NCLEX-RNPredictor and NCLEX-RN Success Assured

NCLEX-RNPredictor and NCLEX-RN Success Assured Annie Ruth Grant Walden University Walden University COLLEGE OF EDUCATION This is to certify that the doctoral study by Annie Grant has been found to be complete and satisfactory in all respects and that any and all revisions required by the review committee have been made. Review Committee Dr. Janet Reid-Hector, Committee Chairperson, Education Faculty Dr. Ioan Ionas, Committee Member, Education Faculty Dr. James Valadez, University Reviewer, Education Faculty Chief Academic OfficerEric Riedel, Ph.D. Walden University2015 Abstract NCLEX-RN Predictor Test Scores and NCLEX-RN Successfor First Attempt Test Takers by Annie Ruth Grant MSN, Medical University of South Carolina, 2002BSN, Medical University of South Carolina, 1992ADN, South Eastern Technical College, 1988 Doctoral Study Submitted in Partial Fulfillmentof the Requirements for the Degree of Doctor of Education Walden University December 2015 Abstract Health care professionals and nurse educators are concerned about increasing percentage of first time test takers failing the NCLEX-RN exam. The purpose of this retrospective study was to examine predictive accuracy of the Assessment Technologies Institute (ATI)RN Comprehensive Predictor for passing or failing the NCLEX-RN exam in a cohort of nursing students (N = 195). South Eastern Technical College in South Carolina is in jeopardy of losing accreditation for their nursing program because of the low percentage of first time test takers failing. The college’s pass rate on the NCLEX-RN exam has been below the national and state averages for the last 2 years. Guided by Bloom’s taxonomy and Knowles’ andragogical model of learning as the theoretical mainstay, factors that predict success with the NCLEX-RN exam for first time test takers were examined. Inferential and descriptive statistics were used to determine if a relationship existed between NCLEX-RN scores and the independent variables. A Pearson r correlation test was conducted to address whether the ATI Comprehensive Predictor accurately predict student success with the NCLEX-RN exam on first attempt. Multiple regression was employed to test for a significant relationship between prenursing GPA, final GPA, age, gender, and ATI predictor scores. Regression analysis results showed ATI Predictor scores to significantly predict student success with the NCLEXRN exam on first attempt. Based on these Findings, the Structured Learning Assistance Program was proposed to assist in preparing students for NCLEX-RN success. Positive social change occurs withinthe community, nursing programs, and health care by increased NCLEX-RN pass rates enhancing the number of nurses entering into health care. NCLEX-RN Predictor Test Scores and NCLEX-RN Successfor First Attempt Test Takers by Annie Ruth Grant MSN, Medical University of South Carolina, 2002BSN, Medical University of South Carolina, 1992ADN, South Eastern Technical College, 1988 Doctoral Study Submitted in Partial Fulfillmentof the Requirements for the Degree of Doctor of Education Walden University December 2015 Dedication Gods’ grace and mercy brought me through this journey along with prayers and encouragement from my family and friends. I would like to dedicate my project study tomy late parents, Robert Emanuel and Annie Lee Fore for teaching and showing me that hard work and determination gets results. I see them smiling down from heaven. I wouldlike to thank my husband, Clayton Grant, and my children and grandchildren, Clayton Jarrett, Alicia Nicole, Talayah Zemirah, and America Dava’ for their smiles and encouragement. Lastly, I would like to thank my sister, Bernise Belcer and brother-in- law, Derrick Belcer for their time and patience proofing my work. Acknowledgements I would like to thank my chairperson, Dr. Janet Reid-Hector for exceptional guidance through this project. I would like to thank my second chair, Dr. Ioan Ionas andmy University Research Reviewer, Dr. James Valadez for their guidance in assisting meto achieve this wonderful goal. Table of Contents List of Tables..................................................................................................................vi List of Figures .............................................................................................................. vii Section 1: The Problem....................................................................................................1 Introduction .............................................................................................................. 1 Definition of the Problem.......................................................................................... 3 Rationale................................................................................................................... 4 Evidence of the Problem at the Local Level......................................................... 4 Evidence of the Problem From the Professional Literature................................... 7 Definition of Terms................................................................................................... 9 Significance of the Study..........................................................................................11 Research Questions..................................................................................................14 Literature Review.....................................................................................................14 Theoretical Framework.......................................................................................15 Historical Perspective on the Nursing Shortage ..................................................21 National Council of State Boards of Nursing ......................................................30 Assessment Technology Institute (ATI)..............................................................31 Health Education Systems Incorporated (HESI) .................................................34 Critical Thinking ................................................................................................35 NCLEX-RN Test Plan........................................................................................37 Predictors of NCLEX-RN Success .....................................................................42 Remediation.............................................................................................................49 i Implications .............................................................................................................51 Summary..................................................................................................................53 Section 2: Methodology .................................................................................................55 Introduction .............................................................................................................55 Research Questions..................................................................................................56 Hypotheses...............................................................................................................56 Data Collection ........................................................................................................57 Design and Data Analysis ........................................................................................58 Descriptive Statistics................................................................................................59 Demographic Data ...................................................................................................60 Academic Information..............................................................................................61 Admission (Prenursing) GPA .............................................................................61 Final GPA ..........................................................................................................61 ATI Predictor Scores..........................................................................................62 NCLEX-RN Scores............................................................................................62 Inferential Statistics............................................................................................63 Multiple Regression Analysis.............................................................................64 Testing of the Hypotheses ..................................................................................66 Predictive Ability of Variables ...........................................................................70 Findings...................................................................................................................70 Discussion................................................................................................................71 Summary of Key Findings........................................................................................73 ii Descriptive Statistics..........................................................................................73 Inferential Statistics............................................................................................74 Section 3: The Project ....................................................................................................77 Introduction .............................................................................................................77 Overview of the Problem/Issue...........................................................................77 Description and Goals ........................................................................................77 Rationale..................................................................................................................78 Review of the Literature...........................................................................................79 Policy.................................................................................................................79 Policy Recommendation.....................................................................................80 Retention Interventions ............................................................................................86 Structured Learning Assistance ..........................................................................88 Project Overview .....................................................................................................89 Implementation ........................................................................................................90 Potential Resources and Existing Supports...............................................................91 Students .............................................................................................................91 The School of Nursing........................................................................................91 Faculty ...............................................................................................................91 Potential Barriers .....................................................................................................91 Roles and Responsibilities of Student and Others.....................................................92 Project Evaluation ....................................................................................................92 Implications for Social Change.................................................................................93 iii Conclusion...............................................................................................................94 Section 4: Reflections and Conclusions..........................................................................96 Introduction .............................................................................................................96 Project Strengths......................................................................................................96 Limitations...............................................................................................................97 Recommendations....................................................................................................97 Scholarship ..............................................................................................................98 Project Development and Evaluation........................................................................98 Leadership and Change ............................................................................................99 Analysis of Self as Scholar.......................................................................................99 Analysis of Self as Practitioner...............................................................................100 Analysis of Self as Project Developer.....................................................................101 The Project’s Potential Impact on Social Change....................................................101 Implications for Future Research............................................................................102 Applications to the Field of Education....................................................................102 Local Level ......................................................................................................103 State Level .......................................................................................................104 National Level..................................................................................................104 Directions for Future Research...............................................................................104 Reflection and Conclusion .....................................................................................105 References...................................................................................................................107 Appendix A: Policy Recommendation .........................................................................126 iv Appendix B: South Eastern Technical College Structured Learning Assistance Policy .139Appendix C: Sample Case Study ....................................................................................................................................1 41 Appendix D: Student Signature Form...........................................................................144 Appendix E: Sign in Sheet ...........................................................................................145 Appendix F: Cover Letter ............................................................................................146 Appendix G: Permission Letter....................................................................................147 v List of Tables Table 1. 2010 /2011 NCLEX-RN National Pass Rates for Associate Degree, South Carolina, and School of Study................................................................................... 6 Table 2. Percentages of Items From Each Client Needs Category/Subcategory...............41 Table 3. Frequency Counts (N = 195).............................................................................59 Table 4. Descriptive Statistics for Selected Variables (N = 195).....................................60 Table 5. Model Summary...............................................................................................65 Table 6. ANOVA Summary...........................................................................................66 Table 7. Coefficient Table: GPA Variables and NCLEX-RN Success ............................67 Table 8. Coefficients Table: Age and Gender.................................................................69 Table 9. Coefficients Table: ATI Predictor Score ...........................................................69 Table 10. Intervention Strategies....................................................................................83 vi List of Figures Figure 1. 4-Circle Critical Thinking Model. ...................................................................36 Figure 2. Respondents’ age ............................................................................................60 Figure 3. Sex of respondents. Distribution of respondents’ gender (N = 195). ................61 Figure 4. Students' admission GPA. ...............................................................................61 Figure 5. Students’ final GPA. .......................................................................................62 Figure 6. ATI predictor test scores. ................................................................................62 Figure 7. NCLEX-RN first attempt test results...............................................................63 vii Section 1: The Problem Introduction The National Council of the State Board of Nursing (NCSBN) has established three entry levels of practice for registered nurses (RN): associate degree, diploma, and baccalaureate degree. Upon completion of an accredited nursing program, students are required to pass a National Council Licensing Examination (NCLEX), which corroborates competence in performing safe and effective care as a newly licensed nurse.The licensing authorities within each NCSBN govern the NCLEX-RN examination (exam). The NCSBN is responsible for protecting the public by requiring each candidateto pass this exam. According to Rees (2006), many qualified students accepted into nursing schools do not graduate. Attrition in nursing programs is problematic nationwide (Rees, 2006). Traditional nursing students, licensed practical nurses, and paramedic bridge students have difficulty with the course content during the first semester of nursing school (Bonis, Taft, and Wendler, 2007). Students have to adjust to the rigorous nursing curriculum, which includes preparing for clinical and course studies (Rees, 2006). In addition, students are required to take a drug dosage calculation exam and pass with a 90% in orderto progress to the next semester (S. McManus, personal communication, June 10, 2013). Nursing graduates must demonstrate competency, critical thinking, problem solving, delegation, and prioritization skills by passing the NCLEX-RN exam (Bonis et al., 2007; Norton et al., 2006). In addition, graduates must demonstrate the minimum knowledge and abilities needed to provide safe and effective nursing care by employing critical decision-making skills (Norton et al., 2006). An essential component of any nursing program’s success is the pass rate on the NCLEX-RN for first-time test takers. Nursing programs with a history of low passing scores for first-time test takers are at risk for negative impact on their reputations, possibly impacting the school’s enrollment, funding,and accreditation (Rees, 2006). The National League for Nursing Accrediting Commission (NLNAC) and the Commission on Collegiate Nursing Education (CCNE) as well as most state boards of nursing use pass rate data to determine program effectiveness and accreditation (Alameida et al., 2011). Outcome achievement and NCLEX-RN success is a priority forall nurse educators and programs because these benchmarks establish their quality standards and eligibility for accreditation. Nursing programs frequently use NCLEX outcomes to determine content areas that may benefit from curriculum changes and thereby increase student success (Carrick, 2011; Greenspan, Springer, & Ray, 2009). Nursing programs increasingly use such programs as the Assessment Technology Institution (ATI), Health Education Systems (HESI) exit exam, and the Mosby Assessment Test (Mosby). In addition, computerized testing is frequently administered tostudents during the final semester of the nursing curriculum to provide an assessment of their predicted ability to pass the NCLEX-RN exam on the first attempt. The quality of a nursing education program is defined by the performance of the graduates on the NCLEX-RN examination (Harding, 2010). Definition of the Problem The Associate Degree of Nursing (ADN) at South Eastern Technical College (SETC) in the southeastern portion of South Carolina (SC) is in jeopardy of losing its accreditation. Students at this particular college are having difficulty passing the NCLEX-RN exam. Prior to graduating, students are required to take the NCLEX-RN predictor test to determine their readiness for the NCLEX-RN exam. Students who do notachieve a 91% probability of passing the NCLEX exam are required to complete remediation by reviewing the content missed and writing a summary of each area with less than 50%. Results of the predictor test depicting areas of weakness are reviewed withstudents stressing the need for further practice of NCLEX style questions (S. McManus, personal communication, June 10, 2013). The nursing program at the school in question is a 5-semester program that has anoption for students to sit for the NCLEX practical nursing (PN) exam after completing 3 semesters of study. Sixty-four students enter the ADN program during fall and spring semesters. This SC College is a year-round school; nursing students graduate in May andAugust each year. In this research, I focused on the students’ final semester grades, final GPA after program completion, and their scores on the predictor exam. Additionally, I focused on results from the students’ first attempt to pass the NCLEX-RN exam to determine if the NCLEX-RN predictor accurately predicts success for first-time test takers. NCSBN adopted a policy in 1989 to evaluate the passing standards for the NCLEX-RN examination every 3 years in order to ensure that nurses caring for patients are knowledgeable and competent (Roa, Shipman, Hooten, & Carter, 2010). First time test-takers at the college in question failed to maintain the required 89% passing standardfor 2 consecutive years. The State Board of Nursing for South Carolina (2011) required the college faculty to develop and present to them an action plan for improving students’ NCLEX-RN scores by May 2012. Ration aleEvidence of the Problem at the Local Level The ever-changing NCLEX-RN test plan, question format, passing standard, and combinations of demographic, academic, and psychosocial variables make it difficult to identify academic and nonacademic predictors of NCLEX-RN performance (Gilmore, 2008). Researchers have noted that first-time NCLEX-RN pass rates have steadily declined in recent years (Grossbach & Kuncel, 2011; Truman, 2012). Modifications in question format, test plan, and the increase in standards are contributors to escalating concerns of nursing programs, health care institutions, and the community. Researchers are now tasked with exploring strategies that can increase the NCLEX-RN pass rate (DiBartolo & Seldomridge, 2008). Nursing programs with substandard pass rates have a significant problem. Prospective students use the school’s pass rate as criteria for selecting nursing programs.Application and admission rates are affected if the smarter students do not apply. When at risk students are unsuccessful in completing their program of study, loss of program operating revenue may become a problem. Decreased customer s