered in the Department of Nursing specifically for nursing students. This course would be mandatory for students who receive less than a 75 in a nursing test or a course grade of less than 75. This course would be offered both fall and spring semesters. The student would be required to take the course in the semester following the low grade either in the unit test or course grade of 75 or less. Students would be notified in writing by the level coordinator that they would be required to take this course. Students would receive a pass/fail grade and would not be able to continue in a nursing course the following semester unless they complete this course. Students would be required to bring their Loma Linda Worksheets with them to the course. The focus would be on test taking skills, test anxiety and computerized test taking. All testing in the Department of Nursing is objective in format, similar to the NCLEX-RN, however it is not done on the computer. The course would also be open to any other student interested in improving their test-taking skills, however students who are required to attend would receive priority scheduling. Based on the number of students who receive less than a 75 on a unit test currently, there should be approximately ten to twelve students per semester in this course.
Benefits to Faculty, Students and University
The benefits of this model are many. Students would be more inclined to take this course seriously if they were required to attend and had to pay for it. Faculty would have this course counted in as part of their workload. There are two faculty already interested in teaching this course. It would not be taught by senior level faculty, therefore, the tuition generated would cover the overload salary. Because this course would be a regularly scheduled course, there would be less scheduling conflicts for students. Instructional materials would be chosen by faculty and purchased by the student. Most importantly, a structured course leads to better outcome measurement.
There would be no policy changes to be approved. The policy in the students' handbook would have to be changed to read, "the student would be required to attend an academic support course" rather than "obliged to attend."
Some opponents to this approach may argue that the gatekeepers should be the admissions office. The only students who should be accepted into the program would be the ones with a high school GPA of 2.5. However, some research has shown that GPA is only predictive of NCLEX success for Whites and Hispanics and not a valid predictor for Blacks and Asians (Endres, 1997). At WCU students need a cumulative GPA of 2. before they begin the nursing courses, which is congruent with university policy. The university frowns upon departments deviating from the university policy unless an outside accrediting agency mandates a higher GPA. At this time, no accrediting agency or State Board of Nursing dictates what an acceptable GPA needs to be. The Department of Nursing additionally requires that students need a combined SAT of 1 prior to entering.
We are entering into a period of a severe nursing shortage. The current supply of RN's is expected to outstrip the demand (Horns, Sullivan, & Goodman, 199 1). This is expected to continue for the next 2 years as the bulk of the baby boomers reach their 6's and 7's. It is this age group which utilizes the bulk of the health care. It is therefore important that we attempt to assist all students who are interested in the nursing profession to be successful.
The Tyler rationale has provided the foundation for curriculum development in nursing and continues to do so today. The period between 196-197 was one of the largest curriculum growth decades in nursing education. It was during this decade that nursing decided that if it were to be considered a true profession, we needed to identify and develop our theoretical body of knowledge. The following concepts, although somewhat modified, are consistent with Tyler's rationale and represent contemporary nursing curriculum today (Walker & Soltis, 1997). Only several of the concepts will be discussed as they relate to this proposal.
According to Tyler's rationale, learners, society, and subject matter provide the data for developing the philosophy, objectives, and conceptual framework of the nursing curriculum. Since the ultimate goal of the student in any nursing program is to be able to practice as a registered nurse, students should be provided with the tools needed to achieve success on the licensing examination. Learning Experiences: In the nursing curriculum, these occur in a variety of settings. All learning experiences should be planned to meet the objectives of the program and should offer the student the opportunity to practice the behavior stated in the objective. Philosophy: This is placed in a primary position in nursing curriculum. It should be consistent with the parent institution and brings the faculty's value system to a more conscious level.
It may be argued that a college education is a kind of commodity to which all have an equal fight. Being educated can be argued to be an avenue to power, prestige and a better paying job. The failure to pass the NCLEX-RN by new graduates has consequences. The immediate result is the unavailability of those graduates who fail to the employment pool as Registered Nurses.
If as educators we truly embrace an egalitarian philosophy and believe all students deserve an opportunity to be successful, then it is both practical and ethical to identify early on students who are at risk and offer an attempt in assisting them to be successful.
This will enable the student to set realistic goals and improve self-esteem. The extent to which they are successful will only benefit the work force and society at large. Evaluation: This is the phase, which provides feedback about the outcomes of the nursing program. When an intervention program is in place and the data that has been collected has been inconsistent, it is difficult to determine if the program objectives are being met. Evaluation in nursing is both formative and summative. The academic support program proposed would measure the extent to which an intervention for at-risk students is successful in assisting those students to be successful on the NCLEX-RN.
Alexander, J., & Brophy, H. (1997). A five-year study of graduates' performance on NCLEX-RN. Journal of Nursing Education, 3 6 (9), 443 -445.
Barkely, T., Rhodes, R., & Dufour, C. (198 8). Predictors of success on the NCLEXRN. Nursing and Health Care Perspectives, 19 (3), 132-137.
Brown, M. (1997). The effects of a support group on student attrition due to academic failure. Journal of Nursing Education, 26 (8), 324-327.
Endres, D. (1997). A comparison of predictors of success on NCLEX-RN for Affican American foreign-born, and white baccalaureate graduates. Journal of Nursing Education, 36 (8), 365-371.
Heupel, C. (1994). A model for intervention and predicting success on the National Council Licensure Examination for Registered Nurses. Journal of Professional Nursing, 1 (1), 57-6.
Homs, P.N., O'Sullivan, P., & Goodman, R. (199 1). The use of progressive indicators as predictors of NCLEX-RN success and performance of BSN graduates. Journal of Nursing Education, 3, 9-14.
Houchin, M. (1994). Preparing students psychologically for the NCLEX-RN. Nurse Educator, 19(l), 14-16.
National Council of State Boards of Nursing. (1999). New York, New York.
O'Connor, P. & Bevil, C. (1996). Academic outcomes and stress in full-time day and part-time evening baccalaureate nursing students. Journal of Nursing Education, 35 (6), 245-251.
Academic Support 12
Stevens, K. (Ed.). (1996). Review of research in nursing education. New York: NLN Press.
Walker, D. & Soltis, 1 (1992). Curriculum and aims. New York: Teachers College Press.
Wall, B., Miller, D., & Widerquist, I (1993). Predictors of success on the newest NCLEX-RN. Western Journal of NursinpResearck 15, (5), 628-643.
West Chester University. (1999). Undergraduate student handbook. West Chester, Pennsylvania.