Can you have both retention and increased pass rates on the NCLEX-RN?
Article Outline
Abstract
This article presents a retention project in an associate degree nursing program. Initiatives were taken to retain students in the nursing program as well as to increase the pass rate on the National Council Licensure Examination (NCLEX)-RN. The first nursing course was primarily targeted for retention but initiatives were used with all students in the program. Preliminary results show a significant increase in retention, graduation, and increase in the scores on the NCLEX-RN.
Keywords: Students, Retention, NCLEX-RN
1. Introduction
For 2 years, the faculty at Georgia Highlands College has been dealing with the problem of a higher than desirable attrition rate and National Council Licensure Examination (NCLEX)-RN scores that were lower than previous scores. They struggled with the age-old question of “Is it possible to increase retention and increase the state board pass rate?” Although the pool of applicants for the program was three times greater than the number of students accepted and the accepted students had higher grade point averages than students in past years, the attrition rate was still high with approximately one third of students being unsuccessful in the first semester and an additional 10–15% of accepted students not graduating. Similar associate degree nursing schools in the state increased their pass rate at the expense of a higher attrition rate. For 2 years, faculty members discussed their concern with retention among themselves and with peer faculty. Possible retention efforts discussed were always put off because of a busy teaching schedule and numerous college and department responsibilities. Nursing faculty members were also skeptical about the potential negative effects retention would have on the pass rate for the NCLEX-RN. In the summer of 2004, the nursing program applied for and received a US$25,000 grant from the Promise of Nursing for Georgia Nursing School Grant initiative to work on retention. This grant provided the opportunity for the faculty to examine this problem and take measures to retain students as well as to provide them with the skills to be successful.
2. Attrition problems
Attrition in this nursing program and programs throughout the country has been a problem. Many qualified students who are accepted into the nursing program do not graduate. With the nation experiencing a significant shortage of nurses and Georgia at a 17.5% vacancy rate for nursing positions, which is expected to reach 25% by 2010 (Georgia Nursing, 2003), not retaining well-qualified students wastes space in the programs; the biggest stumbling block in the nursing program is the first semester of nursing for both the generic students and the licensed practical nurse (LPN) and paramedic bridge students.
During 1999 to 2003, the average rate for generic students from first to second semesters was 66%. During the first semester, students have to adjust to the rigorous nursing curriculum that includes preparation for clinical experience as well as classroom studies. They also take their first math clinical calculations test, which they must pass to pass the course. Additionally, they take nursing examinations with application- and analysis-type questions that mimic the NCLEX-RN questions. Although the biggest problem with retention is in the first semester of nursing, the overall retention rate for students entering the freshman year and graduating from the program is 57% over the past 5 years.
The LPN–RN and the paramedic–RN bridge students who enter the summer between the first and second year also have difficulty passing their first semester in the program. Over these same years (1999–2003), the pass rate in the first semester for LPN bridge students was 69%, with 53% having graduated from the program. The paramedic–RN students have had a passing rate of 89% in their first semester over the past 3 years, but last year, only 78% of them completed the program.
Over the past 2 years, some efforts such as tutoring by graduate students and nursing faculty have been made to increase the retention of generic students in the program. This resulted in an increase in retention. Sixty-nine percent of all students who entered the program completed it and graduated in 2 academic years in 2004. In Fall 2004, in the first semester of nursing, there were 38 students who did not pass the first clinical calculations test. A nursing faculty member was paid an overload to help tutor these students. As a result, all 38 of these students passed the second mathematics test.
Recent students demonstrate that both psychological support and functional support, which provide direct help such as orientation programs, tutoring, and prompt feedback from instructors, facilitate learning and student retention (Oehlkers & Gibson, 2001, Shelton, 2003). In an effort to identify areas that are problematic for students, the students were interviewed individually and in small focus groups. They reported that they had problems with time management, including the issue of commuting to school, prioritization, study skills, and test-taking skills related to application-type questions.
In an attempt to better prepare students to take the NCLEX-RN and improve the pass rate from 88.7% in 2003 and 88.1% in 2004, the faculty began work on program testing. Two faculty members took a National Council of State Boards of Nursing Test Writing and Item Development course, whereas five other faculty members attended a workshop on test construction. One major concern of the nursing faculty is that they did not have the ability to appropriately analyze test items on the examinations given in the nursing program. An aged scanning machine was used to grade tests, giving only the number missed on a test item and not providing statistical information on the validity and reliability of the examination question. No information was provided about whether strong or weak students missed the item or whether it was a discriminating item or not.
A “Student Success Project” was planned, which focused on retention of students, increasing the number of graduating students, and increasing pass rate on the NCLEX-RN. The first nursing semester for both the generic and bridge students was the primary target because the highest attrition in the program occurs during this period. However, efforts throughout the program were implemented to help the students study smarter, prepare them for application and analysis questions, and improve their math skills. Incoming students were required to attend a 2-day mandatory workshop prior to entering the program. The workshops covered time management, establishing priorities, scenarios, small group work, relaxation techniques, and a panel discussion with presently enrolled students who discuss the challenges and successful strategies they use. Incoming students were paired with second-level students through an organized, faculty-led “Operation Outreach Program.”
Students entering the nursing program often have difficulty taking application questions. Although they were very successful in the general education courses taken prior to nursing, those questions are usually knowledge- and comprehension-type questions. It is believed that students often have the knowledge and the ability to pass the tests, but they do not think on the application level with the first tests taken in the nursing program. Many times, students do poorly on these few tests and then have difficulty pulling their average up to a passing grade. To help students apply the content learned in class, the faculty identified recent graduates from the nursing program who had an interest in helping lead study groups. Successful graduates who were familiar with course content and comfortable approaching the faculty and the staff of the nursing department were asked to tutor students on an individual and group basis. The faculty assisted these graduates by providing course outlines and copies of the current nursing textbooks used in the course. Additionally, a faculty member was paid an overload to tutor students having difficulty with clinical calculations through individual consultation and timed practice tests.
An online review test program was purchased and students were encouraged to take these practice tests to address the concern that students were not preparing adequately for the NCLEX-RN. Furthermore, the nursing faculty was assisted with test analysis and student test data reports through the use of test analysis software and training. A nursing faculty member who had excellent computer skills and was well respected by her peers for test writing was given release time to oversee all test items and work with other faculty members on item writing.
Stokes (2003) found positive outcomes from gatherings between the faculty and nursing students. Gatherings gave students the opportunity to share feelings and experiences informally with the faculty, and these were reported by students to be very beneficial. At Georgia Highlands College, the nursing faculty found that a close working relationship between students and the faculty received positive feedback from students. This relationship was formalized with faculty mentor groups. Faculty and student mentoring meetings were scheduled, and individual mentoring of all students was implemented.
3. Results
The effectiveness of the program cannot be totally evaluated at this time because most of the students have not yet graduated and have not yet taken the NCLEX-RN. However, the data are very positive, demonstrating increased retention in the program, increased graduation rates, and an increase in the pass rate on the NCLEX-RN. Table 1 depicts the relationship of the project objectives and the results.
Table 1. Comparison of project objectives, pre-project percentage, project goals, and results
| Objective | Preproject percentage | Project goal | Result |
|---|---|---|---|
| Increase retention by increasing the pass rate of students in the first semester of the nursing program | Generic students, 66% | Generic students, 75% | Generic students, 79% |
| LPN–RN bridge students, 69% | LPN–RN bridge students, 75% | LPN–RN bridge students: Summer 2004, 72%; Summer 2005, 68% | |
| Paramedic–RN bridge students, 89% | Paramedic–RN bridge students, 90% | Paramedic–RN students: Summer 2004, 88%; Summer 2005, 78% | |
| Increase the number of graduating students | Generic students, 56.7% | Generic students, 70% | Generic students—will graduate in May 2006; present retention, 74% |
| LPN–RN bridge students, 52.6% | LPN–RN bridge students, 70% | LPN–RN bridge students admitted Summer 2004, 56% | |
| Paramedic–RN bridge students, 66.6% | Paramedic–RN bridge students, 70% | Paramedic–RN students admitted Summer 2004, 75% | |
| Increase the pass rate on the NCLEX-RN | 87% in 2003 and 88.1% in 2004 | 95% Pass rate | 75 Graduates (one did not take the NCLEX-RN); 70/74 passed, with 94.59% pass rate |
3.1. Changes made in the project
When the project was first proposed, the online testing for students was not included in the project. This has been an extremely helpful student aid that required the students to become active learners. Students who graduated and passed the NCLEX-RN reported that this was a very helpful study tool between the time of graduation and the time of the licensure examination. Other students reported that the online testing helped them to prepare for faculty-made tests in nursing before graduation. Other project initiatives were aimed more at providing students with guidance regarding success strategies and had little involvement on the student's part. The online sample tests have received such positive feedback from the students that the faculty members are now requiring students to complete some of these tests each semester with a minimum score of 80% (students may repeat these multiple times). Based on the positive feedback, the nursing program purchased an additional online testing program for the first-year nursing students. This additional program has practice tests with rationales and is geared toward first-level students. Students reported that they have found these tests to be helpful tools in preparing for the unit tests in the nursing program.
3.2. Graduate-led study groups
The success of the graduate-led study groups and individual tutoring was limited. It was difficult to identify and retain qualified, interested, recent graduates of the programs to lead study groups and provide individual tutoring for the students in the nursing courses. Three recent graduates were identified, but one never completed employment paperwork and only came one day when he met with two students. The other two graduate nurse tutors had successful study groups that met one to two times a week with 4–15 students at a time. The average test scores of students in one group improved 10 points after joining the study group. One of the successful tutors moved, and the other was unable to continue because of job and academic commitments. However, as previously stated, the faculty members' tutoring of the students in clinical calculation skills was very beneficial for the latter.
3.3. Big Sister/Brother program
The Big Sister/Brother program started out with strong student interest, but participation was minimal after the first 2 months. Meetings tended to become less and less beneficial to the students as they became involved in their own course work. Although the students' Big Sisters/Brothers were well meaning and the student leader for this group had appropriate goals and ambitions, she did not have the time needed to devote to this effort. Faculty involvement has provided the organization and leadership needed to make this a well-functioning component of this project. Future evaluation of the effectiveness of the program will also be conducted by the faculty. Two faculty members are now overseeing the program and have structured the program to include regular meetings between students based on identified objectives, goals, and developmental needs, as well as a plan to accomplish the goals of the student and the maintenance of a log. This activity takes an average of 1 hour of contact per month.
4. Summary
The overall effectiveness of this project is noteworthy. Efforts for retention were previously discussed numerous times, but the initiative financial backing was not present. After seeing the effectiveness of this project at this time, the nursing program and the college are now committed to continue almost all aspects of the project.
Acknowledgments
This project was funded by the Promise of Nursing for Georgia Nursing School Grant program administered by the Foundation of the National Student Nurses' Association. Funding for the grant was contributed by several hospitals and health care agencies in Georgia, Johnson & Johnson, and by national companies with an interest in supporting nursing education. The funds were raised at a Gala Fundraising Event sponsored by Johnson & Johnson.
References
- Georgia Nursing, 2003, November–January 2004. Health Care Workforce Policy Advisory Committee Georgia Department of Community Health. Retrieved December 10, 2005, from http://findarticles.com.
- . Learner support experience by RNs in a collaborative distance RN-to-BSN program. Journal of Continuing Education in Nursing. 2001;31(6):266–273
- . Faculty support and student retention. Journal of Nursing Education. 2003;42(2):68–76
- . Gatherings as a retention strategy. ABNF Journal. 2003;13(4):80–82
PII: S1557-3087(06)00026-6
doi:10.1016/j.teln.2006.04.001
© 2006 National Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.