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Nursing Education – Passing The Nursing State Boards

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

The following information is from the Oklahoma Board of Nursing Task Force, that investigated the pass and fail rate of nursing students that have taken the NCLEX. The scores for the state of Oklahoma were lower than most of the states in the Union, prompting the formation of a task force and investigation of possible reasons for the low scores. What all perspective nursing students can gain from this report is how crucial it is to sit for the boards as soon as possible after graduation and to take advantage of all the help available in preparing for the NCLEX. The nurses efforts in putting this wealth of knowledge together has been a monumental task and all nursing schools across the country are grateful for the information that they have been able to provide after many long hours of research.

Summary of Information from Pass Rate Reports

In reports submitted by nursing education programs with NCLEX pass rates ten percentage points or more below the national average, the following commonalities were noted:

1. Some programs do not regularly use accessible sources of data to evaluate the correlation between admission scores, grade point average, NCLEX predictor examination scores, and NCLEX pass rate. This impacts the ability of the program to make informed decisions about changes likely to result in an improvement of their NCLEX pass rate.

2. Many programs have only recently begun the use of NCLEX predictor examinations as a requirement of the program. Data on the efficacy of these examinations and on appropriate follow-up plans is limited.

3. Grade inflation is a factor leading to a low NCLEX pass rate in some nursing education programs, particularly in programs that allow significant point credit in theory courses for attendance, participation, and completion of assignments.

4. Some programs do not identify minimum academic requirements for admission to the program. Instead, a point system may be used to select those who are deemed to be better qualified. While the use of point systems in admission decisions may be appropriate, point systems fail when applicant numbers drop. In cases in which there is a small applicant pool, identifying minimum academic requirements (such as minimum scores on standardized pre-entrance examinations) may be necessary to ensure that students admitted have a reasonable chance of success in the program and on the NCLEX examination.

5. Student characteristics identified by programs as leading to NCLEX failure include a high number of work hours, family commitments, English as a second language, and low admission points.

6. In some cases, problems within the program, such as resignation of the program director, faculty turnover, inexperienced faculty, lack of knowledge regarding the NCLEX examination and/or test development, and increased use of adjunct faculty were noted as having an impact on the NCLEX pass rate.

Nursing education programs tend to take similar actions to address NCLEX pass rate concerns. Actions commonly taken by programs include:

1. Initiating the use of an NCLEX predictor examination as a requirement in the program

2. Requiring students to complete NCLEX review, tutoring, or other actions if the predictor examination score is low

3. Increasing the minimum passing grade

4. Providing faculty education in the areas of the NCLEX examination and test development skills

5. Changing or increasing admission requirements

Results of Survey of Nursing Education Programs

In December 2002, a survey was sent to all state nursing education programs to identify the directors’ perceptions of factors impacting the NCLEX pass rate and the actions taken by programs to address pass rate. Based on the data obtained from 50 respondents (an 86.2% return rate), the task force noted the following:

1. The majority of programs have minimum academic requirements for admission; generally based on minimum scores on standardized assessment tests and/or a minimum required grade point average on high school or college courses.

2. The minimum grade average to earn a “C” in nursing courses tends to be higher than the parent institution’s requirement. The majority of respondents require at least a 75% average to pass nursing courses.

3. Most respondents allow students who fail a course to repeat the course one time, and almost half only allow students to repeat one course in the program. Respondents with a pass rate at or above the national average were slightly more likely to allow students to repeat a course only once and to repeat only one course in the program. A higher number of respondents with a pass rate below the national average had no limit on the number of courses that could be repeated.

4. Most respondents have established a written policy to identify students at risk for failure in the program or on the NCLEX. The indicators most commonly used are scores earned on nationally-normed examinations designed to predict NCLEX success, grades earned in nursing courses, and repeats of nursing courses. Once the student has been identified as at-risk, the majority of respondents will notify the student and require the student to meet with a faculty advisor at least once.

5. Nearly all respondents report using a standardized NCLEX predictor examination, but only 34.8% require students to earn a certain score on the exam as a requirement for course completion or graduation.

6. Student and graduate issues most often identified as negatively impacting pass rate are the number of hours of employment, a limited number of hours spent studying, more family responsibilities, being less academically qualified, and an inadequate amount of time spent preparing for the NCLEX. Respondents with a pass rate below the national average were more likely to note that students spend less time studying.

7. No single faculty/program issue was identified by the majority of programs as having a negative impact on the pass rate. Increased faculty turnover was selected most often as a negative factor. Respondents with an NCLEX pass rate below the national average were more likely to identify that administration has pressured the program to maintain capacity enrollment and that faculty spend inadequate time evaluating NCLEX result data and planning program changes based on the data.

8. The majority of respondents believe that their administrations have been supportive of maintaining high academic standards.

9. Most respondents report that faculty have received training on test development and instructional techniques.


Recommendations for the Oklahoma Board of Nursing

1. Clearly articulate and enforce regulations requiring programs to use a systematic program evaluation process to analyze student outcomes on the NCLEX examination and develop appropriate actions based on the analysis.

2. Continue to evaluate full-time faculty to student ratios in the classroom and clinical area to determine the relationship between such ratios and student outcomes.

3. Ensure that pass rate reports include a thorough analysis of student and program factors impacting success on the NCLEX exam.

4. Hold nursing education programs accountable for their NCLEX pass rates. Utilize focus survey visits, warnings and conditional approval status when there is evidence of continued low pass rate and failure to meet educational standards.

5. Develop a mechanism to communicate and encourage the use of best practices that promote NCLEX success.

6. Utilize the annual report for ongoing evaluation of factors influencing each program’s NCLEX results.

7. Provide opportunities for faculty development related to the NCLEX examination and curricular resource sharing.

8. Require that every program whose pass rate is below the standard provide a pass rate report to the Board, regardless of its size.

9. Institute regulations requiring the NCLEX candidate (excluding foreign-educated and other endorsement candidates required to take the exam) to pass the examination within one year of graduation from the program. If the candidate does not take the exam or pass within this time period, the candidate would be required to complete additional education prior to re-testing.

Recommendations for Nursing Education Programs

1. Identify requirements for English language proficiency and develop a plan for continued support of students for whom English is a second language.

2. Consider providing part-time program options to allow students to complete their nursing education at a slower pace.

3. Use the systematic program evaluation plan to track the correlation of such factors as admission/ACT scores, high school or college GPA, nursing course GPA, other selected student characteristics, repeats of coursework, scores on NCLEX predictor examinations, with results on NCLEX examination.

4. Perform a cross-analysis of the curriculum with the detailed NCLEX test plan, in order to ensure essential elements are covered adequately.

5. Utilize consultants, including Board staff consultants, as needed in program evaluation and curriculum development.

6. Provide continuing education for faculty members on test development and analysis skills.

7. Assess students for at-risk status upon admission or early in the program. Implement a plan to assist at-risk students with success in the program and on the NCLEX.

8. Develop and publicize scholarship programs in order to facilitate minimal employment during the time the student is in the nursing education program

Recommendations for Students and NCLEX Candidates

1. Accept responsibility for own success in the program and on the NCLEX examination and become an active participant in the learning process.

2. Participate in study and test-taking skill workshops early in the program to facilitate the development of such skills.

3. Seek out all available resources to ensure minimum work hours while attending the nursing education program.

4. Join a study group early in the program and ensure that the study group time is used effectively.

5. Use NCLEX review material and study questions throughout the program to increase own familiarity with the NCLEX examination.

6. After graduation, develop a study plan for NCLEX preparation. Use computerized NCLEX practice exams on a regular basis. Practice taking these exams in a campus computer lab to simulate NCLEX testing conditions.

7. Take the NCLEX examination as soon as possible after graduation, as studies show that early completion of the NCLEX increases chances of success.

Recommendations for Employers

1. Establish programs that foster success for employees attending nursing education programs.
Consider options such as providing full-time benefits for part-time status during the school year, full-time salary for reduced hours, and tuition reimbursement.

2. Encourage new graduates employed as nurse technicians/nursing assistants to adequately prepare for the NCLEX exam, through options such as allowing specified work hours for planned study sessions, reimbursement for review courses, and reimbursement for the examination.

3. Provide special recognition for employees who pass the NCLEX examination, such as restaurant and movie coupons, employee newsletter notice, or other options.

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