USE OF STANDARDIZED MASTERY CONTENT
ASSESSMENTS GIVEN DURING THE FIRST YEAR OF A
BACCALAUREATE NURSING PROGRAM FOR PREDICTING
NCLEX-RN OUTCOMES
TABLE OF CONTENTS
I. CHAPTER ONE: INTRODUCTION 1
A. Significance of the Problem 1
B. Significance of the Study 7 C. Educational Foundations 9
D. Research Design 10
1. Research Question 10
2. Definition of Terms 11
3. Assumptions 13
4. Limitations 13
E. Summary 14
II. CHAPTER TWO: REVIEW OF LITERATURE 16
A. Overview 16
B. History of Standardized Testing and NCLEX-RN 16
C. Predicting NCLEX-RN Performance 21
1. Literature on NCLEX-RN failure 21
2. Literature on NCLEX-RN success 26
D. Summary of the Literature Reviewed 35
E. Educational Framework Applied to Nursing Education 36
1. Behaviorism and Constructivism 36
2. Foundational Concepts of Nursing 41
F. Conclusion 43
III. CHAPTER THREE: METHODS 46
A. Introduction 46 B. Formulation Stage 46
1. Goal of the Study 47
2. Research Objective 47
3. Rationale for the Research 47
4. Purpose of the Research 48 5. Research Questions 48
C. Planning and Implementation Stage 48 1. Sampling and
Research Design 48 a. Description of Nursing Program 51
, b. Use of ATI in the Nursing Program 52
2. Data Collection 54
a. Instruments and Procedure 55
i. Fundamentals Assessment 58 ii. Pharmacology Assessment
58 iii. Mental Health Assessment 58 iv. NCLEX-RN Licensure
Exam 60
3. Description of Data Analysis 60
4. Description of Data Validation 63
5. Description of Data Interpretation 63
IV. CHAPTER FOUR: DATA ANALYSIS 65 A. Sample Description
65 B. Data Validation 66 C. Data Interpretation 67
1. Descriptive Analysis 67 a. Group Comparisons 69
b. Binary Logistic Regression 70
V. CHAPTER FIVE: DISCUSSION 78
A. Demographics 80
B. Correlations Among Variables 81
C. Group Comparisons 82
D. Binary Logistic Regression 83
E. Implications 85 F. Limitations 86
G. Recommendations for Practice 87 H. Recommendations for Future
Research 88
I. Summary 88
VI. REFERENCES 90
VII. LIST OF APPENDICES
A. Standardized Testing Policy 99
B. Assessment Results from ATI 103
C. Letter of Approval-Eleanor Mann School of Nursing 104
D. Research Approval Form-University of Arkansas 105
,LIST OF TABLES
1. Concept Comparison 41
2. Mastery Assessment Placement 53
3. Levels of Proficiency 57
4. Content-Specific Assessment Levels with Cut Scores 57
5. Item Distribution in Client Need Categories 59
6. Group Score Compared to National Average 67
7. Participants by Group, Gender and Age 68
8. Content Assessment Scores by Group 70
9. Between Variable Correlations 71
10. Full Model Main and Interaction Effects 72
11. Model Fit Statistics 74
12. Results of Stepwise Logistic Regression 76
, 1
Chapter One: Introduction
Significance of the Problem
The scope of nursing practice has expanded significantly over the decades since
Nightingale’s Notes on Nursing were authored in 1859. No longer is the scope of nursing limited
to the physical and psychological needs evident to Florence Nightingale during the Crimean War
and throughout her career. “The challenges that face the nursing profession today have become
increasing complex” (Billings & Halstead, 2005, p. xiii). Nursing has grown to include advanced
practice skills in specialized units where evidence-based nursing interventions are supported
with strong scientific research. Nurses are leaders in health care, influencing policies. They
perform as scientists to support and create evidence-based nursing interventions. Nurses are
employed in academia, corporate and political arenas (Holstein, Zangrilli & Taboas, 2006) as
well as in the community and at the bedside.
To meet the variety of roles in the profession, schools of nursing and nurse educators
continually strive to improve the success and educational experience of students. Recognizing
the needs of students to achieve success is critical to the profession and teaching practice. A
hallmark measure of success for schools of nursing, nurse educators and nursing graduates is
passing the National Council Licensure Exam for Registered Nurses (NCLEX-RN). For schools
of nursing, the first-attempt pass rate of its graduates is a defining characteristic of a quality
program. The licensure examination validates the nursing student’s acquisition of the knowledge
base needed to provide safe nursing practice (Holstein et al., 2006).
Likewise, NCLEX-RN failures can have many negative ramifications. Low pass rates on
NCLEX-RN can have serious implications impacting the academic institution, the nursing
ASSESSMENTS GIVEN DURING THE FIRST YEAR OF A
BACCALAUREATE NURSING PROGRAM FOR PREDICTING
NCLEX-RN OUTCOMES
TABLE OF CONTENTS
I. CHAPTER ONE: INTRODUCTION 1
A. Significance of the Problem 1
B. Significance of the Study 7 C. Educational Foundations 9
D. Research Design 10
1. Research Question 10
2. Definition of Terms 11
3. Assumptions 13
4. Limitations 13
E. Summary 14
II. CHAPTER TWO: REVIEW OF LITERATURE 16
A. Overview 16
B. History of Standardized Testing and NCLEX-RN 16
C. Predicting NCLEX-RN Performance 21
1. Literature on NCLEX-RN failure 21
2. Literature on NCLEX-RN success 26
D. Summary of the Literature Reviewed 35
E. Educational Framework Applied to Nursing Education 36
1. Behaviorism and Constructivism 36
2. Foundational Concepts of Nursing 41
F. Conclusion 43
III. CHAPTER THREE: METHODS 46
A. Introduction 46 B. Formulation Stage 46
1. Goal of the Study 47
2. Research Objective 47
3. Rationale for the Research 47
4. Purpose of the Research 48 5. Research Questions 48
C. Planning and Implementation Stage 48 1. Sampling and
Research Design 48 a. Description of Nursing Program 51
, b. Use of ATI in the Nursing Program 52
2. Data Collection 54
a. Instruments and Procedure 55
i. Fundamentals Assessment 58 ii. Pharmacology Assessment
58 iii. Mental Health Assessment 58 iv. NCLEX-RN Licensure
Exam 60
3. Description of Data Analysis 60
4. Description of Data Validation 63
5. Description of Data Interpretation 63
IV. CHAPTER FOUR: DATA ANALYSIS 65 A. Sample Description
65 B. Data Validation 66 C. Data Interpretation 67
1. Descriptive Analysis 67 a. Group Comparisons 69
b. Binary Logistic Regression 70
V. CHAPTER FIVE: DISCUSSION 78
A. Demographics 80
B. Correlations Among Variables 81
C. Group Comparisons 82
D. Binary Logistic Regression 83
E. Implications 85 F. Limitations 86
G. Recommendations for Practice 87 H. Recommendations for Future
Research 88
I. Summary 88
VI. REFERENCES 90
VII. LIST OF APPENDICES
A. Standardized Testing Policy 99
B. Assessment Results from ATI 103
C. Letter of Approval-Eleanor Mann School of Nursing 104
D. Research Approval Form-University of Arkansas 105
,LIST OF TABLES
1. Concept Comparison 41
2. Mastery Assessment Placement 53
3. Levels of Proficiency 57
4. Content-Specific Assessment Levels with Cut Scores 57
5. Item Distribution in Client Need Categories 59
6. Group Score Compared to National Average 67
7. Participants by Group, Gender and Age 68
8. Content Assessment Scores by Group 70
9. Between Variable Correlations 71
10. Full Model Main and Interaction Effects 72
11. Model Fit Statistics 74
12. Results of Stepwise Logistic Regression 76
, 1
Chapter One: Introduction
Significance of the Problem
The scope of nursing practice has expanded significantly over the decades since
Nightingale’s Notes on Nursing were authored in 1859. No longer is the scope of nursing limited
to the physical and psychological needs evident to Florence Nightingale during the Crimean War
and throughout her career. “The challenges that face the nursing profession today have become
increasing complex” (Billings & Halstead, 2005, p. xiii). Nursing has grown to include advanced
practice skills in specialized units where evidence-based nursing interventions are supported
with strong scientific research. Nurses are leaders in health care, influencing policies. They
perform as scientists to support and create evidence-based nursing interventions. Nurses are
employed in academia, corporate and political arenas (Holstein, Zangrilli & Taboas, 2006) as
well as in the community and at the bedside.
To meet the variety of roles in the profession, schools of nursing and nurse educators
continually strive to improve the success and educational experience of students. Recognizing
the needs of students to achieve success is critical to the profession and teaching practice. A
hallmark measure of success for schools of nursing, nurse educators and nursing graduates is
passing the National Council Licensure Exam for Registered Nurses (NCLEX-RN). For schools
of nursing, the first-attempt pass rate of its graduates is a defining characteristic of a quality
program. The licensure examination validates the nursing student’s acquisition of the knowledge
base needed to provide safe nursing practice (Holstein et al., 2006).
Likewise, NCLEX-RN failures can have many negative ramifications. Low pass rates on
NCLEX-RN can have serious implications impacting the academic institution, the nursing
