National Council Licensure Examination - Research Paper Example

Qualitative critique predictors or success for NCLEX in nursing Copyright Academia-Research, Inc. 30 July 2006 Introduction - National Council Licensure Examination To become a registered nurse, a nursing student must be accepted into a nursing college with an accredited nursing program. The prerequisites for applying to nursing programs vary from school to school. The required requirement courses, such as anatomy, physiology, and microbiology, must be completed at the college with a grade point average of 2.0 or better. After the prerequisites are completed, an application to the school of nursing can be made. In the United States, there are three types of nursing programs. First, there are diploma programs, which involve two years of full time study. These are mostly on the east coast and are remnants of the original hospital-based nursing schools. Second, there are Associate Degrees in Nursing (ADN) programs that also require two years of full-time study. In addition to the nursing curriculum, they require general education courses to obtain an ADN. Third, there are Baccalaureate of Science in Nursing (BSN) programs that mandate four years of full time study. The BSN programs are university based programs and require general education courses in addition to the nursing classes. After the nursing program is successfully completed, the candidate is eligible to take the National Council Licensure Examination for Registered Nurses (NCLEX or NCLEX-RN). Since it was first administered in July of 1982 [1], the NCLEX has undergone many changes. It started as a two-day paper-and-pencil exam that tested each specialty area, such as medical, surgical, pediatrics, mental health, and women's health, separately. Next, the exam format was changed so that the specialties were blended together. However, it still was a two-day paper-and-pencil test. The most recent change occurred in 1994. At that time, the test was extended into a Computer-Adaptive Test (CAT) version. It is now given on computer and lasts an average of 3 to 4 hours. The CAT version has presented new challenges for nursing school graduates and faculty. Nursing graduates must be successful on NCLEX in order to practice nursing. There are three major reasons for higher education administrators and educators to be concerned about failure on NCLEX. A lower regional, state or national failure rate has an impact on the health care profession for two reasons: it decreases the number of graduates available to the workforce, and it increases the amount of time until the graduate is licensed and can actually contribute to the workforce and the profession [2]. The second reason is that lower pass rates reflect poorly on the nursing program at institutions of higher education and may ultimately mean budgetary cutbacks or program closure and waning nursing student enrollments. Students often choose programs accredited by the National League for Nursing [4] and programs with a reputation for high NCLEX pass rates. Nursing education programs in some USA states were reported to have a pass rate of at least 92.5% of the national average (National Board of Examiners for Registered Professional Nurses, 1999) during the period of 1991 to 2000. Faculty may experience frustration and concerns about the reputation of their programs based on licensure exam success or failure [5]. This has motivated faculty to identify factors related to the program, teaching or students contributing to NCLEX success or failure. A third reason for studying factors predicting NCLEX performance is the impact of failure on the self-esteem of the graduate and the implications for decreased professional self-confidence [2, 5] described feelings experienced by graduates who failed the NCLEX as anger, shame and despair. A review of the literature over the past 20 years reveals many studies relating to performance of graduates on the NCLEX. These studies fall into two categories: student characteristics and performance on the licensure examination and characteristics of the nursing program and performance on the licensure examination. 2. Predictors of Success on NCLEX based on student and program characteristics Tests often utilized in nursing programs to measure learning and predict success on NCLEX fall into two categories: standardized and teacher-made tests. Examples of standardized tests include the Mosby Assess Test, the National League for Nursing (NLN) achievement tests, and the Health Education Systems, Incorporated (HESI) examinations. Other examples include an examination offered by Arnett Development Company and the Pre-Registered Nurse's test offered by Educational Resources, Incorporated. The Arnett test was found to predict NCLEX pass rates [6]. Mosby Assess Test performance has been identified as a significant predictor on NCLEX success [11, 12]. NLN achievement tests have also been shown to be significant predictors of success [24, 25, 26, 27]. Performance on a comprehensive teacher-made senior examination was not shown to correlate with NCLEX success [21]. There is considerable literature to support a relationship between faculty characteristics and nursing education program as predictors of success on NCLEX. Only four studies were found in which these variables were measured [15, 19, 20, 21, 22, 23]. Whitley and Chadwick interviewed 28 graduates who had failed the NCLEX in one baccalaureate nursing program in 1983 to learn what factors the graduates thought contributed to failure. Graduates expressed that the program needed more clinical practice, better skills laboratory facilities, increased clinical time and more basic teaching [19]. Students recommended giving attention to admission and retention of students, because many of these students were average or below average. 3. Sampling Size of the Nursing program Examining the literature concerning the relationship between nursing program size and pass rates of graduates produces conflicting results. Dell and Valine (1990) contended that a large number of failures on NCLEX occurred in programs with small numbers of graduates [18]. This was refuted by research done by [15] and [17] utilizing sample West Virginia programs. The population of this sample study consisted of 19 West Virginia programs of nursing that qualify graduates to become registered nurses from 1991 to 2000. One program opened during this period, so data were only available from 1994 through 2000. Because data were gathered from all programs in the population, the sample and the population were the same. Because data were only from one example state, West Virginia, generalizability of the study is limited. 4. Methodology The purpose of this study was to determine the relationship between selected characteristics of nursing programs in West Virginia and the percentage of graduates passing the NCLEX. The study examined program data obtained from the West Virginia Board of Examiners for Registered Nurses and individual nursing programs in West Virginia from the Fall 1991 semester through the Spring 2000 semester. This study compared program, program faculty, graduating class pre-graduation standardized examination scores, and pass rates of graduates on NCLEX. 5. Data Collection This study utilized a causal comparative and correlational design to investigate the relationship between the dependent variable of NCLEX pass rates and the independent variables. Because it was beyond the investigator's ability to control the independent variables, this design was appropriate for the study. Data were obtained through archival reports from the West Virginia Board of Examiners for Registered Nurses (WVBOE) from data submitted by each dean, director or program chair for programs studied and from surveys completed by the administrators. The researcher collected data from the annual report submitted by each program to the West Virginia Board of Examiners for Registered Nurses (WVBOE) [14]. Permission was obtained from the WVBOE in order for the investigator to examine records on file in the board office for the time period during times mutually convenient to the researcher and the WVBOE. A data collection tool [14] adapted by this investigator was utilized. In order to procure data not obtainable from the WVBOE, a survey designed by this investigator was sent to each of the deans and directors during the spring semester of 2001. Deans, directors or program chairs were contacted by electronic mail to familiarize them with the study and to promote completion on a timely basis. This researcher in order to encourage participation and expedite the return of data provided a stamped, self-addressed envelope. Follow-up telephone calls and electronic mails were sent to attempt to obtain responses from those who did not respond to the initial mailing. 6. Data Analysis The data were first entered into Microsoft Excel and later transferred into SPSS. Data for each program included average scores of graduates on standardized achievement tests (Mosby Assess Test, Arnett Development Test, Health Education Services Incorporated Exit Exam, and Educational Resources, Incorporated Pre-RN Examination); number of graduates of the program; program policies on absenteeism, grading scales, and repeating nursing courses; faculty to student ratios in the clinical courses; percentage of faculty turnover from one year to the next; percentage of part-time faculty; faculty educational levels; years of full-time teaching experience per faculty member; years of faculty nursing experience and percentage of faculty holding national certification in teaching areas. Analysis was performed using descriptive statistics and Analysis of Variance (ANOVA). ANOVA is an appropriate technique for determining significant differences of means of two groups [16]. This was accomplished by categorizing the data by program, by associate degree (two year) or baccalaureate (four year) status, and by whether the pass rate was above or below the rate established by the WVBOE as compared to the national average for each year of the ten-year period. Additionally, multiple regression analysis of the data was determined using SPSS. This technique was appropriate, because the investigator was to predict or analyze scores on one dependent variable by combining the predictive power of multiple independent variables [16]. In this case the investigator was interested in which independent variables predicted higher pass rates on NCLEX. 7. Result Findings The purpose of the study was to investigate the relationships between mean program scores on standardized pre-graduation nursing examinations, program attendance policies in classroom and the clinical component, program grading scales, policies on repeating nursing courses, and the percentage of faculty holding national certification upon the pass rates for graduating classes on the NCLEX. The population of this study consisted of nineteen undergraduate nursing programs preparing graduates for entry into practice as registered nurses during a period of ten years. This was the total number of nursing programs in existence in West Virginia during the study period. There were nine two-year programs leading to the associate degree, one hospital program leading to a diploma, and nine four-year programs leading to a bachelors degree in nursing. After 1997 the hospital diploma program became an associate degree program, changing the previous number to ten associate degree programs, zero diploma programs, and nine bachelors programs. One program included in the study opened during the period from 1991 to 2000, so had only graduates from six years from 1994 to 2000. Eight programs were in private 46 institutions while the remaining eleven programs were in public institutions of higher learning. Size of nursing programs was determined by the number of graduates per year. This ranged from seven graduates to 154 graduates. The latter was a total number of students graduating from all the campuses of one institution. Late in the study period the graduates of these programs were listed separately and thus showed smaller numbers for the parent institution. The mean class size was 43.6 for the 187 graduating classes in the ten-year period. Clinical teaching ratios ranged from one instructor per 4.5 students to one instructor per 11 students. The mean number of students taught by a clinical instructor was 8.49 students for the ten year period. It is possible that these ratios could have included community settings rather than exclusively hospital settings. It should be noted that the state of West Virginia mandates that there be no more than eight students per instructor in the clinical area. Pre-graduation comprehensive standardized test results were reported by class on the annual report to the West Virginia Board of Examiners for Registered Professional Nurses for only a three year period from 1998 to 2000. These consisted of the Mosby Assess Test Unsecured, Health Education Systems Incorporated (HESI) Exit Exam, the Educational Resources Incorporated Pre-RN Exam, and the Arnett Computer Adapted Test. In order to compare the scores, the researcher ranked the mean score on the class by comparing it with the national average for all students taking the examination that year. The Table below shows how numerical codes were determined for the variable of pre-graduation standardized achievement test scores. Table Numerical Coding for Graduating Class Average Score to National Average Scores on Comprehensive Pre-Graduation Standardized Examinations 1991-2000 _____________________________________________________________________ Comparison to National Average Numerical ranking assigned _____________________________________________________________________ 21 - 25 % above 10 16 - 20 % above 9 6 - 10 % above 8 1 - 5 % above 7 at national average + or - 0.4 % 6 1 -5 % below 5 6 - 10 % below 4 11 - 15 % below 3 16 - 20 % below 2 21 - 25 % below 1 Mean coding score of all classes 6.73 _____________________________________________________________________ It should be noted that comprehensive pre-graduation tests were not used by all the programs in the study. For individual tests, the numbers were very small in comparison to the total 187 class years. The mean ranking for the 40 total class years 48 from 1998 to 2000 was 6.73. This translates into a mean score near the national mean to approximately 1% above the national average for the pre-graduation examinations from 1998 to 2000. Pass rates for graduating classes in the state of West Virginia on the NCLEX ranged from 46% to 100%. The mean pass rate for all classes in the nineteen programs during the decade was 84.89%. These figures were compared to the national pass rate ranging from 83.84% to 93% with a national average of 86.93% for the decade. This is higher than the mean West Virginia pass rate of 84.89%. The West Virginia pass rate was therefore higher than the national average pass rate from 1991-2000. 8. Conclusions Based on analysis of this research study, conclusions have been reached about the 19 nursing programs in West Virginia from 1991 to 2000. Each of the twelve independent variables is examined as they relate to the dependent variable, pass rates on the NCLEX. There was no significant relationship between mean scores of graduating classes on standardized pre-graduation comprehensive tests and pass rates on NCLEX. Although it could be concluded by the statistics that pre-graduation standardized testing does not make a difference in NCLEX pass rates, this researcher cautions against doing so given the small numbers and use of different tests. Faculty and program administrators should not abandon their use of such testing based on these findings, because there are some points to consider before taking action. 9. Implications American society is in the midst of critical nursing shortages. Factors contributing to this crisis are increased longevity of Americans with chronic illnesses, expanding need for acute specialty and ambulatory care outside traditional hospital settings, an aging nursing faculty which is not being replaced by younger counterparts and the failure of nursing programs to supply graduates to meet these demands. The market looks to higher education to address the shortage by producing more nursing graduates. Furthermore, academia is pressured to increase enrollments of nursing students on a shrinking budget without additional faculty to teach students. This results in increased use of part-time faculty if they can be found or full-time faculty with excessive workloads. Since nursing education administrators have little control over the aforementioned, they should attempt to manipulate variables predicting success on the NCLEX. This study has implications to the role of higher education administrators in seven functions defined by [28]. These include planning, organizing, staffing, directing, coordinating, reporting, and budgeting (POSDCoRB). In the present study, program variables predicting success on NCLEX were mandatory attendance policies for both classroom and clinical courses. Given the foregoing, nursing education administrators should direct faculty to adopt consistent program policies in which a significant portion of the course grade is earned through attendance. Evaluation plans should include criteria for periodic monitoring of the effectiveness of such policies and reporting this to the parent institution or state board of nursing. Another implication for nursing education administrators is the limitation of the number of nursing courses which students are allowed to repeat. In the present study, programs that allowed the fewest number of nursing courses to be repeated had the highest pass rates on NCLEX. This finding supports such policies and implies that administrators should direct faculty to continue or adopt such program polices on attendance. Although not statistically found to be a predictor of NCLEX pass rate success in this study, administering pre-graduation standardized achievement tests will help faculty to identify students at risk of failing NCLEX. Administrators should budget money to pay for such testing and encourage faculty to adopt program policies in which a significant portions of the course grades are earned from scores on the standardized tests. Reasonable attempts should also be made to remediate at-risk students who have failed nursing courses and/or have earned scores that predict failure on the licensure examination. The nursing education administrator may need to coordinate with other college or university departments such as student support services in order to assist students with test-taking strategies. Given that graduating classes with faculty teaching experience of at least 30 years had a negative relationship with NCLEX pass rates in this study, nursing education administrators should bear this in mind. They should monitor teaching effectiveness of all faculty but particularly those with 30 or more years of experience. Faculty development programs should be encouraged in order to keep faculty abreast of new teaching technologies and strategies while maintaining vitality and effectiveness in teaching. A statistically significant negative correlation was found between graduating classes taught by faculty with less than 10 years of clinical nursing experience and pass rates on NCLEX and positive correlations between faculty with 10 to 19 years of nursing experience. This has implications to the nursing education administrator in terms of hiring (staffing) nursing faculty who have significant experience within the field of nursing if feasible. They should also encourage current faculty to practice nursing in their fields in order to stay abreast of new skills, technologies, and information. 10. Recommendations for further research Further research could be performed on the existing data on pre-graduation standardized achievement tests from this study to determine whether significant relationships exist between comparisons of the graduating class by national mean to NCLEX pass rates. This could be performed by simply recoding the comparison codes by one percent intervals rather than five percent intervals. This would more accurately reflect how the graduating class performed against the national mean for the pre-graduation test. Research should be replicated for a five year period from 2001 to 2006 in West Virginia and surrounding states bordering West Virginia to study the relationships between pre-graduation standardized comprehensive examinations and NCLEX pass rates. Most schools in West Virginia currently use these tests and are required to report results to the West Virginia Board of Examiners for Registered Nurses on their annual reports to the board. Research should also be performed to study the relationships between other variables such as faculty salaries, rank, tenure status, and work loads and pass rates on NCLEX. Further research should study the correlation between the use of technology, such as interactive television and web-based courses, and pass rates on NCLEX. Studies should determine what relationships exist between distance learning sites and pass rates on NCLEX. REFERENCES [1] Arathuzik, D., & Aber, C. (1998). Factors associated with national council licensure examination-registered nurse success. Journal of Professional Nursing, 14, 119-126. [2] Ashley, J, & O'Neil, Jean. (1991). The effectiveness of an intervention to promote successful performance on NCLEX-RN for baccalaureate students at risk for failure. 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